Testosterone deficiency?


Testosterone deficiency? – Dr. Rob America’s Fitness Doctor®

Shriveled testicles, “What?” drooping scrotal sacs, “Come on!” decrease in sex drive, erectile dysfunction, decreasing muscle mass, increasing body fat, less energy, decreased sense of well-being, more fatigue and competition from younger men signals a declining virility…..”What gives Doc?”  This decline could accompany the aging process, and be reluctantly accepted as fate. But, that does not need to be the case! However, I am also seeing younger and younger men who experience these changes and this is not normal!

What is particularly disturbing is in the last 10 years the number of young men, under the age of 40, and some in their early 30’s, that I see with hypogonadism associated with type 2 diabetes (insulin resistant), obesity, high cholesterol, sexual dysfunction, and fatigue.

Men with testosterone deficiency are often under-diagnosed and often undertreated. The first signs of decline in testosterone are generally slightly vague: diminished subjective energy levels, increase in irritability, decline in mood, decline in cognitive performance, and loss of early morning erections.

Some men complain of infertility, decrease in beard and body hair, increase in body fat, decrease in muscle mass, gynecomastia (man boobs), increase in belly fat, changes in size or firmness of testicles.

While decreased sex drive and erectile quality are often the most frequent complaints associated with falling testosterone levels, they are actually some of the latest symptoms, with other symptoms present much sooner.

Often, men and their family members attribute these symptoms to psychosocial stressors or “aging” and do not seek medical help from their doctor. As testosterone declines, age-related drops in testosterone levels is associated with identifiable signs or symptoms: a decline in muscle mass and strength, decrease of bone mass, increase in body fat, particularly abdominal and chest fat, coronary artery disease, increasing cholesterol, decline in cognitive skills or concentration and memory, decline in stamina and exertion performance, increased frequency of erectile dysfunction, decline in sex drive and frequency of sexual thoughts, and decreased sense of overall well-being, decreased energy level and stamina.

Hormones released from the brain regulate testosterone production. The hypothalamus and pituitary gland located in the brain produce hormonal signals that result in the production of testosterone. The hypothalamus is located just above the brain stem, and among its many functions, it produces gonadotropin-releasing hormone (GRH). GRH travels to the pituitary gland located in the base of the brain stimulating the gland to release FSH (follicle stimulating hormone) and LH (luteinizing hormone). These hormones travel through the bloodstream to activate the sex organs in both men and women. These hormones also have a role in regulating testosterone levels in the bloodstream.

The majority of testosterone circulates in the blood bound to a carrier protein, which is a hormone produced in one area of the body and has its effect on another area it also assists the hormone to travel through the bloodstream. This carrier protein is called “sex hormone binding globulin,” or SHBG. When testosterone is being carried by SHBG, it is considered “bound”. Bound testosterone does not play an active role in the body; only the unbound or “free” testosterone is able to enter the different cells of the body and exert its androgenic and anabolic effects. Anything that affects the function or the amount of SHBG can also affect the total circulating amount of active testosterone.


  • More subtle
  • Progresses over 20 year period
  • Starts in 30’s
  • A decline in muscle mass and strength
  • Decrease of bone mass
  • Increase in body fat, particularly abdominal and chest fat
  • Metabolic Syndrome (coronary artery disease and increased cholesterol)
  • Decline in cognitive skills, concentration and memory
  • Decline in stamina and exertion performance
  • Increased frequency of erectile dysfunction
  • Decrease in sex drive and frequency of sexual thoughts
  • Decreased sense of overall well being, perception of energy level and stamina
  • Depression
  • Fatigue
  • Anxiety
  • Aches and pains
  • Loss of muscle elasticity

As men age testosterone is increasingly converted to estrogen. Which is why men never need estrogen therapy. Sometimes they need medication to decrease estrogen levels.  When taking testosterone, it may convert to estrogen in a process called aromatization.  Men end up suffering from to little testosterone, and too much estrogen.

Obesity…estrogen is stored in fat and fat cells have a sizeable amount of the enzyme called aromatase, which transforms converted testosterone into estrogen.  These high levels of estrogen compete for receptor sites.  Obesity presents more problems with the potential for cancer, heart disease, and diabetes.  Excessive alcohol, drug interactions and zinc deficiency also promote aromatization and resulting high estrogen levels.  Exactly what you don’t want!

So What Can You Do About It?

First, start eating man food! That’s not fried chicken wings and beer!  That’s real food from the earth!  What comes out of the ground and off a tree or bush or from an animal or fish. Second, get regular, meaningful exercise on a consistent basis strength training 3 days per week and cardiovascular training the other 3 days per week.  Third, improve your sleep.  Get 8 hours of regular, uninterrupted sleep nightly.  Fourth, limit your alcohol consumption. Fifth, stop smoking.

Make sure to see your physician and ask for labs to be done to check your testosterone levels and all the other necessary tests to be performed.  Symptomatic men with TT level less than 300ng/dL may be candidates for testosterone therapy optimization.

Now let me share with you my opinion based on currently available research as to the best form of testosterone replacement if you need your testosterone levels optimized.  Ideally injectable testosterone replacement therapy is given once per week.  This minimizes testosterone peak levels, which has a direct effect on estradiol levels.  The greater the testosterone peak the greater the estradiol peak. This is minimized by weekly injections. Excess conversion to DHT does not occur with once a week dosing and testosterone levels are well maintained.  Once testosterone therapy is started it should be monitored regularly for appropriate levels, estradiol conversion, hemoglobin and hematocrit, sides effects, medication reactions particularly anticoagulants and testicular atrophy.  Also testosterone therapy does not cause prostate cancer.


“Fitness is the Footprint of Life.  Follow It!”

Dr. Rob Kominiarek,  America’s Fitness Doctor®

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