Case Study of a Man with Testosterone Deficiency:
Brad, a 56-year-old white male, used to be a strong, macho man. However, during the last 2-3 years, something has changed. His muscles are not as firm and strong as before, although he continues working out. His belly and breasts have become flabby. He even had two or three prostate infections that were difficult to cure, even with antibiotics.
Brad feels increasing fatigue when he participates in sports. Brad, who was always a bit jolly, has lost much of his smile and joy. Brad is concerned about his depressed mood, but what makes him really lose his self-assurance is that his sexual potency is failing. Not only can he lose his erection in the middle of intercourse, but also there are times when he cannot even get an erection. Even his sex drive is declining.
Looking at women does not arouse him as much as it used to. What is Brad suffering from? Most of Brad’s problems are typical of testosterone deficiency.
To better understand what this means and what can be done about it, let us review some basic information on testosterone.
Role of Testosterone in Men:
Testosterone has many roles, some of which are: Safeguarding against cardiovascular disease. Testosterone makes the heart beat stronger, widens the lumen of the coronary arteries, and increases the blood supply to the heart.
It reduces serum cholesterol and minimizes atherosclerosis. Testosterone reduces high blood pressure by causing vasodilation and makes blood more fluid by increasing the fibrinolytic activity of the blood, which is the capacity to oppose blood clot formation and dissolve blood clots.
Testosterone protects against obesity and diabetes, and decreases the severity and incidence of these diseases by reducing fat mass and increasing lean muscle mass, and by increasing the efficacy of insulin to make glucose penetrate into the brain, the muscles, the heart, and other lean-tissue targets.
Testosterone helps develop and maintain reproductive health–penis size and sexual potency, prostate, body hair, and testicles (blood supply, sperm count, and fertility).
Testosterone supports the brain and nerves by increasing the blood supply and the number of connections between neurons. It sustains the bones–the density and strength; the muscles–the mass and strength, and the skin–blood supply and sebum secretion. Lastly, it also improves the mood and memory, and reduces anxiety.
The daily production of testosterone in young, healthy men is seven milligrams a day, an amount of 20-30 times higher than in women. In young men, a circadian rhythm of serum testosterone has been documented with 20% higher levels of testosterone in the morning than in the evening.
Factors That Affect Testosterone Production:
Intense physical activity, such as frequent sexual intercourse, long-distance running, and other strenuous activity, burns a greater amount of testosterone and can thereby deplete levels. Emotional stress also decreases the secretion of estrogen, but positive emotions such as happiness and sexual pleasure may temporarily increase testosterone in young individuals. Foods high in protein or saturated fat increase testosterone production, but sweets and high cereal fibers can reduce levels.
Testosterone levels decrease with aging.
Approximately every four seconds, one testosterone-producing Leydig cell dies in the testes without being replaced. Of the 700 million Leydig cells at age 18, only about one-third will remain at age 70-80, and free testosterone levels will decrease by more than 50% in the urine and blood. Consequently, over time, men will experience the mental and physical symptoms of testosterone deficiency, while their height and size remains comparable to what they were in their twenties.
An aging body still needs as much testosterone and other hormones as a young adult body of the same size and height. Sadly, with aging, the body can no longer produce the amount of testosterone that he needs to stay young and healthy, and consequently, his health goes downhill.
Testosterone Deficiency in Men–Diagnosis:
The male usually shows abdominal obesity with an aging appearance. His face has wrinkles. There may be headaches, ringing of the ears, palpitations, and shortness of breath. There is decreased muscle mass and strength, arthritis, muscle pains, joint pains, slow bowel movements.
There is lack of mental firmness, indecisiveness, hesitancy, loss of self-confidence, lack of authority, and submissiveness. There may also be depression. Fatigue is noted with decreased sex drive, erections, excessive emotion, loss of initiative, and loss of interest in life.
The patient appears pale, slumped, fragile, older-looking. There is lack of muscle tone, a flabby belly, and increased body fat. Peyronie’s disease may be present. The penis appears small. The patient appears nervous, irritable, and hesitant, with a depressed attitude.
Lab tests for testosterone in men include total and free testosterone, sex hormone binding globulin, estradiol, and possibly FSH and LH; 24-hour urine tests are also performed for breakdown products of testosterone. I do salivary testing for accuracy.
I prefer treating testosterone deficiency with transdermal, bio-identical liposomal gels that are compounded by a compounder pharmacist, or can be obtained through a commercial pharmacy. Also administered at times are the injectable forms, which are usually used when a patient has a very severe deficiency or is above 60 years old.
Oral testosterone is to be avoided, and is not recommended for long-term use due to increased risk of liver damage. The sublingual form is not used in my practice.
Contraindications to Testosterone Treatment in Men:
An absolute contraindication is prostate cancer. A relative contraindication includes active prostate infection or obstruction of urinary flow by enlarged prostate, otherwise known as benign prostatic hypertrophy.
How Do You Begin Testosterone Treatment?
In most patients, testosterone can be easily started and the patient is quickly brought into relief, although replacement works slowly. Gradually the first improvements are felt after 1-3 months of treatment. For improvement of sexual potency, it often takes more than 3-6 months. Faster and greater improvement is seen in men whose diet is near perfect for testosterone treatment–that is, high animal protein, devoid of sweets and starches, and low alcohol. So therefore it is best to eat a paleolithic diet of fruits, vegetables, meats, poultry, eggs and fish with a well-balanced mixed amino acid supplement, detoxification, and of course, eat organic. Avoid alcohol, vinegar, caffeinated drinks, soft drinks, sweets, breads, pastas, cereals, and milk products.
Indications For Treatment:
The indications for treatment in men include chronic, long-term administration for all degrees of testosterone deficiency. I start my patients with a small dose and gradually titrate it upward, rechecking their blood tests as well as their PSA, estradiol, free and total testosterone, and sex hormone binding globulin. Diet is important, as well as vitamins and detoxification.
Follow-up In Men:
The follow-up in men includes a complete consultation with careful administration and physical activity, as well as adequate amino acids. Exercise is also important.