Low testosterone treatments: medications& non-medications

Currently, there are many different types of testosterone treatments available, ranging from topicals to injectables. However, prevention may be at the very core of solving health issues in the modern world, even with respect to testosterone treatments. Obesity leads to many problems including heart problems and arthritis. Hypogonadism and quality of life may be affected by obesity. As such, weight loss may be a preventative strategy. It has been demonstrated that weight loss can decrease visceral as well as abdominal fat. Less body fat may mean better cardiovascular health and also perhaps less aromatization of testosterone to estradiol. Estradiol in men can sometimes affect sexuality.

Paradoxically, investigators have found that an extremely high protein diet without fat may actually reduce blood levels of testosterone. It is postulated that fat is needed along with protein to synthesize natural testosterone in the body through conversion of cholesterol. Good fats such as those from monosaturated fats and polyunsaturated fats may be useful. Such fats are found in nuts and fish.

The response of the body to intense anaerobic exercise such as weight lifting has been studied. Researchers have found that weight lifting, rather than aerobic exercise, may increase blood testosterone. Testosterone levels peak at 20 minutes after exercise and return to baseline in another 10 minutes. Several mechanisms of elevated testosterone have been postulated including hemoconcentration, decreased metabolic clearance and increased synthesis. Researchers have found that the rise in testosterone is LH independent, which suggests that the elevation in testosterone could be local at the Leydig cell level. Testosterone response to exercise has also been observed in older men’s Health.

The search continues for the ideal androgen for replacement therapy. It should target bone, muscle and the brain specifically, without untoward effects on the prostate or heart. The major goal of androgen substitution is to replace testosterone at levels as close to physiological levels as possible. Testosterone enanthate and testosterone cypionate, (150-200mg ), administered intramuscularly every 1-2 weeks have been the mainstay of testosterone substitution, besides the topicals. A major disadvantage is the strongly fluctuating levels of plasma testosterone, which are not in the physiological range at least 50% of the time. Lower doses given more frequently (50-100mg), administered intramuscularly every 7 days produce more sustained levels, but may be less practical for long-term therapy. These prohormones are converted peripherally to dihydrotestosterone (DHT) and 17beta-estradiol (E2), generating supraphysiological levels. The significance of this is unclear, however, it has been suggested that continuous or repeated supraphysiological levels may increase the risk of prostate cancer. Orally administered testosterone is an acceptable oral alternative in Canada and Europe for some time, but is not yet available in the U.S..

Transdermal delivery systems allow for absorption directly into the systemic circulation at a controlled rate (4-6mg testosterone/day), thus alleviating the fluctuations in levels.  Transdermal scrotal patches were developed to take advantage of the highly permeable scrotal skin, however, high concentrations of 5-alpha reductase present in the scrotal skin has led to higher levels of DHT, a testosterone metabolite of concern regarding prostatic hyperplasia and cancer. Non-scrotal patches have been developed, however, because enhancers are needed to increase absorption, local skin irritation has been reported. Second-generation patches have reduced skin side-effects. Gel preparations applied directly to non-genital skin have been shown to provide some of the same beneficial effects as injectables and patches. A transbuccal (gum surface) delivery system, intranasalas well as an axillary delivery system is now available

Possibly in the future, newer classes of compounds may provide an alternative to testosterone. Selective estrogen receptor modulators, (SARMs), have been used to treat female osteoporosis and in breast cancer therapy. Trials on animal models have demonstrated androgenic effects similar to testosterone on muscle mass, sexual function, and bone density.  One androgen, 7 alpha methyl 19 nortestosterone (MENT) is currently being investigated for male contraception. This synthetic androgen is not affected by alpha reductase and may have some benefits for aging males. Dihydrotestosterone (DHT) itself has been studied as an alternative to testosterone, as it does not undergo aromatization. That study found no adverse prostate effects.

The demand for androgen replacement will continue to grow as new and safer products are available for patients and as more clinical trials document efficacy. At low testosterone clinic in Houston, we pride ourselves for having many years of experience in treating hypogonadism and will help you navigate the many treatment choices that you may have.