Testosterone is the prodominant male hormone, it plays a key role in the development of male reproductive tissues. It can convert to dihydrotestosterone (DHT) which is the most potent male hormone, this is responsible for producing male sexual characteristics, such as the virile body (muscle and bone mass), beard, body hair, deep voice, erections.

The daily production of testosterone in young healthy men is 7mg per day. This is 20-30 times higher than in women. In young men, usually the testosterone levels in the morning are 20% higher than in the evening. Testosterone production is greatly stimulated by the pituatary hormone luteinizing hormone (LH). In individuals who don’t produce LH, T levels are very low (less than 20% of normal). The testicles produce the majority of T, however a small amount is produced by the adrenal glands and in other tissues like fat cells.

Factors that affect T production like intense physical activity burns greater amounts of T, therefore deeply depleting the levels. Likewise, intense emotional stress blocks the release of LH and thus T secretion is affected. Positive emotions may temporarily increase T levels. Foods high in protein or saturated fat increase T production. Sweets, sugars and high cereal fibre diets can reduce T levels. T levels decrease with ageing, by the time a male reaches the age of 70, free T levels will decrease by more than 50% consequently over time most men will experience the mental and physical symptoms of T deficiency.

There are many complaints relating to T deficiency, the main ones are physical appearance, with abdominal obesity, decreased muscle mass and strength, lack of mental firmness, loss of self confidence and authority, depressed mood, suicidal tendencies, persistant fatigue that increases with physical activity, decreased or absense of sex drive and erections, increased nervousness and irritability, loss of initiative and interest in life, physically fragile, poorly undeveloped beard, decreased body hair, prostate enlargement and smaller genitals.

Long term T deficiency may increase susceptibility to increase cardiovascular risks, fertility, obesity, type 2 diabetes, depression, memory loss, osteoporosis and poor wound healing. The best lab tests for T are bloods testing total Testosterone, androstanediol glucoronide, SHBG and estridiol, and the pituitary hormones such as LH and in particular FSH (follicle stimulating hormone). FSH is more often abnormal than LH. The best conditions for testing are to perform blood and 24 hour urine tests under sedentary conditions to obtain baseline levels. Patients should avoid intense physical activity 24-72 hours prior (example sex, vigorous exercise or emotional stress). This can reduce T temporarily. If the patient is already on topical therapy, blood tests should be done 8-14 hours after application. If on injection therapy, patients may need to wait 12 days after injection.

T restoration works slowly. Generally the first improvements are felt after 1-3 months of treatment, for improvement of sexual potency it often takes 3-6 months. A faster and greater improvement is seen in men with a near perfect diet, high in protein, the avoidance of sweets and carbohydrate starches (bread, pasta, rice, cereals) and extremely low in alcohol. To optimize T treatment and activity, eating a paleolithic diet which combines fruits, vegetables, lean meat, chicken, eggs and fish.

Topical therapy is the number one route as it completely bypasses the liver and provides more consistent levels without fluctuations in comparison to injectable testosterone.

Here at custom made medicine, we can show you how to best utilise your testosterone topical therapy. Careful supplementation, with the assistance of laboratory test results, usually provides an improved quality of life and elimination of symptoms.

Determining the cause of lowered T may be difficult, however, we can look at lifestyle changes to boost your T production, reducing estrogen levels and combating elevated estrogen levels and increasing testicular output of testosterone as well as testosterone supplementation.

Erectile dysfunction is most commonly due to diabetes(31%) and cardiovascular disease(62%). Here at custom made medicine, we can look at your blood levels and together with your physician bring them to levels which will increase night time erections or libido depending on the levels we aim for. Please refer to our erectile dysfunction link for the many treatments available.


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