Testosterone replacement for the ageing man
Testosterone is the most important male sex hormone and its production is declining with age. This decline in male testosterone production can start as soon as the age of 25.Testosterone is produced mainly in the testis by the Leydig cells. At age 19 there are 7 millions of Leydig cells. At age 80 only 2.5 millions remain !
This decline is adversely affecting the ageing male quality of life and overall health. Testosterone replacement therapy can help to overcome these problems. This post is about testosterone replacement therapy for healthy men as an anti ageing treatment for the improvement and maintenance of a good health and a satisfying quality of life.
This what Testosterone levels look like with ageing. The charts below show the free (active hormone) testosterone decrease between the age of 20 to the age of 75. Reference: Liu et al. Reproductive Biology and Endocrinology (2015) 13:111 DOI 10.1186/s12958-015-0107-z
- Cardiovascular system protection
- Protection against obesity and diabetes
- Brain protection by increasing blood supply and neurons connections
- Bones, muscles and skin protection
- Reduces anxiety and improves the mood and memory
- Reproductive functions : sexual potency, fertility
- In short : what you can see on the picture, not really struggling, easy…
What are the complaints of middle aged men with a Testosterone deficiency ?
- An aging appearance with abdominal fat and decreased muscle strength, flabby skin.
- Stress, fear, irritability, nervousness, anxiousness, hypochondria.
- A severe deficiency can lead to a depression.
- Sex decline, absence of libido, no sex drive, erectile dysfunctions.
- Loss of self confidence, indecision, doubts, lassitude, tiredness.
- In short : what you can see on the picture, struggling , not so easy…
Diagnosis of a testosterone deficiency in an ageing male
There is no widely accepted consensus about what is a testosterone deficiency. Most laboratories will set up a “normal range” between 270 to 1100 ng/dl. A lot of doctors will not consider any treatment if you are in that range. Recently many eminent specialists have questioned this attitude because there is no clinical evidence for these figures. The range simply means that 95% of the male patients who have visited the laboratory for whatever the reason are between these values. If a patient functions well at 600 ng/dl and suffers from a poor quality of life and declining health when he is at 400 ng/dl should he be refused a testosterone replacement therapy because he is within the “normal range” ?
There is no universal optimal level for hormones in general and for testosterone in particular. Each patient has his own “right” level. This is because testosterone cells receptors are different for each individual . Also, the laboratory will measure the total testosterone, but only the free testosterone is efficient. This free part can be estimated but is not measured in a standard blood test as it is difficult and very expensive. This free (active) testosterone represents only around 1% of the total testosterone. This is why clinical symptoms should be more important than the result of the laboratory when discussing a testosterone prescription.
In this excellent study published in 2015 Malcolm Carruthers, Paul Cathcart & Mark R. Feneley (2015) Evolution of testosterone treatment over 25 years: symptom responses, endocrine profiles and cardiovascular changes, The Aging Male, 18:4, 217-227, the conclusion was : “It is suggested that because of excessive reliance on laboratory measures of androgens and undue safety concerns, many men who could benefit from symptom relief, improvement in related clinical conditions and given preventive medical benefits remain untreated.“ A diagnosis of Testosterone deficiency is made on the clinical assessment, the history, the Aging Male Symptoms score (AMS) and of course an initial blood test. You can test yourself your AMS score (or give it to your favourite ageing male) Men quality of life AMS questionnaire . The AMS questionnaire has been created in 1996 to assess symptoms of the aging male and to evaluate the response to testosterone replacement therapy.
For each question you grade yourself 1, 2,3,4 or 5 points. Then you sum up the total of points.
Results are interpreted in a given clinical context for each patient. The AMS questionnaire is also used for the monitoring of the treatment and patient symptomatology improvement. -from 1 to 26 you are fine
-from 27 to 36 you are experiencing minor effects of deficiency. You can fix this with a healthier lifestyle, more exercise, weight loss, more proteins in your diet.
-from 37 to 49 there is a testosterone deficiency and you may consider to have a testosterone replacement therapy.
-above 50 : you are suffering from a severe deficiency and you need a treatment.
These thresholds are purely indicative and each patient is different so the test needs to be discussed with your doctor in order to replace these results in their proper clinical context.
Testosterone Replacement Therapy
Testosterone is available under these forms
- Transdermal gel
All these presentations are effective but the transdermal gel form is the best form to use for an anti ageing treatment because it is very easy to apply (no needles) and also because this route will bypass the liver thus increasing the quantity of testosterone available into the blood.
Tolerance and efficiency are usually assessed at 4 months, 12 months and once a year.
Efficacy on symptoms such as libido, erectile function, mood is usually seen after 2 or 3 months. It takes a few more months for muscle mass, abdominal fat, bone density. Progress is assessed with the AMS score and a biological follow-up.
A doctor walks you through a video about the symptoms and treatments for low testosterone.
Dr Thierry Vidal is a member of the International Society for The Study of the Aging Male. ISSAM. Skin Oasis Clinic- 25 27 George Street-London-W1U 3QA For an Anti Ageing Consultation : 020 7486 5134
- Testosterone threshold – does one size fit all?
Avinash Maganty , Jonathan E. Shoag , Ranjith Ramasamy-The Aging Male
- Thierry Hertoghe,MD-The Hormone Handbook-2nd Edition-International Medical Books-Publications.
- Liu et al-Dynamic alteration of serum testosterone with aging: a cross-sectional study from Shanghai, China-Reproductive Biology and Endocrinology (2015) 13:111 DOI 10.1186/s12958-015-0107-z.
- Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men.
Bruno Lunenfeld , George Mskhalaya , Michael Zitzmann , Stefan Arver , Svetlana Kalinchenko , Yuliya Tishova , Abraham Morgentaler-The Aging Male
- Evolution of testosterone treatment over 25 years: symptom responses, endocrine profiles and cardiovascular changes– Malcolm Carruthers , Paul Cathcart , Mark R. Feneley
The Aging Male
- The Effect of Testosterone Replacement Therapy on Prostate-Specific Antigen (PSA) Levels in Men Being Treated for Hypogonadism A Systematic Review and Meta-Analysis. De-Ying Kang, MD and Hong-Jun Li, PhD. Medicine Volume 94, Number 3, January 2015.
- The Aging Male Symptoms questionnaire : Berlin Center for Epidemiology and Health Research
- Testosterone Deficiency and Cardiovascular Mortality: Morgentaler A. Testosterone deficiency and cardiovascular mortality. Asian J Androl 2015;17:26-31
Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20–79.