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Low Test

Low Test

June 25, 2014

Is Male Menopause Real?

Low Test symptoms may be to blame for a sluggish sex drive, fatigue, and erectile dysfunction (ED).

Are you feeling tired and cranky, and your sex drive isn’t doing much for you? You may even have some issues with ED, also known as erectile dysfunction. It is possible you could be going through “the change?” Turns out, midlife hormonal fluctuations aren’t just a “woman issue.” Mature males can have menopause as well — in the form of low testosterone (Low T).

Low Test can bring down your self esteem.

The word “male menopause” — which also goes by andropause or, as some have dubbed it,”men-o-PAUSE” — is a bit of a misnomer, but the physical state of being is very real.

What does Low Test mean?

Whereas women experience a sudden drop in hormones that signals a change in their ability to reproduce, with male menopause the result is a gradual decline in testosterone. Because it happens slowly (over a period of years), the symptoms of male menopause (e.g., fatigue, sluggish sex drive, irritability, depression, muscle loss, and erectile dysfunction) may be subtle and hard to detect.

Men’s testosterone levels fall naturally as we age — on average, about 1% a year after age 30. By the time you reach 70 years of age, your testosterone levels may drop more than half its peak. Though aging is the main cause of Low Test, there are other conditions and medications, such as testicular cancer, a scrotum injury, chemotherapy, radiation treatment, and mumps, are all possible culprits.

How can I know if it is Low Test?

Are you tired, irritable, and/or disinterested in all the things that once brought you joy, including sex? If you think  you may have Low T, Core Medical Group can order a blood test, but only after ruling out other causes, such as depression. Symptoms of Low Test, such as fatigue and erectile dysfunction, may also mimic depression. It can also present as a side effect of heart disease, obesity, or other health condition. Core Medical Group will help you figure out if an underlying medical condition, such as an autoimmune disorder, is causing your Low Test results.

Once we review your completed Medical History forms, we will schedule you to get required blood work plus acomprehensive medical evaluation. We have a national network of labs and will locate one close to you or schedule a Core Medical Group phlebotomist to come to your Dallas location. If you already have blood work and it has all of the necessary tests required and is less than one year old we may opt to use it if the proper biomarkers meet our medical criteria.

Core Medical Group
3333 Lee Parkway Suite 600 • Dallas, TX 75219
214-414-9891
866-641-CORE (2673)




Low Testosterone – what causes it?

Low Testosterone – what causes it?

August 5, 2011

What causes testosterone deficiency?

Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics, and is important for maintaining muscle bulk, adequate levels of red blood cells, bone density, sense of well-being, and sexual and reproductive function.

Inadequate testosterone production is not a common cause of erectile dysfunction (ED). When ED does occur with decreased testosterone production, testosterone replacement therapy may improve the ED.

As a man ages, the amount of testosterone in his body gradually declines. This natural decline starts after age 30 and continues throughout life. The significance of this decline is controversial and poorly understood.

Symptoms of testosterone deficiency:

  • decreased sex drive
  • decreased sense of well-being
  • depressed mood
  • difficulties with concentration and memory
  • erectile dysfunction

What are the changes that occur in the body with testosterone deficiency?

Changes that occur with testosterone deficiency include:

  • a decrease in muscle mass, with an increase in body fat
  • variable effects on cholesterol metabolism
  • a decrease in hemoglobin and possibly mild anemia
  • fragile bones (osteoporosis)
  • a decrease in body hair

How do I find out if I have a testosterone deficiency?

The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. It sometimes may take several measurements of testosterone to be sure if a patient has a deficiency, since levels of testosterone tend to fluctuate throughout the day. The highest levels of testosterone are generally in the morning. This is why doctors prefer, if possible, to obtain early morning levels of testosterone.

What options are available for testosterone replacement?

The options available for testosterone replacement are:

  • intramuscular injections, generally every two or three weeks
  • testosterone patches worn either on the body or on the scrotum (the sac that contains the testicles). These patches are used daily. The body patch application is rotated between the buttocks, arms, back or abdomen.
  • testosterone gels that are applied daily to the shoulders, upper arms, or abdomen.

For a free consultation on what would work best for you, contact us at:

info@coreinstitutes.com or call us at 866-641-CORE (2673)




Testosterone Therapy – Cypionate Description

Testosterone Therapy – Cypionate Description

May 10, 2011

Testosterone Cypionate Description

Testosterone Cypionate Injection, for intramuscular injection, contains Testosterone Cypionate which is the oil-soluble 17 (beta)- cyclopentylpropionate ester of the androgenic hormone testosterone.

Testosterone Cypionate is a white or creamy white crystalline powder, odorless or nearly so and stable in air. It is insoluble in water, freely soluble in alcohol, chloroform, dioxane, ether, and soluble in vegetable oils.

The chemical name for Testosterone Cypionate is androst-4-en-3-one,17-(3-cyclopentyl-1- oxopropoxy)-, (17β)-. Its molecular formula is C27H40O3, and the molecular weight 412.61.

The structural formula is represented below:

Testosterone Cypionate Injection is available as 200 mg/mL Testosterone Cypionate.

Each mL of the 200 mg/mL solution contains:
Testosterone Cypionate 200 mg
Benzyl benzoate 0.2 mL
Cottonseed oil 560 mg
Benzyl alcohol (as preservative) 9.45 mg

Testosterone Cypionate – Clinical Pharmacology

Endogenous androgens are responsible for normal growth and development of the male sex organs and for maintenance of secondary sex characteristics. These effects include growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution, such as beard, pubic, chest, and axillary hair; laryngeal enlargement, vocal cord thickening, and alterations in body musculature and fat distribution. Drugs in this class also cause retention of nitrogen, sodium, potassium, and phosphorous, and decreased urinary excretion of calcium. Androgens have been reported to increase protein anabolism and decrease protein catabolism. Nitrogen balance is improved only when there is sufficient intake of calories and protein.

Androgens are responsible for the growth spurt of adolescence and for eventual termination of linear growth, brought about by fusion of the epiphyseal growth centers. In children, exogenous androgens accelerate linear growth rates, but may cause disproportionate advancement in bone maturation. Use over long periods may result in fusion of the epiphyseal growth centers and termination of the growth process. Androgens have been reported to stimulate production of red blood cells by enhancing production of erythropoietic stimulation factor.

During exogenous administration of androgens, endogenous testosterone release is inhibited through feedback inhibition of pituitary luteinizing hormone (LH). At large doses of exogenous androgens, spermatogenesis may also be suppressed through feedback inhibition of pituitary follicle stimulating hormone (FSH).

There is a lack of substantial evidence that androgens are effective in fractures, surgery, convalescence, and functional uterine bleeding.

Pharmacokinetics

Testosterone esters are less polar than free testosterone. Testosterone esters in oil injected intramuscularly are absorbed slowly from the lipid phase; thus, Testosterone Cypionate can be given at intervals of two to four weeks.

Testosterone in plasma is 98 percent bound to a specific testosterone-estradiol binding globulin, and about 2 percent is free. Generally, the amount of this sex-hormone binding globulin in the plasma will determine the distribution of testosterone between free and bound forms, and the free testosterone concentration will determine its half-life.

About 90 percent of a dose of testosterone is excreted in the urine as glucuronic and sulfuric acid conjugates of testosterone and its metabolites; about 6 percent of a dose is excreted in the feces, mostly in the unconjugated form. Inactivation of testosterone occurs primarily in the liver. Testosterone is metabolized to various 17-keto steroids through two different pathways. The half-life of Testosterone Cypionate when injected intramuscularly is approximately eight days.

In many tissues the activity of testosterone appears to depend on reduction to dihydrotestosterone, which binds to cytosol receptor proteins. The steroid-receptor complex is transported to the nucleus where it initiates transcription events and cellular changes related to androgen action.

Indications and Usage for Testosterone Cypionate

Testosterone Cypionate Injection is indicated for replacement therapy in the male in conditions associated with symptoms of deficiency or absence of endogenous testosterone.

  1. Primary hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy.
  2. Hypogonadotropic hypogonadism (congenital or acquired)-idiopathic gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.

Contraindications

  1. Known hypersensitivity to the drug
  2. Males with carcinoma of the breast
  3. Males with known or suspected carcinoma of the prostate gland
  4. Women who are or who may become pregnant
  5. Patients with serious cardiac, hepatic or renal disease

Warnings

Hypercalcemia may occur in immobilized patients. If this occurs, the drug should be discontinued.

Prolonged use of high doses of androgens (principally the 17-β alkyl-androgens) has been associated with development of hepatic adenomas, hepatocellular carcinoma, and peliosis hepatis –all potentially life-threatening complications.

Geriatric patients treated with androgens may be at an increased risk of developing prostatic hypertrophy and prostatic carcinoma although conclusive evidence to support this concept is lacking.

Edema, with or without congestive heart failure, may be a serious complication in patients with preexisting cardiac, renal or hepatic disease. Gynecomastia may develop and occasionally persist in patients being treated for hypogonadism.

This product contains benzyl alcohol. Benzyl alcohol has been reported to be associated with a fatal “Gasping Syndrome” in premature infants. Androgen therapy should be used cautiously in healthy males with delayed puberty. The effect on bone maturation should be monitored by assessing bone age of the wrist and hand every 6 months. In children, androgen treatment may accelerate bone maturation without producing compensatory gain in linear growth. This adverse effect may result in compromised adult stature. The younger the child the greater the risk of compromising final mature height. This drug has not been shown to be safe and effective for the enhancement of athletic performance. Because of the potential risk of serious adverse health effects, this drug should not be used for such purpose.

Precautions

General

Patients with benign prostatic hypertrophy may develop acute urethral obstruction. Priapism or excessive sexual stimulation may develop. Oligospermia may occur after prolonged administration or excessive dosage. If any of these effects appear, the androgen should be stopped and if restarted, a lower dosage should be utilized.

Testosterone Cypionate should not be used interchangeably with testosterone propionate because of differences in duration of action.

Testosterone Cypionate is not for intravenous use.

Information for Patients

Patients should be instructed to report any of the following: nausea, vomiting, changes in skin color, ankle swelling, too frequent or persistent erections of the penis.

Laboratory Tests

Hemoglobin and hematocrit levels (to detect polycythemia) should be checked periodically in patients receiving long-term androgen administration.

Serum cholesterol may increase during androgen therapy.

Drug Interactions

Androgens may increase sensitivity to oral anticoagulants. Dosage of the anticoagulant may require reduction in order to maintain satisfactory therapeutic hypoprothrombinemia.

Concurrent administration of oxyphenbutazone and androgens may result in elevated serum levels of oxyphenbutazone.

In diabetic patients, the metabolic effects of androgens may decrease blood glucose and, therefore, insulin requirements.

Drug/Laboratory Test Interferences

Androgens may decrease levels of thyroxine-binding globulin, resulting in decreased total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged, however, and there is no clinical evidence of thyroid dysfunction.

Testosterone Cypionate Description

Testosterone Cypionate Injection, for intramuscular injection, contains Testosterone Cypionate which is the oil-soluble 17 (beta)- cyclopentylpropionate ester of the androgenic hormone testosterone.

Testosterone Cypionate is a white or creamy white crystalline powder, odorless or nearly so and stable in air. It is insoluble in water, freely soluble in alcohol, chloroform, dioxane, ether, and soluble in vegetable oils.

The chemical name for Testosterone Cypionate is androst-4-en-3-one,17-(3-cyclopentyl-1- oxopropoxy)-, (17β)-. Its molecular formula is C27H40O3, and the molecular weight 412.61.

The structural formula is represented below:

Testosterone Cypionate Injection is available as 200 mg/mL Testosterone Cypionate.

Each mL of the 200 mg/mL solution contains:
Testosterone Cypionate 200 mg
Benzyl benzoate 0.2 mL
Cottonseed oil 560 mg
Benzyl alcohol (as preservative) 9.45 mg

Testosterone Cypionate – Clinical Pharmacology

Endogenous androgens are responsible for normal growth and development of the male sex organs and for maintenance of secondary sex characteristics. These effects include growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution, such as beard, pubic, chest, and axillary hair; laryngeal enlargement, vocal cord thickening, and alterations in body musculature and fat distribution. Drugs in this class also cause retention of nitrogen, sodium, potassium, and phosphorous, and decreased urinary excretion of calcium. Androgens have been reported to increase protein anabolism and decrease protein catabolism. Nitrogen balance is improved only when there is sufficient intake of calories and protein.

Androgens are responsible for the growth spurt of adolescence and for eventual termination of linear growth, brought about by fusion of the epiphyseal growth centers. In children, exogenous androgens accelerate linear growth rates, but may cause disproportionate advancement in bone maturation. Use over long periods may result in fusion of the epiphyseal growth centers and termination of the growth process. Androgens have been reported to stimulate production of red blood cells by enhancing production of erythropoietic stimulation factor.

During exogenous administration of androgens, endogenous testosterone release is inhibited through feedback inhibition of pituitary luteinizing hormone (LH). At large doses of exogenous androgens, spermatogenesis may also be suppressed through feedback inhibition of pituitary follicle stimulating hormone (FSH).

There is a lack of substantial evidence that androgens are effective in fractures, surgery, convalescence, and functional uterine bleeding.

Pharmacokinetics

Testosterone esters are less polar than free testosterone. Testosterone esters in oil injected intramuscularly are absorbed slowly from the lipid phase; thus, Testosterone Cypionate can be given at intervals of two to four weeks.

Testosterone in plasma is 98 percent bound to a specific testosterone-estradiol binding globulin, and about 2 percent is free. Generally, the amount of this sex-hormone binding globulin in the plasma will determine the distribution of testosterone between free and bound forms, and the free testosterone concentration will determine its half-life.

About 90 percent of a dose of testosterone is excreted in the urine as glucuronic and sulfuric acid conjugates of testosterone and its metabolites; about 6 percent of a dose is excreted in the feces, mostly in the unconjugated form. Inactivation of testosterone occurs primarily in the liver. Testosterone is metabolized to various 17-keto steroids through two different pathways. The half-life of Testosterone Cypionate when injected intramuscularly is approximately eight days.

In many tissues the activity of testosterone appears to depend on reduction to dihydrotestosterone, which binds to cytosol receptor proteins. The steroid-receptor complex is transported to the nucleus where it initiates transcription events and cellular changes related to androgen action.

Indications and Usage for Testosterone Cypionate

Testosterone Cypionate Injection is indicated for replacement therapy in the male in conditions associated with symptoms of deficiency or absence of endogenous testosterone.

  1. Primary hypogonadism (congenital or acquired)-testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy.
  2. Hypogonadotropic hypogonadism (congenital or acquired)-idiopathic gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.

Contraindications

  1. Known hypersensitivity to the drug
  2. Males with carcinoma of the breast
  3. Males with known or suspected carcinoma of the prostate gland
  4. Women who are or who may become pregnant

10. Patients with serious cardiac, hepatic or renal disease

Warnings

Hypercalcemia may occur in immobilized patients. If this occurs, the drug should be discontinued.

Prolonged use of high doses of androgens (principally the 17-β alkyl-androgens) has been associated with development of hepatic adenomas, hepatocellular carcinoma, and peliosis hepatis –all potentially life-threatening complications.

Geriatric patients treated with androgens may be at an increased risk of developing prostatic hypertrophy and prostatic carcinoma although conclusive evidence to support this concept is lacking.

Edema, with or without congestive heart failure, may be a serious complication in patients with preexisting cardiac, renal or hepatic disease. Gynecomastia may develop and occasionally persist in patients being treated for hypogonadism.

This product contains benzyl alcohol. Benzyl alcohol has been reported to be associated with a fatal “Gasping Syndrome” in premature infants. Androgen therapy should be used cautiously in healthy males with delayed puberty. The effect on bone maturation should be monitored by assessing bone age of the wrist and hand every 6 months. In children, androgen treatment may accelerate bone maturation without producing compensatory gain in linear growth. This adverse effect may result in compromised adult stature. The younger the child the greater the risk of compromising final mature height. This drug has not been shown to be safe and effective for the enhancement of athletic performance. Because of the potential risk of serious adverse health effects, this drug should not be used for such purpose.

Precautions

General

Patients with benign prostatic hypertrophy may develop acute urethral obstruction. Priapism or excessive sexual stimulation may develop. Oligospermia may occur after prolonged administration or excessive dosage. If any of these effects appear, the androgen should be stopped and if restarted, a lower dosage should be utilized.

Testosterone Cypionate should not be used interchangeably with testosterone propionate because of differences in duration of action.

Testosterone Cypionate is not for intravenous use.

Information for Patients

Patients should be instructed to report any of the following: nausea, vomiting, changes in skin color, ankle swelling, too frequent or persistent erections of the penis.

Laboratory Tests

Hemoglobin and hematocrit levels (to detect polycythemia) should be checked periodically in patients receiving long-term androgen administration.

Serum cholesterol may increase during androgen therapy.

Drug Interactions

Androgens may increase sensitivity to oral anticoagulants. Dosage of the anticoagulant may require reduction in order to maintain satisfactory therapeutic hypoprothrombinemia.

Concurrent administration of oxyphenbutazone and androgens may result in elevated serum levels of oxyphenbutazone.

In diabetic patients, the metabolic effects of androgens may decrease blood glucose and, therefore, insulin requirements.

Drug/Laboratory Test Interferences

Androgens may decrease levels of thyroxine-binding globulin, resulting in decreased total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged, however, and there is no clinical evidence of thyroid dysfunction.




CORE Institute Blog

CORE Institute Blog

May 5, 2011

Low testosterone levels put men at high risk for cardiovascular disease, diabetes and early death, but testosterone replacement therapy may help better the odds, according to new studies.

Some experts believe that low testosterone levels, which become more common with age, are linked to several health conditions. These include loss of bone and muscle mass, depression, decreased libido, and, most important, the metabolic syndrome — a cluster risk factors that increase the chances of developing heart disease, stroke and type 2 diabetes.

The studies, all of which were expected to be presented at The Endocrine Society’s annual meeting, in San Francisco, suggest that therapy to raise testosterone back to normal levels may have several positive effects.

One study showed that testosterone treatment significantly reduced abdominal fat, total cholesterol, LDL (“bad”) cholesterol, triglycerides and body mass index (a measure of body fat). It also helped raise HDL (“good”) cholesterol.

Researchers in a second study found that men older than 63 benefited as much as younger men.

“We conclude that if elderly men have a deficiency of testosterone, it is worthwhile to treat them with testosterone,” co-author of both studies, Farid Saad of Berlin-headquartered Bayer Schering Pharma — a drug company that makes a form of testosterone therapy — said in a prepared interview.

A third study added to previous evidence that low testosterone increases one’s chance of early death from any cause in the long run.

In the study, funded in part by drug maker Novo Nordisc, researchers looked the causes of death in almost 2,000 German men aged 20 to 79 years. The men with low testosterone at the start of study, which had an average follow up period of 7 years, had a more than 2.5 times greater risk of dying during the next 10 years compared with men with higher testosterone. These men tended to be older, fatter and had a greater prevalence of diabetes and high blood pressure than the men with higher testosterone levels, Haring said.

This difference was not explained by age, smoking, alcohol intake, level of physical activity or increased waist circumference (a risk factor for diabetes and heart disease), according to researcher author Robin Haring, a Ph.D. student from Ernst-Moritz-Arndt University of Greifswald, Institute for Community Medicine.

Low testosterone levels predicted increased risk of death from cardiovascular disease and cancer but not death of any other single cause, the study found.




Testosterone and Its Function

Testosterone and Its Function

April 6, 2011

Testosterone and Its Function

Testosterone is the most important sex hormone (otherwise known as androgens) produced in the male body. It is the hormone that is primarily responsible for producing the typical adult male attributes. At puberty, testosterone stimulates the physical changes that characterize the adult male, such as enlargement of the penis and testes, growth of facial and pubic hair, deepening of the voice, an increase in muscle mass and strength, and growth in height. Throughout adult life, testosterone helps maintain sex drive, the production of sperm cells, male hair patterns, muscle mass and bone mass.

Testosterone is produced in the testes and in the outer layer of the adrenal glands (called the adrenal cortex); in females, small amounts of testosterone are produced by the ovaries.

While it is commonly perceived that testosterone is not a major factor in prepubescent male development, testosterone is active long before puberty begins. For example, while a fetus is still in the womb, testosterone and a related substance cause the male genitalia to form.

Testosterone Production

The body carefully controls the production of testosterone. Chemical signals from two glands in the brain – the pituitary and hypothalamus – tell the testes how much testosterone to produce.

The hypothalamus controls hormone production in the pituitary gland by means of gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). LH orders the testes to produce testosterone. If the testes begin producing too much testosterone, the brain sends signals to the pituitary to make less LH. This, in turn, slows the production of testosterone. If the testes begin producing too little testosterone, the brain sends signals to the pituitary gland telling it to make more LH, which causes the testes to make more testosterone.

Physical Symptoms Related to Low Testosterone

Signs of low testosterone in men may include decreased sex drive, erectile dysfunction (ED), lowered sperm count or increased breast size. Men also may have symptoms similar to those seen during menopause in women – hot flashes, increased irritability, inability to concentrate and depression.

Some men may have a prolonged and severe decrease in testosterone production. As a result, they may experience loss of body hair and reduced muscle mass, their bones may be more brittle and prone to fracture, and their testes may become smaller and softer. In younger men, low testosterone production may reduce the development of body and facial hair, muscle mass and genitals. In addition, their voices also may fail to deepen.

Conditions That Could Cause Low Testosterone

There are a number of specific medical conditions that can cause low testosterone. Often, such conditions are most evident in younger men. Some of these conditions are associated with the testes, pituitary gland and hypothalamus gland. Other men experience low testosterone levels as a result of various genetic factors.

The effects of aging on testosterone production – Andropause

As men age, their ability to produce testosterone declines. Some men’s production of LH decreases with aging, which lowers testosterone production. Moreover, a protein called sex hormone binding globulin (SHBG) increases in older men, which reduces the amount of free (unbound) testosterone in the blood that is available to tissues, such as muscles.

Aging also causes changes in the daily cycle of testosterone production. For example, younger men show a peak of testosterone in the morning, but this finding is blunted in older men.

The decrease in testosterone production as men age is sometimes referred to as andropause.

Testes-Based Conditions

Men whose testosterone deficiency is caused by an abnormality in the testes often display increased FSH levels, increased LH levels and impaired sperm production. These conditions include:

  • Trauma – a direct physical injury to the testes may damage the cells that produce testosterone.
  • Orchitis – testicular inflammation can occur after a post-puberty bout with the mumps (there is a higher risk of risk of infertility than low testosterone.)
  • Radiation treatment or chemotherapy – these therapies for other diseases may damage the testosterone-producing cells of the testes.
  • Testicular tumors – treatment of testicular tumors may directly affect testosterone production.

Pituitary/Hypothalamus-Based Conditions

Men whose low testosterone levels result from defects in the pituitary or hypothalamus generally have a low or low-normal FSH level and low or low-normal levels of LH. These conditions include:

  • Pituitary tumors – the growth of abnormal tissue in the pituitary can disrupt the gland’s normal functioning and interfere with hormone production.
  • HIV/AIDS – viruses or other infectious agents may directly or indirectly affect the hypothalmus, pituitary or testes and can decrease testosterone levels; as many as 50 percent of men infected with the human immunodeficiency virus (HIV) may have low testosterone.

Genetically-Based Conditions

Men may have low testosterone as a result of chromosomal abnormalities or genetically-based conditions. These conditions include:

  • Klinefelter’s syndrome – a genetic condition in which an extra X chromosome is present (about one in every 400 men have this); testosterone production is low to low normal; men with this syndrome also may have markedly reduced bone density.
  • Kallmann’s syndrome – usually a recessive genetic disorder associated with the X chromosome, which occurs in about one of every 10,000 men. A deficiency of GnRH impairs the release of LH and FSH, which decreases testosterone production; men with the syndrome lack the sense of smell; testes do not enlarge at puberty.
  • Prader-Willi syndrome – a genetic disorder characterized by decreased muscle tone in infancy that improves with age, underdeveloped genitals (including undescended testes in boys) and low sex hormone levels. An obsession with food and compulsive eating, also linked with this disorder, may begin before the age of six.
  • Myotonic dystrophy – the most common adult form of muscular dystrophy, this genetic condition only occurs in men and is carried on the Y chromosome; because testicular failure usually occurs around the age of 30 to 40, men may have sons at risk for the disease.

Importance of the medical history

Sometimes physical symptoms can suggest a medical problem. For example, a man who, as he ages, has a progressive decrease in muscle mass, loss of libido, erectile dysfunction (ED) or reduced sperm count may have low testosterone. Similarly, a teenager who still has the appearance of a young boy – small testes, penis and prostate; scant pubic and body hair; and a high-pitched voice – shows clear signs of someone with inadequate testicular function.

There are cases, though, that may involve some medical detective work. Therefore, it is extremely important to provide the doctor with a detailed medical history. Things that should be discussed include:

  • past or present major illnesses;
  • all prescription and nonprescription drugs currently being taken;
  • family/relationship problems, such as sexual problems; and
  • any major life events or changes that have occurred.

A family history also may help the doctor to pinpoint a genetic basis for the problem.

The doctor can use these clues to identify the correct diagnosis.

Physical examination

During the physical examination, the doctor will look at:

  • the amount and distribution of body hair;
  • presence and degree of breast enlargement;
  • size and consistency of the testes;
  • abnormalities in the scrotum; and
  • size of the penis.

Measuring hormone levels

Testosterone levels vary from hour to hour, so the time at which blood is drawn for testing can affect the results. However, the generally acceptable range of values is 300 to 1,200 nanograms per deciliter (ng/dl). Generally, the highest testosterone levels occur in the early morning hours; therefore, doctors will often measure testosterone levels at this time.

Testosterone circulates in the blood in three forms:

  • about 30 percent of testosterone is bound tightly to a protein called sex hormone binding globulin (SHBG);
  • about 68 percent is weakly bound to another protein called albumin; and
  • about two percent circulates freely in the bloodstream.

Determination of low testosterone may require more than one blood test. A normal total testosterone reading may not necessarily indicate that a man has normal levels of free testosterone. For example, some men with increased levels of SHBG and low blood levels of free testosterone may have normal levels of total testosterone. Therefore, labs often measure the total testosterone levels and its components.

Other tests

  • Because low testosterone levels may affect bone mass, the doctor may want to assess any bone loss with bone density testing.
  • Genetic testing can confirm the presence of an inherited condition.
  • If tests cause the doctor to suspect a problem within the pituitary gland, he/she may want to examine the gland to see if a tumor is present. Two examination procedures are most common, and neither penetrates the skin. A computed tomography, or CT, is a computer-assisted X-ray process. Magnetic resonance imaging, or MRI, uses a combination of radio waves, high intensity magnetic fields and computer technology to produce images of the body’s interior.



TESTOSTERONE AND HCG THERAPY – FUNCTIONS AND BENEFITS

TESTOSTERONE AND HCG THERAPY – FUNCTIONS AND BENEFITS

TESTOSTERONE AND HCG THERAPY – FUNCTIONS AND BENEFITS

Function of Testosterone

Testosterone is the most important sex hormone or androgen produced in men. The function of testosterone is primarily the producing the normal adult male characteristics. During puberty, testosterone stimulates the physical changes that constitute the attributes of the adult male.

Throughout adult life, testosterone helps maintain sex drive, the production of sperm cells, male hair patterns, muscle mass and bone mass. Testosterone is produced in men by the testes and in the outer layer of the adrenal glands.

The hypothalamus controls hormone production in the pituitary gland by means of gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to make follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). LH orders the testes to produce testosterone. If the testes begin producing too much testosterone, the brain sends signals to the pituitary to make less LH. This, in turn, slows the production of testosterone. If the testes begin producing too little testosterone, the brain sends signals to the pituitary gland telling it to make more LH, which causes the testes to make more testosterone.

Symptoms of Low Testosterone

The failure of the testes to produce a sufficient level of testosterone in the adult male results in a low testosterone level. Physical signs of low testosterone in men may include:

  1. Declining sex drive,
  2. Erectile dysfunction (ED)
  3. Low sperm count
  4. Decrease in lean muscle mass
  5. Insomnia or sleep disorder
  6. Depression
  7. Chronic fatigue.

Conditions Causing Male Testosterone Deficiency

Testosterone deficiency can be caused by different conditions: 1) effects of aging; 2) testes based conditions; 3) genetics; and 4) conditions caused by the pituitary and hypothalamus.

  • The effects of aging on testosterone production
  • Testes disorder
  • Pituitary/Hypothalamus disorder
  • Genetically-based condition

Function of Testosterone Therapy

The function of testosterone hormone replacement therapy is to increase the level of testosterone in the adult male diagnosed with testosterone deficiency (low testosterone) or hypogonadism. Testosterone replacement should in theory approximate the natural, endogenous production of the hormone. The clinical reasons for treatment of testosterone deficiency in men include:

  • Increased male sex drive
  • Improve male sexual performance
  • Enhance mood in men
  • Reduce depression in men
  • Increased energy and vitality
  • Increase bone density
  • Increased strength and endurance
  • Reduce body fat
  • Increase body hair growth
  • Reduce risk of heart disease
  • Develop lean muscle mass with exercise

Function of HCG Therapy is to Stimulate the Testes to Prevent Loss of Natural Testosterone Production and Avoid Testicular Atrophy while the Male Patient is Undergoing Testosterone Hormone Replacement Therapy

The hormone HCG is prescribed for men in this therapy to increase natural testosterone production during the course of therapy as a result of the stimulation of the testes by the HCG. No testosterone medication is administered in this treatment. The treatment objective is to cause the male testes to naturally produce a higher volume of testosterone by HCG stimulation of his testes with the result that the patient experiences a continuing higher blood level of testosterone while on treatment. Another treatment objective is to avoid the use of any anabolic steroid and its adverse side effects upon the patient.

HCG Therapy normally increases natural testosterone production by the male testes while HCG is administered to the patient during the treatment period However, HCG Therapy can also result in a continuation of increased testosterone production and a resulting higher level of testosterone in the bloodstream after treatment is completed when the cause of the patient’s low natural LH secretion by the pituitary is not due to the patient’s natural genetics, aging process, injury to or loss of one or both testes; a medical disorder or disease affecting the testes, or castration.

HCG Therapy can result in a continuing higher level of natural testosterone production by the testes after HCG Therapy is completed when the underlying cause of the low LH secretion and resulting low testosterone production (1) is due to the prior use of one or more anabolic steroids by the patient or (2) due to the administration of testosterone in a prior hormone replacement therapy without the required concurrent HCG Therapy to prevent the patient’s endocrine system (hypothalamus pituitary-testes axis) from shutting down the natural production of testosterone by the testes and causing testicular atrophy.

Types of Testosterone Therapy for Men

A good male testosterone replacement therapy produces and maintains physiologic serum concentrations of testosterone and its active metabolites without significant adverse side effects.

The leading types of testosterone therapy for men include:

  • Testosterone Injection with HCG
  • Testosterone Transdermal Cream with HCG
  • Testosterone Transdermal Gel with HCG

Benefits of HCG Therapy for the Male Patient Undergoing Testosterone Hormone Replacement Therapy

  • Increases natural testosterone production by the testes
  • Prevents loss of natural testosterone production by the testes while the male patient is undergoing testosterone hormone replacement therapy
  • Prevents atrophy of testes while male patient is being treated with testosterone replacement therapy
  • Increases physical energy and elimination of chronic fatigue
  • Improves sex drive
  • Improves sexual performance
  • Improves mood
  • Reduces depression
  • Increases lean muscle mass
  • Increases strength and endurance as a result of exercise
  • Reduces body fat due to increased exercise
  • Increases sperm count and therefore male fertility
  • HCG Therapy can also result in a higher level of natural testosterone production after HCG Therapy is completed when the cause of a man’s current low testosterone production is the prior use of anabolic steroids that shut down or reduced the pituitary gland’s production of LH and decreased testosterone production.

Human Chorionic Gonadotropin (HCG)

HCG is compounded by a compounding pharmacy or manufactured by pharmaceutical company in 10,000 IU (International Units) for reconstitution with sterile water for injections in 10 cc vials.

HCG is a natural protein hormone secreted by the human placenta and purified from the urine of pregnant women. HCG hormone is not a natural male hormone but mimics the natural hormone LH (Luteinizing Hormone) almost identically. As a result of HCG stimulating the testes in the same manner as LH, HCG therapy increases testosterone production by the testes or male gonads as a result of HCG’s stimulating effect on the leydig cells of the testes.

The Decline in Gonadal Stimulating Pituitary Hormone LH (Leutenizing hormone)

The natural decline in male testosterone production that occurs with aging is attributed to a decline in the gonadal stimulating pituitary hormone LH (Luteinizing hormone). As a result of the hypothalamus secreting less gonadoropin-releasing hormone (GhRH), which stimulates the pituitary gland to produce LH, the pituitary gland produces declining amounts of LH. This decrease in the pituitary secretion of LH reduces the stimulation of the gonads or male testes and results in declining testosterone and sperm production due to the decreased function of the gonads. The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

How HCG Therapy Increases Plasma Testosterone Level in Men with Low Testosterone Production

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone. The male endocrine system is responsible for causing the testes to produce testosterone. The HPTA (hypothalamic-pituitary-testicular axis) regulates the level of testosterone in the bloodstream. and . The hypothalamus produces gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release Leutenizing hormone (LH).

LH released by the pituitary gland then travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without the continuing release of LH by the pituitary gland, the testes would shut down their production of testosterone, causing testicular atrophy and stopping natural testosterone produced by the testes.

As men age the volume of hypothalamus produced gonadotropin-releasing hormone (GnRH) declines and causes the pituitary gland to release less Luteinizing hormone (LH). The reduction if the volume of LH released by the Pituitary gland decreases the available LH in the blood stream to stimulate the testes to produce testosterone.

In males, HCG mimics LH and increases testosterone production in the testes. As such, HCG is administered to patients to increase endogenous (natural) testosterone production. The HCG medication administered combines with the patient’s own naturally available LH released into the blood stream by the Pituitary gland and thereby increases the stimulation of the testes to produce more testosterone than that produced by the Pituitary released LH alone. The additional HCG added to the blood stream combined with the Pituitary gland’s naturally produced LH triggers a greater volume of testosterone production by the testes, since HCG mimics LH and adds to the total stimulation of the testes.

HCG Clinical Pharmacology

The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens.

Thus HCG sends the same message and results in increased testosterone production by the testis due to HCG’s effect on the leydig cells of the testis. HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level.

Following intramuscular injection, an increase in serum HCG concentrations may be observed within 2 hours; peak HCG concentrations occur within about 6 hours and persist for about 36 hours. Serum HCG concentrations begin to decline at 48 hours and approach baseline (undetectable) levels after about 72 hours.

HCG is not a steroid and is administered to assists the body in the continuing production of its own natural testosterone as a result of LH signals stimulating production of testosterone by the testis.

This LH stimulates the production of testosterone by the testes in males. Thus HCG sends the same message as LH to the testes and results in increased testosterone production by the testes due to HCG’s effect on the leydig cells of the testes. In males, hCG mimics LH and helps restore and maintain testosterone production in the testes. If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone




Older Men With Low Testosterone Face Greater Depression Risk

Older Men With Low Testosterone Face Greater Depression Risk

March 6, 2011

THURSDAY, March 6 – Low testosterone levels in older men are associated with an increased risk of depression, an Australian study says.

Between 2001 and 2004, researchers at the University of Western Australia in Perth studied 3,987 males aged 71 to 89. The men provided demographic and health information and were tested for depression and cognitive difficulties. The researchers also checked the men’s testosterone levels.

The 203 men who met the criteria for depression had significantly lower total and free (not bound to proteins) testosterone levels than those who weren’t depressed. After controlling for other factors, such as cognitive scores, education level and body-mass index, the researchers concluded that men in the lowest quintile (20 percent) of free testosterone were three times more likely to have depression compared to those in the highest quintile.

The findings were published in the March issue of the Archives of General Psychiatry.

While more research is needed to determine how low hormone levels may be linked to depression risk, the study authors believe it may be caused by changes in the levels of neurotransmitters or hormones in the brain.

“A randomized controlled trial is required to determine whether reducing prolonged exposure to low free testosterone is associated with a reduction in prevalence of depression in elderly men,” the researchers wrote. “If so, older men with depression may benefit from systematic screening of free testosterone concentration, and testosterone supplementation may contribute to the successful treatment of hypogonadal (with low hormone levels) older men with depression.”

Between 2 percent and 5 percent of people are affected by depression at any given time, according to background information in the study. Women are more likely than men to be depressed, but that difference disappears at about age 65. A number of previous studies have suggested that sex hormones may be a factor.




Symptoms of Low Testosterone

Symptoms of Low Testosterone

January 17, 2011

Testosterone is a hormone made by the body. Most of the testosterone in a man’s body is produced in the testicles. It helps:

  • Maintain reproductive tissues
  • Stimulate sperm production
  • Stimulate and maintain sexual function
  • Increase muscle mass and strength
  • Maintain bone strength

Just like your cholesterol or blood pressure, there is a numerical range of testosterone levels (also known as T levels) that are considered normal. The brain and the testicles work together to keep testosterone in this range. When levels of testosterone are below normal, the brain signals the testicles to make more. When testosterone levels reach a normal level, the brain signals the testicles to make less.

Testosterone can fall below normal levels. This can happen when a signaling problem between the brain and the testes causes a drop in the amount of testosterone that is being produced. Also, if the brain feels that there is too much testosterone in the body, it can signal the testes to cut production. Another reason Low T can occur is that your body simply can’t produce enough testosterone.

It’s natural for men to produce less testosterone as they age. What’s not a natural part of aging is a medical condition known as hypogonadism — that can be caused by Low T. Symptoms include reduced sexual function, depressed mood, and decreased energy.

The signs and symptoms of Low T may be difficult to tell from the changes that occur with normal aging. Symptoms are frequently subtle, and are similar to those caused by other medical conditions.

Your doctor can tell if you have hypogonadism by giving you a medical exam to assess your signs and symptoms, then performing blood tests. Your doctor can also decide if treatment options such as testosterone replacement therapy (TRT) could help bring the T levels back to normal.

When you look at each of the signs and symptoms individually, you may not think they point to Low T. That’s because they may be difficult to tell from the changes that occur with normal aging, and may, in fact, be caused by other medical conditions. Check out the signs and symptoms of Low T below to see if any of them apply to you:

  • Sexual dysfunction (unable to maintain erections)
  • Reduced sex drive (reduced sexual activity)
  • Decreased energy
  • Loss of body hair, reduced shaving
  • Depressed mood
  • Increase in body fat
  • Decrease in bone strength
  • Reduced muscle mass

If you think that many of these signs and symptoms apply to you, don’t ignore them. They could be a sign of Low T or other health conditions. Only your doctor can tell if you have hypogonadism by giving you a medical exam to assess your signs and symptoms, then by performing certain blood tests. So when you speak to your doctor, ask if you should be tested.

When a man’s testosterone falls below a level of around 300 ng/dL, it’s generally considered to be low. But there are treatment options that can help bring low testosterone levels back to normal and keep them there. Your doctor will tell you about the risks and benefits of treatment and can help you decide if it is right for you.




Checking Your Testosterone

Checking Your Testosterone

A testosterone test checks the level of this male hormone (androgen) in the blood. Testosterone affects sexual features and development. In men, it is made in large amounts by the testicles. In both men and women, testosterone is made in small amounts by the adrenal glands; and, in women, by the ovaries.

The pituitary gland controls the level of testosterone in the body. When the testosterone level is low, the pituitary gland releases a hormone called luteinizing hormone (LH). This hormone tells the testicles to make more testosterone. See a picture of the pituitary gland.

Before puberty, the testosterone level in boys is normally low. Testosterone increases during puberty. This causes boys to develop a deeper voice, get bigger muscles, make sperm, and get facial and body hair. The level of testosterone is the highest around age 40, then gradually becomes less in older men.

In women, the ovaries account for half of the testosterone in the body. Women have a much smaller amount of testosterone in their bodies compared to men. But testosterone plays an important role throughout the body in both men and women. It affects the brain, bone and muscle mass, fat distribution, the vascular system, energy levels, genital tissues, and sexual functioning.

Most of the testosterone in the blood is bound to a protein called sex hormone binding globulin (SHBG). Testosterone that is not bound (“free”) can also be checked if a man or a woman is having sexual problems.

Why It Is Done

A testosterone test is done to:

  • See why a man is having problems in fathering a child (infertility). A low amount of testosterone can lead to low sperm counts.
  • Check a man’s sexual problems. A low level of testosterone may lower a man’s sex drive or not allow him to have an erection (erectile dysfunction).
  • See whether a high level of testosterone is causing a boy younger than age 10 to have early signs of puberty.
  • Check a decreased sex drive in a woman. This may be due to the level of testosterone in her body.
  • Find out why a woman is developing male features, such as excessive facial and body hair (hirsutism) and a deep voice.
  • Find out why a woman is having irregular menstrual periods.
  • See if testosterone-lowering medicines are working in a man with advanced prostate cancer.
  • Find the cause of osteoporosis in a man.

How To Prepare

You do not need to do anything before you have this test. Your doctor may want you to do a morning blood test, when testosterone levels are highest.

How It Is Done

The health professional taking a sample of blood will:

  • Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
  • Clean the needle site with alcohol.
  • Put the needle into the vein. More than one needle stick may be needed.
  • Attach a tube to the needle to fill it with blood.
  • Remove the band from your arm when enough blood is collected.
  • Put a gauze pad or cotton ball over the needle site as the needle is removed.
  • Put pressure to the site and then a bandage.

Further Reading:

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Talking to a Physician about Low Testosterone

Talking to a Physician about Low Testosterone

The signs and symptoms of Low Testosterone may be difficult to tell from the changes that occur with normal aging, or may be assumed to be caused by other medical conditions. So if you have symptoms of Low Testosterone, talk to your doctor during your routine checkup and ask if you should have a blood test.

If you have diabetes, ask your doctor if you should be tested for Low Testosterone. The Endocrine Society recommends that all men with type 2 diabetes have their testosterone levels checked. Patients who have been diagnosed with diabetes have an increased chance of also having Low Testosterone.

Having a prepared list in hand is a great way to make sure that your doctor addresses all your questions about Low Testosterone. That’s why we’ve created this useful Doctor Discussion Guide. Simply print it out and take it with you to your next doctor visit. If there are more questions you would like to ask, be sure to add them to the list.

Remember, only your doctor can decide if you need a blood test. So the more information you provide will help him decide what’s best for you.

  1. I don’t feel sick; I just don’t feel like myself anymore. What could be causing it?
  2. Are the symptoms I am experiencing and my other conditions related to Low Testosterone? Considering my symptoms, should I be tested for Low Testosterone?
  3. What medical treatment options are available if I have Low Testosterone?
  4. What is the difference between the different testosterone replacement therapies?
  5. If I have Low Testosterone, what happens if I don’t have it treated?
  6. How does my diet, fitness and lifestyle affect my testosterone?

If you’re taking any prescription medications, over-the-counter medications or vitamin supplements, be sure to tell your doctor.

There are several different treatment options available. Which treatment depends on what you and your doctor decide is appropriate.

FDA approved treatment options:

Gels

Testosterone gels are applied daily. The testosterone in the gel is absorbed into the body through the skin. Gels provide continuous delivery of testosterone throughout the day It’s important to make sure that other people are not exposed to the gel. This typically occurs when skin-to-skin contact is made with the application site.

Patches – Patches allow testosterone to be absorbed by the skin. Patches are applied daily.

Injections – Testosterone is given in shot form, usually in the upper buttock, every 1-2 weeks, by your doctor.

Buccal Tablet – In your mouth, the tablet is applied to the gum, where testosterone is absorbed over a 12-hour period.

Pellets – Pellets are placed under the skin near the hip by a doctor during a surgical procedure.




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