1. What is Testosterone replacement therapy?

A. Testosterone Replacement Therapy (TRT) is necessary only if Testosterone levels are below normal. There are two forms of Testosterone in the human body: The Total (or bound) Testosterone level (TT) and the Free Testosterone (FT). Free Testosterone levels can be detected by simple, painless saliva testing. Over 75% of the Testosterone in saliva is in the FT form. FT drives the normal sex drive in both men and women.

2. What are some of the signs of low levels of Testosterone?

A. The best-known signs of low FT (hypogonadism) are feeling fatigued for no reason, loss of drive or interest in sports or sex, development of a pot belly and increased fat, shrinking penis, and decreasing libido. Perhaps the most dangerous sign of hypogonadism is heart attacks (myocardial infarctions).

3. Why is Testosterone good for your heart? I thought it raised cholesterol?

A. Testosterone is produced from cholesterol in the body. It does not cause cholesterol to form. Natural Testosterone has actually been shown to lower the "bad cholesterol" level, and decrease clotting of the blood. In patients who suffered heart attacks, Testosterone levels were almost a hundred points lower in those who had had heart attacks versus those who had not. (Conrad Swartz, 1987) Low Testosterone levels increase the risk of both prostate cancer and severe heart disease (CAD or CHD). Very high blood levels of Testosterone might protect against coronary heart disease or CHD, especially in men over age 60.

4. Is Testosterone replacement therapy safe?

A. Natural Testosterone can be used safely in large doses by men who are deficient. Normal healthy doses present no health risks to men. Only if the levels of Testosterone metabolites, such as DHT or E2, rise above ideal physiologic range, can problems occur. These include baldness, prostate enlargement, shrinking of testicles, increased acne, and loss of sex drive with moodiness and emotionality.

Testosterone USP is a white odorless powder which dissolves in alcohol or organic solvents. It can penetrate intact skin if applied without a carrier agent, but only a small amount is absorbed. This form of Testosterone has been available since the 1940s. Bioidentical Testosterone can be made in the laboratory from saponins found in soybeans and yams. TestoCreme®, AndroGel® and Androderm/Testoderm patches are made with micronized USP-T which has been finely ground to disperse evenly.

Women have been using Estrogen patches for 15 years. The hormones Estrogen and Testosterone are naturally derived from a food source, soybeans or a Mexican yams. They are bioidentical to that same hormone secreted by the testicles or the ovaries.

5. Why use a cream/gel, as opposed to an injection, subcutaneous pellets, or a patch?

A. Self-administration of Testosterone or Estrogen via an adhesive patch is safe and effective, but can be awkward (particularly in social situations) for hormone replacement. Testosterone pellets (Testopel®) are used for long term Testosterone replacement in men, and can be inserted during a clinic visit, beneath the skin of the abdomen, to deliver Testosterone incrementally over a 3 month period.

Administration of hormone therapy in a cream or gel form is more convenient to use and is invisible and discrete. The first Testosterone gel, AndroGel™ 1% was approved in August 2000. All of these are prescription items and need to be applied once daily.

6. Will the use of Testosterone cause a female to exhibit male sexual characteristics?

A. Estrogen has catabolic (tissue breakdown) activity. Testosterone has anabolic (tissue repair and building ) action. Testosterone protects again heart attacks and osteoporosis in both men and women. Estrogen levels in women are ten times that in men, while Testosterone levels in men are ten times that of women. If a woman uses Testosterone at a man's level, she would begin to exhibit masculine sexual characteristics, and develop a beard, a deep voice, and loss breast tissue. These effects are not reversible and are used in transgender reassignment surgery.

7. What other conditions does Testosterone seem to be helpful in?

A. Testosterone is life saving for AIDS patients suffering with AIDS wasting syndrome (AWS) in both men and women. Testosterone increases appetite, stimulates immune system and helps pack on muscular tissue. These medical uses of Testosterone to stimulate red blood cell production, improve immune system function and increase the appetite and ability to gain weight are most effective in these patients. Other uses include the stimulation of protein build up in major traumas such as burns and cancer. Sexual effects of Testosterone in men and women are similar and desirable in the treatment of Impotence and sexual libido decrease in both sexes. Testosterone helps women with osteoporosis and both Fibrocystic Breast Disease and Breast Cancer. Testosterone is even used in children who are hormone deficient to stimulate bone growth in adolescence and encourage the formation of secondary sexual characteristics (e.g., to stimulate penile growth and pubic and auxiliary hair development in boys who have delayed puberty due to genetic diseases).

Testosterone is used to treat dry eyes, and osteo weakness in older men and women who are frail and at risk for breaking a bone if they fall. Testosterone injections will reverse a deadly attack of angioedema which is a severe allergic reaction which threatens breathing. In some men, Testosterone will stop their snoring and in others it may increase it.

8. What are the negative effects of too much Testosterone?

A. Interestingly, the negative effects of too much Testosterone include increased snoring, baldness and loss of sex drive, all symptoms similar to those which occur when there is too little Testosterone. Additional negative effects of supranormal Testosterone include acne, increased aggression and risk-taking behaviors, rapid weight gain, and thickening of the blood due to too much iron pigment or hemoglobin (Hgb).

Men as they age may become feminized due to not enough Testosterone and too much Estrogen. Estrogen also increases the clotting of blood, with damaging effects on men by increasing the risk of stroke and high blood pressure. Estrogen increases cancer risk and raises blood pressure in women, too. Too much Testosterone can increase DHT and in the presence of too much Estrogen increase prostate cancer risk.

9. Will the use of Testosterone increase the normal risk of prostate problems? What about PSA?

A. Prostate Specific Antigen (PSA) is used as a screening test for prostate cancer along with a rectal exam. PSA is also present in women with breast or uterine cancer and in breast milk. When women reach menopause their risk of heart disease and stroke is the same as men's. When men reach andropause, their risk of prostate cancer increases exponentially with each decade. The number one cause of death in men is heart disease, while the most common cause of death in women is cigarette smoking (*women become more easily addicted than men).

Why does incidence of these diseases increase AFTER hormone levels start to drop? The causes of prostate cancer include genetic, dietary and hormonal abnormalities. The longest trial in thousands of men (24 years in Iceland) measuring their Testosterone, DHT, Estrogen, PSA and Free Testosterone levels, revealed that there was no causal relationship between any one hormone and prostate cancer. Men with low Testosterone and a family history for prostate cancer were most likely to get the disease early.

Older men with higher Estrogen levels developed the highest number of cases of prostate cancer. The longest trial of Estrogen use in women for over 25 years revealed that Estrogen was not effective in prolonging life in women over men due to its contributive effects on heart disease. Castration and Estrogen are used to treat prostate cancer in men and Progesterone and Testosterone are used to treat breast cancer in women. Hormones are very complicated and cannot act alone in human beings; they are all interrelated and balance is essential to maintain health. Perhaps the reason women live longer is because men die sooner.

10. There seems to be a lot of Testosterone products on the market. Are these pills and creams effective?

A. Testosterone products all raise Testosterone levels if they contain Testosterone. The question of effectiveness depends on how much of the hormone is absorbed. To mimic the pattern and rhythm of hormones as much as possible, the higher levels of Testosterone, cortisol and DHT occur early in the morning and the lower levels occur at night.

Free Testosterone levels are crucial, and DHT is essential for regulating sexual drive. The best products deliver the most stable amount of Testosterone and cause the lowest conversion to Estrogen.

Testosterone, a Class 111 drug, found in all hormone creams/patches or gels, requires a prescription. These hormone products need to be applied once daily to maintain levels that stay close to normal and do not rise too high or drop too low. Side effects of any hormone depend on the extent to which receptors (target cells) are stimulated on sebaceous glands, hair follicles, and both muscle tissue and brain tissue.

It does not take much hormone to exceed the recommended dosage, and when using too much cream or gel, side effects result. The benefits of smaller amounts of application are obvious when trying to avoid transference to a partner or child. Monitoring by a physician and regular blood or saliva tests are important to find the ideal level for each individual. We are all very similar but very different at the same time.

11. Why is Testosterone important?

A. Testosterone is the most important hormone in the male body. Yet many men, of all ages, suffer from decreased energy, diminished libido and reduced muscular size and strength due to less than optimal levels of Testosterone.  Aging, stress, over-training, obesity, past anabolic steroid use, and drug abuse are the most common causes for these problems. To put it bluntly, without normal levels of Testosterone it is impossible to look and feel like a man!

12. How does the body produce Testosterone?

A. Testosterone is produced in the testes (gonads, balls, testicles) from progesterone and other precursors (androgen, DHEA, etc.) which are all products of cholesterol. (See diagram below). For this reason they are all called "sterols". When signaled by the pituitary gland in the brain via luteinizing hormone (LH), the testes, in the presence of adequate precursors, produce Testosterone. In order for the testes to be able to produce healthy amounts of Testosterone (5-10 mg/day), a number of nutritional substances and hormones are required including DHEA, Androstenedione, LH, FSH, dopamine, zinc, vitamin C, vitamin A and Estradiol (E2).

Maintaining adequate levels of these nutrients and hormones in the body is essential to ensure that one can maintain healthy levels of Testosterone. Testosterone is produced on a daily basis, and receptors exist throughout the body. Recent clinical findings demonstrate that the presence of these other substances, along with the proper diet, sex and exercise program, are essential for most men to once again produce healthy levels of Testosterone.

13. What is TestoJel®? How does it differ from TestoCreme®?

A. TestoJel® 1% (patent pending) is an all-natural, prescription-only pharmaceutical product that provides for the continual support of healthy levels of Testosterone for women only.

Prior to the development of topical creams/gels, the only reliable method of restoring normal Testosterone levels was through prescription hormone replacement by injections or patches. TestoCreme® 10% and TestoJel® 1% are natural hormone replacement therapy treatments containing the same Testosterone as that produced by the human body, delivered via a daily application of a topical cream or gel. All hormone products are soybean-based, topically-applied percutaneous preparations. Topical hormone creams/gels are identical to natural testosterone production and make their way into the blood stream through the skin.

TestoCreme® and TestoJel® are compounded in a percutaneous organogel matrix to deliver natural Testosterone. Used for decades in Europe, percutaneous creams/gels for men and women have proven effective for delivering hormones to the body without side effects.

14. How do TestoCreme® and TestoJel® work?

A. Initially formulated for a patient with complete pituitary destruction, a 10% Testosterone cream was first compounded by Women's International Pharmacy in the same manner as other pharmaceutical products back in 1995. For exclusive use by Dr. Kryger's private patients, a local pharmacy, Central Avenue Pharmacy, still makes TestoCreme® to our specifications by the exacting pharmaceutical standards and by the same technology using a unique formula developed with the help of the compounding pharmacist, Dana Gordon.

TestoJel® or TestoCreme® is applied by rubbing it into the thin hairless skin in a small area (4" diameter) below the armpits. Over a period of several hours, the hormone enters the body and is slowly released into the circulation via the lymphatic system. Saliva tests have shown it takes about three days to reach steady state levels, however Testosterone can be detected in the blood within two hours. This is a truly timed-release technology.

Positive Results in Clinical Practice: over five years of testing have demonstrated that regular application of TestoCreme® therapy, coupled with periodic saliva tests to monitor hormone levels, provide a continuous, beneficial and naturally healthy level of Testosterone. This steady state is believed vital to experiencing the many benefits of balanced sexual hormones, including increased sex drive, improved muscle size and strength, increased energy, and firmer erections.

15. What is the advantage of hormone delivery in percutaneous gels or creams?

A. Percutaneous gel/cream application of hormones requires that only a small amount be applied to the skin once daily. Clinical studies show that elevations in blood Testosterone levels remain constant throughout the day. The adequacy of the Testosterone dose can be checked with a simple blood or saliva sample. Percutaneous creams use the natural reservoir of fatty tissue in the skin to deliver a continuous flow of hormones into the body between applications. Variances in individual plasma levels occur due to differences in skin absorption rates and body fat levels. This can be corrected by adjusting the volume or amount of the TestoJel® in women or TestoCreme® in men until the optimal physiological effect is achieved.

16. Do you ever use other hormones, and can these be transferred to my partner?

A. For certain patients with multiple deficiencies, several hormones may be compounded into a single cream for ease of delivery. Following extensive evaluation of blood chemistry, we have developed patient-specific creams containing the hormones DHEA, Progesterone, Melatonin and/or Pregnanelone to address individual deficiencies. The cream/gel is most effective when applied in the morning, following a shower. Hands should be thoroughly washed following application. Alternatively, a disposable glove may be worn while applying the cream, which can then be safely discarded. We have seen no evidence of transference between individuals.

17. What are the benefits to using TestoJel® over other gel products?

A. When used properly TestoJel® in women has been clinically demonstrated to be safer, more effective and easier to use than oral, injectable, or patch Testosterone preparations being developed. Currently, no one has had any problems with skin irritation as is sometimes seen with transdermal patches, especially in warm and humid climates. The Testosterone gels generally dry completely in 1 to 2 minutes, leaving no visible trace or smell. TestoJel® with only one tenth of the amount of Testosterone found in TestoCreme® is safe enough for a woman to use without masculinization effects. Application can be clitoral for rapid action, or on inner thighs for a more prolonged effect. Vaginal application is not recommended, due to the gel's alcohol content which can result in irritation of sensitive mucous membranes.

18. What about the liver effects of andro/testo products?

A. Both TestoCreme® and TestoJel® bypass the digestive system because they are applied to the skin and absorbed into the blood via transference from lipid cells. Oral ingestion of hormones is less effective because the substances are metabolized in the liver before being fully dispersed by the blood stream: the so-called "first pass effect" of liver metabolism.

The liver is responsible for converting many hormones into inactive metabolites that can then be excreted from the body. By bypassing digestion with TestoCreme® or TestoJel®, the enzymes responsible for converting pro hormones (17ßHSD and 3ßHSD) into Testosterone can do their job. By the time most androstenedione products reach the liver, they are converted into non active metabolites and/or excreted from the body. This means that a higher percentage of these androgen precursors can be converted into Estrogen instead of Testosterone as claimed. By using a much lower dose than is needed when taken orally, cream and gel delivery systems offer a superior choice to other Testosterone products both in terms of cost and effectiveness.

19. So why use androstenedione at all? 

A. There is no more than a theoretical reason to combine both androstenedione and androstenediol. Studies have proven that both are ineffective in men as far as raising Testosterone levels. However Estrogen levels are a different matter. Due to the fact that Testosterone can become either Estrogen or DHT, since different enzymes are used for conversion, when used together they have no additive effect in enhancing Testosterone production. At the same time, these oral agents and topical prohormones may be minimizing the potential for efficient action of either enzyme. This allows increased potential for unwanted effects such as male breast development (gynecomastia) and increased aggression.

20. How were TestoCreme® and TestoJel® discovered and developed?

A. Hormone blood testing revealed that although a man's Testosterone level may be only mildly diminished, he may have lost the daily circadian rhythm of Testosterone release which affects libido. A mixture of Testosterone in a transdermal gel restores this pattern of peaking hormone levels in the early morning. By monitoring the frequency of morning erections, Dr. Kryger was able to determine how many men were responding to this testosterone gel product. After a study of 57 men revealed that in a statistically related manner the amount of Testosterone used directly affected the frequency of erections. The higher the Testosterone dose, the higher the blood level of both free (active) and total (bound) Testosterone. Dr. Kryger has been using this combination successfully for years in place of injections for both men and women to increase Testosterone levels. For more information, visit http://www.wellnessmd.com/testosterone.html.