testosterone print version
Low Testosterone - The Unsuspected
by Rick Cohen MD
There are more than forty million
men in the U.S. suffering from low levels of testosterone. But the vast majority
of them don't even know it. As the tremendous popularity of Viagra suggests, many
of these men are experiencing symptoms of male sexual dysfunction. Others find
themselves fighting more subtle battles against obesity, fatigue, depression and
insomnia-common symptoms of low testosterone that most doctors overlook or attribute
to the natural process of aging or stress. (1-2)
Why is modern medicine
missing the low testosterone mark?
Standard laboratory tests have failed
to pinpoint the problem. While medical science has determined that while a man's
total (protein-bound) testosterone levels remain relatively stable over time,
his bio-available (free) levels gradually decline at an alarming rate of two percent
each year beginning at age thirty. This means that a man in his sixties is functioning
with only about forty percent of the testosterone he had in his twenties. However,
when standard laboratory tests are performed, most men typically have only their
total levels of testosterone evaluated. Their more important bio-available levels
go unchecked. (3-4)
To make matters worse, most physicians require a
diagnosis of hypogonadism (a medical term used to classify total testosterone
levels that fall below a specified laboratory limit) prior to prescribing any
testosterone replacement medication. As a result, millions of American men who
are suffering from symptoms of low testosterone are walking around undiagnosed
and untreated. (5)
Detection: A Necessary First Step.
it comes to treating and eliminating the symptoms of low testosterone, detecting
the problem is a fundamental first step. Are your testosterone levels low? Take
the 10-point quiz below to and find out.
1. Are you over the age of 35?
2. Do you have poor muscle tone?
3. Are you prone to weight gain, particularly
around the midsection?
4. Do you frequently feel weak and tired without any
5. Is your recovery from exercise slow?
6. Do you have
a low sex drive or symptoms of sexual dysfunction?
7. Do you feel depressed,
irritable or unmotivated?
8. Do you have difficulty coping with stress?
9. Do you have trouble getting a good night's sleep?
10. Do you smoke cigarettes,
drink alcohol regularly or take prescription medicines?
If you answered
"yes" to any two of these ten questions, chances are your testosterone
levels are less than optimal. How can you know?
The answer is simple:
Test yourself in the comfort and privacy of your very own home.
to being more convenient and less costly than standard laboratory serum tests,
recent medical research has proven salivary hormone testing to be far more accurate
when it comes to measuring bio-available testosterone and a number of other key,
male hormones. (6)
Prohormones - A Better Option for Men with Reduced
or Borderline Levels of Testosterone.
While the soon-to-be-released topical
testosterone medication, AndroGel (7), will eliminate the need for painful injections
and irritating patches for the few men who have been diagnosed with hypogonadism,
but there is a kinder (and smarter) alternative for men who do not need or do
not qualify for testosterone replacement therapy. That alternative is ProMale.
Based on innovative European technology, ProMale is an all-natural, non-prescription
product developed several years ago by an U.S. physician for use in his own medical
What does ProMale do? It provides for the effective application
of prohormones (steroid hormone precursors)-the basic, raw materials a man's body
needs to produce testosterone.
While ProMale is not intended as a treatment
for hypogonadism, it offers a safe, effective and accessible treatment option
to the millions of men who are interested in maximizing their physical, mental
and sexual potential. The more specific benefits associated with the use of ProMale
and high levels of testosterone in include: (8-13)
o Improved mood and
overall sense of well-being.
o Increased muscle mass and strength.
An enhanced sex drive and function.
o Better memory, concentration and visual
o Improved cardiac health through the natural reduction of cholesterol,
blood pressure and blood sugar.
o Increased tolerance to stress.
As an all-natural topical prohormone formula, ProMale differs
from testosterone replacement medications in several important ways. First, it
does not replace testosterone directly. As a result, ProMale does not suppress
the body's own ability to produce testosterone and is far less likely to promote
the onset of testicular atrophy (a common side effect linked to the use of prescription
Second, prohormone formulas like ProMale can
never push a man's testosterone levels too high because the important 17 and 3
beta hydroxysteroid enzymes that are used to convert prohormones into testosterone
are "rate limited." This means that regardless of the quantity of prohormones
delivered to the body, only a fixed amount of these will ever be converted to
In addition, prohormones can always be synergistically
used in conjunction with any other natural or pharmaceutical therapies to stimulate
the body's own ability to produce testosterone. And last, but certainly not least,
prohormones cross the blood/brain barrier more quickly than testosterone does.
As a result, they may be more effective in enhancing cognitive and sexual functions
than testosterone itself. (14-19)
A Prohormone Primer:
in the testes, testosterone is the end result of a series of biochemical steps
that all start and fundamentally depend on cholesterol (the primary material from
which all steroid hormones are created). Before it can become testosterone, however
cholesterol must be chemically converted into several different prohormones in
the following order-progesterone, DHEA, androstenedione and androstenediol. (20)
Like estrogen, progesterone is also considered a
female hormone. Still, the male body requires it to create a variety of important
stress hormones such as cortisol and DHEA.
Like testosterone, progesterone
levels decline with age and as a result of stress. In addition, laboratory studies
and clinical evidence show that progesterone plays an important role in buffering
the hormonal effects of high estrogen by opposing the activity of estrogens on
a cellular level. This particular prohormone may also inhibit the abnormal growth
of prostate cells by interfering with the 5-alpha reductase enzyme, which converts
testosterone to DHT. (21)
Produced in the adrenal glands,
DHEA plays an important role in male hormone production. Like testosterone and
progesterone, DHEA levels significantly decline over time-and in response to chronic
This particular prohormone has many well-documented benefits, the
most notable of which is to boost immune function, mood and libido. In clinical
practice, DHEA has proven to be very effective in supporting and restoring healthy
adrenal function, improving energy and enhancing overall health and well being.
Androstenedione and 4-Androstenediol
prohormones, androstenedione (AD) and 4-androstenediol (4AD), are effective in
enhancing testosterone production because they are only one, small biochemical
step away from testosterone. And it is for this reason that AD and 4-AD can have
such a strong and positive effect on male health and well-being. While the hormones
progesterone and DHEA are necessary in the testosterone production cycle, they
cannot be used reliably to support testosterone production. (23-24)
(andro-4-ene,3,17 dione) and (4AD) (4-androstene-3beta, 17 beta-diol) are naturally-occurring
steroid hormones found in some plants and in all animals. In mammals, they are
produced in the gonads and adrenal glands and can be directly measured in the
blood stream. Based on the most recent research, 4AD is considered the preferred
andro prohormone for use by men. 4AD is not only more readily converted to testosterone
than AD, it is not directly converted to estrogen, which in high amounts can adversely
effect male health. [Widely-recognized as a female hormone, most men are surprised
to learn that estrogen is also present in their bodies. Produced in very small
amounts as a by-product of the testosterone conversion process, normal levels
of male estrogen encourage a strong libido and healthy brain function. High estrogen
levels, on the other hand, can lead to the suppression of testosterone production
and a reduced testosterone supply. High estrogen levels can also contribute to
fatty weight gain, prostate enlargement and a higher incidence of heart disease.]
Prohormones in Olympic History - The Birth of a "Secret
First synthesized in the 1930's, androstenedione was first
studied by Dr. Charles Kochian (a world-renowned expert in steroid hormones) who
discovered its anabolic and androgenic properties. Dr. Kochian's findings remained
relatively unrecognized, however, until the Berlin Wall fell and many of East
Germany's highly-advanced athletic training and nutrition secrets were revealed.
What was determined? That during the 1970's and 1980's, the country's most
victorious Olympians were using an AD nasal spray to boost their testosterone
levels and, as a result, their athletic performance. The effects of this nasal
spray included large, fleeting-and virtually undetectable-elevations in testosterone.
And it was these significant and sudden increases in serum testosterone that served
to enhance the athlete's muscle strength prior to a competitive event. (29)
Because it plays a key role in determining energy, mood, libido, muscular
and sexual development, testosterone is the most important hormone in the male
body. But as part of the natural metabolic process, testosterone can be readily
converted into the end hormones estrogen and DHT. The production of these two
hormone by-products can sometimes cause side effects (such as increased body fat,
an enlarged prostate or increased hair loss.)
Chemically very similar
to AD and 4-AD, norandrostenedione and norandrostenediol convert to nortestosterone.
While the range of nortestosterone's benefits are somewhat more limited than those
of testosterone, this hormone does not convert to DHT or estrogen and is therefore
a better option for androgen-sensitive men. Nortestosterone is also a better choice
for men who specifically seek the anabolic effects of testosterone such as increased
muscle size, strength, quicker recovery from training and injury.
- Making the Right Choices
When it comes to deciding on which kind of
prohormone product you should be using, there are a few basic rules to follow:
If you choose to use an oral product avoid the use of Androstenedione
opting instead for Androstenediol.
A study published in the February 9,
2000 issue of The Journal of the American Medical Association provided interesting
data on the effectiveness of oral androstenedione. Study results showed no increase
in testosterone levels and a moderate increase in estrogen levels among subjects
taking 100mg dose of androstenedione. After being given a relatively large (300mg)
dose of androstenedione, a short (two-hour) but measurable (34%) increase in testosterone
resulted (30). Unfortunately, this increase was accompanied by an even more significant
rise in estrogen. As previously mentioned, sustained high levels of estrogen can
increase a man's risk of obesity, prostate disorders and cardiovascular disease.
Because the use of oral androstenedione appears to promote increased levels
of estrogen and has only short-term effects on testosterone, it is a less than
optimal choice for restoring healthy testosterone balance. In comparison, research
studies have shown that androstenediol is much more effectively converted to testosterone
and does not elevate estrogen. (31)
The Oral Dosing of Prohormones
is Costly, Inefficient and Potentially Unhealthy.
Before any oral prohormone
can enter into the blood stream, it must first be metabolized in the liver where
enzymes such as aromatase (which converts androstenedione and testosterone to
estrogen) destroy a full 95% of the prohormone dose. For this reason, large doses
of androstenedione are needed to elevate testosterone. And even small doses cause
significant estrogen increases. (32)
High doses of oral prohormones can
also reduce levels of good (HDL) cholesterol. And the extremely high amounts of
steroid metabolites found in the urine after a small (50mg) oral dose of androstenedione,
suggest that oral prohormones may be damaging to the liver. (33)
because oral prohormones are so rapidly metabolized, they offer only small and
fleeting (two to three hour) increases in testosterone-even when large doses are
taken. In order to achieve the desired effects, repetitive (three to four times
daily) high dosing is required.
The Advantages of Sublingual Delivery
New delivery systems such as cyclodextrin tablets and liposomal sprays enhance
the transport of prohormones through the mucus membranes of the mouth. This sublingual
approach to prohormone delivery by-passes liver metabolism, allowing for their
rapid absorption, directly into the blood stream. Consequently, prohormones delivered
sublingually are safer and more effective than those taken orally. Recent studies
have shown that at a 25mg dose cyclodextrin-based androstenediol raises testosterone
300% more effectively than a 300mg dose of oral androstenedione. In addition,
the low dose cyclodextrins have no effect on estrogen levels. (34-37)
the rapid and short-acting effects (two-three hours) of sublingual prohormones
make them an impractical choice for long-term testosterone restoration. (Ed.-
See section after references called IAS notes).
For Optimum Absorption and Results.
Using the skin as a natural reservoir
for delivering a continuous flow of prohormones to the body, a next generation
of topical products have quickly become the delivery system of choice. In addition
to maintaining their original potency, by-passing entirely the destructive effects
of the liver, transdermal prohormones are absorbed evenly and quickly (within
forty-five minutes of application) into the skin. Perhaps more importantly, their
effects are not fast or fleeting, transdermal prohormones enter the bloodstream
slowly and consistently. In addition, transdermal delivery offers several other
significant advantages over both oral and sublingual products.
advantages include: (38-40)
single, morning application is simply all that is required.
Because they are applied to the skin and not swallowed, transdermal
prohormones do not pass through the liver; they therefore provide for higher potency
at a lower (and ultimately more economical) dose.
Continuous Support of Healthy
Because transdermal prohormones are absorbed evenly over time,
topical delivery provides continuous support for the testosterone production process.
It is this "steady-state" approach to testosterone enhancement has been
shown most clinically effective in maximizing the overall benefits of prohormone
use. Transdermal delivery does not create the unnatural hormone "spikes"
that typically accompany the use of oral and sublingual products.
As well as negatively influencing a man's overall
health and well-being, low testosterone has also been linked to the onset of diabetes,
osteoporosis, prostate disorders, Alzheimer's and cardiovascular disease. As a
result, millions of men around the world have been safely undergoing testosterone-related
treatment for more than fifty years. And with the vast amount of scientific data
that has been compiled over the past decade alone, the benefits of testosterone
restoration can no longer be scientifically questioned. (41-42)
there is virtually no scientific evidence to suggest that testosterone restoration
causes prostate cancer, testosterone and prohormone therapies remain controversial
due to their possible role in worsening an undiagnosed prostate cancer. (43-47)
Some controversy has also been created by a few members of the media, medical
profession and government who question the ethics and safety of prohormone use.
Unfortunately, the vast majority of these individuals do not know-or understand-the
significant differences between prohormones and anabolic steroids. (Ed. We recommend
reading Dr. Wright's article in this Bulletin regarding lowering hormone related
Anabolic steroids are synthetically derived, frequently-abused
and used with great health risks to artificially enhance athletic performance
and strength. Prohormones are naturally present in the body, abuse-proof and can
be safely used to restore healthy levels of testosterone. (48-50)
A Transdermal, Multi-Prohormone Formula for Men.
ProMaleTM is a rejuvenative
topical prohormone formula specifically designed for the aging male. Formulated
according to the same standards of purity and quality found in prescription medications,
ProMale uses a percutaneous (through the skin) gel matrix to deliver these important
o Androstenediol-to enhance the androgenic effects
of testosterone (increased libido, sexual function and improved mood)
and norandrostenedione-to enhance the anabolic effects of nortestosterone (increased
strength and lean mass)
o DHEA-as a buffer against stress
its estrogen and prostate protecting effects.
ProMale is most effective
when used by [men who suffer from symptoms related to reduced or borderline levels
of testosterone]. The product is for [those who want to restore their youthful
vigor and vitality] as well as those who simply have an [interest in building
lean mass and enhancing their overall athletic performance]. ProMale should not
used by men be with pre-existing, hormone-dependent cancers (such as a prostate),
those with unstable blood pressure or those under the age of twenty-five. Any
man over fifty years of age should have a baseline prostate exam and PSA measurement
prior to using ProMale for the first time.
Enhancing the Effects of
In order to maximize the effects of ProMale-or any other testosterone-enhancing
product-it is important to follow a hormonally-balancing dietary plan and to adhere
to an appropriate fitness program. For additional information on diet and exercise,
please read the Anti-Aging Zone by Dr. Barry Sears (51) and
refer to the Spring 2000 issue of the IAS Anti-Aging Bulletin. Outlined below
are a few fundamental suggestions that can help you restore and maintain healthy
levels of testosterone: (52-60)
o Take steps to buffer and release mental
o Get at least one hour of exposure to sunlight daily (especially
during winter). Sunlight plays an important role in regulating testosterone release
in the brain.
o Support your body's natural, hormonal circadian rhythms by
going to bed and waking up early.
o Limit your alcohol intake to one glass
of red wine daily.
o Reduce or eliminate your use of testosterone-reducing
medications, especially diuretics, anti-fungals and cholesterol lowering drugs.
o Slim down. Excess body fat raises estrogen and inhibits testosterone production.
A Basic Dietary Strategy:
As the saying goes, "You are
what you eat!" If you want to maintain high level of testosterone, don't
forget to pay attention to these important dietary rules:
amounts of protein.
"Protein" in Latin means "above all
else." Know that adequate protein is a dietary necessity as it stimulates
testosterone release. And it's the fundamental building block for muscle repair
Eat more vegetables.
Especially green, leafy
and cruciferous vegetables such as broccoli, cauliflower, kale, Swiss chard, Brussels
sprouts and cabbage. These vegetables contain phytochemicals essential for healthy
metabolism of estrogen (Ed.- For further information see Jonathan Wright MD's
article in this same issue).
Limit your intake of refined, high-carbohydrate
These include simple sugars such as cookies, candy and ice cream;
and starches such as breads, potatoes and pasta. Excess intake of these carbohydrates
raise blood sugar rapidly, creating chronically elevated levels of the hormones
insulin and cortisol. These two hormones oppose the action of testosterone and
diminish its production.
Eat healthy fats.
such as (the Omega 3 fatty acids found in fish and flaxseed) and saturated fats
are essential for normal testosterone production. All steroid hormones are produced
from cholesterol and when fats are deficient in the diet, this process will be
inhibited. Studies clearly indicate that low fat diets result in lower testosterone
levels. Those higher in protein, lower in carbohydrate, and moderate in fat cause
the greatest sustained levels of testosterone. (Ed.- An interesting tip was given
to me recently, how can you tell if a fat will be good or bad for you? Well- it'll
probably be bad if it congeals at room temperature).
Take a high-quality,
multi-vitamin mineral supplement.
Vitamins A, E, C and B6 and zinc are
all used by the body in converting prohormones to testosterone. In fact, of all
the minerals found in the body, zinc is the most crucial for testosterone production.
Zinc deficiency is very common in the U.S. population, especially among athletes
and the aged. Not only is zinc absent in most commercially-processed foods, it
can be depleted from the body by alcohol and many prescription medications including
Notes on Exercise:
Adequate exercise helps keep
men feeling and looking fit by naturally stimulating testosterone release-and
by preventing its' breakdown. The duration, intensity and frequency of exercise
all determine a man's levels of testosterone. Be aware that testosterone levels
increase most with short, periodic, more intense activity. They decrease with
prolonged, frequent activity. Studies show testosterone levels increase with forty-five
to sixty minutes of exercise. After this time, however, testosterone levels begin
to decline. (61-65). Healthy levels of testosterone are necessary for muscle growth
and repair. Since frequent, extended training doesn't allow sufficient time for
testosterone levels to recover, symptoms of over-training may develop. These symptoms
include muscle soreness, diminished performance, fatigue, immune suppression and
Guidelines for Increasing Muscle and Maximizing the Effects
of Exercise on Testosterone:
o Focus on low-volume, high-intensity strength
o Limit your exercise sessions to sixty minutes or less.
Exercise at high-intensity no more than two-three times weekly.
o Do all
aerobic exercise (except for warm-ups and cool-downs) on separate days (or at
least separate times during the day) from strength training.
o For optimum
fitness, change your exercise regimen every eight to twelve weeks.
Testosterone levels reach a peak during a man's early twenties.
Aging and lifestyle factors such as stress, improper diet, physical inactivity,
smoking, drinking and the use of prescription medications can significantly reduce
these levels. While most physicians have not yet recognized the wide spread incidence
of low testosterone, millions of men are suffering from a variety of debilitating
symptoms which range from sexual dysfunction to depression and fatigue. Currently,
the more subtle symptoms of low testosterone are commonly attributed to stress
or the natural process of aging.
As a result, many symptomatic men are
walking around undiagnosed and untreated. However, thanks to recent innovation
in hormone testing and prohormone delivery techniques, the incidence of low testosterone
can now be significantly reduced- without the use of prescription medications.
We thank Dr. Cohen for his first article in the IAS Anti-Aging
Bulletin, maintaining "healthy" levels of testosterone may be the single
most important factor an aging man can do (it's also important for women too!).
IAS's introduction of ProMale cream allows for transdermal use and provides
an excellent base for regular delivery of the prohormones mentioned in Dr. Cohen's
article. Doses for ProMale cream are 2ml daily for a maximum period of 8-weeks,
after that period an equal period of discontinued use should be applied. This
allows each bottle of ProMale to supply 72-days of Prohormone delivery. Occasional
use of AndroSpray, the sublingual spray that provides androstenedione and androstenediol
can be considered as a way of boosting energy levels through short bursts of testosterone
levels, this could be in addition to the regular base use of ProMale.
Be aware that certain countries have made DHEA, androstenedione and androstenediol
controlled substances, and even though they exist in small quantities in the ProMale
cream this could be problematic. The usual IAS terms and conditions apply and
IAS will always inform you if it knows of any countries that have taken these
steps. To the best of our knowledge DHEA is a controlled substance in Australia,
Canada, EU, New Zealand and Norway. Androstenediol and Androstenedione is a controlled
substance in Norway, and may be a controlled substance in Australia and Canada.
We look forward to further transdermal prohormone delivery systems and indeed
further articles from Dr. Cohen.
going to expand the possibility of both saliva and blood testing laboratory services
to its members. This not only can allow for accurate and regular examinations
for "complete" anti-aging packages but at a simple level can provide
you with a reference point. I.E. Are my testosterone levels increasing, declining
Currently, an "at-home" saliva test kit is available
that can test for testosterone levels. This can also test for estradiol, cortisol
or DHEA. (Please see back page for further details). Basically, you buy a kit,
follow the simple instructions and send the salvia stick off to the laboratory
(there is nothing else to pay!). The lab will then analyze your sample and send
you a report of your hormone level. Such results should be kept and over a period
of time you can see the changes for yourself!
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