Have you noticed any change in the size of your breasts? Do they appear to
have become larger?

Are you shaving less frequently than you used to?
Do you have difficulty maintaining an erection or have your noticed any
change in the firmness of your erection?
If you and your partner are trying to conceive, have you had any fertility
problems?

Do you have sexual intercourse less frequenty than you used to?
Are you less interested in having sex?
Do you often feel extremely tired or sapped on energy at the end of the day?
Has your muscle tone become less firm of has your physique changed to any
significant degree?

Do you tend to get irritable for no apparent reason?
Have you lost interest in your work or other activities that you used to
find enjoyable

Do you experience mood swings?
Do you feel more stressed than usual?
For older men, have your fractured any bones lately>

The Laboratory Test: Detecting the Problem
Testing is easily accomplished, once the decision is made. The blood test
measures the serum levels of testosterone and the 'free' tesostosterone as
well. Deficiency is denoted by a serum level below 350 ng/dl. The blood
sample should be draw in the morning because there may be significant
variation depending on stress at work, exercise, or other hormonal therapy
(such as DHEA, thyroid, growth hormone].

In Europe, a more sensitive test of Free Testosterone function is measured.
It is called the F.A.I.; free androgen index. The value is determined by
dividing the level of free testosterone by 100 times the sex hormone
binding globulin. "This key factor should normally be in the range of 70-
100% and andropausal symptoms are almost always present when it falls below
50 per cent." Malcolm Carruthers, MD. p.132 Male Menopause: Restoring
Vitality and Virility. HarperCollins Publishing. London, England. 1996
 Lastly, measurements of FSH (follicle stimulating hormone) and LH
(luteining hormone) are elevated in 70% of the men with complaints of
"andropause." Normal values are less than 5; often much less.
 The Prostate Examination: Before starting on testosterone replacement,
every male needs to have a prostate examination. This examination, often by
a urologist, is to document the status of the prostate gland. Any
irregularities, hypertrophy, or urinary complaints needs to be documented
and treated, prior, to starting testosterone.
 Before starting testosterone replacement, the man needs to have a PSA
(prostate specific antigen) blood test. Values that are raised are followed
by a PSA II test that may identify prostatic hypertrophy. Testosterone
replacement is absolutely contraindicated in men with prostate cancer.
 Men should repeat this prostate and PSA testing every six months or as
directed by their physician.
 Treatment Alternatives:
 Since in healthy young men, testosterone is secreted all day long with a
peak in early morning, the ideal replacement would follow this pattern.
There are two delivery mechanisms for testosterone: oral and parenteral.
Parenteral refers to through the skin or injections. While oral tablets
may be easy to use, they are not natural, physiologic or healthy. Oral
testosterone may dramatically raise the testosterone level, only to have it
drop a few hours later. The major drawback to oral testosterone is the
"first pass effect." This means that the oral testosterone is absorbed and
sent directly to the liver. In the liver, the testosterone effects many
enzyme systems and raise the potential for liver dysfunction and even
tumors. Most of the oral testosterone is deactivated by liver cells. Oral
testosterone raises 'bad' cholesterol and lowers 'good.'
 The newest delivery system for testosterone is the testosterone patch. One
company, Alza Corporation, produced a scrotal patch called Testoderm(R).
The individual applied the patch to a shaved scrotum and it delivered 2.5-4
mg of testosterone. It is somewhat awkward and uncomfortable. Ciba-Geigy
Corporation produced a larger testosterone patch worn on the back;
Androderm(R). Although it contains 12.5 mg of testosterone, because of the
thicker skin on the back it delivers 2.5 mg of testosterone. Both patches
need to be changed daily. Most men need two Androderm(R) patches, and are
not comfortable with either method.
 The parenteral delivery system used most often since the 1940's has been
intramuscular injections of testosterone. There are five injectable
testosterone approved in the United States:
Aqueous Testosterone: very short acting (1-2 days)
Testosterone Cyprionate: short acting (2-4 days)
Testosterone Proprionate: short acting (2-4 days)
Testosterone Enthanate: longer acting {7-10 days)
Deca-Durabolin: longer acting, muscle pain relief (7-10 days)
Physicians will mix two or three of these to get a longer and mixed effect.
With the short acting testosterones, some men will feel a rush due to the
unnaturally high levels for a few days. Occasionally, they may become more
aggressive and experience fluctuations in mood, energy and sexual function.
But reduction of the dose and education are usually sufficient to modify
his behavior.
 Some compounding pharmacists will make testosterone gel in 3-5% solutions.
This works similarly to the patch, but is applied twice daily. More rapid
absorption occurs over thin skin (scrotum, face) while slower absorption
occurs over the abdomen. This is aqueous testosterone-- do not use methyl
-testosterone as it has liver toxicity effects.
 However, the best delivery system for high daily levels of testosterone is
the testosterone pellets. Studies in the United States, Europe and the Far
East show that testosterone pellets can maintain a stable hormonal level
for up to 120 days. Although there is individual variation from
manufacturer and by patient, this delivery system has been the easiest for
men to accept when long term replacement is indicated.
 Additional Steps to Be Taken: Men on testosterone replacement should take
160 mg of Saw Palmetto with Pygeum twice daily. This herb will block the
conversion of testosterone to dihydrotestosterone (DHT) which affects
prostate hypertrophy and possibly cancer development. There are no
significiant side-effects to this herb. In higher dosages, it is registered
as Proscar.(R)
 Risks of Low Testosterone: Until recently, few men in the United States
elected testosterone replacement because of the fear of prostate cancer. In
Europe, testosterone replacement is much more common. Recent studies imply
that U.S. men are misinformed. Rather, the medical literature documents
that low levels of testosterone are directly correlated to:
heart disease and myocardial infarction
strokes and cardiovascular disease
prostate cancer (yes, low levels are higher risk)
senile dementia
osteoporosis and hip fracture
Conclusion: A new philosophy directs the replacement of testosterone in
men. Higher testosterone levels have systemic effects, not only improved
sexual performance, but also, decreased stress, stronger muscles and
possibly less heart, bone, and blood vessel disease.