About Testosterone


“Low testosterone levels for men can mean high health risks. After decades of research and hype surrounding female menopause and hormone replacement therapy, men have recently started receiving some attention about their own age-related hormonal decline – “Male Andropause.”

Low testosterone levels for men can mean high health risks. After decades of research and hype surrounding female menopause and hormone replacement therapy, men have recently started receiving some attention about their own age-related hormonal decline. Most people call it “Male Menopause”, but in medical circles the scientific term is known as andropause.

At NBH Lifetime Health, we have been treating men of all ages for testosterone deficiencies for more than ten years. A simple lab test for free and total testosterone will determine if the male is deficient in this primary male hormone. We also test the estradiol level to determine if testosterone is converting to estradiol. Another important test is DHEA. This hormone is often called the body’s repair hormone and master hormone.

For males in the 40’s and above, we offer tests for the major heart factors including cholesterol, homocysteine, fibrinogen, and CRP. Testosterone is of course a major heart factor in that low levels are associated with heart disease. We have found that most men over 40 have less than optimal levels of free testosterone. More and more, we are finding the younger males can also have these difficulties.

Declining testosterone levels
Declining testosterone levels can lead to the development of numerous symptoms such as a decrease in virility, libido and sexual activity, general sense of well-being, as well as fatigue, depression and sleep disturbances. In addition to problems such as sexual dysfunction or general malaise, low testosterone also translates into decreased muscle mass and strength, as well as a decrease in bone mass and an increase in abdominal fat. Studies show that the latter two pay a role in degenerative diseases such as osteoporosis, cardiovascular disease and diabetes. Moreover, depleted testosterone levels are being linked to the incidence of various lipid disorders and heart disease.

Less bone, more fat
While osteoporosis hasn’t always been considered a disease that afflicts males, the rising incidence of bone mass degeneration among aging men points a finger to some age-related cause. As androgen receptors are expressed in osteoblasts (bone-forming cells) researchers now believe that androgens have some direct effect on bone formation and resorption.

Declining Testosterone, Fat Mass and Heart Risk
A growing body of research now suggests that an age-related increase in fat mass, or obesity, can be attributed to a fall in free testosterone and growth hormone levels. Moreover, studies report a connection between abdominal obesity and increased cardiovascular mortality and Type II diabetes mellitus. Recent findings from the University Hospital in Ghent, Belgium illustrate that age is related to a drop in free testosterone levels and free insulin-like growth factor-1, while contributing to an increase in body mass index and fat mass.

One recent study consisting of 372 males aged >20-85, revealed that body mass index and age were independent factors in determining testosterone levels. These decreased by about one quarter when researchers compared the young controls to men in the elderly group, while free testosterone levels fell by almost half with age. Likewise, fat-free mass decreased by 18.9%. In a subgroup of 57 men aged 70-80 years, the lower that testosterone levels dropped, the higher the percentage of body and abdominal fat, as well as plasma insulin levels.

Low Testosterone and Increased Risk of Diabetes and Adipose Fat.
Other findings indicate that low testosterone levels predisposed men to adipose fat which, in turn, seemed to raise their risk of diabetes mellitus. Researchers at the University of Washington’s Department of Medicine set out to examine the effects of age-related decreasing serum testosterone levels on intra-abdominal fat in a group of 110 second-generation healthy Japanese-American men. Measurements were taken first to establish baseline levels of glucose, body mass index, visceral adiposity, subcutaneous fat, fasting insulin and C-peptide levels, and overall testosterone levels (which were within the normal range relative to the men’s age).

When the researchers performed follow-up measurements 7.5 years later, their results indicated that intra-abdominal fat had increased by an average of 8.0 centimeters squared. More importantly, though, they found that the change in intra-abdominal fat correlated to baseline total testosterone levels, but they were not significantly related to other measurements such as body mass index, total fat or subcutaneous fat. The study authors concluded that, in their sample, “lower baseline total testosterone independently predicts an increase in intra-abdominal fat. This would suggest that by predisposing to an increase in visceral adiposity, low levels of testosterone may increase the risk of type II diabetes mellitus.”

Low testosterone Levels, Excess Abdominal Fat and Heart Disease
Similarly, another study that analyzed some of the health effects of excess abdominal fat, also referred to as android obesity, reported that individuals exhibiting upper body excess fat distribution tend to have lower levels of plasma testosterone and growth hormone levels, suggesting what the authors describe as “complex hormonal abnormalities”.

Abdominal obesity lends itself to an apple-shaped figure and has been related to a heightened risk of conditions such as cancer, diabetes and heart disease. These researchers believe that, “Visceral fat tissue, through its portal drainage, could be an important source for free fatty acids that may exert complex metabolic effects: involvement in hepatic lipogenesis, increase in hepatic neoglucogenic flux, reduction in insulin metabolic clearance and involvement in peripheral insulin resistance through a competition mechanism described by Randle.”

They conclude that abdominal obesity may be related to diabetes by means of an enhanced fatty acid made available from fat tissues (visceral and subcutaneous) in individuals who are genetically predisposed to type II diabetes. Research has also pointed to the possibility of a link between abdominal obesity and hypercorticism, or elevated cortisol levels. A reason for this, suggest scientists, might be that excess cortisol opposes testosterone and growth hormone production, both of which are regulators of body fat. Moreover, low testosterone levels also seem to encourage cortisol levels to rise and elicit their many aging effects, including immune dysfunction, brain cell injury, arterial wall damage and other assaults.

Hypogonadism (low testosterone) and Heart Trouble
Low testosterone levels have also been implicated in playing a role in the development of chronic diseases such as atherosclerosis and cardiovascular heart disease. One study found that, in assessing a group of men and postmenopausal women over 50 years of age for levels of various hormones as they might relate to health conditions, plasma estradiol levels were highest in hypertensive men and testosterone levels were lowest in men with coronary heart disease. The researchers conclude that perhaps, “Decreased testosterone and/or increased estradiol may have an adverse effect on lipid profile in elderly men.”

Another study conducted among a male population likewise reported that low testosterone may be a risk factor for coronary heart disease, which may relate to lipoprotein metabolism by endogenous testosterone. Results showed that mean plasma testosterone levels among patients with coronary heart disease were significantly—about 40%—lower than in healthy subjects. Moreover, there was a negative association between plasma testosterone levels and plasma triglyceride levels and lipoprotein (a), which translated into higher blood lipid levels relative to lower testosterone levels. Contrarily, a positive association between plasma testosterone levels and high-density lipoprotein cholesterol and high-density lipoprotein 3 cholesterol meant that higher testosterone levels equaled higher “good” cholesterol levels.

The Natural Aging Factor
It is well documented in research that sex hormones such as testosterone are vital components in the sexual development of pubescent males, as well as contributing to the increase of their muscle and bone mass as they transform from boys into men. Meanwhile, dwindling testosterone levels as a result of metabolic aging trigger the opposite kind of effects, including the loss of body hair and progression of male pattern baldness, loss of muscle and bone mass, and increased fat.

Additional Information

Low testosterone levels aren’t just the prospect of a small segment of the male population but rather, they tend to affect the male population as a whole. Natural aging causes a gradual decline in male hormones, so that by age 70, men have less than a quarter of their optimal testosterone levels. Some figures reveal that free testosterone levels start to fall at the age of 25. At NBH Lifetime Health, we have treated many men in their 30’s and even several in their 20’s.

While men with normal testosterone levels sometimes exhibit some of the symptoms, which may very well stem from other causes besides hypogonadism, the fact that androgen therapy usually alleviates these symptoms suggests a hormonal deficiency as the root cause of such deterioration in health.

Many study results show a positive role in maintaining adequate testosterone levels in aging males. In terms of overall body composition, for example, research has demonstrated a measurable increase in lean body mass and in mid-arm circumference and the decrease in waist-to-hip ratio in elderly men, after they received androgen replacement therapy to treat their low testosterone levels.

Meanwhile, in younger, healthy men (i.e. athletes), testosterone treatment has shown to have a positive effect on increased fat-free mass of about 10% and in muscle size. More specifically, studies have shown that administering testosterone to older men with low levels can help to ward off atherogenic type diseases. For example, a Polish study of 22 men with baseline serum testosterone concentrations below 3.5 ng/ml reported that intramuscular injections of testosterone enanthate (200 mg) every two weeks for 12 months resulted in decreased total cholesterol and low-density protein cholesterol levels.(10) In addition, no significant decrease in HDL-cholesterol levels or HDL2- and HDL3-cholesterol subfractions was apparent.

As one researcher noted: “The adverse effects of low testosterone levels are apparent, bothersome, and serious enough to warrant further examination of how androgen impacts on various aspects of male health, and how androgen replacement therapy can serve as a means to contain age-related hormonal pitfalls.” The biggest challenge may conceivably be to restore the reputation of testosterone, which has been cast as a “bad steroid” for some time. Another task for research will be to continue building a case for the vital role that androgens have with regard to bone, heart, sexual, mental health and general well being. Offering solid proof of testosterone’s various functions will help to show that, while testosterone therapy may not be appropriate for every man, it would be a shame for other men to miss out on its merits.

Prostate cancer – the myth of testosterone causation
A number of studies have tried to relate high testosterone levels with the incidence of prostate cancer, but the evidence shows that maintaining youthful testosterone levels does not affect prostate cancer risk, whereas waning testosterone levels carry their own health threats.

Estrogen: The belief that estrogen, rather than testosterone, is one of the prime hormonal initiators of prostate cancer is based on the fact that while testosterone levels are highest in young men, prostate cancer essentially is never seen in this population. It is only in older men, who have lower levels of testosterone but higher levels of estrogen and its breakdown products, that prostate cancer is a significant health threat. However, young men do have high levels of estradiol so this belief is questionable at best.

Further, high doses of estrogen have been used to treat cancer of the prostate and the GnRh agonist, Lupron, is used to decrease the levels of testosterone as a chemotherapy treatment. However, Lupron would also decrease estrogen. Many men have been treated successfully in the past with DES, diethylstilbestrol, and it controlled prostate cancer. Men can get significant breast enlargement with DES. Estrogen treatment is again being used to treat prostate cancer.

Conventional Studies: The Institute of Medicine report includes some data showing that optimal levels of testosterone do not cause prostate cancer, and in fact may protect against this major killer of elderly men. No study has shown that testosterone causes prostate cancer and we have not had a single male develop prostate cancer on our program.

Population-based studies clearly document the relationship between aging and both increases in prostate cancer incidence rates and decreases in circulating [and free] testosterone levels. While this relationship does not equal causality, the findings do raise intriguing hypotheses regarding the influence of testosterone on inhibiting prostate carcino-genesis.

Insurance: Hypogonadism is a medical term. To be diagnosed with hypogonadism, a person must have low levels of testosterone as defined according to expected ranges on blood tests. Many men over the age of 40 (and even younger) would not fall into this medical classification. At NBH Lifetime Health, we strive for “optimal levels” of free testosterone. Most of our patients cannot be medically defined as suffering from hypogonadism although they suffer from all of the symptoms (Male Menopause) of low free testosterone. Optimal levels at NBH Lifetime Health means levels expected of young healthy men between the ages of 25 to 30. Insurance generally does not pay for treatment designed for those who merely wish to obtain “optimal levels. At NBH Lifetime Health, you are the client, not the insurance company.

Benefits of Testosterone Supplementation:
  • Increase in bone density, bone formation, and bone minerals
  • Increase in energy
  • Improvement in sexual function
  • Decrease in body fat
  • Increase in HDL and decrease in LDL levels
  • Decrease in heart disease
  • Improved brain function, learning and memory
  • Improved blood glucose levels
  • Decreased blood pressure
  • Increase in sexual desire
  • Increase in both muscle strength and in the diameter of muscle fibers
  • Enhancement of skin and hair texture
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Hormones – Testosterone

Testosterone is the primary male sex hormone, responsible for male sexual development and is critical in maintaining erectile function, libido, normal energy levels, and mood. It also controls a wide range of other physical functions throughout the body. As with other hormones, testosterone declines with age in both men and women. At the age of eighty (80), the levels are only one fifth of the levels obtained in youth.

Both men and women benefit from the supplementation of testosterone. At optimal levels, testosterone increases bone density and bone formation, increases muscle strength, enhances energy and sexual function, decreases body fat and moderates cholesterol levels.

It is also the hormone that keeps a woman’s skin soft and supple. Testosterone is a hormone both men and women need to replenish as they venture into their fifties and beyond.

Possible Side Effects:

Increase in aggressive behavior if the dose is too high. Testosterone should not be prescribed if prostate cancer is present. Testosterone has not been shown to cause prostate cancer; however, it may accelerate the growth of a tumor. PSA levels should be monitored yearly or every 6 months.


Testosterone can be administered orally, by injection, patches, pellet implants or in a cream/gel form. The safest most natural way to take testosterone is in the cream or gel form. It is quickly absorbed, short acting and least liver toxic. Dosing is usually done twice daily and the strength varies from 50mg to 100mg administered in the morning and evening. For men over 200 pounds, the recommended dose is increased.

Frequently Asked Questions:

Will women taking testosterone get an increase in hair growth?
No, they would have to take a man’s dose to experience any hair growth. While men take 100mg to 200mg daily women, only take 4mg to 8mg.

How often can I get my prescription refilled?
Testosterone is a controlled substance and cannot under any circumstances be refilled before your dose is due to run out. Take your medication exactly as prescribed by your doctor.

Will taking testosterone cause my body’s own production to decrease?
Yes it can in some cases and some men may experience a small decrease in testicular size, although unsettling, this does not impact sexuality or well-being.

Additional Information:

Testosterone is a hormone secreted by the ovaries, adrenal glands and testes. While women need a much smaller amount, it helps control a woman’s libido and also appears to enhance the functions of estrogen. In both males and females, it also helps to strengthen bones in preventing osteoporosis.

Testosterone levels begin declining when a man is in his thirties. The total testosterone may not decline drastically. However the free testosterone, which is the biologically active testosterone, declines dramatically with age. Because the drop in testosterone is more gradual, the symptoms of andropause (male menopause) appear over a longer period of time as compared to female menopause. Symptoms appear as a gradual decrease in energy, thinning bones and muscles, increased visceral fat, depression, and impaired sexual function.

Testosterone deficiency has also been linked to hypertension, obesity, increased risk of heart disease and depression. Stress levels may also play a role in declining testosterone levels.

The Science

“Loss of testosterone causes loss of libido, energy, strength, sexual function, memory, cognition, muscle and bone. Testosterone replacement, as far as quality of life is concerned, is tremendous.” Medical Crossfire 2001Jan;Vol.3 No.1:17-18

“Symptoms of low testosterone may occur due to decreased serum levels or reduced receptor site sensitivity. In spite of normal blood levels patients will still feel and function better when testosterone is prescribed.” Medical Crossfire 2001 Jan;Vol.3 No. 1:17-18.

“Testosterone replacement improves muscle mass and strength, libido, erectile function, bone density, memory, cognition, myocardial function. It is unconscionable for physicians not to treat men with testosterone.” Medical Crossfire 2001Jan;Vol. 3 No.1:47-50.

“Low testosterone levels are associated with an increased risk of diabetes, heart disease, and carotid atherosclerosis.” Diabetes Care 2003 June;Vol. 36, No. 6: 20-30.

“Testosterone levels have nothing to do with causing prostate cancer.” Cancer 1999, July 15;88(2):312-5.

“None of the 12 longitudinal population based studies, such as the “Physician’s Health Study,” found any increased risk of prostate cancer in men with higher levels compared to men with lower levels of testosterone.” New England Journal of Medicine 2004;350:482-92.

“Low testosterone levels increase cardiovascular disease. High testosterone levels protect against cardiovascular disease.” Diabetes Metab 1995 Vol. 21:156-161.

“Testosterone replacement in women significantly decreases carotid atherosclerosis and cardiovascular disease.” American Journal of Epidemiology 2002;155: 437-445

“Administration of testosterone to women eliminates hot flashes, lethargy, depression, incontinence, fibrocystic disease, migraine headaches, and poor libido. Testosterone also improves well-being, sexual desire, frequency and intensity of orgasm.” Consultant; 1999 August: 2006-07.

“Higher testosterone levels increase cognition and memory.” Neurology 2005 Mar. 8; 64-5:866-71.

“Testosterone decreases cholesterol and raises HDL.” Atherosclerosis 1996 Mar;121(1): 35-43.

“Low testosterone levels are associated with higher cardiovascular risk. Testosterone supplementation reduces abdominal fat and improves insulin sensitivity. Testosterone lowers cholesterol also.” Diabetes Metab 2004 Feb;30(1):29-34

“Hormone replacement therapy in postmenopausal women and testosterone replacement in men reduce the degree of central obesity.” Obesity Review 2004 Nov; 5(4): 197-216.

“High doses of synthetic, anabolic steroids cause side effects. No such side effects have been observed using low doses of natural testosterone. Avoidance of supraphysiologic levels prevents any side effects.” Female Patient 2004 Nov; Vol.29: 40-45.

“Testosterone increases bone density in women. Testosterone protects against heart disease in women.” Journal of Reproductive Medicine 1999; 44(12):1012-20

“Low DHT (dihydrotestosterone) predicted a higher rate of cancer. Higher DHT levels were associated with a lower risk of cancer”. Brit.J.Urol 1990 Mar;77(3)443-37.

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