More can be learned from a large, randomized, placebo-controlled trial of finasteride treatment in 18,800 men aged 55 or more. Finasteride is a 5α-reductase inhibitor which acts to prevent the metabolism of testosterone to dihydrotestosterone (DHT) – the most active androgen in the prostate. The trial showed a greater overall incidence of prostate cancer in the control group, but men treated with finasteride were more likely to have high grade tumors (Thompson et al 2003), suggesting that reduced androgen exposure of the prostate may delay the presentation of prostate cancer and/or promote advanced disease in some other way.
Nearly 1 out of every 4 men over age 50 experience the pain of losing the ability to perform sexually as a result of erectile dysfunction (ED). Common causes of ED are atherosclerosis, diabetes, prescription drug use (namely high blood pressure, depression, and allergy drugs), and—you guessed it—low testosterone. Supplements that may help include the following:
Testosterone boosters are used by many athletes worldwide to achieve a significant muscle mass increase within a short period of time.[1] However; one cannot be completely confident in terms of the quality and efficacy of such products because of several reasons, such as the possibility of bad storage conditions and originating from an unreliable source. Over the years, some consumers of testosterone boosters have complained of kidney and liver abnormalities that could be linked to their use of boosters.[10] Cases of erroneous product administration have occurred in the past as athletes may not follow the instructions on the label fully, which can lead to many side effects.[11] In the present case, a man was admitted to a hospital because of a severe abdominal pain. The pain was later found to be caused by liver injury. The diagnosis confirmed that the levels of the key hepatic enzymes were markedly elevated. The medical complications observed were found to have occurred following the consumption of two courses of a commercial testosterone booster. According to researchers based in the US, about 13% of the annual cases of acute liver failure are attributable to idiosyncratic drug- and/or supplement-induced liver injury.[12] Marked increase in the levels of ALT, AST, and gamma-glutamyl transferase was observed after consuming the first course of the commercial testosterone booster, and they started to decline after the 2nd and 3rd course. This abruptly increases the levels of liver enzymes after the first course may be attributed to the interruption effect of commercial testosterone booster on liver function as a result of the effects of its ingredients.
There have been case reports of development of prostate cancer in patients during treatment with testosterone, including one case series of twenty patients (Gaylis et al 2005). It is not known whether this reflects an increase in incidence, as prostate cancer is very common and because the monitoring for cancer in patients treated with testosterone is greater. Randomized controlled trials of testosterone treatment have found a low incidence of prostate cancer and they do not provide evidence of a link between testosterone treatment and the development of prostate cancer (Rhoden and Morgentaler 2004). More large scale clinical trials of longer durations of testosterone replacement are required to confirm that testosterone treatment does not cause prostate cancer. Overall, it is not known whether testosterone treatment of aging males with hypogonadism increases the risk of prostate cancer, but monitoring for the condition is clearly vital. This should take the form of PSA blood test and rectal examination every three months for the first year of treatment and yearly thereafter (Nieschlag et al 2005). Age adjusted PSA reference ranges should be used to identify men who require further assessment. The concept of PSA velocity is also important and refers to the rate of increase in PSA per year. Patients with abnormal rectal examination suggestive of prostate cancer, PSA above the age specific reference range or a PSA velocity greater than 0.75 ng/ml/yr should be referred to a urologist for consideration of prostate biopsy.

Unlike aerobics or prolonged moderate exercise, short, intense exercise was found to be beneficial in increasing testosterone levels. The results are enhanced with the help of intermittent fasting. Intermittent fasting helps boost testosterone by improving the expression of satiety hormones, like insulin, leptin, adiponectin, glucacgon-like peptide-1 (GLP-1), cholecystokinin (CKK), and melanocortins, which are linked to healthy testosterone function, increased libido, and the prevention of age-induced testosterone decline. When it comes to an exercise plan that will complement testosterone function and production (along with overall health), I recommend including not just aerobics in your routine, but also:
This herb, used for centuries in foods, even poultices, was reported in the International Journal of Sport Nutrition and Exercise Metabolism to have reduced body fat and improved total testosterone levels versus a placebo in a double-blind trial. Fenugreek may also be helpful if you feel your sex drive is on the wane, as other research has found it can boost libido. You can get it in curries (it’s used to flavor them) and teas, or as a supplement in TestroVax, by Novex Biotech, which promises to boost testosterone levels 42% in 12 days. (novexbiotech.com)

"Some say it's just a part of aging, but that's a misconception," says Jason Hedges, MD, PhD, a urologist at Oregon Health and Science University in Portland. A gradual decline in testosterone can't explain a near-total lack of interest in sex, for example. And for Hedges' patients who are in their 20s, 30s, and early 40s and having erectile problems, other health problems may be a bigger issue than aging.
Low testosterone levels may contribute to decreased sex drive, erectile dysfunction, fragile bones, and other health issues. Having low testosterone levels may also indicate an underlying medical condition. See your doctor if you suspect you have low testosterone. A simple blood test is all it takes to check if your testosterone falls within the normal range.
While researchers in Brisbane, Australia, found that while Testofen (“a standardized [fenugreek] extract and mineral formulation”) significantly improved the sexual arousal, orgasm, and the general quality of life of participants, it did not remarkably increase testosterone above normal levels. Participants who took Testofen were more satisfied with their energy, well-being, and muscle strength than those who took the placebo.
There is no definite age to recommend when is appropriate to start using a Testosterone Booster. It depends on the age in which you initially hit puberty, and how long your body produces testosterone at its peak level. If you feel as though your Testosterone levels have started to decline, usually characterised through a decrease in strength, energy, libido and ability to build size, then these are usually good determinants that it may be time to commence using a Natural Testosterone booster. The Typical age range is between 21- 25, however this is highly variable depending on your own genetics, training and diet.
A recent study compared total and bioavailable testosterone levels with inflammatory cytokines in men aged 65 and over. There was an inverse correlation with the pro-inflammatory soluble interleukin-6 receptor, but no association with interleukin-6 (IL-6), highly sensitive CRP (hsCRP), tumor necrosis factor-α (TNF-α) or interleukin-1β (IL-1β (Maggio et al 2006). Another trial found that young men with idiopathic hypogonadotrophic hypogonadism had higher levels of proinflammatory factors interleukin-2 (IL-2), interleukin-4 (IL-4), complement C3c and total immunoglobulin in comparison to controls (Yesilova et al 2000). Testosterone treatment in a group of hypogonadal men, mostly with known coronary artery disease, induced anti-inflammatory changes in the cytokine profile of reduced IL-1β and TNF-α and increased IL-10 (Malkin, Pugh, Jones et al 2004).

If you are serious about losing weight, you have got to strictly limit the amount of processed sugar in your diet, as evidence is mounting that excess sugar, and fructose in particular, is the primary driving factor in the obesity epidemic. So cutting soda from your diet is essential, as is limiting fructose found in processed foods, fruit juice, excessive fruit and so-called "healthy" sweeteners like agave.


Binge drinking on the other hand does impact Testosterone levels – especially on a short term basis. Two studies (22 & 23) show that large acute quantities of alcohol consumption in a short period led to decreases in Testosterone levels by a whooping 20-23% after 24hours! Note however this is drinking to extreme excess! Likewise, chronic alcohol abuse is known to reduce testosterone more notably (as seen in alcoholics).

It may be unlikely to completely eliminate products with EDCs, but there are a number of practical strategies that you can try to limit your exposure to these gender-bending substances. The first step would be to stop using Teflon cookware, as EDCs can leach out from contaminated cookware. Replace them with ceramic ones. Stop eating out of cans, as the sealant used for the can liner is almost always made from powerful endocrine-disrupting petrochemicals known as bisphenols, e.g. Bisphenol A,
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Phthalates are found to cause poor testosterone synthesis by disrupting an enzyme required to create the male hormone. Women with high levels of DEHP and DBP (two types of phthalates) in their system during pregnancy were found to have sons that had feminine characteristics Phthalates are found in vinyl flooring, detergents, automotive plastics, soaps and shampoos, deodorants, perfumes, hair sprays, plastic bags and food packaging, among a long list of common products. Aside from phthalates, other chemicals that possess gender-bending traits are:

“I'm a truck driver and for 13 hours a night I sit in my truck and I drive. Out of boredom, I'd stop and eat. That was all until Andro400 – ever since then my life has changed. I started out weighing 341 pounds, and since taking Andro400 I've dropped 85 pounds! There's no cravings – I actually don't even think about food anymore. One thing that Andro400 said on the radio ad is it attacks belly fat – well let me tell you it did – the 2nd month is where I saw a drastic change in the size of my stomach. I've lost 6 inches! I'm sleeping better. My knee pain went away. I've had some lower back issues and that went away, and I can only attribute that to Andro400. It's a Life Changer for me!”

It sounds like a creature from Jurassic World, but this plant is worth learning to pronounce, especially if you haven’t had great sex since dinosaurs roamed the earth. A 2012 study showed that consuming six grams of tribulus root for 60 days improved erections and frequency of sex in men with low sperm counts. It also reduced sexual fatigue. Furthermore, their testosterone jumped by a whopping 16%. “Trib,” as it’s called, is thorny and bitter, so look to a supplement for consuming it. Epiq’s Quad Test includes Tribulus terrestris. (epiqresults.com)
This being my initial use of product I do find an overall improvement in mind and body "maleness" related to focused goal and strength improvements. Has it turned me into a super stud..no, but at a recent 60th birthday, increased desire has added to performance and that is what I was looking for.I have reinstated diet and exercise that also has made physical and mental health achievements Will finish current bottle, and evaluate overall products worth once completed. Further evaluation pending...

5. Beef.  Is there a manlier food than steak? Release your inner carnivore if you want to boost your testosterone level. Lean beef is rich with zinc, saturated fat, iron, protein and magnesium. We’ve already mentioned earlier on how zinc can enhance the production of testosterone. Lean beef can be an excellent food choice, since you can increase your testosterone level and muscle mass at the same.
It sounds like a creature from Jurassic World, but this plant is worth learning to pronounce, especially if you haven’t had great sex since dinosaurs roamed the earth. A 2012 study showed that consuming six grams of tribulus root for 60 days improved erections and frequency of sex in men with low sperm counts. It also reduced sexual fatigue. Furthermore, their testosterone jumped by a whopping 16%. “Trib,” as it’s called, is thorny and bitter, so look to a supplement for consuming it. Epiq’s Quad Test includes Tribulus terrestris. (epiqresults.com)

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.
Miscellaneous: Sleep: (REM sleep) increases nocturnal testosterone levels.[142] Behavior: Dominance challenges can, in some cases, stimulate increased testosterone release in men.[143] Drugs: Natural or man-made antiandrogens including spearmint tea reduce testosterone levels.[144][145][146] Licorice can decrease the production of testosterone and this effect is greater in females.[147]
Infertility in men and women Infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. There are numerous reasons for both male and female infertility but many ways in which medical assistance can overcome problems that people may face. Everything concerning infertility is discussed and explained here. Read now
In Western society, we seek help from pharmaceuticals at the onset of a problem the way a toddler calls for mommy every time he needs to pee.  The toddler will soon realize that he actually does not need a 3rd party to relieve himself.  In the same light, you most likely do not need pro-hormones, hormone replacement therapy, testosterone patches and creams, injections, or contraband steroids.  There are natural approaches to amplifying your testosterone levels.
Conflicting results have been obtained concerning the importance of testosterone in maintaining cardiovascular health.[29][30] Nevertheless, maintaining normal testosterone levels in elderly men has been shown to improve many parameters that are thought to reduce cardiovascular disease risk, such as increased lean body mass, decreased visceral fat mass, decreased total cholesterol, and glycemic control.[31]
Vitamin D is a fat-soluble vitamin and is obtained from sunlight. In the active form, it acts as a steroid hormone in the body. These days many people suffer from vitamin D deficiency because lacking exposure to sunlight, but taking vitamin D supplements to improve the weakness. Low vitamin D levels also lower the testosterone levels, but with intake of vitamin D, the testosterone levels boost. In typical cases, vitamin D doesn’t show the significant result in testosterone levels but people who are vitamin D deficient shows an increase in testosterone levels.
“I can't tell you how good the product is! I'm in the best shape of my life. I used to take blood pressure medication and I don't even take that anymore. It's changed every aspect of my life. I was a 40 waist and I'm down to a 36. I'm 54 years old, and people tell me I look better than I ever have, and I look like I'm in my early 40s! And I'm telling you it's the Andro. This product is so much better than even the advertisements! From taking Andro400 I immediately notice a burst of energy . . . and my skin color, my sexual advancements, my energy, plus the weight loss, the toning of the body, and the increase strength and endurance . . . it's like night and day where I was then and where I am now, and Andro400 has made the difference. And my wife also takes it, 1 pill every other day, and she has experienced an amazing transformation in her body alone, with her hair, her complexion, and as well as in the gym. It's an outstanding product. My customers, my friends, my family, everybody is noticing the difference!”
Beast Sports recommends taking four capsules twice per day. The pills are about the same size as a multivitamin or a Tylenol liquid gel pill — not tiny tablets, unfortunately, but they aren’t horse pills. They smell like the boxes of raisins your Mom packed into your school lunch, but stale, like they were forgotten in the pantry for a few years, and a little spicy, like she sprinkled curry powder on them. If you follow this eight pills per day regime, your $46 bottle will last you twenty-two days, and cost you about $2 per day.
I was reading in the university health news daily website that a study performed by researchers at the University of Texas M.D. Anderson Cancer Center found that men with prostate cancer who ate 3 tablespoons of milled or ground flax seeds each day had decreased prostate cancer cell proliferation compared to similar men who did not eat flax seeds. According to the American Cancer Society, men who supplement their diets with flax seed have lower PSA levels and slower growth of benign as well as cancerous prostate cells.

Overall, few patients have a compelling contraindication to testosterone treatment. The majority of men with late onset hypogonadism can be safely treated with testosterone but all will require monitoring of prostate parameters HDL cholesterol, hematocrit and psychological state. It is also wise to monitor symptoms of sleep apnea. Other specific concerns may be raised by the mode of delivery such as local side effects from transdermal testosterone.
While I do have a pretty manly mustache, I’m not a doctor or a medical expert. I’m a guy with a law degree he’s never used who blogs about manliness. What I’m about to share shouldn’t be taken as a substitute for qualified medical expertise. It’s simply my experience and views on the subject. Before you make any changes in lifestyle or diet, talk to your doctor or healthcare provider. Be smart.
Testosterone has two major effects on bones: (a) through conversion to estradiol by way of the enzyme, aromatase, testosterone inhibits osteoclastic activity and hence bone resorption; and (b) through conversion to DHT via 5-α-reductase, it stimulates osteoblastic activity and so enhances the laying down of bone (Tivesten et al 2004; Davey and Morris 2005). Hypogonadal men are at risk for the development of osteopenia or osteoporosis and hence for subsequent fracture (Fink et al 2006). About one-third of all osteoporotic hip fractures occur in men and the risk of any osteoporotic fracture in men over 50 is as high as 25 percent (Seeman 1997; Adler 2006). Although treatment with testosterone in hypogonadal men increases bone mineral density (Katznelson et al 1996), it has not yet been established that this results in a reduction in fracture rate.

Here’s a scary thought: You may be less of a man than your father was—at least hormonally. A study in the Journal of Clinical Endocrinology and Metabolism found that, on average, testosterone levels were higher in men of the same age in the ’80s than they were in the 2000s (due, researchers speculate, to higher rates of obesity and the wider use of medication these days).  


We reviewed the ingredient lists of our supplements and cut three that prescribed us an overdose of magnesium. While it’s possible to stay under the 350mg daily limit of supplemental magnesium by taking fewer pills than the manufacturer recommends, we were concerned that any manufacturer would advise you to exceed the recommended safety limit for magnesium intake by almost a third.

The final two studies looked directly at soy vs testosterone levels. The first looked at introducing consumption of soya flour on testosterone levels. They found that those who ate the Soy flour lowered their T levels during the study (43). And the second study looked at the consumption of soy protein isolates (powder) in healthy men. They found that testosterone levels decreased upon consumption of soy powder (45).
All the active substances available in TestoGen are fully natural. And their efficacy and safety is science-backed. So, if you don’t have individual sensitivity to the supplement ingredients and purchase the product directly from the manufacturer instead of purchasing from unknown suppliers, the likelihood of side effects during the supplementation is minimal. And the customer feedback proves this.
“Before taking Andro400, my husband weighed 290 lbs. He's a diabetic and his blood pressure was through the roof. I purchased Andro based on the reviews, and he's lost 60 - 70 lbs! ​It's enhanced him health-wise in a lot of aspects too. He used to be depressed because of his weight. The fact that he was losing weight like crazy gave him a lot of relief. He's not depressed now, he's really happy. He's more loving. And it's so exciting for me as a wife to see him happier -- it made me happier​! ​ So I'm really grateful. Andro400 gave him a lot of ​energy ​ too because of the testosterone boost.​ The 3 main things everybody's noticing are: no more​ depression, a lot more energy and ​the huge weight loss. He went from size 42 to 38, so it's like, oh my God it's WORKING!! Trust me, we've tried a lot of other things that didn't work. And that's why I'm so excited because it's actually, literally changing our lives!”
It's not enough just to increase the testosterone your body produces, because as we age, the testosterone we naturally produce is often bound by SHBG (sex hormone binding globulin) thus becoming unavailable for use in the body. It’s imperative that your testosterone remains unbound or “free” if you want to enjoy all the wonderful benefits testosterone provides.
We required all of our testosterone boosters to have magnesium, but gave preference to magnesium aspartate, citrate, lactate, and chloride. These forms have been found to be more easily absorbed than magnesium oxide and sulfate. (On the other hand, it didn’t count if the supplement had magnesium stearate, which is used to make pills not stick together.)
Zinc is little more of a nice-to-have ingredient than a must-have. It’s on our radar as an ingredient that possibly boosts testosterone levels, and while we couldn’t find enough supporting evidence that taking zinc would increase natural testosterone, low zinc levels have been connected to infertility. A low zinc level is also possibly a sign of hypogonadism. The closest support we found is in a study which found that people recovered from nutritional deficiency-related problems more quickly if they took a zinc supplement than those who did not. Zinc is available in many foods, such as oysters, fortified breakfast cereals, and red meat.
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Watch out for ingredients that interfere with blood clotting If you are taking any kind of blood medication, take aspirin or ibuprofen, or have any kind of blood-related condition, you’ll want to consult your doctor before taking any of these supplements. Fenugreek, Forskolin, and Acetyl-L-carnitine are just a few of the ingredients that can make these situations worse and increase your chances of bruising and bleeding.

Dr. Anthony’s Notes: I use Maca often in cycles throughout the year. I typically buy the raw Maca powder, which has a VERY “dirt-like” earthy taste. Beware if you are a bit squeamish on tastes! How To Take Maca: 1500-3000mg of Maca powder is a typical dosage take daily alongside food. From personal experience, I've found that it’s best to buy the Maca powder as a standalone supplement and throw it into a blended protein shake to mask the taste.


That there is an association between depression and testosterone concentration seems possible because of the observation that depression may be associated with reduced testosterone concentrations, hypogonadal men may have their symptoms of depression relieved by TRT and that testosterone itself may have anti-depressant properties (Pope et al 2003). The evidence, however, is inconsistent. Seidman and colleagues (2002), for example, found that there was no relationship between testosterone and depression but there was an association of testosterone with dysthymia. McIntyre and colleagues (2006), on the other hand, found that middle-aged men with depression did have a reduction in bio-available testosterone.
Testosterone is considered to be the "male hormone" that's produced in men by the testes. Although women's ovaries produce some testosterone, the hormone is produced in much higher concentrations in men and it is responsible for many of the secondary sex characteristics seen in men such as a deeper voice and hair on the chest, in addition to contributing to a healthy libido, building muscle mass, and maintaining energy levels.
Testosterone has several positive effects on sexual function, but its most significant effect is on libido, sexual interest and arousal. Boys going through puberty develop an enhanced interest in sex (thoughts, fantasies, masturbation, intercourse) as a consequence of rising levels of testosterone. Hypogonadal men usually have a significant improvement in libido when TRT is initiated (Wang et al 2000; Morley and Perry 2003).

Take 1 teaspoon. Incredibly dense in nutrients and feed by bees to the larvae who grows on to be the queen bee. I found one human study where a 4g daily serving led to an small increase in testosterone in older men (ref 78). There are also numerous animal studies (ref 79) showing positive effects. Personally I source NZ manuka royal jelly from Manuka Health.

Sergeant Steel ran into trouble here because it contains Shilajit — a type of plant-based resin. Shilajit is banned in Canada because the Canadian government found heavy metal levels when investigating the ingredient. Shilajit is hard to find, and sensitive to water and variations in temperature, so most manufacturers mix it with additives to make it more stable. Research at Boston University School of Medicine found that “nearly 21 percent of 193 ayurvedic herbal supplements [...] contained lead, mercury or arsenic,” and included shilajit on the list of contaminated ingredients. Even though Sergeant Steel lists its shilajit is “purified,” it doesn’t offer any third-party testing to confirm whether or not their shilajit contains heavy metals, and so we cut it.

There are the testosterone deficiency signs, such as loss of sexual desire, erectile dysfunction, impaired fertility, chronic fatigue, etc. But it’s not always possible to understand which medical condition caused the decrease in testosterone levels. For example, if you always feel exhausted and have no sexual desire, it may provide evidence of depression.


Other stereotypical "macho" behaviors can affect testosterone in women, according to a 2015 report in the Proceedings of the National Academy of Sciences. For example, posing in a powerful way increases testosterone in both women and men. The 2015 report showed that having women role-play a position of power — acting like a boss — had the same effect.

A related issue is the potential use of testosterone as a coronary vasodilator and anti-anginal agent. Testosterone has been shown to act as a vasodilator of coronary arteries at physiological concentrations during angiography (Webb, McNeill et al 1999). Furthermore men given a testosterone injection prior to exercise testing showed improved performance, as assessed by ST changes compared to placebo (Rosano et al 1999; Webb, Adamson et al 1999). Administration of one to three months of testosterone treatment has also been shown to improve symptoms of angina and exercise test performance (Wu and Weng 1993; English et al 2000; Malkin, Pugh, Morris et al 2004). Longer term studies are underway. It is thought that testosterone improves angina due its vasodilatory action, which occurs independently of the androgen receptor, via blockade of L-type calcium channels at the cell membrane of the vascular smooth muscle in an action similar to the dihydropyridine calcium-channel blockers such as nifedipine (Hall et al 2006).
Common side effects from testosterone medication include acne, swelling, and breast enlargement in males.[10] Serious side effects may include liver toxicity, heart disease, and behavioral changes.[10] Women and children who are exposed may develop virilization.[10] It is recommended that individuals with prostate cancer not use the medication.[10] It can cause harm if used during pregnancy or breastfeeding.[10]

There are valid concerns about the safety of long-term treatment with testosterone particularly with respect to the cardiovascular system and the potential for stimulating prostate cancer development. There are no convincing hard data, however, to support these concerns. If anything, the data strongly suggest that adequate testosterone availability is cardioprotective and coronary risk factors such as diabetes, obesity and the metabolic syndrome are associated with reduced testosterone levels. It is certainly appropriate to avoid giving testosterone to men with prostate or breast cancer but it is not appropriate to accuse testosterone of inducing the development of de novo prostate cancers since evidence for this accusation is lacking (Wang et al 2004; Feneley and Carruthers 2006).

We do note that Beast Sports’ supplemental magnesium level is fairly low — 26 mg per serving, up to 52 mg per day. If your diet is not particularly rich in magnesium (found in leafy greens, nuts, and whole grains), Beast Sports may not give you enough to meet the daily recommended dose. However, if you’re taking other multi-vitamins or supplements with magnesium, you’re less likely to cross that 350mg daily upper limit.

Created specifically to fit your needs, Myoshred is the only all-natural testosterone boosting formula designed by men for men. This revolutionary supplement is engineered to annihilate fat, stripping away that pudgy layer to reveal the lean, sculpted muscle underneath. Only Myoshred can give your muscles the nutrients they need to grow to mind-blowing proportions, so you can show off your hard-earned success.


This doesn’t mean Super Test is perfect — we take a closer look at some of its ingredients below — but it beats out the competition. Every other supplement we looked at either didn’t have all four ingredients, overdosed us on vitamins or minerals (a good way to develop kidney and liver problems), contained ingredients that would harm us, or some combination thereof.


Studies have demonstrated reduced testosterone levels in men with heart failure as well as other endocrine changes (Tappler and Katz 1979; Kontoleon et al 2003). Treatment of cardiac failure with chronic mechanical circulatory support normalizes many of these changes, including testosterone levels (Noirhomme et al 1999). More recently, two double-blind randomized controlled trials of testosterone treatment for men with low or low-normal serum testosterone levels and heart failure have shown improvements in exercise capacity and symptoms (Pugh et al 2004; Malkin et al 2006). The mechanism of these benefits is currently unclear, although a study of the acute effects of buccal testosterone given to men with chronic cardiac failure under invasive monitoring showed that testosterone increased cardiac index and reduced systemic vascular resistance (Pugh et al 2003). Testosterone may prove useful in the management of cardiac failure but further research is needed.
Testosterone is a steroid sex hormone found in both men and women. In men, testosterone is produced primarily by the Leydig (interstitial) cells of the testes when stimulated by luteinizing hormone (LH). It functions to stimulate spermatogenesis, promote physical and functional maturation of spermatozoa, maintain accessory organs of the male reproductive tract, support development of secondary sexual characteristics, stimulate growth and metabolism throughout the body and influence brain development by stimulating sexual behaviors and sexual drive. In women, testosterone is produced by the ovaries (25%), adrenals (25%) and via peripheral conversion from androstenedione (50%). Testerone in women functions to maintain libido and general wellbeing. Testosterone exerts a negative feedback mechanism on pituitary release of LH and follicle-stimulating hormone (FSH). Testosterone may be further converted to dihydrotestosterone or estradiol depending on the tissue.
As blood levels of testosterone increase, this feeds back to suppress the production of gonadotrophin-releasing hormone from the hypothalamus which, in turn, suppresses production of luteinising hormone by the pituitary gland. Levels of testosterone begin to fall as a result, so negative feedback decreases and the hypothalamus resumes secretion of gonadotrophin-releasing hormone. 
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