Tag Archives: testosterone

Infertility to Acne: Treatment and Prevention of Polycystic Ovarian Syndrome. Part 2


Worried about pregnancyIn part one of this series we looked at the cause of polycystic ovarian syndrome (PCOS) and the many complications it causes. Weight gain, acne, excess hair growth on the face and body,  high cholesterol and high blood sugar due to insulin resistance are among the problems associated with PCOS.  One particular area of concern for PCOS sufferers is infertility due to lack of ovulation. PCOS is the cause of anovulatory infertility in  3 out of 4 cases. Before the acceptance of medical therapy for infertility due to PCOS  a surgical approach referred to as a wedge resection of the ovary was performed which allowed patients with PCOS to ovulate and conceive normally. Low success rates with this procedure, complications of surgery and improved medical therapies have all resulted in the end of this type of treatment in most situations.  At present, treatment of infertility associated with PCOS generally consists of using a drug to combat insulin resistance known as metformin often in combination with the fertility drug clomid, which has a high rate of success.

Treatment of the excess hair growth associated with PCOS often consists of using the drug spironalactone and the use of birth control pills. Spironalactone is a very interesting drug used for decades as a salt depleting diuretic but also has an effect to block the action of the male hormone testosterone. The action of spironalactone to block testosterone was discovered when it was noticed that men using this diuretic developed tender nipples and breast enlargement (gynecomastia). Oral contraceptive agents are also useful to combat hirsutism because these agents also cause reduce testosterone levels by putting the ovary in a dormant “resting” state.  Cosmetic procedures are always another option to treat unwanted hair growth. Laser hair removal appears to be replacing the older modality of electrolysis for this purpose.

Can PCOS be cured? Once PCOS develops it can be controlled but not cured unless the ovaries are removed. At menopause  PCOS-related problems diminish as the ovary stops making sex hormones including testosterone which is one of the culprits during the reproductive years. A recent study published this year in the journal Pediatric Endocrinology showed that using metformin treatment in pre-adolescent girls thought to be at risk for PCOS reduces the risk and/or the severity of PCOS in later years. It may do this by blocking fat accumulation in the abdomen and liver which seems to set off the insulin resistance. Metformin is not FDA approved for this purpose and as a generic drug there is little profit potential in developing this treatment. I expect it will be many years before preventive therapy for PCOS will come before the FDA for approval .

This information is strictly for educational purposes. Due to high risk of toxicity of medical therapy in young women who can potentially become fertile under treatment for PCOS, no drug should be taken without the close supervision of a physician. The reader agrees to the Terms of Service of this website, metabolism.com

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Boyfriend Has Low Testosterone. What Can Lu Do?


Lu posts these concerns to Metabolism.com

My boyfriend is in his early 40′s and has been taking testosterone therapy. Instead of his levels increasing, they have decreased…his total is now in the single digits. He takes very good care of himself as he is a fitness trainer and body builder (takes vitamins, etc.). Obviously, with his total level being in the single digits, he has all the “symptoms” of low-T and is frustrated that the therapy is having a reverse reaction. He also suffers from Migraines and has recently been in a car accident that he suffered brain trauma in. I’m wondering if there could be a connection between the trauma and low-T or lower T. Any advice or direction you can head us in would be much appreciated.

In reply Dr. Pepper writes:

Hi Lu

You can’t pour water into a cup and wind up with less water in the cup then what you put in. Likewise, if someone takes testosterone supplement they will have more testosterone in their body then they started with. However, some things can influence the blood levels so one person will have higher or lower levels then someone else taking an identical dose. I have seen a wide variation in how testosterone gels are absorbed through the skin. These products include Androgel, Androderm, Testim, Axilron and Fortesa. One person may not see much of an increase in blood levels of testosterone on one of these gels while another will see levels zoom up to a 1000. Absorption of testosterone that is injected with a needle is less variable. Levels go very high in the first few days after the the injection but after 2 or 3 weeks levels will be low again. Here’s an important point. Since testosterone replacement turns off the body’s production of testosterone, if you stop taking replacement your body will not be making testosterone for weeks to months after resulting in very low levels on blood tests. People who abuse testosterone know this and will have the doctor check their testosterone level a month or two after their last dose, so the doctor will see the low levels and give them a prescription for more medication.

Can head trauma effect the testosterone level? For that to occur the pituitary gland would have to be damaged and that will often be associated with other obvious brain damage. In children less severe trauma can hurt the pituitary.

Hope some of this information is helpful in trying to figure out what is going on with your boyfriend. Good luck.

Gary Pepper, Editor-in-Chief, Metabolism.com

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Newly Diagnosed with Low Testosterone John Wonders About His Treatment


John has recently been diagnosed with low testosterone levels and sends metabolism.com this inquiry:

John writes;

I’m so glad I found this site! About a month ago I was diagnosed with low T – mine is 140. Very, very low. Symptoms were NO libido, fatigue, massive weight gain (from 195 to 275 in 9 months), swelling below the knees. Not sure if the T is responsible for all of this, but would love your opinion (at the same time – the same day, actually – i was also told I had type 2 diabetes (blood sugar of 203). Is there a link here?

My endocrinologist put me on Enenthate shots, 1ml every 2 weeks (done 2 shots so far). Do you think this is a good dosage? Are the shots better than the cream? I’m concerned about see-sawing T levels – will they go up after the shot but creep back down again before the next treatment?

I’d really appreciate any insight, my doc did not spend a lot of time going into these kinds of details with me, it was a bit disappointing. I’m a white male, a little over 6′ and 42 years old. Naturally I understand you are only giving an opinion, not actual medical advice. Thanks so much.

Reply by Dr. Pepper:

Thanks for your inquiry John. My first thought about the situation you describe is why would a 42 year old man develop low testosterone? Personally, I never take it for granted that the cause of newly diagnosed low testosterone is “aging”. There are many significant medical conditions that need to be ruled out primarily disorders of the testicle, and pituitary gland. Additional blood tests such as LH, FSH and prolactin and possibly radiological tests are often needed to make that determination. I don’t want to go on a wild goose chase here but swelling of the legs, rapid weight gain, low testosterone and type 2 diabetes may all be caused by an excess of cortisol in the body, known as Cushing’s Syndrome. That could be one way to unify all the events you describe.

Testosterone is generally administered as an injection or rubbed on as a gel. In nature, testosterone levels are more or less constant from day to day, so applying testosterone gel every day mimics this environment pretty well. The injections given every two or three weeks cause a rapid increase of testosterone to unnaturally high levels followed by steady decline often to low levels again before the next shot. My opinion is that shots are much less desirable although they tend to be a lot cheaper and simpler than the daily gels.

You may want to seek a second opinion to find out if other problems exist to explain how you developed low testosterone in the first place.

Keep us posted and good luck.

These comments are for educational purposes only and are not intended to provide medical care or advise.

Gary Pepper, M.D., Editor in Chief, Metabolism.com

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Adopted Children Experience Early Sexual Maturity


Puberty occurs when areas within the brain awaken beginning a cascade of hormone signals which conclude with the gonads (ovaries and testicles) increasing their production of the female and male sex hormones estrogen and testosterone. Under the influence of these hormones a child begins the transition from childhood to sexual maturity. In boys puberty is associated with a growth spurt, the appearance of facial, axillary (arm pit) and pubic hair, acne, deepening of the voice, growth of the testicles and penis while girls undergo a growth spurt, develop breasts, acne, pubic and axillary hair, and growth of the clitoris.

Historical data shows the average age of puberty today is many years sooner than in previous generations. Most experts attribute earlier puberty to better nutrition. A recent article in metabolism.com reviewed how “over-nutrition” accelerates obese children into puberty sooner (referred to as precocious puberty) than normal weight children. The latest studies on causes of precocious puberty suggests that a child’s social environment also exerts an important influence on the timing of puberty. Researchers in Madrid publishing in The Journal of Clinical Endocrinology and Metabolism 95:4305 2010 analyzed the age of puberty in normal children, adopted children and children whose families immigrated (children not adopted but subject to high levels of personal stress) to Spain. Adopted children were 25 times more likely than other groups of children to undergo precocious puberty (breast development before the age of 8 years in girls, and boys under 9 years of age with testicular growth). Over-all girls were 11 times more likely than boys to demonstrate precocious puberty.

Researchers speculate that socio-emotional stresses early in life of children who are later adopted result in changes in the brain that cause premature maturation of vital nerve pathways. This early brain maturation later results in stimulation of the pituitary gland, turning on the hormone pathways that cause puberty. This seems strange to me because various forms of deprivation in childhood can also delay puberty. For example, girls who have anorexia remain child-like in their body development and may fail to menstruate even into their late teens. A decade ago I studied hormone levels in adults during the stress of illness and surgery and found this lowered the sex hormone levels in their blood. This makes sense from an evolutionary point of view because during stressful conditions nature wisely cuts off the reproductive hormones. Why make babies if the environment is hostile in some way? Why the opposite occurs in children under stress of adoption is an interesting but unanswered question.

Gary Pepper, M.D.,
Editor-in-Chief, metabolism.com

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Trying to Cope with Symptoms of Low Testosterone


One of our members notes loss of sex drive, strength, motivation. He is concerned that this could be due to low testosterone levels;

Here is his comment;

I’m 64 years old. Excellent health. 6 ft tall, 177 pounds, work out three times a week…….finding my self depressed, losing strength…..haven’t had any sexual desire in last 3 years……..I use the VA for all my health issues. My doctor said he tested my levels and they were normal, but he wouldn’t let see the results. Based on my info could someone tell me what my level should be at. Also, I noted someone said they got tested free…how is that ?? My only option without paying is to use the VA, and I’ve already noted that experience. Thank You.

My reply:

My first thought is to find out what the actual testosterone level is, as well as free testosterone. A doctor that refuses to share a patients lab results with them has lost credibility. Many “normal” results are subject to interpretation but the doctor may not want to be bothered explaining the finer points of diagnosis. This applies to many medical conditions but is particularly common when diagnosing low thyroid or gonadal (testicular) function. Additional testing may be necessary to make the diagnosis. If any of the pituitary hormones, prolactin, LH or FSH are abnormal then testosterone levels could be in the “normal” range and yet the patient can be suffering from significant disease. Finally, it is still possible that symptoms like those you describe are not related to testosterone deficiency and a search for other medical explanations seems appropriate.

As far as getting free testing for medical conditions I am not able to provide a clue. Perhaps one of our members knows of a way and I would welcome their comments.

Best of luck.

Dr. Gary Pepper, Editor-in-Chief, Metabolism.com
These comments are for informational purposes only and are not intended as medical advice or therapy.

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Low Testosterone May Signal Serious Medical Conditions


Dennis is a middle aged man with a testosterone of 70. He suffers with weakness, muscle aches, soreness of the breast, and carries a diagnosis of fibromyalgia. He inquires if treatment with testosterone will benefit him (see his inquiry in our Comments section).

While I cannot offer medical advice on this website I can make some general comments that may be helpful. In my medical practice I see many men of this age with low testosterone. Usually the testosterone levels are in the low 200’s or slightly less. Symptoms of moodiness, fatigue, weakness, low motivation, and loss of sexual interest and function are the most common complaints. Evaluation for causes of low testosterone usually reveals a failure of the pituitary gland to make enough gonadotropins, the hormones that cause the testicle to manufacture testosterone. In almost all these cases the pituitary gland appears otherwise normal. Many of these men are started on testosterone replacement and generally have a nice improvement in their complaints.

What concerns me about Dennis is that a level of testosterone of 70 is extremely low and can suggest more unusual causes of low testosterone. Tumors of the pituitary gland, injury to the testicle, or rare genetic defects (usually discovered in childhood), cause testosterone levels as low as this. Alcoholic liver cirrhosis may also have similar effects. The fact that his breast is tender is another clue that this is a severe form of testosterone deficiency. My advice to Dennis is to have his V.A. doctors perform a full endocrine evaluation to make sure nothing else is causing the low testosterone. Giving testosterone replacement may only cover up the symptoms of a more significant medical condition.

I hope that helps. Dennis…let us know how this turns out.

Gary Pepper, M.D.
Editor-in-Chief, metabolism.com
The disclaimer of metabolism.com applies to this and all of my posts.

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Testosterone Replacement for Men


Testosterone, the primary hormone produced by the testicle, promotes most of the masculine characteristics of the body. These ‘secondary sexual characteristics’ include development of the penis, increased muscle strength and mass, facial and body hair and male sexual function. There are many medical conditions in men that result in low testosterone levels, a condition known as hypogonadism. Hypogonadism can cause symptoms such as loss of energy, depression, thinning of the bone (osteoporosis), loss of sexual interest and function and muscle wasting. Men are less likely than women to be evaluated for osteoporosis. Osteoporosis increases the risk of hip fracture which has a mortality rate of 30% during the first year. For that reason screening for low testosterone and associated osteoporosis before a fracture occurs can result in life saving treatment.

Trauma to the testicles such as sports injuries or mumps, tumors of the pituitary gland or simply prolonged and severe illnesses can all cause low testosterone levels. Testosterone levels in men typically decline with aging and by the age of 60 about 20% of men have low testosterone levels. Hypogonadism developing due to aging is sometimes called ‘andropause’. The first challenge for those suffering from a low testosterone level is to have the condition properly diagnosed since symptoms are non-specific and may be attributed to age alone. Diagnosing low testosterone can usually be done with a simple blood test. Doctors disagree about the best test to use for diagnosing low testosterone but in general the total or free testosterone level (not bound to a carrier substance in the blood) or both together, are the most frequently used.

Once a low testosterone level is detected and if there is no reversable cause of this problem then testosterone replacement is generally advised. The use of an injection to administer testosterone has been the most commonly used method until the last decade or so. Testosterone containing patches and gels have been developed that can be applied to the skin. The hormone is then absorbed through the skin into the blood stream. Although testosterone can be taken by mouth this method is not advised due to the risk of liver toxicity.

Among the first preparations designed for skin application was Testoderm which employs a testosterone containing patch applied directly to the testicle. Due to inconvenience and discomfort this product has not been very popular. Another patch is Androderm which can be placed on any area of skin on the body which is free of hair. The adhesive on the patch occasionally causes a skin rash, and the patch itself is cumbersome. Up to one third of individuals using a testosterone patch experience some discomfort.

Avoiding the inconvenience of a patch is Androgel which was approved by the FDA in 1999. Testim is another testosterone gel product. The gel is rubbed directly into the skin every day without the need for a patch. Many men find this the easiest and least irritating of the transdermal preparations of testosterone. Studies have shown high levels of patient satisfaction with gel product. In a study conducted at Duke University researchers found that men with testosterone levels less than 300 ng/dl treated with Androgel (testosterone gel) had significant improvement in sexual function, muscle strength and lean body mass. Overall satisfaction was better with Androgel than with the testosterone patch.

Can testosterone gel be of benefit to women too? Some physicians have used small amounts of testosterone gel applied to the clitoris and labia to improve sex drive and orgasm in women with sexual dysfunction. Controlled studies of testosterone gel used in this manner in women are currently not available although some experts assert that testosterone is beneficial to a woman�s sexual response.

There are several important precautions to follow when using testosterone supplementation. Although testosterone probably does not cause cancer to develop within the prostate, it will promote the growth of prostate cancers that otherwise may have been indolent. For this reason PSA levels should be monitored and the prostate examined regularly in testosterone users. Excessive amounts of testosterone may cause breast enlargement (gynecomastia) due to the body’s conversion of excess testosterone to estrogen. Aggressive behavior may be promoted as well.

Testosterone is a controlled substance which can be obtained by prescription from a licensed physician only. When used appropriately it can make a substantial contribution to the well being of men with hypogonadism.

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Older Men in Boston Area to Die Sooner?


Elderly the manMen over 50 with low male hormone (testosterone) levels have a shorter life expectancy than men with of similar age with higher testosterone levels. Or so says a new medical study in the Journal of Endocrinology and Metabolism. Of the almost 800 men over the age of 50 who were studied, those who had the lowest testosterone levels had a 40% increased risk of dying over a 12 year period than men with higher levels . The authors (Gail Laughlin et al) of the study speculate that the lower testosterone levels gives rise to the metabolic syndrome of hypertension, abdominal obesity and lipid abnormalities (abnormal fats in the blood) which result in early death. Dr. Laughlin does not advocate giving testosterone to prevent these developments, however.

So what connection could this have with the lives of men in Boston. If you recall a previous study mentioned in this blog (http://blog.metabolism.com/2007/03/21/boston-men-show-decline-in-testosterone-male-hormone-levels/) it was noted that men in Boston have lower testosterone levels than men in other parts of the country. Therefore it is my personal observation that if you combine the information of these two studies we should conclude that men in Boston will have shortened life spans. Taking this one step further, it is known that stress can lower a man’s testosterone. Therefore if the Red Sox lose the World Series causing a tremendous rise in stress in Bosten men, they will have even lower testosterone levels and die even sooner. I ask you, can we afford to have the Red Sox lose knowing what might happen to the low testosterone Boston males?
Your thoughts please….

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Human Growth Hormone, Testosterone, Estrogen: Healers or Harmers? Part 1.


Let’s face it, nature wants us dead. We were born to die. That may seem a bit harsh but I don’t make the rules. Can the use of human growth hormone and sex steroids help us delay this inevitability? Maybe.

After birth most living things are programmed to develop physically and sexually, to rise to dominance in their environment, pass on their genetic material as fast and as frequently as they can…then die. The species which masters these simple principles rules the earth. As well they have. I refer to cockroaches, ants and other creepy crawlers. Then comes us, the humans. We lag behind because we are slow reproducers and possess a stubborn refusal to die.

I am imagining most of you nodding your head in agreement as you read the programmed stages of life…develop sexually (yes), dominance (yes, yes), pass on genetic material fast and furious (oh yes, oh yes). Then comes the frown and gnashing of teeth… death you say? Death can’t be part of the plan. How could we be programmed to die?

Scientific support for a natural death wish comes from several angles. For example, there is a suicide gene in our cells. The term for programmed cell suicide is apoptosis. When the genes for apoptosis are turned on in a cell, the cell dies. These genes (some are termed “reaper” genes) are responsible for cell suicide. From another perspective we learn that the machinery for cell repair and replication has a built in limit. After a certain amount of replication the cell machinery runs out of supplies and the cell will die. Together these irreversible features of cells guarantee death.

During the development years (up to age 25 or so) the apoptosis genes mostly serve constructive purposes like removing tissues that stand in the way of growth or to prevent cancer cells from reproducing. The chemical messages of growth and development produced in our endocrine glands (known as hormones) are released into our blood in abundant amounts. These hormones include growth hormone, sex hormones (testosterone and estrogen), and adrenal hormones such as DHEA. After that these hormones gradually decrease and our abilities and physical attributes begin to decline.

The role of growth hormone in the adult remains controversial. Once the bones have grown to full adult size some experts claim that there is no other important role for growth hormone. I disagree. There are many tissues in the body that have “receptors” for HGH so that growth hormone can continue to play a role in maintenance of bone, muscle, brain, immune cells and other tissues. I believe that nature intended “growth” hormones to maintain, sustain and repair the body that it helped create during the development years. Without them the aging process through cell suicide, starvation, or disrepair is unopposed, and decline and death are not far behind.

To cripple the body a good starting place would be elimination of the machinery for making the caretaking hormones. The onset of menopause is the most obvious example of natural ending of the hormone making process. The changes of menopause due to estrogen deficiency that occur in the skin, hair, bone, arteries (arthrosclerosis), are all very well known. Not to mention hot flashes, moodiness and loss of libido which reduce the quality of life. Less obvious but just as critical hormonal declines associated with aging are the steady dwindling of testosterone in men, and the reduction of growth hormone and DHEA levels in both sexes.

The questions before us are whether or not replacement of these hormones will delay aging or improve the quality of our lives.

Important Notice: Hormones such as growth hormone, testosterone, and T3 are prescription drugs to be prescribed by a licensed professional within a doctor patient relationship. Prescribing or using growth hormone for the purpose of enhancing athletic performance, or using these hormones without a prescription is illegal and punished by fines and possibly jail. Metabolism.com and Dr. Pepper continue to support a lively debate about the appropriate use of these medications to help patients with true medical needs.

Gary Pepper, M.D.
Director, Metabolism.com

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