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Testosterone Replacement

Our anti-aging medicine program offers you an individualized method to looking and feeling your best. 

Anti-aging medicine includes a more holistic approach to health in an effort to maintain your quality of life as the years go by. The components of treatment include the optimization of hormone levels, the strategic administration of vitamins, minerals, and supplements, as well as working with you to optimize your daily lifestyle habits.

The goal of anti-aging medicine is not to extend the human lifespan. There's a saying about anti-aging medicine - that it involves "adding life to your years, not  years to your life". 

Image by Szabolcs Toth
Hormones and Aging

As we age, the levels of hormones in our body change. Some of these hormone changes are a natural part of life. For example, in puberty men undergo the androgenic effects of testosterone, resulting in male sex characteristics. However, some of the changes in hormone levels are not. In fact, some scientists believe that obesity disrupts the hormone cycle that indirectly results in the alteration of sex hormones such as testosterone and estrogen. 

Andropause or Low T


Testosterone is the hormone responsible for male characteristics during sexual development. Essentially, testosterone is what makes a man, a man. Testosterone effects include the development of sex characteristics, increase in libido, increase in muscle strength, increase in bone density, and increase in muscle mass.  Testosterone may also be responsible for positive effects on mood and cognition.

Typically, testosterone levels start to decline in men after about the age of 35 years old.  There are many possible causes for this decline in testosterone, including obesity, low physical activity, among others. Unfortunately, low testosterone can lead to entering a spiral that makes it infinitely more difficult to return to a normal state of health.

Do I have low testosterone? What are some of the symptoms of low testosterone levels?

Some of the symptoms of low testosterone can include, but are not limited to:

  • Fatigue

  • Difficulty losing weight

  • Difficulty getting or maintaining an erection

  • Inability to focus

  • Decreased morning erections

  • Low bone density

  • Depression

  • Reduced muscle strength

  • Increased body fat

  • Loss of body hair

  • Small testicles

If you have any of the symptoms listed above, you may benefit from testosterone replacement. 

What are some of the negative effects of testosterone replacement?

Nothing in medicine is without risk, testosterone replacement included. Some of the known side effects could include, but are not limited to:

  • Rise in the number of red blood cells

  • Increase in blood pressure

  • Increase in cholesterol

  • Acne

For men who are looking to have children in the future, taking testosterone medication can decrease your sperm count. So this should be a consideration, especially for younger men, and discussed with your doctor. Before getting testosterone replacement, it is best to be examined by a license physician to determine if you are eligible.

Are there any benefits to testosterone replacement?

According to the American Urological Association, testosterone replace can result in better erectile function and better sex drive. Testosterone replacement can also help with improvement of anemia, increase bone density. Lastly, testosterone replacement can help to improve symptoms of depression. 

Anecdotally, testosterone replacement therapy may improve fatigue, energy levels, ability to think clearly, and other quality of life measures. However, the research and evidence thus far has been inconclusive concerning these claims.

Isn't there a natural way to increase testosterone levels?

There are many natural, non-medication, methods to increase testosterone levels. It may sound cliche' or even strange, but the best ways to increase testosterone levels naturally revolve around healthy lifestyle choices.

  1. First, ensure you exercise at least 5 days per week. You should include both weight training and aerobic activity into your exercise regimen.

  2. Next, maintaining a healthy diet is key. The issue with many Americans tends to be the overconsumption of carbohydrates and sugars, leading to diabetes, heart disease, and overall poor health. Garbage in means garbage out.

  3. Last but not least, adequate sleep is critical to our body's hormones maintaining normal levels. Poor sleep quality can cause an imbalance in morning cortisol levels, indirectly affecting the diurnal rhythm of testosterone.

Just because you do everything possible to increase your testosterone levels naturally, it is still possible for levels to decline. 

How do you test for low testosterone levels?

Testosterone levels can be checked by a simple routine blood test. Typically, a doctor will first do a complete review of your medical history and a physical exam. Based on the history and exam, your doctor may run other tests in addition to checking testosterone levels. Some of the other blood tests that should be checked, depending on your medical situation include:

  • Prolactin

  • Thyroid hormones (TSH, T3, T4)

  • Luteinizing Hormone (LH)

  • Follicle Stimulating Hormone (FSH)

  • Estradiol

  • Complete blood count

  • Prostate specific antigen (PSA)

Your doctor may check some of these levels or more than these, depending on your situation.

Isn't taking testosterone really dangerous? What are the risks?

There are possible side effects, as listed above. However, the FDA has approved many formulations of testosterone for appropriate indications. Taking any prescription medication, including testosterone, should always be done under the supervision of a licensed physician. Appropriate testosterone dosages, routine laboratory evaluations (every 6 to 12 months), and routine follow-ups with a doctor can make testosterone replacement as safe as possible.

As for other dangers, there are many myths that have been perpetuated both in the media and by medical professionals that have caused testosterone replacement to be unjustly feared. For example, many in medicine previously believed that taking testosterone would cause an increased risk for heart disease. In fact, low testosterone is a risk factor for cardiovascular disease. Simply, this means that men with low testosterone are a greater risk for suffering from a heart attack.

Doctors also used to believe that taking testosterone would cause prostate cancer. Currently, there is no evidence linking testosterone to the development of prostate cancer. 

Don't you have to inject yourself with testosterone? Is there a way to replace testosterone without needles?

The injectable form of testosterone is probably the most common. However, there are many formulations of testosterone and different methods of administration. Some other ways to take testosterone include topical gels, creams, and foams, topical patches, implanted pellets, and sublingual tablets. The pill form of testosterone is rarely, if ever, prescribed because of the known negative effects on the liver.

Dehydroepiandrosterone (DHEA)

Dehydroepiandrosterone, or DHEA, is a steroid hormone and weak androgen and weak estrogen. It is an intermediate in the production of estrogen and testosterone. DHEA is primarily produced in the adrenal glands, which are small glands located on the top of both kidneys. DHEA is also produced in smaller amounts in the brain, testes, and ovaries. Peak levels of DHEA in the bloodstream peak around age 20 and decreases gradually over the lifespan. As a result, DHEA has been considered to be potentially important in the field of anti-aging.

What is the function of DHEA in the body?

DHEA has weak effects as an androgen and as an estrogen. DHEA is thought to be primarily a neurosteroid and neurotrophin. It is able to stimulate production of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), growth factors that are responsible for maintaining the health and survival of nerve cells. DHEA levels in the blood have been correlated with age-related neurodegenerative diseases, ADHD.

How do you increase levels of DHEA in the human body?

DHEA can be taken orally and is available in the U.S. as a supplement over the counter. Therefore, it can be found at many drug stores,  pharmacies, and supplement shops. DHEA is also available as a prescription drug as prasterone. There are also ways to increase levels of DHEA naturally. 

Before taking any medication or supplement, it's best to first consult an experienced, licensed physician.

Are there any natural ways to increase DHEA?

Yes. You can increase your body's production of DHEA through regular exercise. Another method of increasing your body's levels of DHEA is to restrict the number of calories you consume. 

Cholecalciferol (Vitamin D3)

Cholecalciferol is a fat-soluble vitamin that is naturally produced by the human body when the skin is exposed to sunlight. Although originally considered to be a vitamin, vitamin D3 is more appropriately labeled a pro-hormone. 

What are signs of vitamin D deficiency?

Vitamin D deficiency in children typically presents as growth abnormalities of the bones, known as rickets. It adults, vitamin D deficiency is typically asymptomatic, meaning there are not any consistent signs or symptoms.

Research on hormones and aging

Ahmad R, Haque M. Obesity: A Doorway to a Molecular Path Leading to Infertility. Cureus. 2022 Oct 27;14(10):e30770. doi: 10.7759/cureus.30770. PMID: 36320802; PMCID: PMC9612950.

Prough RA, Clark BJ, Klinge CM. Novel mechanisms for DHEA action. J Mol Endocrinol. 2016 Apr;56(3):R139-55. doi: 10.1530/JME-16-0013. Epub 2016 Feb 23. PMID: 26908835.

Roberts E. The importance of being dehydroepiandrosterone sulfate (in the blood of primates): a longer and healthier life? Biochem Pharmacol. 1999 Feb 15;57(4):329-46. doi: 10.1016/s0006-2952(98)00246-9. PMID: 9933021.

Omura Y. Beneficial effects and side effects of DHEA: true anti-aging and age-promoting effects, as well as anti-cancer and cancer-promoting effects of DHEA evaluated from the effects on the normal and cancer cell telomeres and other parameters. Acupunct Electrother Res. 2005;30(3-4):219-61. doi: 10.3727/036012905815901226. PMID: 16617690.

Image by Szabolcs Toth

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