C. Norman Shealy, M.D., Ph.D.

TESTOSTERONE FOR LIFE, Abraham Morgentaler, M.D., McGraw Hill, N.Y., 2009

I heard Dr. Morgentaler’s presentation of this information at the AntiAging Congress in December. The subtitle of the book is enough to make anyone want the details:

Recharge your Vitality, Sex Drive, Muscle Mass and Overall Health!
Not much missing!
Low testosterone is virtually inevitable, beginning at age 50 (or earlier) with decreasing levels of testosterone as we mature. By age 70, over 70% of men have low bioavailable testosterone.

Symptoms/Signs may include:
Low sex drive/libido
Low energy
Erectile dysfunction
Decreased ability to reach orgasm
Decreased seminal fluid
Decreased muscle mass
A “feeling” of a numb penis-but not sensory loss
Depression/low motivation/lack of drive, etc
Truncal obesity
Loss of body hair

Most labs report total testosterone, which is of little value. Free testosterone, that not bound to a protein, is much more reliable. Low total testosterone levels may be symptomatic when the level is below 400 ng/dl. ?FREE testosterone below 50 ng/dl may be symptomatic. When testosterone is low, it is also important to check Luteinizing Hormone, the pituitary hormone responsible for production of testosterone and Prolactin, which, at levels twice “normal” can reduce testosterone and be a symptom of a rare pituitary tumor. The author recommends a prostate biopsy if the PSA is elevated. Personally I recommend instead taking 600 mg of Co-Q 10 and 12 daily of saw palmetto, 160 mg double strength extract for the rest of your life. There is NO circumstance under which I would allow a prostate biopsy!!!

For clinically significant low testosterone, there are numerous health benefits of replacement therapy, including potential reversal of all the signs and symptoms. There are several testosterone treatment protocols:

Oral testosterone—NOT recommended-can cause liver damage

Intramuscular injections of long lasting testosterone-last 2 to 4 weeks. Not bioidentical. Dosage 100 mg per week

Patches-I do not recommend

Gels-I do NOT recommend the two PharmacoMafia forms, AndroGel? or Testim?.

I recommend 10% to 20% testosterone gel, available from a compounding pharmacy. This is best rubbed firmly on the skin of the scrotum each morning.

Testosterone pellets-the author of the book strongly prefers these-he is financially involved!? It requires a knife jab into the buttocks every 3 months. I do NOT recommend this!

One of the medical concerns for many decades has been the fear that testosterone therapy will aggravate prostate cancer. The evidence strongly suggests that testosterone replacement is far safer that low levels of testosterone and testosterone therapy may prevent prostate cancer! Heart disease is much lower in men with normal levels of testosterone.

Risks (“side effects”):
Testes shrinkage—only the man will know!? Not of any known medical risk
Fluid retention-rarely a significant problem but needs to be watched
Acne-mild and usually subsides after several months
High blood pressure-RARE and may be due to fluid retention
Rash-from any of the skin applications. Much more common with patches and the PharmacoMafia gels.

Breast enlargement-from conversion of testosterone to estrogen. An annoying problem that can be treated with anastrozole, which prevents conversion of testosterone to estrogen, BUT it has many significant “side effects”!!

The Bottom Line:
Benefits far outweigh the relatively minor risks. Most men will be healthier and happier if they add natural testosterone once they have any of the symptoms of low testosterone

Incidentally, many postmenopausal women need a touch of testosterone, best used as a 2.5 to 5% addition to natural progesterone cream (with or without biest).

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