A Guide to Testosterone Supplementation for Older Men
  by James Occhiogrosso, N.D.


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Testosterone is an extremely important hormone for the overall health of the human body and particularly critical for male sexual ability, libido, and satisfaction.  Aside from sexual problems, recent studies have shown testosterone deficiency contributes to reduced muscle mass, reduced bone mass, male breast enlargement, depression, atherosclerosis, increased risk of development of Alzheimer’s disease, anemia, and diabetes, and increased overall mortality from all causes.  [1] [2] [3] [4] [5] [6] [7] [8] [9] [10]  

There are two forms of testosterone in the body—free and bound. The bound form travels through the bloodstream bound to a protein and is not available for use.  The free form is the one that has the active role.  Most laboratory tests are done using blood and measure total testosterone—which is the combination of both free and bound forms.  Saliva tests measure free hormones and can be done simply and inexpensively in the privacy of your home.

It is important to remember that only free testosterone does the work.  Thus, measurement of total testosterone does not tell the full story.  Aging men often have total testosterone levels in the normal range but low free testosterone.  A common symptom of this is inability (or reduced ability) to have an orgasm during normal intercourse.  Medically, this is known as anorgasmia or orgasmic dysfunction.  While this can also be due to nerve desensitization, particularly for diabetics, in most healthy men it is due to low free testosterone.  Another common symptom is a lack of spontaneous erections during the night or early morning, which—barring other medical conditions—is almost always due to low free testosterone levels. 

Adequate testosterone is essential for a man to have normal libido, orgasms, and spontaneous erections.  Unfortunately, there is no specific value to determine what an adequate or normal level is.  What is normal for one man may be woefully insufficient for another.  If your testosterone level falls on the low side of normal and you are having symptoms (as mentioned above), replacement therapy may be in order, particularly if you are not experiencing nocturnal erections.

Before supplementing to increase your testosterone level it is advisable to see your doctor.  Low testosterone can be caused by a benign pituitary tumor or other conditions, and it is wise to rule these out first.  If your level is low, and all medical causes are ruled out, you can then try to increase it with herbs and other natural products.  Failing that, your doctor can prescribe testosterone cream for you. 

Try a Natural Approach First

There are many herbs reputed to increase testosterone levels, sexual libido, or erectile function.  Most of them have little backing other than manufacturer’s claims.  Some—like red panex ginseng, ginkgo biloba, tribulus terrestris, saw palmetto, and mucuna pruriens have been studied in humans and appear to have measurable effects on either libido, testosterone level, or erectile function. 

I have had good results with a well-formulated skin cream that contains extracts of several of the above herbs along with other natural ingredients as well as homeopathic testosterone and homeopathic human growth hormone.  It is formulated to support increased testosterone levels in older men, and my experience is that it works quite well.  Since it is an all-natural product with no artificial or animal ingredients, it is well worth a try before taking the next step.  In my book, I discuss many other ways to enhance testosterone production, but this herbal product can help many men. Click here to order it.

Prescription Testosterone Replacement

If a natural approach to raising your testosterone fails, you may want to consider prescription testosterone replacement.  Many medical professionals frown on testosterone supplementation in any form.  But the latest research suggests that this paradigm is wrong and that low testosterone levels, particularly low free testosterone levels, are actually associated with prostate dysfunction.  Recent studies have challenged the prevailing theory that testosterone supplementation in men with low levels of the hormone is harmful. [11] [12] [13] [14] [15] [16] [17] [18] [19]

There is no evidence that testosterone replacement therapy can initiate prostate cancer, but some professionals believe there is a theoretically increased risk.  Since there is some controversy, it is prudent that supplementation with prescription testosterone is done under the auspices of a medical professional who is up to date on such supplementation, and after a thorough prostate exam to rule out cancer.  A natural testosterone cream (like the one listed below) merely helps your body produce more testosterone. Since it does not directly provide significant amounts of testosterone, it has little risk.

There are many different types of prescription testosterone therapies.  The only one of value is natural USP bio-identical testosterone cream.*  This is typically available from a compounding pharmacy that prepares a concentration according to your doctor’s prescription.  Many doctors tend to use other forms of testosterone, including bi-weekly injections and skin patches.  These are typically made of synthetic chemicals similar, but not identical to natural testosterone.  Such products are not completely recognized by the body and can have serious side effects, which include the possibility of liver damage.  Intravenous injection and skin patches initially raise testosterone far too high and allow it to drop too low near the end of the cycle.  This subjects the body to alternating levels of testosterone that are nowhere near normal and can cause significant problems, not the least of which is that the excess testosterone can convert to estrogen and cause breast enlargement.

The average man produces about 4 to 7 mg of testosterone per day in a circadian pattern.**  Normal testosterone levels can usually be reached within a few weeks by using a low dose transdermal cream mixed by a compounding pharmacy to contain about 25 to 50 mg of testosterone per dose. [20]  Typically, only about ten percent of the dose is absorbed into the blood, so this will yield about 2.5 to 5 mg of testosterone per day.  The International Academy of Compounding Pharmacists can help you locate both a doctor and a compounding pharmacy in your area.  (800-927-4227 — http://www.iacprx.org)

If you are using prescription testosterone cream, it is important to measure the dosage carefully.  Concentrations may differ between pharmacies, so the amount used must be carefully measured to deliver the desired dose.  The goal is simply to bring your testosterone level back to normal.  Increasing it beyond a biological normal range could cause other problems.

The normal range for total testosterone for a male is about 280-1100 ng/dl with the higher limit for young men.  Reference ranges for testosterone are often grouped by age and can vary slightly between laboratories.  A normal level for free testosterone is between 1.5 to 2.9 percent of the total value, again with the higher limit for young men.  Consider supplementing if your free testosterone is on the low side and you are having symptoms, even if your total testosterone level is normal.  This is particularly true if you are older than sixty.  The determinant should be how you feel—not just the laboratory value. 

One interesting thing about testosterone values is that the high limit of normal for a man over sixty is more than 30 percent below that of a forty year old.  This may be obsolete. Many experts consider that values for young men are also valid for older men. [21] [22]

How to use Natural or Prescription Hormone Creams

Testosterone creams of either type are designed to be readily absorbed into the bloodstream through the skin.  They typically use a liposome base that aids their absorption.  When spread on thin-skinned areas of the body, the cream is quickly absorbed into the fatty parts of the skin tissue and transported into the blood stream.  It is important to rotate areas where the cream is used so that no particular skin area gets overused.  Hormones are stored in the fatty tissue layer just below the skin.  If you use the same skin area day-after-day, the tissue becomes saturated and will absorb less. 

Continuous supplementation with any hormone causes the body to shut down internal production of that hormone.  To prevent this, you should cycle hormone use.  Use the hormone for about three weeks and then take a one-week break.  The resulting deficit during the break triggers the body to turn up production of that hormone.  Sometimes a few months of cycling may nudge the body to permanently increase production, thus eliminating the need for external supplementation. 

Tracking Your Response

When using supplemental hormones, it is essential to keep track of your body’s response.  Hormonal imbalances often occur many years before symptoms of dysfunction appear and it may take several months for your body to come into balance.  It is important to measure your hormone levels prior to implementing a program to rebalance them.  The best way to do this is with saliva tests that accurately measure free hormones.

Establishing a record over a period of time allows you to monitor and adjust your progress to best enhance your overall health.  Excessive supplementation can cause serious problems, and insufficient supplementation is not effective.  The best way to track hormone levels is to test them before starting and repeat testing regularly at one or two month intervals.  It is best to pick a specific laboratory for your testing and stick with it.  Laboratories may have different equipment or testing protocols that may make results slightly different.  An inexpensive saliva home test kit is available on my website to monitor your progress.  Click here to order one.  Since testosterone levels fluctuate during the day, it is also best to make your measurements at the same time of the day. Mid afternoon is usually best.

Summary

Restoring your testosterone level to its biological norm can be very rewarding in terms of how you feel and for your overall health.  Testosterone levels drop slowly as a man ages and the effects of low testosterone often progress so slowly that they are hardly noticeable.  But, by the time a man reaches his fifties or sixties his testosterone level is significantly reduced.  Some men feel this strongly and experience significant symptoms.  Others hardly notice it.  However, having abnormally low levels of free testosterone increases your risk of many chronic illnesses, as well as reducing sexual ability and satisfaction.  Just remember that hormones are very powerful and a little goes a long way.  Also, remember that more is definitely not better and excessive supplementation can damage your health.

Click here to order our Natural Testosterone cream.  •
Click here to order our Home Saliva Test Kit.  •
• Low Testosterone Questionnaire •


* USP is an acronym for United States Pharmaceutical and indicates a pharmaceutical grade product. Bio-identical means the substance is identical to that produced by the body.

** A circadian pattern (or circadian rhythm) is a biological process that repeats at 24-hour intervals.
 


References:

[1] Osvaldo P. Almeida, et al, Low Free Testosterone Concentration as a Potentially Treatable Cause of Depressive Symptoms in Older Men, Archives of General Psychiatry, Vol. 65 No. 3:283-289, March 2008

[2] Gail A. Laughlin, et el, Low Serum Testosterone and Mortality in Older Men, The Journal of Clinical Endocrinology & Metabolism, Vol. 93, No. 1:68-75, Jan 2008

[3] Shores, M. et al.  Low Serum Testosterone and Mortality in Male Veterans. Archives of Internal Medicine, Vol. 166, No. 15:1660-1665, Aug 2006.

[4] Shores, M.M., et al. Increased incidence of diagnosed depressive illness in hypogonadal older men. Archives of General Psychiatry, Vol. 61, No. 2:162-167, Feb 2004.

[5] Kay-Tee Khaw, et al, Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men, Circulation, Vol. 116:2694-2701, Nov. 2007

[6] Fukui, M., et al. Association Between Serum Testosterone Concentration and Carotid Atherosclerosis in Men With Type 2 Diabetes. Diabetes Care, Vol. 26, No. 6:1869-1873, June 2003.

[7] Travison, T., et al. The Relationship between Libido and Testosterone Levels in Aging Men. The Journal of Clinical Endocrinology & Metabolism, Vol. 91, No. 7:2509-2513, July 2006.

[8] Moffat, S.D., et al. Free testosterone and risk for Alzheimer disease in older men. Neurology, Vol. 62, No. 2:188-93 Jan. 2004.

[9] Ding, E.L., et al. Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes. Journal of the American Medical Association, Vol. 295 No. 11:1288-1299, March 2006.

[10] Ferrucci, L. et al. Low Testosterone Levels and the Risk of Anemia in Older Men and Women. Archives of Internal Medicine, Vol. 166, No. 13:1380-1388, July 2006.

[11] Stattin, P., et al. High levels of circulating testosterone are not associated with increased prostate cancer risk: a pooled prospective study. International Journal of Cancer, Vol. 108, No. 3:418-424, Oct. 2003.

[12] Kravchick, S. et al. Predictive criteria for prostate cancer detection in men with serum PSA concentration of 2.0 to 4.0 ng/mL. Urology, Vol. 66, No. 3:542-546, Sept. 2005.

[13] Severi, G., et al. Circulating steroid hormones and the risk of prostate cancer. Cancer Epidemiology Biomarkers & Prevention, Vol. 15, No. 1:86-91, Jan 2006.

[14] Morales, A. Androgen Replacement Therapy and Prostate Safety. European Urology, Vol. 41, No. 2:113-120, Feb. 2002.

[15] Parsons, J.K., et al. Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy. Cancer Epidemiology Biomarkers & Prevention, Vol. 14, No. 9:2257-2260, Sept. 2005.

[16] Barqawi, A., et al. Testosterone Replacement Therapy and the Risk of Prostate Cancer. Is There a Link? International Journal of Impotence Research, Vol. 18, No. 4:323-328, July 2006.

[17] Hoffman, M., et al. Is low serum free testosterone a marker for high grade prostate cancer? Journal of Urology, Vol. 163, No. 3:824-827, March 2000.

[18] Marks, L., et al. Effects of testosterone administration on prostate tissues in men with ADAM syndrome. Paper presented at the Annual Meeting of the American Urological Association 2006, Atlanta, Georgia, May 2006.

[19] M. M. Miner, et al, Testosterone and Ageing: What Have We Learned Since the Institute of Medicine Report and What Lies Ahead?, International Journal of Clinical Practice, Vol. 61, No. 4:622-632, May 2007

[20] Lee, John, The John Lee Medical Letter, March 2002.

[21] Vermeulen, A. Androgen Replacement Therapy in the Aging Male—A Critical Evaluation. The Journal of Clinical Endocrinology & Metabolism, Vol. 86, No. 6:2380-2390, March 2001.

[22] Prehn, R. T. On the prevention and therapy of prostate cancer by androgen administration. Cancer Research, Vol. 59:4161-4164, Sept. 1999.


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