Mouse Model of Transgender Men Finds Active Testosterone Worsens IVF Outcomes

A study presented at ENDO 2022 in Atlanta this past summer suggests that active testosterone therapy for transgender men may negatively impact IVF outcomes.

Research presented by Amanda Schwartz, MD, a reproductive endocrinology and infertility fellow at the University of Michigan, found that female mice currently receiving testosterone had fewer and less developed eggs retrieved. In contrast, discontinuing testosterone therapy in mice led to similar egg retrieval rates compared to the control group.

The authors write that the impact of testosterone (T) on reproductive potential is poorly understood and that masculinizing hormones have demonstrated mixed effects on ovarian histology and data on assisted reproductive outcomes are limited to small case series. “There is consensus among major medical societies to encourage fertility preservation counseling prior to initiation of gender-affirming hormone care,” they write, “however, it is uncertain whether a break in T treatment prior to undergoing oocyte cryopreservation is beneficial. We hypothesized that T treatment would not have an impact on IVF outcomes.”

For this study, the researchers implanted 38 female mice with silastic tubing with either 10 mg T enthanate in ethanol (n=20) or ethanol alone (n=18) at 10 weeks of age. The mice were divided into four groups: current T implant, current sham implant, T cessation, and control cessation.

The team monitored T levels and reproductive cycles. Mice with the testosterone and sham implants underwent ovarian stimulation 12 weeks post-implantation. Implants were removed after 12 weeks for the testosterone cessation and control cessation groups, and mice underwent ovarian stimulation two weeks later.

Mice with current T treatment had fewer oocytes retrieved (17 vs. 36), compared with the current sham implant group. The mice undergoing active testosterone therapy also had fewer mature oocytes (13 vs. 28.1), and two-cell embryos (12.78 vs. 26.9) retrieved than the current sham implant group. There was no significant difference in maturity or fertilization rate. Females who had 2-cell embryos transferred from current T implant mice were less likely to have a live birth than those with transfers from current sham implant mice (25% vs. 80%). Conversely, the T cessation group and control showed no significant difference between total oocytes, mature oocytes or 2-cell embryos retrieved.

“In a mouse model of gender-affirming testosterone, active T treatment negatively impacted IVF outcomes,” the authors conclude. “Improved outcomes following cessation of T treatment support reversibility of T impact on reproductive potential.”

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How to increase testosterone: medications, supplements, and more

Testosterone is a hormone present in both men and women, but it’s considered a “male sex hormone” since it plays a more significant role in many bodily processes in biological males. Testosterone is involved in sperm production, sex drive, and building muscle mass, among other essential functions. When someone has low testosterone levels (aka “low T”), it can lead to symptoms like decreased sexual function, loss of muscle mass, increased fat stores, and fatigue (Sizar, 2022).

If you’ve been diagnosed with low T or suspect that you may have it, continue reading to find out more about how to increase testosterone.

Created by doctors, backed by science.

Created by doctors, backed by science.

How do you know if you have low T?

Low T is a common diagnosis in men, as natural testosterone levels begin decreasing in a person’s mid-30s. According to some studies, testosterone levels decline about 1–2% a year, starting around age 30–40. An estimated 39% of men 45 or older have low testosterone (Miah, 2019; Mulligan, 2006).

The normal levels of testosterone in the blood are typically considered 300 ng/dL to 1000 ng/dL (Qaseem, 2020). According to the American Urological Association (AUA), having a value below 300 ng/dL is a “reasonable cut-off” to be diagnosed with low testosterone, which can trigger treatment (Mulhall, 2018).

Though we have a pretty clear range for normal testosterone levels, two people can have very different symptoms at different levels. That’s also why healthcare providers might still treat someone with slightly higher T levels, above the 300 ng/dL “cut-off,” if they have typical low T symptoms.

• Fatigue and decreased energy
• Low sex drive
• Loss of muscle mass or difficulty gaining muscle
• Increased fat in the body
• Moodiness
• Depression
• Erectile dysfunction
• Loss of facial or body hair
• Osteoporosis

The above symptoms could be caused by low T as well as other medical conditions. If you experience any of these symptoms and suspect that you may have decreased testosterone, bring it up with your healthcare provider. There are tests that can be done to help determine if low T or something else might be causing your symptoms.

Typically, your provider will require two early morning tests on separate days before diagnosing you with low T since levels can fluctuate (Sizar, 2022).

Increasing testosterone with medications

If you’re diagnosed with low T, the most common approach is using medications under the guidance of your healthcare professional. There are multiple options:

Testosterone replacement therapy

Testosterone replacement therapy (TRT) can be given in multiple ways: through the skin in either gel or patch form, or as an intramuscular injection. Gel products are applied to the arm, shoulder, or abdomen, then absorbed into the skin. Injections are usually given in the muscle and can be administered in a healthcare office or self-administered at home. The dose and frequency of TRT is different for each individual (Sizar, 2022).

• Acne
• Skin irritation where gel or patch was used
• Breast enlargement (gynecomastia)
• Decrease in sperm count
• Smaller testicle size
• Mood swings
• Increased red blood cell counts
• Difficulty sleeping
• Headaches
• Increased risk of blood clots

With regular use of TRT, the body can stop producing testosterone naturally. This could be a problem when stopping TRT, as it can take some time for the body to start making testosterone again. For most men, once they start TRT, they’ll be on it long-term.

Clomid

Another medication that raises testosterone levels is Clomid, so it’s often prescribed off-label to help increase testosterone in men. Usually taken once a day or every other day, studies have shown that taking Clomid can increase testosterone through a unique mechanism of action. It tricks your body into thinking that your sex hormone levels are lower than they are, leading it to increase testosterone levels. In men, clomiphene helps to increase the natural production of testosterone and sperm in the testes (Mbi Feh, 2022).

Unlike testosterone replacement therapy (TRT), one of the main benefits of Clomid for low T is that clomiphene does not interfere with sperm production—which is critical for men who want to preserve their fertility (Wheeler, 2019). Clomid may not be the fix for every man trying to raise his testosterone levels, and because it’s used off-label, it may not be covered by insurance. However, it is usually well tolerated and doesn’t have the same side effects as TRT.

How to naturally increase testosterone: 4 strategies

There’s only so much you can do to fight aging, including the natural decline in testosterone as you get older. Still, some strategies can help you optimize your testosterone levels. However, if you have clinically diagnosed low testosterone or a medical condition that causes low T, these strategies can’t replace, but rather support, treatment of that condition

1. Maintain a healthy body weight

One of the most important strategies is maintaining a healthy body weight. Extra body fat can contribute to decreased testosterone levels (Lo, 2018).

If you have excess weight or obesity, weight loss through aerobic exercise (cardio) and resistance training (weight lifting) can decrease fat stores and help you build muscle. These have both been associated with maintaining higher levels of testosterone in the body. One small study showed that combining intensity and resistance training led to an increase in testosterone levels that lasted up to 48 hours after the workout (Lo, 2018; Riachy, 2020).

2. Eat a nutritious diet

Studies suggest that adopting healthy eating patterns may promote T production.

Dietary considerations include decreasing the amount of sugar, dairy products, and red meats you eat, as these are linked to low testosterone levels. Be sure to eat healthy fats (like nuts or fish), and increase dietary fiber (through whole grains, fruits, and vegetables) to help keep you full and prevent weight gain from unhealthy fats and carbohydrates. Within reason, it’s a good idea to limit simple carbs and overly processed foods (Skoracka, 2020; Lo, 2018).

3. Get enough sleep

Sleep is an important factor in testosterone production. The body makes most of its testosterone during sleep, so if you’re not getting enough sleep or your sleep is low quality (e.g., you have trouble falling or staying asleep or have sleep apnea), you might see your testosterone levels decline (Liu, 2019).

4. Avoid unhealthy substances

Other ways to naturally support testosterone include avoiding tobacco products, limiting alcohol, and managing stress (easier said than done, right?) (Lo, 218).

Most men will experience some level of testosterone decline as they age. If the loss of testosterone is significant and causes symptoms, it is definitely something to discuss with your healthcare provider. They can complete a workup to see if you require any prescription treatments or may be able to increase your testosterone levels naturally. Having low T can affect not only your sexual health but your overall health as well.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

References

1. Da Ros, C. T. & Averbeck, M. A. (2012). Twenty-five milligrams of clomiphene citrate presents positive effect on treatment of male testosterone deficiency-a prospective study. International Brazilian Journal of Urology, 38, 512-518. doi:10.1590. Retrieved from https://www.scielo.br/j/ibju/a/gVjRJ6FvJ33NLPkVsCXXj4L/
2. Lerchbaum, E., Pilz, S., Trummer, C., et al. (2017). Vitamin D and testosterone in healthy men: a randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism, 102(11), 4292-4302. doi:10.1210/jc.2017-01428. Retrieved from https://academic.oup.com/jcem/article/102/11/4292/4096785
3. Lo, E. M., Rodriguez, K. M., Pastuszak, A. W., & Khera, M. (2018). Alternatives to testosterone therapy: a review. Sexual Medicine Reviews, 6(1), 106-113. doi:10.1016/j.sxmr.2017.09.004. Retrieved from https://www.sciencedirect.com/science/article/pii/S2050052117301221
4. Liu, P. Y. (2019). A clinical perspective of sleep and andrological health: assessment, treatment considerations, and future research. The Journal of Clinical Endocrinology and Metabolism, 104(10), 4398–4417. doi:10.1210/jc.2019-00683. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3104227
5. Mbi Feh, M. K. & Wadhwa, R. (2022). Clomiphene. StatPearls. Retrieved on Sept. 22, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK559292/
6. MedlinePlus. (2019). Testosterone injection. Retrieved from https://medlineplus.gov/druginfo/meds/a614041.html
7. Miah, S., Tharakan, T., Gallagher, K. A., et al. (2019). The effects of testosterone replacement therapy on the prostate: a clinical perspective. F1000Research, 8, F1000 Faculty Rev-217. doi:10.12688/f1000research.16497.1. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392157/
8. Mulligan, T., Frick, M. F., Zuraw, Q. C., et al. (2006). Prevalence of hypogonadism in males aged at least 45 years: the HIM study. International Journal of Clinical Practice, 60(7), 762–769. doi:10.1111/j.1742-1241.2006.00992. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16846397/
9. Mulhall, J. P., Trost, L. W., & Brannigan, R. E., et al. (2018). Evaluation and management of testosterone deficiency: AUA Guideline. Journal of Urology, 200, 423. doi:10.1016/j.juro.2018.03.115. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29601923/
10. Qaseem, A., Horwitch, C. A., Vijan, S., et al. (2020). Testosterone treatment in adult men with age-related low testosterone: a clinical guideline from the American College of Physicians. Annals of Internal Medicine, 172(2), 126-133. doi:10.7326/M19-0882. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31905405/
11. Riachy, R., McKinney, K., & Tuvdendorj, D. R. (2020). Various factors may modulate the effect of exercise on testosterone levels in men. Journal of Functional Morphology and Kinesiology, 5(4), 81. doi:10.3390/jfmk5040081. Retrived from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739287/
12. Sizar, O. & Schwartz, J. (2022). Hypogonadism. StatPearls. Retrieved on Sept. 20, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK532933/
13. Skoracka, K., Eder, P., Łykowska-Szuber, L., et al. (2020). Diet and nutritional factors in male (in)fertility-underestimated factors. Journal of Clinical Medicine, 9(5), 1400. doi:10.3390/jcm9051400. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291266/
14. Wheeler, K. M., Sharma, D., Kavoussi, P. K., et al. (2019). Clomiphene citrate for the treatment of hypogonadism. Sexual Medicine Review, 7(2), 272-276. doi: 10.1016/j.sxmr.2018.10.001. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30522888/

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.

Anger and testosterone: evidence that situationally-induced anger relates to situationally-induced testosterone

Testosterone has been shown to relate to power, dominance, social status, and aggression. However, no research has related situationally induced changes in testosterone to subjective emotional experience. Based on the fact that anger relates to power, dominance, social status, and aggression, we predicted that testosterone would be uniquely related to the subjective experience of anger. In this study, salivary testosterone and cortisol were measured both prior to and following an anger-inducing event. In line with predictions, anger was associated with increased testosterone but not cortisol. These results provide the first evidence of a subjective emotional experience linked with changes in testosterone.

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Sexual problems? It’s probably not low testosterone

NEW YORK (Reuters Health) – If you believe the ads from drugmakers such as Solvay Pharmaceuticals, you might well think that getting a testosterone prescription is the key to save a faltering sex life in middle age.

But a new study adds to evidence that men’s levels of the hormone can vary quite a bit without causing sexual problems like impotence and decreased libido.

“Testosterone replacement therapy has become a very common thing,” said Dr. Michael Marberger, who heads the urology department at the University of Vienna Medical School in Austria, and led the new study.

“It is like putting more gas in the car to make it go faster,” he told Reuters Health.

There is no doubt that very low testosterone levels affect the body and dampen sex drive. But where to set the threshold is still an open question, whose resolution is not made easier by natural variation in the male sex hormone.

Its level dwindles with age, for instance, and fluctuates between countries, races and individuals — even from one hour to the next.

In the new study, funded by GlaxoSmithKline, researchers used data from an earlier study of more than 8,000 middle-aged and older men at risk for developing prostate cancer.

The men filled out questionnaires about their sexual function – whether they could keep an erection, whether they lacked sex drive — and had blood drawn. Various other measures were taken, too.

One in five had testosterone levels below 300 nanograms per deciliter of blood, the threshold for what Solvay and others call “Low T.”

And about two in five men had at least “a small problem” in one or more areas related to their sex life.

Of the measures taken — age, urinary symptoms, body mass index (BMI) and diabetes — testosterone showed the weakest link to the men’s sexual function.

“We need a lot less testosterone for sexual function than people used to think,” said Marberger, whose findings appear in the British Journal of Urology International. “Obesity impacts sexual function much more.”

For instance, earlier research has shown that erectile dysfunction can disappear by itself over time, especially in men who aren’t obese.

Marberger, a paid consultant for GlaxoSmithKline, which makes diabetes and weight loss drugs, added that doctors are often too quick to give patients testosterone, when high blood pressure or obesity might be the real culprit.

Every year, millions of testosterone prescriptions are written to U.S. men, and some products aren’t cheap. Solvay’s AndroGel, for example, costs about $280 per month. It can cause swelling around the joints and in the breasts, but Marberger said most side effects aren’t serious.

Dr. Frederick Wu, a hormone expert at the University of Manchester, was critical of the some of the study’s methods, but agreed with the overall message.

“Most people with erectile problems do not have hormone problems,” he told Reuters Health, but often have blockages in the arteries in their penis.

He stressed, however, that a lot of research has found that once testosterone dips below a certain threshold, it does impact sexual function.

But the exact level is controversial, and the picture gets extra murky because many of the symptoms that accompany very low testosterone — fatigue, depression, loss of muscle strength and bone density — are commonly found in seniors.

“Low testosterone and sexual problems quite often coexist,” said Wu, “but the causal relationship isn’t clear.”

SOURCE: link.reuters.com/gyk92q British Journal of Urology International, online October 18, 2010.

Free Testosterone, Direct (Female)

Although Testosterone is generally viewed as a male-only hormone, women’s ovaries also make small amounts of testosterone. It helps many organs and body processes in women.

The pituitary gland in the brain controls the amount of testosterone the body makes.

Some testosterone is called free if it is not attached to proteins.

Free testosterone and albumin-bound testosterone are also referred to as bioavailable testosterone. This is the testosterone that is easily used by your body.

Reference ranges for females:

Age:	T Level (ng/dL):
0-5 mo.	20-80
6 mos.-9 yrs.	< 7-20
10-11 yrs.	< 7-44
12-16 yrs.	< 7-75
17-18 yrs.	20-75
19+ yrs.	20-75
Avg. adult female	15-70

What does it mean if your Free Testosterone, Direct (Female) result is too low?

Low testosterone can cause one or more of the following symptoms in women:

– sluggishness
– muscle weakness
– fatigue
– sleep disturbances
– reduced sex drive
– decreased sexual satisfaction
– weight gain
– fertility issues
– irregular menstrual cycles
– vaginal dryness
– loss of bone density

It is important to note that research in this area is still limited.

Because the symptoms linked to low testosterone are so common, a doctor will look for signs of other issues or conditions before making a diagnosis.

The two main causes of low testosterone are:

– diminishing levels of the hormone as a normal result of menopause and aging
– problems with the ovaries or the pituitary or adrenal glands.

Testosterone decreases naturally as a woman ages. Levels of other hormones, such as estrogen, also reduce over time, especially when a woman reaches menopause.

Around the time that menopause begins, a woman may be more likely to have less testosterone because the ovaries are producing fewer hormones.

Also, medications that combat the side effects of menopause can lower testosterone levels. One such medicine is oral estrogen.

Problems with the ovaries and adrenal glands can also cause lower levels of testosterone. A woman may have reduced levels if her ovaries have been removed, for example, or if she has adrenal insufficiency, which means that the adrenal glands do not work correctly.

There is currently a lack of research into the treatment of low testosterone in women. Many doctors are much more concerned about testosterone levels that are too high.

If a woman reports any of the symptoms listed above, a doctor will likely check for other, more common, conditions first.

If a woman has not yet reached menopause, the doctor will likely advise on the best time to test the testosterone levels. This is because they fluctuate throughout the menstrual cycle.

Understand and improve your laboratory results with our health dashboard.

Upload your lab reports and get your interpretation today.

Our technology helps to understand, combine, track, organize, and act on your medical lab test results.

What does it mean if your Free Testosterone, Direct (Female) result is too high?

Women with high levels of testosterone may have polycystic ovary syndrome (PCOS). This condition can cause:

– Extra hair growth, especially on the face

Upload your lab report, and we’ll interpret and provide you with recommendations today.

Men’s Health Questions Answered: What is Low Testosterone?

Men’s health topics are important to discuss with a doctor, but for many men it is difficult to have these conversations with their health care provider. Discussing sex, prostate health and hormonal imbalance can be uncomfortable, but understanding these conditions and how they affect overall health is critically important for every man.

Arnold Bullock, MD, Professor of Urologic Surgery at Washington University School of Medicine in St. Louis, specializes in men’s health. He encourages men to ask their questions and engage in honest conversations with their doctors. To help start this conversation, Bullock answers some of the questions regarding a common men’s health condition: Low Testosterone.

Low Testosterone: Frequently Asked Questions

What is Low Testosterone?

Low testosterone is a condition in which the testicles fail to produce the male sex hormone testosterone. According to the American Urological Association, about 2 men in every 100 have low testosterone.

The condition of low testosterone—also called hypogonadism—refers to an inadequate amount of testosterone to stimulate the male hormone receptors on some cells in the body, such as in the male reproductive organs, muscles and bones.

Testosterone levels change throughout a man’s life.

Newborn boys have very high testosterone levels, because they need that testosterone in utero to develop as males. From the age of two years until the start of puberty, a boy’s testosterone level is naturally very low. That level spikes again during puberty, causing boys to develop underarm hair, go through growth spurts and develop sexually. An adult male’s testosterone level should be between 270 and 1000. Testosterone levels peak at about the age of 20 years, and then the testosterone slowly declines with age. In younger men, the average testosterone level is in the range of 650. When the testosterone is under 300, that’s when we would consider an adult male to have low testosterone.

What are the symptoms of Low Testosterone?

There are several common signs of low testosterone:

• Low Sex Drive
• Erectile Dysfunction
• Low Sperm Count or Low Ejaculate Volume
• Depressed Mood
• Decreased Sex Drive
• Lethargy
• Fatigue
• Decrease in Muscle Mass
• Loss of Pubic, Facial and Underarm Hair

Many of these symptoms could have different causes, which is why it is so important for a man to bring his concerns to a doctor. If we know that you are experiencing these symptoms, we can get to work on testing to identify and treat the condition.

Most of my patients with low testosterone say, “Doc, I just don’t have energy. I don’t feel like cutting the grass or playing golf.”

How is Low Testosterone tested?

If you have one or more of the above symptoms, we will measure your testosterone level with a blood sample.

Testosterone levels vary throughout the day. Men have much higher testosterone in the early morning than they do at night. This is called diurnal variation. Because of this variation, it’s important to schedule a blood draw in the morning—especially for younger men, whose testosterone levels vary more drastically than those of a man over 65.

Any level over 350 is considered average. Some labs report testosterone levels up to 800 or 1000, but the average man probably won’t measure that high, and there is not a benefit to having a significantly higher testosterone level. For instance, your sex drive at 500 is not going to differ from your sex drive at a level of 350.

It’s when the testosterone level is below 300 that we begin to think about treatment options for most men.

How is Low Testosterone treated?

Low testosterone can be treated directly by taking hormone replacement therapy.

Testosterone supplements can be taken in a variety of forms. The most common form my patients prefer is a gel. The gel is convenient, because you can rub it in once a day, after you shower, dry off and start dressing. This is a small addition to your daily routine, and keeps your testosterone level very stable from day to day.

There are other forms of testosterone supplement, such as a patch or injection, that we can discuss with men.

Oral testosterone supplement pills are associated with risks for heart disease and liver disorders. While a pill might be convenient, it comes with greater risks than other forms of testosterone supplement.

Should I take a “testosterone booster?”

There is a lot of advertising on the radio, television and internet for “testosterone boosters.” The guys in these ads talk about how the products changed their lives, and they show results through before and after pictures of men who are slimmer and more muscular.

The problem with the word “booster” is that it is not a medical term.

When you want to sell a product, you can claim that it does whatever you want to say it does, as long as you don’t include a medical diagnosis in that claim. “Boost” is not a medical term. If a product says it is going to “raise your testosterone level,” that’s a medical claim. In the medical world, though, “boost” does not mean anything.

What is a testosterone “booster?” Basically, a men’s health multivitamin. If you read the list of ingredients on the bottle, they are mostly the same as what you find in an inexpensive multivitamin at the store. The difference is in the cost. These products cost much more than the average multivitamin, and they give you the impression that they are raising your testosterone levels, but they are not actually doing so.

The results that men see after taking these “boosters” are really from the workout guide that comes with the “booster.” Healthy lifestyle changes—improved diet and exercise—can improve the symptoms of low testosterone. Diet and exercise can increase energy levels, help you avoid a sedentary lifestyle and naturally improve heart health. It’s too bad you can’t buy the workout guide and leave behind the expensive “boosters.”

Making these lifestyle changes, in conjunction with hormone replacement therapy through testosterone supplements, can raise a man’s testosterone levels. If your doctor suggests testosterone supplements, your levels will be monitored regularly to measure the outcomes and monitor your health.

Treating Low Testosterone with the Division of Urology

The Division of Urology is an international leader in providing innovative, high-quality medical care. For men with low testosterone, Arnold Bullock and Dane Johnson, MD, offer the most advanced care available in a compassionate, respectful and responsive environment.

Mary Culver Department of Surgery

Washington University School of Medicine

Signs of High Testosterone in Women

While testosterone is typically associated as being a ‘man’s’ hormone, women also have it, just in much lower quantities. The average testosterone level for men varies between 280 and 1,100 nanograms per deciliter, depending on the man’s age. However, normal levels for women are between 15 and 70 nanograms per deciliter. It is possible for women to have higher levels than the average. In this case, it is important to be aware of the symptoms of too much testosterone because it can lead to several health issues if left untreated.

Causes of Excessive Testosterone

High testosterone in females is generally a result of an underlying health issue. Polycystic ovary syndrome results in enlarged ovaries that do not release eggs, excessive body hair, and infrequent menstrual periods. It can also lead to heart disease, type 2 diabetes, obesity, infertility, and depression. Hirsutism which is a hormonal condition linked to genetics that results in unwanted hair growth. It usually impacts the face, chest, and back. In the event a woman with hirsutism has excessively high testosterone, then it could result in a deepened voice, balding and acne. Finally, high testosterone could occur due to congenital adrenal hyperplasia, a category of inherited disorders that impact the adrenal glands. There is no cure for congenital adrenal hyperplasia, but with treatment, it is possible to avoid facial hair and irregular menstrual periods.

Symptoms of Too Much Testosterone

In the majority of cases, testosterone imbalances will impact the woman’s physical appearance. The woman may develop excess hair, acne, increased muscle mass, and reduced breast sizes. However, it can also impact a woman’s overall health. Some women report experiencing mood swings as well as a loss of libido. It can also result in infertility and obesity. Any of these signs is an excellent reason to schedule an appointment with your doctor to seek high testosterone in female treatment.

Diagnosis of High Testosterone

First, the doctor will perform a physical examination. They will look for patterns of facial hair, body hair, and acne. The doctor will also need to ask personal questions related to the woman?s mood changes, menstrual cycle, and libido. From this initial exam, the doctor should be able to narrow down the cause to one of the above medical conditions. In the event the doctor suspects Polycystic Ovary Syndrome (PCOS), they may examine the pelvic area to search for any abnormalities. From there, the doctor will require a blood test. Hormone levels can be tested, and the lab will also check your cholesterol and glucose levels. For PCOS, an ultrasound of the uterus and ovaries will be necessary.

Treatment for High Testosterone

In the event, the woman is unhappy with excess body hair; then the doctor may recommend laser therapy. Removing the hair permanently, will not resolve the underlying hormone issue, but it can at least manage the woman’s outward appearance and sense of well being. You should talk to a doctor first before pursuing any hair removal treatment.

It is also recommended for women with high testosterone to manage their weight. A reduction of even 5 to 10 percent in body weight can help with PCOS symptoms.

Treatment of acne and oily skin issues

Elevation in the male hormones can also cause acne and the oiliness of the skin. We recommend a regular Hydrafacial and Epionce skincare products that make a huge difference in skin health and appearance.

Contact Dr. Vanderloos

You do not have to let your hormones get the best of you. Dr. Vanderloos offers hormone management to help women live their best lives. Contact us today to set up an appointment.

Testosterone and Men’s Health

Testosterone, the primary sex hormone in men, rallies sexual desire, and helps to regulate other metabolic activity.

Testosterone plays an important role in puberty, the time when a young person reaches sexual maturity and becomes able to reproduce. (1)

The Role of the Hormone Testosterone in Male Puberty

During male puberty, the following bodily changes typically occur:

• The penis and testicles grow
• Facial, pubic, and body hair develop
• The voice becomes deeper
• Muscles and bones become stronger
• Height growth takes place (1)

After puberty, testosterone helps regulate: (2)

• Production of red blood cells
• Bone density
• Fat distribution
• Muscle strength and mass
• Facial and body hair
• Sperm production
• Sex drive

What Are The Functions of Testosterone After Puberty?

Explore the importance of testosterone in men’s health and its role in regulating various bodily functions post-puberty.

How Does Testosterone Affect Sexual Desire?

The pituitary gland releases hormones into the blood that signal the testicles to produce both sperm and testosterone. That hormone circulates back to the brain, where it perks up libido. “Testosterone positively reinforces the feeling of desire,” says Aaron Spitz, MD, assistant clinical professor in the department of urology at the University of California in Irvine and author of The Penis Book. “It makes things look, smell, taste, feel, and sound sexier.” It also keeps the tissues of the penis flexible and healthy, allowing for a better erection. When testosterone levels are low, it has a dulling impact on libido.

What Causes Low Testosterone Levels In Men?

Testosterone levels gradually drop in men as a natural part of aging. Levels may begin to decline when men are in their thirties, and then a reduction of roughly 1 percent a year starts at age 45, according to research . (3)

Lifestyle factors also have an impact on testosterone production, including exercising too much or not eating a healthy diet. Obesity is strongly linked to lower testosterone levels. Your doctor can order a blood test to find out if your testosterone levels are in the normal range. (4)

What Does It Mean to Have Low Testosterone, or Low T?

In some cases, low testosterone (also known as low T) can also be caused by a medical condition known as hypogonadism , in which the body is unable to produce normal amounts of the hormone. It takes place when there is a problem with the testicles or with the pituitary gland that creates an inability to produce normal amounts of testosterone. In boys, hypogonadism is associated with a delayed start to puberty. In adult men, it can lead to fertility issues and a loss of interest in sexual activity. (5)

The use of drugs and alcohol can impact testosterone function and production, says Dr. Spitz. Major illness can also cause testosterone levels to drop. Kidney failure and dialysis may result in low testosterone, as does liver cirrhosis and HIV.

Specific Signs and Symptoms of Low Testosterone (Low T)

Symptoms for low T vary depending on the cause of the problem and the age when it begins to happen. In younger males, signs may include:

In men who are middle-aged or older, symptoms may include: (6)

• Low energy
• Depressed mood
• Sleep disturbances
• Low sex drive
• Inability to get or maintain an erection
• Low sperm count
• Enlarged or tender breasts
• Loss of muscle and bone strength
• Fertility problems

Not all men with age-related low testosterone have symptoms or are bothered by them, and the seriousness of the complications can vary widely. Symptoms like fatigue, sleep problems, and depression can also be caused by other factors, such as side effects from medication, mental health issues, and excessive alcohol use.

Low Testosterone Prevalence: How Common Is Low T?

According to one study, 1 in 4 men between ages 30 and 79 had total testosterone levels less than 300 nanograms per deciliter (ng/dl), which is generally considered the low end of the normal range. And there were no differences between men of different races or ethnic groups. But not all were feeling the effects of low T. Of the men tested, 12 percent reported having low libido and 16 percent had erectile dysfunction. (7)

But the prevalence of symptomatic androgen deficiency — meaning low levels of T that cause discernable health problems — are on the rise, according to the study authors. Findings project that by the year 2025, as many as 6.5 million American men ages 30 to 79 will have symptomatic androgen deficiency, which is a 38 percent jump from 2000 population estimates.

Health Concerns Related to Low Testosterone (In Addition to Sex Drive Issues)

Testosterone deficiency in men has a major impact outside of the bedroom, too. Low T is associated with several serious health problems: (8)

• Musculoskeletal problems, including osteopenia and sarcopenia (loss of muscle mass)
• Obesity
• Unhealthy cholesterol levels
• Type 2 Diabetes
• Cardiovascular disease

Low Testosterone Tests and Testing — Diagnosing Low T

There are blood tests available to check testosterone levels, but the results aren’t always straightforward. “Blood tests for testosterone are tricky because it can be measured in different ways by different labs, and they don’t always match up with each other,” says Spitz.

If your blood test reveals low testosterone (usually defined as a level lower than 300 ng/dL), the doctor may treat you or refer you to a specialist, such as an urologist or endocrinologist.

Testosterone Products

There are dozens of testosterone products marketed to treat Low T, including gels, injections and natural boosters. Many of these include similar ingredients that put users at risk and may have minimal benefits.

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Testosterone is a male sex hormone produced in the testes and adrenal glands. It is responsible for development of male sexual characteristics, such as a deep voice and body hair. Testosterone levels spike during puberty and then gradually decline after age 30, causing low sex drive and erectile dysfunction in some men. Companies market several products to replace or boost testosterone, including patches, gels and injections. Men may also turn to less popular creams, nasal gels, capsules and tablets. Though administered differently, each testosterone product carries risks. It is important for men to understand these products and weigh the risks and benefits before beginning treatment.

Testosterone Gels

Testosterone gels enjoy the status as some of the most popular new products in terms of sales. These prescription drugs come in packets or pumps.

Depending on the brand of medication, men (and some women) apply gels to arms, armpits, abdomen or the inside of the thigh.

AndroGel

AndroGel is one of the most-used medical products to treat Low T. The blockbuster gel is prescribed as a testosterone-replacement drug, mostly to men whose bodies fail to produce sufficient amounts of the male hormone.

The drug was developed by Brussels-based pharmaceutical company Solvay Pharmaceuticals, and the U.S. Food and Drug Administration (FDA) approved it in 2000 for use by men diagnosed with hypogonadism, a drastic decline in testosterone level due to injury or disease.

Abbott Laboratories, AbbVie’s parent company, bought the drug from Solvay in 2010 and soon began pumping millions into the drug’s marketing. Within two years, doctors sounded alerts about the drug’s dangerous side effects for older users — after many men gained prescriptions as a way to regain their youth or simply boost energy and sex drive.

“The market for testosterone gels evolved because there is an appetite among men and because there is advertising. The problem is that no one has proved that it works, and we don’t know the risks.”

One of the biggest risks with AndroGel and other testosterone products is an increase in risk of heart attacks and strokes. The makers of AndroGel now face a growing number of lawsuits filed by men who suffered strokes, heart attacks and blood clots after using the drug. The lawsuits state Abbott and AbbVie failed to warn consumers about these risks.

AbbVie spent nearly $80 million on aggressive marketing campaigns in 2012, and the gel generated over $1 billion in sales that year. AndroGel is the top-selling testosterone product in the U.S. AbbVie markets it in the U.S., while Abbott markets it overseas.

What Is AndroGel and How Does it Work?

AndroGel is synthetic testosterone mixed into a gel with alcohol that is applied to the skin once daily. The testosterone is absorbed into the skin for continuous 24-hour delivery into the body. The medication can cost as much as $500 a month, but some insurance companies cover it.

As of 2022, the drug is available in two strengths: 1 percent and 1.62 percent. Patients dispense the gel through a multi-dose pump or use single-dose packets. It is quick-drying, clear and odorless when dry.

The two dose strengths have different application sites. Patients can apply the 1-percent gel to the upper arms and shoulders as well as on both sides of the abdomen. For the 1.62-percent gel, the gel should only be applied to the upper arms and shoulders.

In men with Low T, the medication is intended to increase the total amount of circulating testosterone in the body to a normal range found in healthy men. According to the drug insert, this measurement is somewhere between 298 – 1043 ng/dl (nanograms per deciliter). If men use lotion or sunscreen, the amount of testosterone absorbed increases.

After applying AndroGel, men should wash their hands thoroughly with soap and water. It is also important to know that the drug is flammable until dry, and patients should avoid flames, smoking or fire.

In men, testosterone gels may decrease sperm count and increase the risk of prostate cancer. Women and children should not come in contact with gels because they can cause serious side effects, including mood swings, skin conditions and diarrhea. These drugs can also harm unborn babies.

Testosterone Injections

Testosterone also comes in an injectable liquid form. Like gels, these drugs help men who no longer produce enough testosterone, but they are also prescribed to stimulate puberty in young men with a delayed onset of adulthood. Some women take them to treat certain types of breast cancer. One type of injectable, Testopel, is a pellet injected into the skin.

Doctors typically give injections in their clinics. Historically, these kinds of supplements were also the most abused.

Popular brands of testosterone injections include:

• Depo-Testosterone (testosterone cypionate)
• Delatestryl (testosterone enanthate)
• Aveed (testosterone undecanoate)
• Testopel (testosterone pellet)
• Ditate-DS (testosterone enanthate)
• Depo-Testadiol (estradiol cypionate; testosterone cypionate)

Depo-Testosterone

One of the older drugs of its kind on the market, Depo-Testosterone is an injectable hormone (androgen) replacement used to treat men diagnosed with Low T. Pfizer’s unit Pharmacia & Upjohn Co. currently markets the medication.

The FDA originally approved this drug in 1979 to treat men whose bodies do not make enough testosterone naturally. This is what most doctors prescribe the medication for, but patients sometimes use it to enhance muscle growth and athletic performance — medically unapproved uses.

While lack of testosterone can be dangerous for men, having too much can also be deadly. The dangers of androgen therapy drugs include cardiovascular problems such as heart attack and stroke, and studies also point to an increased risk of prostate cancer.

Depo-Testosterone continues to sell and make money for Pfizer. In recent years it enjoyed a resurgence in popularity.

The latest Low T craze, fueled by multi-million dollar ad campaigns launched by major drug companies, pushed the testosterone market to around $2 billion in annual sales. Prescriptions for these drugs increased, and concerned doctors now warn that many men may simply be using the drug to regain lost youth promised to men in pharmaceutical commercials.

About Depo-Testosterone and Its Use

Unlike AndroGel, the most popular testosterone drug on the market, Depo-Testosterone is not a topical gel. Instead, it is a liquid and is designed for injection into the muscle. The active ingredient, testosterone cypionate, is a white or creamy white powder mixed in with other ingredients to make a solution. The drug is available in two strengths, 100 mg and 200 mg.

• Testosterone cypionate (active ingredient)
• Benzyl benzoate (a chigger, tick and mosquito repellent and fixative used in perfume)
• Cotton seed oil
• Benzyl alcohol (preservative)

Testosterone cypionate dissolved in oil gets injected into the muscle and stays in the body for several days. A patient injects a dose every two to four weeks. Hormones then bind to receptors in the body. The body then expels about 90 percent of the testosterone through urine and feces.

Depo-Testosterone is specifically indicated for use only in men with testicular failure that they were born with or because of a disease, such as prostate cancer. Unfortunately, many Low T clinics provide testosterone to men who are simply getting older and naturally producing less testosterone.

The drug’s label warns against the using it for enhancing athletic performance because of the possible side effects. An ingredient in the solution, benzyl alcohol, is also linked to breathing problems in premature infants.

Testosterone Patches

In the 1990s, the FDA approved two testosterone transdermal patches: Androderm and Testoderm. Testosterone patches are designed to deliver testosterone continuously for 24 hours.

A prescription medicine, patches are indicated to treat men who have low or no testosterone because of certain medical conditions. Patches come in different doses and sizes.

Who Should Not Use Testosterone Patches

Men who have breast cancer or who have or might have prostate cancer should not use testosterone patches. Neither should women who are pregnant or may become pregnant or are breastfeeding. Testosterone patches may harm unborn or breastfeeding babies.

Those considering the use of testosterone patches should first tell their healthcare provider if they have:

• Breast cancer
• Prostate cancer
• Urinary problems due to enlarged prostate
• Kidney or liver problems
• Heart problems
• Sleep apnea
• Diabetes
• Other medical conditions

How to Apply Testosterone Patches

Apply the adhesive side of a patch to skin that is clean, dry and not broken. Make sure the patch is pressed firmly in place and that there is good contact with the skin, especially around the edges.

Patches are meant for the back, stomach area, upper arms or thighs; not the scrotum, buttocks or a bony area. Users should avoid areas of skin that are oily, perspire heavily or are covered with hair because the patches may not stick well to these areas, according to the drug’s label.

Every 24 hours, at about the same time each night, remove patches and apply new ones. Rotate the application site every day, and do not use the same site more than once every seven days.

Testosterone patches can cause serious side effects including blood clots in the legs or lungs, enlarged painful breasts, sleep apnea and swelling in the ankles, feet or body, with or without heart failure. They can also increase a user’s risk of prostate cancer, cause more erections than normal or erections that last longer, or in large doses, may lower a user’s sperm count.

Other Testosterone Products

While gel, injections and patches make up the bulk of the current testosterone market, the drugs also come up in creams, nasal gels, capsules and tablets, known as buccal systems. For this drug specifically, buccal systems are applied to the upper gum of the mouth.

• Metandren
• Virilon
• Testred
• Natesto
• Striant
• Oreton (discontinued)
• Methyltestosterone (discontinued)
• Android (discontinued)

DHEA A precursor hormone that can be converted to testosterone or estrogen in the body, DHEA is often marketed as a means of boosting testosterone and muscle mass. Research on those claims is inconsistent. Side effects may include breast enlargement, cholesterol changes and hair loss.

Zinc While there is some evidence that large doses can increase testosterone, taking zinc at doses high enough to be effective can have side effects, including elevated cholesterol, increased prostate cancer risk, and liver or kidney problems.

D-Aspartic Acid An amino acid hyped as a testosterone booster, this supplement has little evidence to back its claims and has been associated with side effects that include increased prolactin levels and breast enlargement, bloating, anxiety, headaches and confusion.

SIXSTAR Testosterone Booster, 60 Caplets

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Description

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