While it is clear that low testosterone levels are harmful to men's health, there is controversy regarding
how high treatment should raise testosterone levels to. The most conservative approach only seeks to raise
testosterone levels to the age-matched "normal" range. The most aggressive approach seeks to restore testosterone
levels to that of a healthy young man. There remains controversy about whether low testosterone or high testosterone
causes greater health concerns. But it is obvious that young men
who have relatively high testosterone levels suffer less cancer and other health problems than older men with
relatively low testosterone levels.
See breast and prostate cancer for
Dr. Weyrich's current view on testosterone safety as it applies to cancer.
Optimize Thyroid Function
In many cases correcting hypothyroidism will cause the body to produce more of its own testosterone or
otherwise relieve the symptoms attributed to low testosterone. This should always be done before
progressing to the treatments below.
Low Dose Clomiphene (Clomid)
In the case of secondary failure, the low doses of the fertility drug clomiphene (Clomid) may be used to
stimulate the testes to produce more testosterone. This has the advantages of maintaining male fertility
(sperm count), not causing testicular atrophy, and producing less estrogen than what occurs in
testosterone replacement therapy.
In one study, 36 Caucasian men, with untreated (blood serum) testosterone levels averaging 247.6ng/dL
and a testosterone/estrogen ratio of 8.7,
were treated with 25mg clomiphene per day for 4-6 weeks. Average testosterone level rose to 610.0ng/dL,
and the testosterone/estrogen ratio improved to 14.2 [Shabsigh2005].
Testosterone Replacement Therapy (TRT)
In the case of primary failure, replacing the testosterone that the testes can no longer
make with exogenous in applications of bio-identical testosterone is appropriate. The mode
of application can be a daily topical cream or gel, weekly injections, or monthly pellets.
Synthetic oral forms have been tried in the past, but were withdrawn from the market due to
unacceptable risks. These methods have the downside that they cause testicular atrophy,
infertility and low sperm count, and increase estrogen levels.
Testosterone is regulated by the FDA as a drug subject to abuse, and in order to legally
prescribe testosterone replacement therapy, a doctor must document abnormally low levels
of testosterone.
Some practitioners have expressed concern
that supplementing with testosterone may increase the risk of prostate cancer. However,
other researchers have reported that testosterone has a protective effect
[Starr2005, pg 196],
[Carruthers2001].
Indeed, the incidence of prostate cancer appears to increase with age, as
endogenous testosterone levels decline.
As discussed in breast and prostate cancer,
elevated estrogen levels are more
problematic than high normal testosterone levels. Since TRT tends to raise estrogen levels to
unhealthy levels, estrogen levels must be monitored during TRT, and if necessary, natural or
pharmaceutical approaches to lowering the conversion of testosterone to estrogen (i.e. aromatase
inhibitors) may be required.
