Healthcare Archives - Page 3 of 3 - Testosterone Replacement Therapy

Are Your Testosterone Levels Normal? It’s All About How You FEEL.

My second round of testosterone level tests results just came back. The first time I was low again, but this time I am "normal". I put that in parenthesis because I don't FEEL normal, and because I am just barely normal on a scale that goes hundreds of points and is meant for men much older than me.

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I am 33 and my Total testosterone is at 278. The scale runs from 250 to 1,100 and is meant for adult males of ALL ages. So I'm at the low end of "normal" for an 80-year-old man? To put this into perspective: The difference between 0 and 278 is less than the difference between 278 and 1,100. This doesn't make sense to me. I looked for normal ranges for men my age, and some other sites online suggest total testosterone levels around 668, which means I'm actually functioning with less than HALF of the normal range.

What I'm trying to say is that, despite having "normal" testosterone levels, I don't feel right. I'm depressed, lethargic, angry, stressed, anxious and weak. My back hurts every day and I can barely even bend over to tie my shoes. I have no sex drive whatsoever and I feel like the world is on my shoulders when, logically, I know it's not. I have nothing to be depressed about. I have a good job, a great wife, a big farm, lots of animals... life is good. But I feel like shit.

So the point is to trust how you feel. You and only you know your body and what feels "normal" to you. Don't let some test dictate your treatment. Be an active participant in your healthcare. Now, if my testosterone levels were in the 400s - 500s (still below the average in men of my age) and I felt this way, I would look at other options. Maybe I just need to be on anti-depressants or something. But I know my body and I know that's not it. I've never been a depressed person. I didn't feel this way until my testosterone started falling.

What am I going to do?
I'm going to continue trying to let my system restart since it appears that I am actually doing better than I was. I'm going to go get another blood test in a month and if I'm doing worse, or not doing better, I'm going to go back on TRT. If I'm doing better, like in the 300s, then I'll give it another month. As long as I'm making progress then I'll keep on keeping on without the TRT. And that is MY decision based on how I FEEL. The goal, after all, is to feel better.

Vermeulen, A. (1996). Declining androgens with age: an overview. In Vermeulen, A. & Oddens, & B. J. (Eds.), Androgens and the Aging Male (pp. 3-14). New York: Parthenon Publishing.

Measurements Converted to (ng/dl)

Age	Number of Subjects	Total Testosterone	Standard Deviation	Free Testosterone	Standard Deviation	SHBG (nmol/L)	Standard Deviation
25-34	45	617	170	12.3	2.8	35.5	8.8
35-44	22	668	212	10.3	1.2	40.1	7.9
45-54	23	606	213	9.1	2.2	44.6	8.2
55-64	43	562	195	8.3	2.1	45.5	8.8
65-74	47	524	197	6.9	2.3	48.7	14.2
75-84	48	471	169	6.0	2.3	51.0	22.7
85-100	21	376	134	5.4	2.3	65.9	22.8

Normal Testosterone Levels in Men (Healthy Non-Diabetic)

Simon, D., Nahoul, K., & Charles M.A. (1996). Sex hormones, aging, ethnicity and insulin sensivity in men: an overview of the TELECOM Study. In Vermeulen, A. & Oddens, & B. J. (Eds.), Androgens and the Aging Male (pp. 85-102). New York: Parthenon Publishing.

Measurements Converted to (ng/dl)

Age	Number of Subjects	Mean Total Testosterone	Standard Deviation	Median Total Testosterone	5th Percentile	10th Percentile	95th Percentile
<25	125	692	158	697	408	468	956
25-29	354	669	206	637	388	438	1005
30-34	330	621	194	597	348	388	975
35-39	212	597	189	567	329	388	945
40-44	148	597	198	597	319	378	936
45-49	154	546	163	527	329	358	846
50-54	164	544	187	518	289	348	936
55-59	155	552	174	547	319	338	866

Am I Too Young for HRT? How Early Is Too Early for TRT?

I am seeing more and more forum posts with people in their mid-twenties to mid-thirties asking about how early is too early to go on permanent HRT. They ask the same questions I've asked, including "Am I too young for HRT?" and "What are my other options?".

The sad thing is that nobody has any answers for them, including myself. I am 33 now. I was on TRT when I was 32. I have secondary hypogonadism. I am not currently taking testosterone replacement because I'm trying all other options first. I've tried HCG. I've tried natural testosterone boosters like tribulus. I've tried cutting off all estrogen using Arimidex. Nothing has worked so far. I am facing the daunting idea of spending 3/4 of my lifetime on permanent testosterone replacement therapy (TRT).

The bodybuilding forums are full of people saying they don't see the problem with it. They think we should all just go on HRT for life and not worry about it. But nobody has done any real long-term (30-40 years) studies on the effects of hormone replacement in men. And being an American citizen, there is the whole healthcare thing to worry about. What if I can't get healthcare because of it? What if healthcare is too expensive for me to afford because of it? What if I lose my healthcare and suddenly can't get my testosterone?

I also worry about the psychological effects of knowing that I'm dependent on some drug for my "manhood". I feel like a skinny, depressed little girlyman right now because I haven't been on my HRT is several months. It sucks. I'm depressed. My bones hurt. I've lost ALL of my muscle. I have no motivation, no sex drive, no energy... my memory is terrible and I'm starting to slack at work, which could have its own consequences. I tell my wife it would be like her being on her period for months straight. So when I go back on HRT I'll remember how bad this has been for me, and it will make me paranoid that I'll lose my prescription some day, or for some reason I won't be able to get testosterone.

If I was 55 or older it wouldn't be as bad. I wouldn't be facing TRT for a longer period than I've even been alive so far. I would have already had children or will be too old to have them anyway.

Are you young and facing a lifetime of TRT? Are you under 35 and are being told by doctors that you should take testosterone for hormone replacement therapy for the rest of your life? Are you over 40 and have been taking testosterone non-stop for more than 20 years? I want to hear from you. A LOT of people in my situation want to hear from you. Please share in the comments below. How young is too young for TRT?

Low Testosterone and Depression in Men

I'm feeling pretty down and out at the moment, which prompted me to write this. Right now I'm doing an experiment to try and get my natural testosterone levels back again, but so far it isn't working. My last test results came back WAY under normal levels for someone my age, and I'm really feeling it.

In fact, I feel JUST like I felt when I decided I'd had enough and was going to see a doctor in the first place, way back several years ago. He diagnosed me with depression and wanted me to take anti-depressants. Having never been "the depressed type" and knowing what I knew from talking to bodybuilders about steroids, I asked him if he would mind running a blood-test to find out what my testosterone levels were at. As suspected, they were very low. So rather than treat a symptom of low testosterone (i.e. depression), we started treating the low test levels with Androgel. Within days I felt like a new man. I was happy, energetic, full of life, sharp at work, more fun in the bedroom.... just like my old self again.

If you're a man over the age of 30 and you are starting to feel depressed, yet have never really been the type to get depressed before, get your testosterone levels checked before committing to treatment with anti-depressants.

It may be that you really do have depression brought on by all the stress that comes with growing up (kids, job, mortgage...) but it doesn't hurt to check. And it may be that your doctor will want to put you on anti-depressants for awhile anyway in addition to hormone replacement therapy (HRT) but at least you'll know what is likely the cause of that depression.

So here I am again with low testosterone, feeling completely depressed, but just knowing what is causing that depression makes it so much easier to deal with. I'll feel better once I get my testosterone levels up into normal ranges again, whether naturally or through medication.

Update: If you've read more recent content on testosteronereplacement.org, you'll know that I am still on TRT. I am on it for life. After six months of being off TRT, my natural levels still had not returned to normal.

Menopur - An alternative to TRT for men with secondary hypogonadism?

Two Alternatives to TRT for Secondary Hypogonadal Men

As I posted before, I have secondary hypogonadism. Read more about the difference between primary and secondary hypogonadism here if you don't already know what that means. Basically, if you have primary hypogonadism (testes are not producing enough testosterone) what you would probably end up doing is taking testosterone for the rest of your life. If you have secondary hypogonadism (testes are fine; problem is elsewhere, such as LH and FSH), taking testosterone will give you primary hypogonadism. However, that doesn't stop doctors from prescribing testosterone to treat secondary hypogonadism. They are comfortable with the medications available; have seen them work wonders for hypogonadal men; and have probably noticed relatively few side-effects for a huge improvement on quality of life.

But there ARE other options. I'm not talking about taking tribulus or zinc supplements; I mean real treatment alternatives that have been anecdotally shown to help some men return their system to its proper balance. The two I have been reading about are listed below....

#1 - Block Estrogen Production
What I'm doing is taking a drug called Arimidex, which was designed to reduce estrogen in women at risk of, or for early treatment of breast cancer. One of the places on which I've found a lot of anecdotal information are the various steroid forums frequented by amateur and professional bodybuilders. A lot of bodybuilders take this drug to combat the side-effects of juicing up with ten times or more of the "natural" levels of testosterone men are supposed to have. The body responds to this much testosterone by making more estrogen (or estradiol to be more precise). I am not doctor, but my understanding is that the male body turns some of the excess testosterone into estrogen. This is called aromatization. Aromatase inhibitors like Arimidex keep that aromatization from happening.

It has been theorized by many in the bodybuilding community, based on limited studies and decades of personal experience, that estradiol is more to blame for shutting down the natural production of testosterone than the actual testosterone that is being injected. It has also been theorized that bringing your body's estradiol levels to near-zero will stimulate your body to produce more testosterone so that it can aromatize it and make estradiol. Although I'm not going to link out to online steroid conversations, there are lots of threads on bodybuilding forums outlining some of the concept and sharing some anecdotal evidence as to the efficacy of this approach. Use Google and I'm sure you'll find them. But keep in mind this approach is using a medication for purposes other than what it was intended for, and for purposes which the medication was not tested for.

With full understanding of the above, I am currently trying this alternative with the knowledge and support of my primary care physician. If it doesn't work within 6 months I will move on to the second alternative below. By the way, an endocrinologist isn't going to want to let you try this approach. He will claim it has to do with these medications not being tested on men, but given the relatively low risk of side effects (when compared with permanent testosterone replacement) of temporarily taking aromatase inhibitors - my guess is it has more to do with the fact that this could FIX your problem. Then your endo would be out of a job. ;-)

#2 - Treat the Problem, Not the Symptom
One of the readers here pointed me to a drug called Menopur. Again, this is a drug for women. It is a fertility drug used to induce the development of multiple eggs and pregnancy in women who are able to produce and release eggs (ovulate). In other words, this is the kind of stuff to blame for Octamoms. But really the active ingredients are two hormones that are produced in men called follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These two hormones are responsible for telling your testes to make testosterone. In my case, as is often the case with secondary hypogonadal men, my body is not producing enough of either of these hormones. So why not take THIS drug instead of taking testosterone? Why not replace what I'm missing instead of replacing the hormone that what I'm missing is supposed to be producing?

If one of the two above alternatives to permanent testosterone replacement therapy (TRT) works for me I'll let you know, at which point I'll probably give up the blog. If neither works for me I will resign myself to a life of testosterone injections (I'm done with the creams; they give me terrible chest acne, and sometimes boils, not to mention the danger of contaminating surfaces like the faucet and towels, which my wife also touches) and you will have an author here at the testosterone replacement therapy blog for a long, long time...

ERT Vs TRT: The Great HRT Double Standard

Why is it ok for post-menopausal women to take estrogen, which is known to increase the risk of breast cancer, but it is taboo for men to take testosterone? What is the difference between estrogen replacement therapy (ERT) and testosterone replacement therapy (TRT)? They are both forms of hormone replacement therapy (HRT) designed to return hormone levels to the normal range for someone of a certain age and gender.

Do we care more about creating a "level playing field" in baseball than we do about our own health and wellbeing? The word "steroids" has been victim to so much stereotyping, so many unfounded rumors and quick-science, that the mere mention that you're taking testosterone sends friends and family members into a panic - as if you're setting out to destroy your life and become some gigantic freak bodybuilder.

Speaking of gigantic freak bodybuilders, I don't see anything wrong with that either. If an adult wants to risk their own health to change the way they look, what business is that of federal, state and local governments? Are they going to make plastic surgery illegal? It is essentially the same issue (risking your health to look "better") with the only difference being that many, MANY more people die, are disfigured permanently, and are permanently disabled due to plastic surgery every year than those who take steroids.

But back to the point at hand... It is a double standard, a downright sickening hypocrisy, that HRT for women is almost universally accepted as "healthcare", while HRT for men is almost universally rejected as "steroid abuse". As this website matures I will be further elaborating on this issue, as it is one that happens to be of great interest to me.

Primary Hypogonadism VS Secondary Hypogonadism

Most men who require hormone replacement therapy with testosterone have some form of testicular injury or primary hypogonadism. In other words, the problem is all in their balls. Those of us who have secondary hypogonadism often have perfectly functioning testes, but the problem lies elsewhere in what's known as the Hypothalamus Pituitary Testicular Axis (HPTA), which is responsible for keeping our male hormones in proper balance.

The problem with secondary hypogonadism, is that the treatment actually CAUSES primary hypogonadism by introducing exogenous (external) testosterone into the system. To understand that, first let's go over some basics...

Hypothalamus:
Among other things, this part of your brain sends GnRH (gonadotropin releasing hormone) down to instruct the pituitary gland to create more LH and FSH.

Pituitary Gland:
Among other things (like growth hormone), this gland at the base of your brain secretes LH (luteinizing hormone) and FSH (follicle stimulating hormone), which travel down to the testes / gonads to instruct them to create more testosterone.

Testes / Gonads:
Endocrinologists might get upset that I use these terms interchangeably. Oh well, screw 'em. You get the point. Your "balls" get the message from your pituitary gland to make more testosterone.

The Axis:
The important thing to remember about the hypothalamus pituitary testicular axis (HPTA), also sometimes called thehypothalamic-pituitary-gonadal axis (HPG), is that it does not run only in one direction. The body tries to reach homeostasis - a healthy balance of these hormones - and the entire system can fall out of whack once you start introducing any of these hormones from outside sources. Which brings me to...

The Problem With Taking Testosterone to Treat Secondary Hypogonadism:
First of all, let's be clear - I take testosterone to treat my secondary hypogonadism. That's because there is currently no choice. Why "cure" something when you can have a customer for life? Why treat my body's inability to create enough GnRH when that would require research money and you already have a product that fixes my "symptoms" ?

Digression aside, the problem with introducing an external source of testosterone is that eventually your gonads see that they are no longer needed. They pack their bags, or - rather - pack INTO their bags, and practically disappear over time. Now guess what? Not only do I have secondary hypogonadism, which might have been made even worse, but I now have a classic case of primary hypogonadism to deal with if I the medical community should ever find a treatment for secondary hypogonadism.

Here's an idea - Why don't pharmaceutical companies make GnRH and market that to the endocrinologists so they can treat the source of my problem? Am I being naive here? Is there more to it than my not-medically-trained mind understands?

All gripes aside, I do feel great. Sure I'll be tied to this drug like a prisoner for the rest of my life, but I feel ten years younger. I'm happy, confident, strong, lean, sharp, motivated, and a lot more fun in the bedroom. And I've yet to see any CONVINCING studies about the long-term health dangers of testosterone replacement in hypogonadal men. Heart disease? Prostate cancer? Show me the studies? These are often-quoted side-effects, but all I hear are doctors "deducing" them because, for instance, taking away a man's testosterone seems to help with pre-existing conditions of prostate cancer. But that is not a cause-and-effect relationship. Just because removing testosterone helps treat or minimizes the recurrence of prostate cancer, doesn't mean it causes prostate cancer. Does it? OK, ok, that's anothe post entirely...