Testosterone FAQ

Leading preventive-aging specialists globally advocate for correcting hormones to optimal levels to ensure peak performance of both mind and body. This generally aligns with maintaining hormone levels around the 75th percentile of those found in a healthy 25-year-old, promoting optimal health and vitality.

To comprehensively assess testosterone levels, both Total and Free Testosterone studies should be conducted. The normal laboratory range for Total Testosterone typically ranges from approximately 300 to 1000 ng/dL for men aged 20 to 70 years, while women fall within the range of 15 to 70 ng/dL. Free Testosterone levels, which account for around 2% of the total, average between 55 to 200 pg/ml for men and 1 to 10 pg/ml for women. Free Testosterone is considered more informative as it reflects the amount of hormone available for productive tasks.

Utilizing a 50-year age span (from ages 20 to 70) to define a "normal range" is not practical. A decline of 70% from youthful levels can lead to significant clinical issues, yet it's considered "within normal range". A more precise approach involves using the upper end of the "normal range" adjusted for age. Maintaining these levels over time is crucial rather than allowing continual decline, ensuring optimal health and well-being.

At a certain stage in life, men will experience a decline in both free and total testosterone levels, which might occur in their 30s, 40s, or later in their 50s. Eventually, these levels will drop below what they were in their 20s. If the total testosterone falls below 300 ng/dL, there's typically no debate—it should be addressed. However, what about a healthy 50-year-old man with a total testosterone of 500 ng/dL and a free testosterone level of 100 pg/dL, who may have had levels of 800 in his early 20s? Should he wait until his total testosterone reaches the "magic" number of 300 before considering TRT? Or is it significant that his levels have already declined by over 35%, coupled with noticeable difficulties in muscle building and weight management? This question lies at the heart of the ongoing debate.

When addressing this debate, two fundamental questions arise. Firstly, what are the advantages of increasing testosterone levels from 500 to 800-1000 ng/dL? Secondly, are there any notable risks, both immediate and over the long term, associated with maintaining such testosterone levels through therapy?

Several studies have been conducted on healthy young men, administering doses of testosterone that elevated their levels into the high adolescent range of 1000 to 2000 ng/dL. In all these studies, lean muscle mass increased while fat mass decreased significantly. Similar research with lower doses has been carried out on moderately obese men, resulting in increased lean mass and even greater fat reduction. Additionally, insulin resistance, triglycerides levels, and energy levels improved. Notably, none of these studies reported any increase in aggressive behavior, contrary to common expectations associated with high doses of testosterone.

Numerous additional studies have been published demonstrating similar effects in older men (aged over 65) with mildly low testosterone levels. The National Institute of Aging (NIA) released findings from studies on Testosterone Replacement Therapy (TRT) concerning body composition (lean muscle and fat ratios) in 108 men. These studies revealed a 6 lb. fat loss and a 5 lb. lean muscle gain when testosterone levels were raised from an average of 370 to 640 ng/dL over 36 months. Additionally, men with initially low bone density experienced an increase in bone density. The accumulating evidence indicates that elevating testosterone levels, regardless of the starting level, leads to improvements in body composition. It is believed that the dosage of testosterone used in this study was too conservative, and a higher dose could have resulted in even more remarkable outcomes without significant increases in adverse effects.

The concern regarding a potential link between testosterone and heart disease stems from a line of thinking that men, who generally have higher testosterone levels than women, also have a higher incidence of heart disease. This has led to speculation that higher testosterone levels may contribute to a greater risk of heart disease. However, this line of reasoning is flawed and reflects the erroneous thinking that often pervades discussions about hormone replacement therapy.

The coexistence of two conditions within the same population doesn't necessarily imply a causal relationship between them. In the case of testosterone levels and heart disease, numerous studies have actually shown the opposite. Extensive research has consistently demonstrated a higher incidence of heart disease in men with low testosterone levels compared to those with higher levels. This is further supported by compelling evidence showing that administering testosterone intravenously during angina leads to an improvement in symptoms. Additionally, studies investigating the impact of Testosterone Replacement Therapy (TRT) on cholesterol levels have consistently shown a decrease in total cholesterol, LDL (bad cholesterol), and triglycerides, with either no change or only a slight decrease in HDL (good cholesterol). Furthermore, restoring testosterone levels to youthful levels can reverse the metabolic syndrome, which in turn reduces the risk of cardiovascular disease.

The short-term risks, also known as side effects, associated with testosterone therapy are minimal. In some cases, individuals who had a tendency to develop acne during adolescence may experience a reactivation of acne when testosterone levels are elevated to adolescent levels. However, this can be effectively managed with topical or oral medications. Additionally, there may be an exacerbation of hair loss on the scalp, which can also be effectively addressed with medications such as Finasteride or Propecia™ that inhibit the conversion of testosterone to dihydrotestosterone.

The primary concern for men considering long-term Testosterone Replacement Therapy (TRT) is whether it might elevate the risk of prostate cancer, benign prostatic hyperplasia (BPH), and cardiovascular disease. At physiologic replacement levels—the range we maintain our patients within—there is no evidence of an increased risk of prostate cancer or significant enlargement of the prostate leading to symptoms. While the longest prospective study, the three-year NIA study, didn't reveal any prostate problems, the vast majority of case-controlled, retrospective, and epidemiological studies spanning many years showed no heightened risk in men with testosterone levels above average.

The concern regarding TRT and prostate cancer arises from the well-documented fact that prostate cancers tend to shrink when deprived of testosterone. However, similar to breast cancer, this doesn't imply a causal or initiating role. If an individual has an occult (as yet undetected) cancer, TRT might potentially stimulate its growth. To address this, we conduct a total PSA screening for all our patients before commencing TRT, and we continue to monitor it closely thereafter.

Physicians who haven't undergone advanced training in Anti-Aging Medicine often adhere to the belief that hormone levels should only be corrected if they fall outside the "normal range". However, the challenge lies in the fact that this "normal range" isn't usually age-specific and encompasses the range within which 90% of all tested individuals fall. Consequently, only 10% of those tested would be classified as either high or low, potentially missing critical optimizations for overall well-being.

It's important to dispel some misunderstandings about testosterone and its categorization. While testosterone falls under the umbrella of compounds known as 'anabolic steroids'—molecules that promote muscle and bone growth—it differs significantly from the steroids often misused by professional athletes. Substances like deca durabolin, oxandrolone, and methyltestosterone, which are commonly abused, have distinct molecular structures from testosterone and are not naturally present in the human body. These compounds are potent anabolic hormones but can have adverse effects on various organ systems like the brain and liver due to their altered structure. Consequently, while they may share muscle-building effects with testosterone, their side-effect profiles are not comparable.

Unfortunately, due to the unethical practices of certain doctors and black-market vendors who sold these drugs in high doses to young men and athletes, they, along with testosterone, were categorized as Schedule II substances akin to morphine and other narcotics. This regulatory classification has unfairly tarnished testosterone's reputation among medical professionals and the general public, hindering many individuals who could benefit from responsible and closely monitored Testosterone Replacement Therapy (TRT).

Despite numerous well-documented benefits and minimal risks associated with Testosterone Replacement Therapy (TRT), controversies persist. At Regenerative Medicine & Aesthetics, our specialists firmly believe that optimizing testosterone levels to the 800-1000 range offers significant benefits to men of all ages.