If in a 46 XY individual testosterone is either not produced in adequate concentrations as in gonadal dysgenesis (MacLaughlin and Donahue 2004), or in the absence of the enzyme 17 alpha-hydroxylase so that testosterone is not produced (Ergun-Longmire et al 2006), or testosterone androgen receptors are absent as in the androgen insensitivity syndrome (Hughes and Deeb 2006), phenotypic females will result.
A: According to the package insert, there are several longer-term side effects that have occurred with testosterone therapy. Testosterone can stimulate the growth of cancerous tissue. Prostate cancer or enlargement of the prostate can develop during prolonged therapy with testosterone, and these conditions are more likely to occur in elderly men. In patients receiving testosterone therapy, tests for prostate cancer should be performed as is current practice. Androgen therapy, such as testosterone, can cause a loss of blood sugar control in patients with diabetes. Close monitoring of blood glucose is recommended. Male patients can experience feminization during prolonged therapy with testosterone. The side effects of feminization include breast soreness and enlargement. These side effects are generally reversible when treatment is stopped. Hair loss resembling male pattern baldness has also occurred. Sexual side effects including decreased ejaculatory volume and low sperm counts have occurred in patients receiving long-term therapy or excessive doses. For more information, please consult with your health care provider and visit //www.everydayhealth.com/drugs/testosterone. Michelle McDermott, PharmD
Topical testosterone, specifically gels, creams and liquids, may transfer to others. Women and children are most at risk of harmful effects from contact with them. You should take care to cover the area and wash your hands well after putting on the medication. Be careful not to let the site with the topical TT touch others because that could transfer the drug.
Individuals with metabolic syndrome are at increased risk for developing coronary artery disease and diabetes mellitus. Predicting who might develop the metabolic syndrome would allow preventive measures to be taken in addition to weight control and other lifestyle modifications such as cessation of smoking and increased exercise. It is known that with decreasing testosterone availability in aging males there is an increase in fat mass and decrease in lean body mass (van den Beld et al 2000), there are disorders of insulin and glucose metabolism (Haffner et al 1996) and dyslipidemia (Tsai et al 2004). Kupelian and colleagues (2006) in analyzing data from the Massachusetts Male Aging Study demonstrated that men with low levels of testosterone, sex hormone-binding globulin, or clinical androgen deficiency, especially men with a BMI of greater than 25, were at increased risk of developing the metabolic syndrome and hence, diabetes mellitus and/or coronary artery disease.
Androgens may modulate the physiology of vaginal tissue and contribute to female genital sexual arousal.[48] Women's level of testosterone is higher when measured pre-intercourse vs pre-cuddling, as well as post-intercourse vs post-cuddling.[49] There is a time lag effect when testosterone is administered, on genital arousal in women. In addition, a continuous increase in vaginal sexual arousal may result in higher genital sensations and sexual appetitive behaviors.[50]
Acne and Allergic Reactions: The testosterone is universally regarded as one of the triggering factors for acne. It stimulates the activity of oil glands making the skin more oily and vulnerable to acne. This body hormone might also cause allergic reactions, such as hives, rash, difficulty breathing, itching, chest tightness, and big swelling of the facial parts.
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Try a protein deprivation diet. According to "Optimum Anabolics," the body produces more testosterone in response to heavy training when there is insufficient protein in the diet. Testosterone provides a hypertrophic, or muscle-building, backup system, allowing for muscle recovery when protein is not available. To follow this diet, take in only 30 grams of high-quality, fast-digesting protein (whey protein) immediately following your weight training. The rest of the days, your calories, split into five or six meals, should be divided between low-glycemic carbohydrates (oatmeal, whole grains and sweet potatoes) and healthy fats. After three weeks of this diet, switch back to a higher-protein diet (1 gram of protein per pound of body weight), adding one extra 20 to 30 gram serving of protein before bed.
If testosterone deficiency occurs during fetal development, then male characteristics may not completely develop. If testosterone deficiency occurs during puberty, a boy’s growth may slow and no growth spurt will be seen. The child may have reduced development of pubic hair, growth of the penis and testes, and deepening of the voice. Around the time of puberty, boys with too little testosterone may also have less than normal strength and endurance, and their arms and legs may continue to grow out of proportion with the rest of their body.

Men who watch a sexually explicit movie have an average increase of 35% in testosterone, peaking at 60–90 minutes after the end of the film, but no increase is seen in men who watch sexually neutral films.[43] Men who watch sexually explicit films also report increased motivation, competitiveness, and decreased exhaustion.[44] A link has also been found between relaxation following sexual arousal and testosterone levels.[45]
As already indicated previously, testosterone levels, particularly bioavailable testosterone, fall with advancing age. This decline in testosterone availability may start to occur early in the forth decade but it usually becomes clinically manifest in the 50s and 60s. Although there is continuing debate about the best way to diagnose hypogonadism in the aging male, there appears to be a general consensus that symptomatic men with reduced levels of testosterone should be given a trial of testosterone therapy if there is no contraindication to do so (Bain et al 2007).
Dobs and colleagues found that men with an increased body mass index had both reduced testosterone and reduced high density lipoprotein (HDL) levels. Treatment with testosterone increased the levels of HDL (Dobs et al 2001). Rising levels of HDL are not a consistent finding with TRT. More often, however, one finds reduced total cholesterol, low density lipoprotein (LDL) cholesterol and triglyceride levels with TRT (Zgliczynski et al 1996; Whitsel et al 2001).
At the present time, it is suggested that androgen replacement should take the form of natural testosterone. Some of the effects of testosterone are mediated after conversion to estrogen or dihydrotestosterone by the enzymes aromatase and 5a-reductase enzymes respectively. Other effects occur independently of the traditional action of testosterone via the classical androgen receptor- for example, its action as a vasodilator via a cell membrane action as described previously. It is therefore important that the androgen used to treat hypogonadism is amenable to the action of these metabolizing enzymes and can also mediate the non-androgen receptor actions of testosterone. Use of natural testosterone ensures this and reduces the chance of non-testosterone mediated adverse effects. There are now a number of testosterone preparations which can meet these recommendations and the main factor in deciding between them is patient choice.
Overall, it seems that both estrogen and testosterone are important for normal bone growth and maintenance. Deficiency or failure of action of the sex hormones is associated with osteoporosis and minimal trauma fractures. Estrogen in males is produced via metabolism of testosterone by aromatase and it is therefore important that androgens used for the treatment of hypogonadism be amenable to the action of aromatase to yield maximal positive effects on bone. There is data showing that testosterone treatment increases bone mineral density in aging males but that these benefits are confined to hypogonadal men. The magnitude of this improvement is greater in the spine than in the hip and further studies are warranted to confirm or refute any differential effects of testosterone at these important sites. Improvements seen in randomized controlled trials to date may underestimate true positive effects due to relatively short duration and/or baseline characteristics of the patients involved. There is no data as yet to confirm that the improvement in bone density with testosterone treatment reduces fractures in men and this is an important area for future study.

The effect excess testosterone has on the body depends on both age and sex. It is unlikely that adult men will develop a disorder in which they produce too much testosterone and it is often difficult to spot that an adult male has too much testosterone. More obviously, young children with too much testosterone may enter a false growth spurt and show signs of early puberty and young girls may experience abnormal changes to their genitalia. In both males and females, too much testosterone can lead to precocious puberty and result in infertility. 
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