The diagnosis of late-onset hypogonadism requires the combination of low serum testosterone levels with symptoms of hypogonadism. Questionnaires are available which check for the symptoms of hypogonadism. These have been validated for the assessment of aging patients with hypogonadism (Morley et al 2000; Moore et al 2004) but have a low specificity. In view of the overlap in symptoms between hypogonadism, aging and other medical conditions it is wise to use a formal method of symptom assessment which can be used to monitor the effects of testosterone replacement.
Longjack, also known as Tongkat ali and pasak bumi, is a shrub hailing from Southeast Asia purporting to improve libido. It’s gaining traction in the scientific community for potentially increasing testosterone levels, and researchers at South Africa’s University of the Western Cape found that longjack improved testosterone levels and muscular strength in physically active seniors (a population with typically low testosterone).
Vitamin D3. Vitamin D3 actually isn’t a vitamin, it’s a hormone — a really important hormone that provides a whole host of health benefits. Our bodies can naturally make vitamin D from the sun, but recent studies have shown that many Westerners are vitamin D3 deprived because we’re spending less and less time outdoors. When we do decide to venture outside, we slather our bodies with sunscreen, which prevents the sun reaching our skin to kick-off vitamin D3 production. If you’re not getting enough sun, you may have a vitamin D3 deficiency, which may contribute to low T levels. If you think you need more vitamin D3, supplement it with a pill. Studies have shown that men who take this supplement see a boost in their testosterone levels. Because I have a darker complexion — which makes me prone to Vitamin D3 deficiency — I took 4,000 IU of vitamin D3 in the morning.
Oral/buccal (by mouth). The buccal dose comes in a patch that you place above your incisor (canine or "eyetooth"). The medication looks like a tablet but you should not chew or swallow it. The drug is released over 12 hours. This method has fewer harmful side effects on the liver than if the drug is swallowed, but it may cause headaches or cause irritation where you place it.
TT may help you but it may have adverse (harmful) results. (See discussion of these side effects below.) The Federal Drug Administration (FDA) has said that testosterone drug labels should state that there is a risk for heart disease and stroke for some men using testosterone products. All men should be checked for heart disease and stroke before, and periodically while on, TT. The AUA however, on careful review of evidence-based peer review literature, has stated that there is no strong evidence that TT either increases or decreases the risk of cardiovascular events.
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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.
Androgens may modulate the physiology of vaginal tissue and contribute to female genital sexual arousal. Women's level of testosterone is higher when measured pre-intercourse vs pre-cuddling, as well as post-intercourse vs post-cuddling. 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.
Changes in body composition are seen with aging. In general terms, aging males are prone to loss of muscle mass and a gain in fat mass, especially in the form of visceral or central fat. An epidemiological study of community dwelling men aged between 24 and 85 years has confirmed that total and free testosterone levels are inversely correlated with waist circumference and that testosterone levels are specifically related to this measure of central obesity rather than general obesity (Svartberg, von Muhlen, Sundsfjord et al 2004). Prospective studies show that testosterone levels predict future development of central obesity (Khaw and Barrett-Connor 1992; Tsai et al 2000). Reductions in free testosterone also correlate with age related declines in fat free mass (muscle mass) and muscle strength (Baumgartner et al 1999; Roy et al 2002). Studies in hypogonadal men confirm an increase in fat mass and decrease in fat free mass versus comparable eugonadal men (Katznelson et al 1998). Taken together, the epidemiological data suggest that a hypogonadal state promotes loss of muscle mass and a gain in fat mass, particularly visceral fat and therefore mimics the changes of ‘normal’ aging.
I recommend using a trans-mucosal DHEA cream. Applying it to the rectum or if you are a a woman, your vagina, will allow the mucous epithelial membranes that line your mucosa to perform effective absorption. These membranes regulate absorption and inhibit the production of unwanted metabolites of DHEA. I personally apply 50 milligrams of trans-rectal DHEA cream twice a day – this has improved my own testosterone levels significantly. However, please note that I do NOT recommend prolonged supplementation of hormones. Doing so can trick your body into halting its own DHEA production and may cause your adrenals to become seriously impaired down.
Stick to protocols that stress large degrees of muscle mass and are moderate- to high-intensity. Additionally, more seasoned gym-goers may want to incorporate forced repetitions periodically into their programs, as testosterone increases have been observed with this type of training.14 Incorporating other post-failure training techniques such as dropsets or partials may similarly be associated with higher T production.
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.