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Q: Low testosterone in Men ( Answered,   1 Comment )
Subject: Low testosterone in Men
Category: Health > Men's Health
Asked by: curiousjim-ga
List Price: $200.00
Posted: 02 Jan 2005 13:36 PST
Expires: 01 Feb 2005 13:36 PST
Question ID: 450553
I would like to know what causes men below the age of 45 to have very
low testosterone(i.e. free testosterone under 7(pg/ml) or total
testosterone under 240(ng/dl); and what cures are available. Also, I
would like to find out what role low testosterone plays in causing
arthritus and depression.
Subject: Re: Low testosterone in Men
Answered By: crabcakes-ga on 02 Jan 2005 23:09 PST
Hello curiousjim,

  Low testosterone, also called hypogonadism, occurs when the testes
produce smaller amounts of testosterone than is considered a normal
range. Not as well known a term as female menopause, andropause, is
the term for the naturally occurring drop in testosterone. A ballpark
normal range for total testosterone in males is 300-1100ng/dl, with
700ng/dl being the mean. This site however quotes 437 to 707 ng/dl as
a normal range. You should base your results on the lab who performed
your test?s range, not these. Regardless of the performing lab, your
results appear to be low, particularly for the free testosterone

Another site quotes these normal ranges:
15.0 ? 40.0 pg/ml as a normal range for free testosterone, and
300ng/dl ? 1,000ng/dl for total testosterone.

Yet another site;
Free testosterone 50?210 picograms per milliliter (pg/mL) and total
testosterone 300ng/dl -1,000ng/dl

  ?Dr. Malcolm Carruthers, a British specialist in men's health, says
that clinicians need to look at the level of free active testosterone
(FAT) rather than total testosterone to get an accurate reading. Dr.
Quigley agrees that measuring FAT is much more accurate. Additionally,
along with measuring total testosterone, Dr. Quigley measures the
man's serum estrogen level. He explains that high serum estrogen could
produce the symptoms of reduced testosterone. If the serum estrogen
level is high, he gives the patient medication that turns off the
estrogen production.?

?Starting at the age of 30, men experience a drop in testosterone by
about 10% every decade, while amounts of the hormone that are still
being manufactured may not be as effective because of increased
production of another hormone called SBHG. For some men, this decrease
in testosterone results in a condition called andropause, which has a
range of symptoms, including:
?low sex drive
?difficulties getting erections or erections that are not as strong as usual
?lack of energy
?irritability and mood swings
?loss of strength or muscle mass
?increased body fat
?hot flashes

  As you will see on the following site, as many as 50% of all men may
have low levers of testosterone.

According to the Great Smokies Diagnostic Lab, these are the causes of
chronic/systemic illness
premature aging
testicular trauma
Kleinfelter's syndrome
autoimmune damage
tobacco and alcohol
sleep apnea
excessive heat

?Subtle clinical signs of hypogonadism may include slight gynecomastia
and soft small testes. However, researchers have noted that "the
findings of physical examination in men with adult-onset hypogonadism
are often normal.?
Secondary hypogonadism can develop as a result of hypothalamic or
pituitary disease, obesity, hypothyroidism or other causes. Some
conditions, such as hypercortisolemia, AIDS and severe systemic
illnesses, can trigger hypogonadism through a combination of both
primary and secondary mechanisms.?

One cause was omitted from the list above, and that is diabetes. Are
you diabetic? Have you been tested recently?
?About one third of men with type 2 diabetes show low levels of
testosterone, and this is seems to be related to abnormal function of
the pituitary gland -- the master regulator of hormone production --
according to a new study.

Although lower total testosterone levels have been reported in type 2
diabetics, the underlying cause has not been known, Dr. Paresh Dandona
of the State University of New York at Buffalo and colleagues note in
the Journal of Clinical Endocrinology and Metabolism.?

?Testosterone helps men reduce body fat and improves the way their
bodies handle insulin. So low testosterone levels may have serious
consequences for men with diabetes, suggests Sandeep Dhindsa, MD, of
State University of New York at Buffalo.
"We are describing a new complication of type 2 diabetes. We are
saying that the largest group of people who have [low testosterone]
are diabetics,"

Testosterone and Depression

  ?There is increasing evidence of an association between testosterone
levels and male depression. Two epidemiological studies examined this
relationship, with inconclusive results. Observational studies
comparing the mean testosterone levels of groups of depressed men with
those of non-depressed controls have also yielded discrepant findings.
In both types of studies diurnal, seasonal situational and age-related
variability in testosterone secretion may have contributed to the
inconsistent results.
One relevant study measured afternoon testosterone in 12 men with
major depression and in 12 age-matched controls. Although no
difference in testosterone levels between the two groups was found,
there was a significant negative correlation between hormone level and
age in the depressed patients, but not in the controls. This suggests
that depressed men may be more sensitive to the normal age-related
decline in testosterone levels. Other studies summarized in the review
corroborate this suggestion. However, the significance of a low
testosterone level in the setting of depressive illness remains

?Leading experts in the field of brain research have observed that
"sex steroids exert profound effects on mood and mental state."6 Many
studies have established a direct relationship between decreased
testosterone levels and negative mood factors such as depression,
anger, confusion, anxiety, and fatigue.32,33 Wang et al. found that
testosterone replacement used to restore androgen balance in
hypogonadal men improved many emotional parameters, including
friendliness, energy levels, and sense of well-being.34 Significantly,
these benefits were maintained over the course of a six-month period
of therapy, precluding the possibility of a short-term placebo

?Men who have low testosterone levels are more likely to suffer
depression, says an article in the February issue of the Archives of
General Psychiatry. Researchers examined the clinical records of 278
men, 45 years or older. Over a two-year period, 21.7 percent of the
men with testosterone deficiency (hypogonadism) were diagnosed with
depression, compared with 7.1 percent of men with normal testosterone
When they adjusted for age, alcohol use and other factors, the
researchers concluded that men with hypogonadism were 4.2 times more
likely to be diagnosed with depression. "Hypgonadal men showed an
increased incidence of depressive illness and a shorter time to
diagnosis of depression. Further prospective studies are needed to
confirm these preliminary findings and to clarify the role of
testosterone in the treatment of depressive illness in older men," the
study authors write.

?While an estimated 4-5 million men in the U.S. and 400,000-500,000 in
Canada suffer from symptoms related to testosterone deficiency, only
about 5% are treated. Aside from the fact that that leaves a lot of
men who simply aren't feeling as good as they should, it also puts a
high number at risk for osteoporosis, or a weakening of the bones, and
cardiovascular problems such as atherosclerosis, hardening of the
arteries - both of which are conditions associated with low
But there's no reason for this condition to get so many men down!
Doctors can easily diagnose low testosterone with a simple blood test.
If levels come back low, further testing, including more blood tests,
taking a sample of tissue from the testicles (called a biopsy), semen
analysis, or brain imaging may be required. Once low testosterone is
diagnosed, there are a number of different treatment options.?

?It's normal for men to lose testosterone gradually, beginning in
their 20s. By age 75, half a man's testosterone is gone, Lites said.
But Michael's testosterone had switched off prematurely. "The real
issue is that if they get into their 60s and 70s and it falls even
below that, based upon where they started, or if they see a more
accelerated drop, they may be at risk for the problems associated with
low testosterone," said Dr. Laurence Levine, a urologist at Rush
Presbyterian Hospital.

Levine calls the condition hypogonadism. Others call it male menopause
or irritable male syndrome, Lites reported. Symptoms can include
depression, weight gain, loss of energy, and less sex drive. And for
some, including Levine's patient, David Mohl, fatigue is also part of

"Right after dinner, I was feeling tired," Mohl said. "I didn't seem
to have much energy."
Mohl's testosterone level was just half of what it should have been,
Levine told him. So Levine prescribed a new testosterone gel. It's
less obvious than a testosterone patch and does not involve the ups
and downs of periodic injections, Levine said.
The gel is spread on -- to an arm, for instance -- once a day.? More
on treatments near the end of my answer.
After using the gel, Mohl said his testosterone returned to normal, and so did he.?

?Loss of testosterone, which happens normally as men age, seems to be
at the root of some memory loss.?
?Previous studies have shown memory loss to be common in men with
prostate cancer who have had treatment with testosterone deprivation
therapy. The therapy involves reducing the body's production of
testosterone and is a common treatment for prostate cancer. However,
it wipes out most of the male hormones in the body. Receptors for
testosterone are located in the brain's memory centers.?

Testosterone and Rheumatoid Arthritis

  There does seem to be a link between low testosterone and rheumatoid
arthritis (RA), but it is not well documented or researched. It
appears that some men with RA do have lower levels of testosterone,
but why remains to be seen. There is a proven link however, between
testosterone and osteoporosis in males.

??there were surprisingly high frequencies of such disorders in this
small group of patients with untreated hypogonadism (P < 0.001) and
very low serum testosterone levels (P = 0.0005). The presence of RADs
in these patients was independent of the etiology of their
hypogonadism and was associated with marked gonadal failure with very
low testosterone levels.?

??the male sex hormone testosterone exerts a powerful, far-ranging
influence over emotional well-being, sexual function, muscle mass and
strength, energy, cardiovascular health, bone integrity, and cognitive
ability throughout a man's entire life.?

?This profile also provides clear insight into testosterone's
synergistic impact on immune, metabolic, and inflammatory functions,
allowing more effective prevention and treatment for a diverse array
of health disorders, ranging from rheumatoid arthritis, heart disease,
and AIDS to obesity, osteoporosis, and prostate cancer.?

A Finish study found no correlation between RA and testosterone levels.
?The findings are not in line with the contention that low
concentrations of testosterone and DHEAS play a part in the aetiology
of RA.?

?Other researchers have conducted studies looking at how sex hormones
influence RA. There also have been a limited number of investigations
into the hormonal status of children with arthritis. However, the past
work has looked mostly at the serum levels, and not the amount of
hormone in the synovial fluid, Hendrix noted. Synovial fluid is
lubricating joint oil. Serum is the fluid portion of the blood.

Zhila Ellis, Ph.D., an assistant research scientist in anatomy and
cell biology who works in Hendrix's lab, led the UI investigation. In
collaboration with St. Louis University's Terry L. Moore, M.D., the UI
researchers examined the synovial fluid and serum from 21 JRA patients
-- half of whom were between ages five and 12, the other half of whom
were between 15 and 18 years old. Specifically, the researchers wanted
to analyse the serum and synovial fluid for levels of testosterone, as
well as the hormones dehydroepiandresterone (DHEA) and its sulphated
conjugate DHEA-S, progesterone and 17 beta-estradiol.

The investigators then compared the hormone levels in the synovial
fluid and serum to the levels found in the serum of a control group of
subjects. The researchers did not look at the synovial fluid from the
control group because it would be almost impossible to sample the
small amount found in non-inflamed joints.

The UI data showed reduced levels of DHEA-S and testosterone in the
synovial fluid and serum of JRA patients. In addition, the ratio of
DHEA/DHEA-S in both synovial fluid and serum was much higher than that
of the corresponding control serum, thus indicating the potential
importance of hormonal imbalances in the JRA disease process.?

?As with women, most men with osteoporosis only become aware they have
it when they suffer a fracture. While both sexes run the risk of
developing brittle bones as a result of smoking or drinking too much,
or from taking high dose steroids over a long period, in men almost
half of all diagnosed cases are idiopathic, which means there is no
known cause.
Twenty per cent of cases are due to a low level of the male hormone
testosterone, a condition known as hypergonadism. Other causes can be
hypothyroidism (under activity of the thyroid gland)
hyperparathyroidism (in which too much of the parathyroid hormone is
secreted, leading to calcium being drained from the bones). A new drug
to counter this action could be available within a couple of years.
Gastrointestinal problems such as coeliac disease, which reduces the
body' ability to absorb food properly is also a known risk factor.
Dr Francis has spent the past 20 years researching into osteoporosis
in men, helping to establish that genetic factors play a major role in
the development of the disease, and that oestrogen (the predominantly
female hormone) may also play a role. He is currently running a
clinical trial comparing calcium and Vitamin C plus testosterone with
testosterone alone.?

??the decline of testosterone production due to aging often begins in
a man's forties. At age 50, it is estimated that at least half of all
males have bioavailable testosterone levels that are lower than that
found in healthy young men.4 The primary cause of this decline is
chronic deterioration of Leydig cells in the testes; a 20-old man has
approximately 700 million Leydig cells, by age 80 that number will be
reduced to about 200 million.5
This age-related drop in testosterone is more pronounced in patients
with chronic illnesses such as rheumatoid arthritis or those at risk
of frailty or wasting conditions. In men of advanced age (over 70),
dramatic drops in testosterone levels often occur in conjunction with
a decline in circulating IGF-1 levels.?

A low serum testosterone level is a risk factor for osteoporosis, at
any age. ?By age 75, one third of all men will be affected by
osteoporosis. Though osteoporosis is thought of as an old person's
disease, it actually can strike at any age.?

?Basal serum testosterone concentrations were significantly lower in
male RA patients than in the osteoarthritis control subjects (P less
than 0.01). After human chorionic gonadotropin stimulation, serum
concentrations of testosterone were also lower in the RA patients than
in normal healthy controls (P less than 0.05). These findings suggest
that diminished testicular steroid biosynthesis might contribute to
the serum testosterone deficiency observed in male RA patients.

The study in this except shows taking testosterone injections was of
no help ?There was no suggestion of a positive effect of testosterone
on disease activity in men with RA.?

The following study found men with with rheumatoid arthritis and low
testosterone, who take prednisone, may be predisposed to other
?Male patients with RA taking low doses of prednisone have lower
testosterone and gonadotropin levels, suggesting that prednisone may
suppress the hypothalmic-pituitary-testicular axis. Since testosterone
affects immune function as well as bone and muscle metabolism,
androgen deficiency in some men with RA may predispose these patients
to more severe disease and to increased complications of steroid
therapy such as myopathy and osteoporosis.?


  First, you should get a complete physical, especially a rectal exam
(DRE)  for prostate problems. Get checked for diabetes and prostate
cancer with blood tests for glucose and PSA, respectively. Another
blood test for testosterone would be a good idea, along with estrogen,
TSH and prolactin. Ideally, have the blood drawn as early in the
morning as possible. Have a second sample drawn a week or so later,
for testosterone, at the same time, and be sure it is sent to the same
lab. Many different testing methods are available, and you do not want
to compare results from Lab A to results from Lab B, as their
methodology and normal ranges will be different.

?Having confirmed the presence of testosterone deficiency, the next
step is to determine the general location of the problem. If most
cases of adult hypogonadism resulted from a defect in the testis,
pituitary luteinizing hormone levels would be a sensitive indicator of
early hypotestosteronemia. Certainly this type of response is true of
hypothyroid cases in which thyrotropin values rise long before
thyroxine levels drop below normal. However, the decreases in
testosterone observed in most hypogonadal men are the result of
inadequate pituitary luteinizing hormone secretion. Because current
serum assays are unable to consistently distinguish between normal and
subnormal pituitary secretion, luteinizing hormone values even in
severely hypogonadal men may be reported to be within the normal
laboratory range.?

?If I have a low testosterone level, will taking supplemental
testosterone help? Maybe. Testosterone supplements, either with
patches or injections, can raise testosterone levels. They may help to
relieve some symptoms and to prevent muscle and bone loss that occurs
with aging in men. However, this has not been definitively proven, and
there is concern that testosterone replacement therapy may increase
the risk of developing prostate cancer. This is because cancers grow
in response to androgens, such as testosterone. In addition, although
men with erectile dysfunction may have low testosterone, in many cases
testosterone administration does not improve the symptoms. Therefore,
consult your doctor for a medical evaluation and consultation to
determine if this is the right therapy for you.?

?Circulating testosterone levels have a diurnal variation in normal
young men, usually reaching a mean maximum level of 25 nmol/L (710
ng/dL) at approximately 8 AM and declining to a mean minimum level of
15 nmol/L (426 ng/dL) at approximately 10 PM.This circadian variation
in testosterone level appears to be a result of temporal modulation of
hormone secretion by the testes rather than of a diurnal change in
testosterone clearance, although the precise mechanism is unknown.
Circulating testosterone is metabolized to DHT in the skin, liver,
prostate, and other organs that contain the enzyme 5
-reductase.Testosterone is also metabolized to estradiol (E2) by the
aromatase enzyme complex in the brain, fat, and testes.?

?A high serum prolactin level may indicate pituitary dysfunction and
may require consultation with an endocrinologist. Serum LH levels are
measured when serum prolactin levels are normal or low to help
differentiate intrinsic testicular failure from a pituitary or
hypothalamic abnormality. LH is usually high in patients with primary
testicular disease. When the serum testosterone level is low and LH is
elevated, testosterone replacement therapy is warranted.?

Rationale for prescribing testosterone replacement therapy:
-stabilizing or increasing bone density 
-enhancing body composition by increasing muscle strength and reducing adipose 
-improving energy and mood 
-maintaining or restoring secondary sexual characteristics, libido and
erectile function

?Testosterone Replacement Therapy is also known as androgen
replacement therapy, and its goal is to eliminate symptoms in men
experiencing male menopause. As testosterone deficiency is a normally
a permanent condition and lifelong treatment is usually required.?

Studies were done, comparing 3 forms of testosterone therapy;
implants, injections, and oral tablets. The study concluded the
testosterone implant was more effective.?? implantation remains
overall the most physiological form of androgen replacement therapy,
is generally well accepted and attended by few side effects; TU may
have a useful role in the initial phases of therapy.?
?n addition to its relatively uncommon congenital causes, testosterone
deficiency in men occurs in a diverse range of clinical conditions.
Even healthy men are now known to begin experiencing progressive yet
subtle declines in testosterone secretion after age 30. Diagnosis can
be challenging, and testosterone replacement therapy does not
alleviate all symptoms in all men. Nevertheless, some men can get
relief with intramuscular long-acting testosterone esters, transdermal
testosterone patches, or transdermal testosterone?
?The most common symptoms of testosterone deficiency in men (eg, loss
of libido, sexual dysfunction, fatigue, loss of stamina, depressed
mood) are vague and not specific for hypogonadism. Furthermore, men as
a group interact with the healthcare system far less often than women,
and when they do visit the physician's office, they often do not
volunteer such complaints unless directly questioned about them.
Physicians can minimize the chance of missing these complaints by
routinely asking about libido, sexual function, and stamina in their
systems assessment. An alternative is to use a simple questionnaire
that patients can fill out in the waiting room.? 

?Patients with normal or slightly low levels of testosterone most
likely will derive no benefit from replacement therapy and as such it
is not recommended.?

Testosterone therapy can be administered in several ways, such as
gels, injections, patches, injections and implants.
?Testosterone replacement has also been linked to improvement in men's
mental functioning, night sweats, bone density and muscle mass.?

Transdermal Delivery: Gels, Creams, Patches, and Pellets

  Human skin is able to absorb hormones into the bloodstream rather
effectively. Controlled transdermal delivery of testosterone, at a
contstant rate is possible,  maintaining a steady blood level.
Injections can cause very high and very low levels. About 50% of men
who participated in clinical trials had a skin reaction to the patch,
ranging from mild to blisters. It was found that applying a 0.1%
triamcinolone acetonide cream before applying the patch eliminated
most skin reactions.

?Because scrotal skin is at least 5 times more permeable to
testosterone than are other skin sites, the first available
testosterone transdermal delivery system (Testoderm; Alza
Pharmaceuticals, Palo Alto, Calif) was designed as a scrotal patch.
Patients using the scrotal testosterone system have reported
substantially improved sexual function, including the achievement of
potency, and an improvement in sense of well-being, mood, and energy.?

  ?Currently, three testosterone transdermal systems are marketed: a
system applied to the scrotum that has no permeation enhancers
[Testoderm, 6 mg, ALZA Corporation, Palo Alto, CA] and two systems
that contain permeation enhancers for application to appendage or
torso skin [Androderm 2.5 mg and 5 mg, SmithKline Beecham
Pharmaceuticals, Philadelphia, PA; Testoderm TTS, 5 mg, ALZA
Corporation, Palo Alto, CA]. Scrotal patches produce high levels of
circulating dihydrotestosterone (DHT) due to the high
5-alpha-reductase enzyme activity of scrotal skin.
Clinical studies of transdermal systems demonstrate their efficacy in
providing adequate testosterone replacement therapy.Skin irritation
may be associated with the use of transdermal systems; however,
Testoderm and Testoderm TTS caused significantly less topical skin
irritation than Androderm in two separate clinical studies.?

  Testosterone gel may increase muscle mass in men, but it is not
without potential side effects. Testosterone may lower HDL, known as
the ?Good Cholesterol?, and some studies show it may cause liver
problems in some men. Although testosterone has not been shown to
cause prostate cancer, it can accelerate cancer growth in men that may
have unknown prostate cancer.

?Nonscrotal transdermal testosterone patches (Androderm, Testoderm
TTS) are applied daily and are available in a 2.5-mg (Androderm) and a
5-mg (Androderm and Testoderm TTS) dose. Blood testosterone levels
rise to peak values within 4 to 6 hours after application, then
decrease slightly to remain within the physiologic range over the next
18 to 20 hours. Applying a patch after showering at night can
reproduce diurnal testosterone levels similar to those seen in younger
men, in whom morning values are somewhat higher than evening ones. The
most common side effect reported is skin irritation. Its frequency
seems to increase with age in men over age 50. It often can be
prevented or reduced by rubbing triamcinolone cream (Aristocort,
Atolone, Kenacort) into the skin before application of the patch.?
?AndroGel is a clear gel that is rubbed into the shoulders, upper arms
or abdomen every day to maintain more even levels of testosterone in
the body. It's available only by prescription, and men who take it
must be evaluated and monitored by a doctor.
AndroGel has caught the attention of men like Poltz because it is
easier to use than previous testosterone medications. Until AndroGel
hit the market, men needing a testosterone boost had to give
themselves injections or wear a patch on their skin. Injections can't
mimic the body's fine control of the hormone, so men often experience
emotional and physical ups and downs, including irritability right
after the injection and fatigue as it wears off. The patches maintain
testosterone at a more even level but can cause skin irritation and
may fall off in hot weather.?
?For years, doctors have used testosterone as a medical treatment for
some men who have abnormally low levels of the hormone because of the
aging process, chronic disease or exposure to alcohol or chemicals.
Symptoms of low testosterone include fatigue, decreased sex drive,
depression and low energy. Between 4 million to 5 million men have
this medical condition, according to Unimed Pharmaceuticals, the
company that makes AndroGel. Some experts say that about 25 percent of
men go through andropause, the male version of menopause, in which
levels of testosterone drop significantly with age. However, in most
men, testosterone levels don't change much with age.?

?Recent research from Harvard Medial School shows that rubbing
testosterone gel on the skin can help relieve depression in
middle-aged men with low blood testosterone levels. In the 1940s,
experiments showed that major depression can be relieved by injecting
testosterone into men with low levels. The treatment never caught on
because effective antidepressant drugs started coming to market. More
recently, however, testosterone patches and gels became available. In
June 2000, the United States Food and Drug Administration approved a
new form of gel for treating muscle loss, decreased sex drive, lack of
energy, and other symptoms of so-called hypogonadism, or underactivity
of the testes.
Harrison Pope, A professor of psychiatry are Harvard Medical School
wondered if the gel might also help males with the combination of low
testosterone and depression not treated successfully with drugs. He
received a grant from Unimed Pharmaceuticals Corp., which makes a
topical skin testosterone gel called AndroGel. Of the first 56 men
screened, Pope and his colleagues found 24 who were both depressed and
had low levels of that hormone. More than 40 percent of the men who
applied to be admitted to the study suffered from both low
testosterone and depression.
Twelve men rubbed 2.5 grams of AndroGel on their skins each night.
Another 10 subjects received identical packets containing a placebo.
By the end of the experiment, Pope found a significant improvement in
mood among those taking testosterone compared with those using the
dummy rub. Ten men on the active gel completed the full eight-week
study. Three showed almost no improvement, and four experienced only
modest relief. However, three enjoyed "striking, dramatic gains."?

?Scrotal patch (Testoderm). Thin scrotal skin is much more permeable
to testosterone absorption than other skin sites. You apply this patch
in the morning and remove it before bathing or sexual intercourse.
Itching and skin irritation can occur, but they're usually mild and
diminish with continued use.
?Nonscrotal patch (Androderm). This patch is applied each night to
your back, abdomen, upper arm or thigh. The site of the application is
rotated to maintain 7-day intervals between applications to the same
site. Up to 50 percent of men experience some skin reaction to this
product, with approximately 7 percent having a severe reaction.

To use testosterone topical scrotal patches:
	     ?	Testoderm patches should be applied to clean, dry scrotal
skin. The scrotal hair should be dry-shaved before a patch is applied.
Do not use chemical hair removers to remove scrotal hair.
	     ?	Each patch should be worn for 22 to 24 hours.
	     ?	Apply a new patch every 24 hours. 
	     ?	Scrotal patches should be removed during bathing, showering,
or swimming and may be reapplied following these activities. Patch
removal is optional during intercourse.
	     ?	If a Testoderm patch falls off, try to reapply it. If it comes
off after being worn for more than 12 hours and it cannot be
reapplied, wait until the next scheduled application time to apply a
new system.

You rub testosterone gel (AndroGel, Testim) into your skin on your
lower abdomen, upper arm or shoulder. As the gel dries, your body
absorbs testosterone through your skin. Avoid showering or bathing for
several hours after an application to ensure adequate absorption. A
potential side effect of the gel is the possibility of transferring
the medication to your partner. You can avoid this by waiting
approximately 5 hours after an application or covering the area before
having skin-to-skin contact.

Gum and cheek (buccal cavity) delivery

  Striant, a small putty-like substance, delivers testosterone through
the natural depression above your top teeth where your gum meets your
upper lip (buccal cavity). This product rapidly adheres to your
gumline and, as exposed to saliva, softens into a gel-like form,
allowing testosterone to be absorbed directly into your bloodstream.
From the makers of Striant, ?STRIANT is a unique system for providing
testosterone to your body. It is a very small tablet-like product that
you put in a comfortable position between your cheek and gum. Once
there, STRIANT gradually releases testosterone that is absorbed into
your bloodstream through your cheek and gum. This type of medication
delivery is called ?buccal? (BUCK-al) delivery. STRIANT should not be
swallowed because testosterone is broken down by the digestive system
and would not be useful to the body.
STRIANT is applied twice daily. This twice-a-day dosing allows it to
keep your body?s testosterone at normal levels throughout the day.
STRIANT delivers amounts of testosterone to your body that approximate
amounts seen in healthy young men.
Placed properly, the buccal system will soften, producing a gel-like
form that remains in place over each 12-hour dosing period. STRIANT is
designed to stick to the tissue of your gum or cheek as it absorbs
moisture. It will stay in place, gradually releasing testosterone that
is absorbed through your gum and cheek directly into your


  ?In men 20-50 years of age, an intramuscular injection of 200 to 300
mg testosterone enanthate is generally sufficient to produce serum
testosterone levels that are supranormal initially and fall into the
normal ranges over the next 14 days. Fluctuations in testosterone
levels may yield variations in libido, sexual function, energy, and
mood. Some patients may be inconvenienced by the need for frequent
testosterone injections.11 Increasing the dose to 300 to 400 mg may
allow for maintenance of eugonadal levels of serum testosterone for up
to three weeks, but higher doses will not lengthen the eugonadal

A German study of testosterone undecanoate showed good results in participants.
?The i.m. injections of 1000 mg TU into either one or both gluteal
regions were well tolerated by all 21 hypogonadal patients included in
the studies. No serious adverse effects were observed. In study II,
detailed weekly diaries of 4 out of 14 patients revealed some
discomfort at the injection site persisting not
longer than 1 week after injection; one patient reported some pain at
the injection site on day 14. No patient reported the injections to be
more painful or inconvenient than former i.m. injections. One patient
reported transient testicular pain at day 28. Clinical examinations
revealed no new occurrence of gynecomastia nor any enlargement or
soreness of the liver; one patient showed sporadic signs of acne 2 and
5 weeks after TU injection. No patient discontinued treatment because
of side-effects.

Testosterone injections should NOT be used in the following circumstances:
?  Breast cancer in men 
?  Breastfeeding 
?  Cancer of the prostate 
?  Pregnancy 
?This medicine should not be used if you are allergic to one or any of
its ingredients. Please inform your doctor or pharmacist if you have
previously experienced such an allergy. If you feel you have
experienced an allergic reaction, stop using this medicine and inform
your doctor or pharmacist immediately.?
Possible Side Effects of Testosterone Injections:
Medicines and their possible side effects can affect individual people
in different ways. The following are some of the side effects that are
known to be associated with this medicine. Because a side effect is
stated here, it does not mean that all people using this medicine will
experience that or any side effect.
?  Persistent painful erection of the penis (priapism) 
?  Reduced volume of ejaculation 
?  Premature closure of the ends of bones in prepubescent males
causing stunted growth
?  Decreased sperm count (oligospermia) 
?  Hoarse voice 
?  Sodium and water retention 
?  Increased frequency of erections in prepubescent boys 
?  Premature sexual development in prepubescent boys 
?  Enlargement of the penis in prepubescent boys

Oral Testosterone:

  ?Although testosterone supplements are manufactured in capsule or
pill form, they are not generally recommended for use in the United
States. They are quickly broken down by the liver and do not achieve
high enough blood levels to be useful. They also may cause adverse
changes in blood lipids (fats) and liver damage. [AACE Clinical
Practice Guidelines]?

?Several alkylated derivatives of testosterone are available for oral
or sublingual use, including methyltestosterone and fluoxymesterone.
Alkylated androgens are more slowly metabolized by the liver than is
natural testosterone, but, like testosterone, these androgens interact
directly with androgen receptors. Although their oral route of
administration is advantageous, clinical response is variable and
plasma levels cannot be determined, because alkylated androgens are
not recognized by most testosterone assays. Moreover, in our clinical
experience, alkylated androgens may increase levels of low-density
lipoprotein cholesterol and profoundly suppress high-density
lipoprotein cholesterol levels because of their route of absorption
and metabolism. Prolonged use of high doses of androgens (principally
the 17 -alkylated androgens) has been associated with development of
the following potentially life-threatening conditions: hepatic
adenomas, hepatocellular carcinoma, and peliosis hepatis. Cholestatic
hepatitis and jaundice may occur at relatively low doses of 17
-alkylated androgens.?

One man from the UK says, of oral testosterone: ?'He put me on
testosterone tablets immediately,' said Reg. 'Within two days I began
to feel better and after a week I was back to normal. It was like
turning the clock back to when I was in my 20s or 30s,' he said.

'I have now been having testosterone treatment for five years and I
can honestly say I couldn't live without it. When I have stopped
taking it, all the symptoms return. I don't get it on the NHS and it
costs me about 1000 a year which to me is money well spent,'
explained Reg.?

Pellet Implants

Pellets are a newer, testosterone delivery system.

  ?The pellet is loaded in the pellet inserter and placed into the
buttock once every 2-5 months. The pellets slowly release the hormone,
usually preventing a 'crash' in hormones until the end of treatment.
Most insurance companies, including Blue Cross, reimburse the
placement of pellets. The pellets may or may not be reimbursable by
individual policies. Medicare does not cover pellets.?

Many years ago, the Food and Drug Administration approved the use of
testosterone pellets for male hormone deficencies.  They are
manufactured in our office by a compounding pharmacist. We place 6-8
testosterone pellets under the skin.   These pellets dissolve slowly 
over a period of approximately  three to four months. This provides a
normal and very stable serum testosterone level.   I feel that the
addition of androgens in this form causes less lowering of HDL
cholesterol, as this does not pass through the liver.

The implant procedure consists of a small incision through which a
trocar and cannula are inserted. The pellets are inserted through the
cannula, and then the cannula is withdrawn. The incision is then
closed with a Steri-Strip, and pressure is applied until bleeding
stops, and the area is then covered with a dressing. We have not had
any major problems in terms of side effects from this procedure. Some
expertise is required in terms of placing the pellets so that
underlying structures are not traumatized.
The average cost per visit (approximately every 3 months) is in the
range of $400. Insertion Fee is $160.00 and Pellets cost $33.00
apiece.The requirement for the use of subdermal pellets include
Good General Health
No evidence for heart disease
Normal Cholesterol levels
Normal PSA levels
Normal prostate examination, no history of prostate disease

One health insurance company?s take: ?Aetna considers implantable
testosterone pellets (Testopel Pellets) medically necessary subject to
the following selection criteria:
A.	As second-line testosterone replacement therapy in males with
congenital or acquired endogenous androgen absence or deficiency
associated with primary or secondary hypogonadism when neither oral
nor intra-muscular testosterone replacement therapy is effective or
appropriate. Primary hypogonadism includes conditions such as
testicular failure due to cryptorchidism, bilateral torsion, orchitis,
or vanishing testis syndrome; inborn errors in testosterone
biosynthesis, or bilateral orchiectomy. Hypogonadotropic hypogonadism
(secondary hypogonadism) conditions include gonadotropin-releasing
hormone (GnRH) deficiency or pituitary-hypothalamic injury as a result
of surgery, tumors, trauma, or radiation, and are the most common
forms of hypogonadism seen in older adults.
B.	For treatment of delayed male puberty. A 6-month-or-shorter course
of androgen may be indicated for induction of puberty in members with
familial delayed puberty, a condition characterized by spontaneous,
non-pathological, late-onset puberty.?

An Australian study concluded ?We conclude that fused pellets of
crystalline testosterone provides very satisfactory depot androgen
replacement exhibiting many desirable features for androgen
?Testosterone pellets are currently in use in the United Kingdom and
in Australia; 3 to 6 testosterone pellets, 200 mg each, are implanted
subcutaneously every 4 to 6 months. Testosterone buciclate, an
experimental formulation, is a long-acting 17 -hydroxyl ester of
testosterone administered intramuscularly at a dosage of 600 mg every
12 weeks.?

Side Effects of Testosterone:
?Androgen therapy does lead to recovery of a normal prostate size (the
prostate shrinks when testosterone levels are low). It does not affect
prostate specific antigen (PSA) levels.
Androgen therapy is not thought to increase the risk of prostate
cancer above that of men with naturally higher testosterone levels of
the same age.
However, the safety of androgen therapy on the cardiovascular system,
prostate and mental functioning still needs to be properly studied.
Further well conducted investigations into whether androgen therapy
benefits bone and muscle are also needed.
Androgen therapy is believed to be a risk factor for heart disease but
the existing studies are inconclusive. In fact, low testosterone
levels have been recorded prior to heart attacks which may indicate
that hormone therapy could help protect against cardiovascular
The use of androgens should also be used with caution in older men who
may have undiagnosed prostate cancer. Sleep apnoea is also an
occasional risk factor with androgen therapy.

?With any testosterone delivery system, prolonged use may cause liver
damage, breast enlargement, or increase the risk of prostate
enlargement. Geriatric patients who could be at risk of prostate
cancer should be evaluated prior to initiation of treatment. In
addition, fluid accumulation may be a serious complication in patients
with preexisting heart, kidney or liver disease, with or without heart
failure. Men with breast cancer or known or suspected prostate cancer
should not receive testosterone therapy. The patch, gel and injections
are not indicated for use in women and should not be used in women.
Testosterone may cause fetal harm.

Patients taking testosterone should be instructed to report any of the
following to their physician:

?  Too frequent or persistent erections 
?  Any nausea, vomiting, changes in skin color, or ankle swelling 
?  Breathing disturbances, including those associated with sleep.?

Additional Information:

  ?What is bioavailable testosterone? Testosterone is present in the
blood as "free" testosterone (2-3%) or bound testosterone. The latter
may be bound to either albumin (a serum protein) or to a specific
binding protein called Sex Steroid Binding Globulin (SSBG) or Sex
Hormone Binding Globulin (SHBG). The binding of testosterone to
albumin is not very tight and is easily reversed; so the term
bioavailable testosterone (BAT) refers to the sum of free testosterone
plus albumin-bound testosterone. Alternatively, it is the fraction of
circulating testosterone that is not bound to SSBG. It is suggested
that BAT represents the fraction of circulating testosterone that
readily enters cells and better reflects the bioactivity of
testosterone than does the simple measurement of serum total
testosterone. Also, varying levels of SSBG can result in inaccurate
measurements of BAT. Decreased SSBG levels can be seen in obesity,
hypothyroidism, androgen use, and nephritic syndrome. Increased levels
are seen in cirrhosis, hyperthyroidism, and estrogen use. In these
situations, measurement of free testosterone may be more useful.?

Testosterone and the Brain

Here?s a short quiz that may be useful to you:

More on testosterone injections

Other Google Answer Questions you may find useful:

Let me point out that this answer is for informational purposes only,
and is not intended to diagnose or treat any medical condition, or to
replace sound medical advice from a licensed physician. Please discuss
your concerns with your physician. Now that you are informed as to
what treatment exists, you and your doctor can determine if
testosterone replacement therapy is for you, and if so, which form
would be best.

If any part of my answer is unclear, please request an Answer
Clarification, before rating. By doing so, I can assist you further,
if possible.
I wish you the best!


Search Terms
Androgen replacement therapy 
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Subject: Re: Low testosterone in Men
From: thedon1-ga on 09 Jun 2005 10:44 PDT
I too have low testosterone for a young man (29) chronic illness
and/or diseases.  I'm eat healthy and workout regularly (5'10"; 78lb;
14%body fat).  The one thing is I have been taking Propecia for the
last 9 years...with success.  Never had any of the symptoms described
as the side effects.  However, I just noticed symptoms that concerned
me (erections weren't as strong; rarely any morning erections and if
so they were more 'chubbies'; also desire was lowered (quit
masturbating and was only having sex 5x a week w/ opposed
to daily masturbating and daily sex).  This was ongoing for 2 months
before I saw my physician (didn't know if it was physcological...until
i realized the loss of morning erections) Initial Dr response was that
I'm probably fine and blood tests showed no issues with Thyroid. 
Requested Hormone test to be done and also a referral to urologist. 
Tests came back and sure enough my Total Testosterone measured 276
ng/dL and Free Testosterone is 9.4 pg/mL (ranges i was given are
260-1000 ng/dL for TT and 10.3-28.8 pg/mL for FT).  Urologist was
somewhat surprised by my low level of Free Testosterone...figuring the
Propecia would make it go higher.  Also, the fact that my Total
Testosterone was so low.  Were in process of measuring my Prolactin
levels to see if there is any Pituitary tumor and if so go from there.
Otherwise it may be in my testicles...which is odd cuz I've never had
this before...nor has anyone in my family (both sides of my family
have tons of kids and healthy lives).  I'll fill you in on what comes
out of my tests and experience.  I hope I don't have to take
Testosterone replacement therapy...but if that's the case oh well. I
do want to have children! I hope there will be no issues there.  Good

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