Testosterone is truly a life source to the male body. Produced primarily in the testes by the specialized Leydig cells, testosterone travels through the body via the bloodstream and binds to receptors on target tissues. There are testosterone receptors all over the body. As might be expected there are many in the genital area.  However, the second largest concentration is in the brain. It is those receptor sites that create sexual desire and trigger the release of nitric oxide to facilitate an erection. 

Leydig cells produce testosterone in response to another hormone called Lutinizing Hormone (LH), which is produced by the pituitary gland. The pituitary is like a thermostat on a wall, as it senses the body's need for testosterone, it releases LH to stimulate the testicles to produce testosterone. Testosterone starts to decline because of aging of the Leydig cells in the testicles and may be made worse by a decline in the pituitary gland's ability to produce LH. The result is andropause-aging. Decline starts about age 27 or 28 and its effects can usually be felt by age 35.

Symptoms of Andropause (low male testosterone symptoms)

• Decreased mental quickness and sharpness
• Decreased energy, strength and endurance
• Less desire for activity and exercise
• Decreased muscle and increased body fat
• Mild to moderate depression and irritability
• Depression and/or loss of eagerness and enthusiasm for daily life
• Decreased sex drive
• Decreased sexual function and/or sensitivity

The good news is that symptoms can be easily corrected by replacing testosterone. Testosterone replacement will continue for the rest of your life.  Some men have difficulty accepting that fact.  The way to view this "rest of your life" thing is to consider that your father had the same problem -- you have a choice he did not have -- you can fix it.

We replace testosterone to the upper end of the "normal" range. The normal range for free testosterone is 140pg to 350pg. Laboratory ranges are determined by testing both sick and healthy men. Sick (andropause) is the lower end of the range. Healthy is the upper end of the range 200 to 350pg.

Testosterone Replacement

We use two methods of replacing testosterone: Twice daily application of a topical cream, or twice weekly self administered injections. Testosterone does the following:

• Builds lean muscle
• Improves sexual performance and enhances sex drive
• Increases energy
• Improves mood
• Improves mental clarity and quickness
• Protects against cancer and heart disease
• Restores lost zest for life

If replacement is done correctly, it is safe and there are no negative side effects. Here is a general progression of how things will change after you start therapy:

Week 1 to 2

*Lifting of a depression you may not know you have - a general increase in enthusiasm and zest for life. Plus, an increased mental sharpness and quickness.

Week 2 to 3

*Increase in energy and metabolism levels-- activity levels are important.

Week 3 to 4

*Start of increase in muscle and decrease in fat -- particularly if you are active and watch your diet -- refined carbs.

Week 4 to 5

*Increase in sex drive - improved interest, performance and satisfaction

Estrogen

As testosterone declines, it allows fat to accumulate particularly around the belly. Fat contains and enzyme called aromatase which converts testosterone to estrogen. Increased estrogen adds to the symptoms of andropause and is unhealthy for the prostate and heart. We use a medication to suppress the estrogen as we raise the testosterone. If good lifestyle habits are practiced, fat will disappear over 3 to 4 months and conversion to estrogen will stop.

Testosterone does not cause prostate cancer. It is the conversion to estrogen as testosterone declines and fat accumulates around the belly that causes an enlarged prostate and/or increases the risk of cancer. It follows that increasing testosterone levels and controlling estrogen lowers the risk of prostate cancer.

Stimulating

When testosterone is introduced from the outside of the body, the glands that produce testosterone read that the body has an adequate supply and they therefore do not need to work and hard.  The result, natural production can decline and testicles can shrink.  We avoid this by having you take a medication to stimulate the testicles as you use  the testosterone.

We use two stimulating medications--HCG injections or clomiphine tablets which do not require an injection. Your option to stimulate and what medication you will use will be discussed with you.

Summary

There is simply no better way that a man age 35 or older can take an action, spend a reasonable amount of money and have a more significant effect on improved quality of life than to treat testosterone deficiency. The question is not be "If I should use testosterone replacement?" The question should be "Who do I work with in replacing testosterone?"