Everything You Need to Know About Testosterone Replacement Therapy

This episode summarizes the key information presented in the "Low Testosterone Causes and Treatments" lecture by Nelson Vergel from ExcelMale.com. It covers the definition of low testosterone, its health risks, diagnostic methods, and treatment options, emphasizing practical advice and addressing common misconceptions.

Understanding Low Testosterone: Causes, Diagnosis, and Treatment – Summary What is Testosterone Deficiency?

Testosterone, the principal male sex hormone (androgen), is also found in women at much lower levels. It influences hair growth, liver protein synthesis, sexual and reproductive health, mood, muscle strength, bone density, and red blood cell production. The decline in testosterone typically starts at ages 30-40, gradually dropping about 1.2% per year.

Defining Low Testosterone & Health Risks

• Normal male levels: 350–1,100ng/dL. For women: 10–50ng/dL.

• Symptoms: Decreased libido and sexual function, fatigue, mood disturbances, muscle and bone loss, increased fat, concentration and memory problems.

• Risks begin to emerge under 300–350ng/dL: Higher metabolic syndrome, erectile issues, mortality, anemia, diabetes/fractures/depression, and arterial problems.

Diagnosis: Thresholds & Testing

• Definitions vary (European, Endocrine Society, insurers) but generally <300–350ng/dL is considered low.

• Diagnosis: Two morning, fasting total and free testosterone tests. LH, FSH help distinguish primary (testicular) vs. secondary (pituitary/hypothalamic) hypogonadism.

• Additional tests: PSA, lipid panel, CBC, estradiol, prolactin.

Physiology & Hormonal Interactions

Testosterone is produced via the hypothalamic-pituitary-testicular axis, starting from cholesterol. Most testosterone circulates bound to proteins (SHBG, albumin); only 2% is “free” and bioactive. Conversion products (DHT, estradiol) profoundly affect male health, especially bone, fat, and cognitive function.

Causes of Low Testosterone

Common causes include aging, obesity, diabetes, chronic illness (liver/kidney/COPD), sleep apnea, drugs (steroids, opiates), genetics, environmental toxins, and other hormonal deficiencies. Sleep quality, weight, and exercise are key modifiable factors.

Treatment Benefits

Normalizing testosterone may improve sexual interest, mood, cognitive function, cardiovascular health, muscle mass, inflammation, glucose control, and quality of life. Most benefits manifest within weeks to months.

Potential Risks and Contraindications

• Risks: Acne, oily skin, decreased HDL cholesterol, increased red blood cells (hematocrit: may require blood donation), rare gynecomastia, male pattern baldness, sleep apnea, anxiety, water retention, reduced fertility.

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