In these cases treatment should be directed at the underlying cause. During the evaluation of low testosterone there may be a diagnosis of a clear cause for the condition that we can treat. There is little data regarding the appropriate criteria for performing the study. Recommendations also included waiting at least 6 months after successful prostate cancer treatment to initiate TRT.50 In addition, several case studies found that TRT is safe following radical prostatectomy for prostate cancer. Young, hypogonadal men and healthy, older men showed modest benefit in fat-free mass and muscle strength. The systematic review above mainly included retrospective case–control or cross-sectional studies and included only two nested case–control studies, which was unable to evaluate the causal relationship between testosterone and T2DM. To summarize, our findings from the meta-analysis provide strong epidemiologic evidence for testosterone deficiency as an important risk factor of T2DM in men. Though the above-mentioned findings strongly suggest that testosterone supplementation has a protective role against diabetes, more clinical trials are still needed to confirm this scenario, to determine the dosage and the approaches. Treatment strategies It is possible that the differences in testosterone levels per se, where women still have comparatively much lower testosterone levels than men with testosterone deficiency, or a potential protective effect of estrogens could explain these differences. DHT, rather than testosterone, may play a role in women with PCOS; long term DHT treatment in female mice displayed ovarian, endocrine, and metabolic characteristics of PCOS seen in humans. In the studies in men described above, there was an association between lower levels of total testosterone and the development of NAFLD. They underwent blood sampling to measure serum SHBG and total testosterone by immunochemiluminescence while FT and BT were calculated. Men with fatty liver had lower total testosterone levels and SHBG levels and higher DHEA and E2 levels. If low testosterone is identified and treated early, it can help protect bone health and reduce the risk of osteoporosis. Women with low testosterone are at higher risk for developing this condition, especially as they age. When testosterone levels drop, bones may lose their strength over time. There is no research on the combination of these factors and how those affect hormone functioning. The associations between these factors and lower testosterone do not necessarily mean that these factors are causing the decline. These products certainly disturb proper hormonal function and may be responsible for the decline in global testosterone. These conditions can disrupt hormone production and balance, leading to a reduction in testosterone over time.Other presenting symptoms of a pituitary adenoma, with or without hyperprolactinemia, are headaches and visual-field defects (Table 3).The controversy surrounding this issue stems mostly from the dearth of long-term randomized studies that answer the question of whether or not testosterone therapy in normal, healthy, aging men is safe and improves quality of life.Still, many would likely benefit from accurate sources of information and discussing any concerns relating to testosterone with a trained health care professional.Almost all studies, however, whether observational or clinical in design, had small samples sizes.One of the studies counted as showing a favorable effect did not demonstrate a change in total or high-density lipoprotein (HDL) cholesterol or triglycerides but reported a 13% reduction in LDL cholesterol.In men with functional hypogonadism arising in relation to NGI (such as men with obesity, T2DM, or any other long-term illness), studies have yielded contradictory data in respect of cardiovascular safety and clinical efficacy of testosterone. In “gray area” patients, expert and guideline statements support the determination of biologically active testosterone by measuring free testosterone.23,30,77 Equilibrium dialysis is the gold standard for free testosterone measurement, but it is complex and not available at many laboratories.78 More commonly available analog assays are not recommended due to lack of sensitivity.13,88 Therefore, most laboratories utilize calculated free testosterone according to Vermeulen method, which is based upon serum total testosterone, SHBG and albumin levels. This may be due to altered serum SHBG levels as seen in older or obese patients, and SHBG levels should be checked and serum testosterone levels repeated. The clinical presentation of TD in adult males can be variable, insidious, and often confused with other clinical conditions.78 Because testosterone is a key regulator in male sexual function pathways, common symptoms of TD include decreased libido, reduced nocturnal erections, ED, and male factor infertility.79,80,81,82 Additional signs and symptoms less specific to TD are reflective of testosterone's broad systemic effects and include decreased energy, decreased cognition, reduced muscle mass, reduced strength, increased adiposity, decreased bone mineral density, hot flashes, sleep disturbance, and depressed mood.23,24,30,78 Hypogonadal symptom screening questionnaires can be sensitive, but are poorly specific for diagnosing TD; accordingly, their use is not strongly recommended. Intratesticular testosterone levels (200–1000 ng ml−1) are 80–100 fold higher than serum levels and are critical for spermatogenesis and maintained by androgen binding protein produced by sertoli cells.16 In addition to testosterone, estrogen aromatized from testosterone, other androgens, and inhibin all provide negative feedback inhibition at the level of the hypothalamus and pituitary glands modulating production.17 3. Cells Culture and Treatments For men’s testosterone, interassay CVs were 7.33 and 15.25% at high and low testosterone, respectively, and intraassay CV was 16.10%. The interassay coefficients of variation (CVs) were 7.08 and 13.81% for high and low testosterone, respectively, and the intraassay CV was 6.36%. Participants provided saliva samples for hormones by spitting into 17-mL polystyrene tubes. Total serum testosterone consists of free testosterone (2%–3%), testosterone bound to sex hormone binding globulin (SHBG) (45%) and testosterone bound to other proteins (mainly albumin −50%) (Dunn et al 1981). We shall try to facilitate this by examining the effects of testosterone on the various symptoms and organs involved. As with any other clinical intervention a decision to treat patients with testosterone requires a balance of risk versus benefit. On the other hand, similarities between normal aging and the symptoms of mild androgen deficiency make the clinical diagnosis of hypogonadism in aging men more challenging. If there is enough damage, the thyroid gland can no longer make enough thyroid hormone, causing hypothyroidism. Hypothyroidism is a disease state where the thyroid gland does not produce enough thyroid hormone to support metabolic processes in the body. Testosterone is men's primary sex hormone and anabolic steroid, serving an essential role in male development. I've helped hundreds of women balance their hormones naturally. Similarly, the incubation of spermatozoa with increasing concentration of nicotine reduces the percentage of viable spermatozoa and increases the number of spermatozoa with altered chromatin compactness, or DNA fragmentation . This meta-analysis involved a total of almost 6,000 participants, and found a reduced sperm count in smokers, with higher effect size in infertile men and in moderate/heavy smokers . Another meta-analysis was conducted in 2016, including only studies performed after the introduction of 2010 WHO manual for the laboratory evaluation of human semen. Other studies failed to demonstrate a detrimental effect of cigarette smoking on sperm concentration 46,47 or found a trend for a reduction of sperm count with the increasing number of smoked cigarettes, without reaching statistical significance . Ten years later Künzle and colleagues found in smokers a decrease of about 15% in sperm density and of about 17% in total sperm count compared to nonsmokers . 6. Mass spectrometric analysis and protein identification This is vital as the anabolic effects of testosterone replacement therapy in military personnel has long-term implications , including protective effects on muscle and bone (which may prevent stress fractures or load carriage incidents ), and the likely improvement in recovery from completed missions or injuries sustained. Using a 14-day eucaloric control period, 28-day intervention of 200 mg/week testosterone enanthate supplementation with an exercise- and diet- induced energy deficit, and subsequent 14-day ad-libitum recovery period; this study demonstrated a reduction in weight loss and improvement in lean mass gain, producing benefits in body composition and health status. Healthcare professionals use testosterone replacement treatment to treat male hypogonadism or low testosterone. “Just checking” testosterone levels without any symptoms or concerns is unlikely to provide benefit or useful information. ASRM's Frequently Asked Questions (FAQ) provides answers to common questions about reproductive health. ASRM has prepared resources to help you explain and advocate for reproductive rights and the continuation of in vitro fertilization and other fertility treatments. ASRM briefing united lawmakers, physicians & patients on IVF access, exposing RRM limits and urging policies to expand fertility care options. (There’s a reason your crown jewels hang away from your body.) Might this just be a new normal that we’re adjusting to? Most children are phone owners by the age of seven, a report from Childwise showed , and it comes with implications. This is an archaic mindset that has been debunked by medical study. Some men feel that they are losing their masculinity, others see these symptoms as proof of their own mortality — a biological midlife crisis. Men may find that they need to shave their face less, or may experience a reduction in hair on the chest, legs, or abdomen, possibly indicating low testosterone. However, whether a high or low SHBG level is concerning in your case depends on how a health professional interprets this result with your symptoms and other results (total and free testosterone levels). It is possible to have low testosterone without symptoms, and it is normal for testosterone levels to decrease gradually with age.3 Low testosterone levels in males can also cause symptoms of reduction in muscle mass, while having the patient gain more body fat. Nevertheless, whether for MH or TDS, the basic diagnostic criteria across all guidelines are broadly similar, including a combination of clinical symptoms with biochemical evidence of low T, plus an impact on physical health and wellbeing. Although the benefits and safety profile of using testosterone to treat well-found MH are well-established, its use in men without a verified diagnosis of hypogonadism carries significantly less reassurance . This is additionally overlaid by increasing observations of ‘testosterone seeking behavior’ (TSB) by vulnerable men whose views have been influenced by unregulated “men’s health” websites and online chatrooms . Whilst it is conceivable that genuine need is now being addressed that was previously unmet, these observations more plausibly reflect the impact of promotional and educational activity to portray testosterone as an “elixir” of sexual and cardio-metabolic youth. Over the past 20 years, there has been a worldwide surge of T prescribing, mainly for age- or obesity-related decline in serum T and/or men reporting erectile dysfunction. AAS, anabolic androgenic steroids, AMH, anti-Müllerian hormone; DHEAS, dehydroepiandrosteronsulfate; FSH, follicle-stimulating hormone; LH, luteinizing hormone; P-, plasma; S-, serum SHBG, sexual hormone-binding globulin. Reproductive hormones (FSH, LH, testosterone, inhibin B and anti-Müllerian hormone (AMH)) were measured using morning blood samples. These disturbances may lead to impaired sexual potency, eventually causing disruption of psychological health in affected males. Considering the above-mentioned environmental risk factors in the regular workup algorithm of clinicians may prove helpful in determining the root cause of hypogonadism and ED in such patients, who may be in need, by presenting a wider range of curative measures . According to the guidelines of the International Consultation for Sexual Medicine (ICSM), TRT is advisable when the level of total testosterone is 281] and/or in the presence of LOH symptoms, with these criteria being consistent across various countries. This analysis can supply evidence of the likely effects of testosterone on overall cardiovascular risk. The absence of such data leads us to examine the relationship of testosterone to other cardiovascular risk factors, such as adverse lipid parameters, blood pressure, endothelial dysfunction, coagulation factors, inflammatory markers and cytokines. This evidence, together with the beneficial effects of testosterone replacement on central obesity and diabetes, raises the question whether testosterone treatment could be beneficial in preventing or treating atherosclerosis. Your hypothalamus and pituitary gland control the amount of testosterone your gonads (testicles or ovaries) produce and release. Testosterone is essential for the production of sperm. Testosterone triggers the development of the male internal and external reproductive organs during fetal development. Recognizing these symptoms is crucial for early detection and effective management of hormonal imbalances.In addition to the natural decline with aging, multiple factors can affect testosterone levels, including those related to lifestyle habits such as smoking, alcohol, and exercise 11,12,13.Nevertheless, whether for MH or TDS, the basic diagnostic criteria across all guidelines are broadly similar, including a combination of clinical symptoms with biochemical evidence of low T, plus an impact on physical health and wellbeing.Standards and samples were added to the wells, the target antibody and HRP‐conjugated secondary antibody were then added according to the instructions.Stress elevates cortisol levels, which constricts blood vessels and lowers testosterone, contributing to reduced libido and erectile dysfunction.Testosterone levels increase during REM sleep, and there’s some evidence that disruptions in sleep could negatively impact a man’s testosterone levels, says hormone specialist Jim Staheli, D.O.A testosterone test checks the level of testosterone in your blood. Radiation to the brain that exposes the pituitary gland can also result in pituitary dysfunction and low testosterone. The contemporary management of functioning prolactin secreting tumors is the use of medications, such as bromocriptine and cabergoline. In homeostasis, LH levels are typically low. Pituitary dysfunction may be a significant cause of testosterone deficiency. Testosterone deficiency is prevalent in men presenting for an infertility evaluation.159 The testes contain germ cells that produce spermatozoa and Leydig cells that produce testosterone; any pathology of the testes can result in infertility and testosterone deficiency, conditions that frequently co-exist. Furthermore, PBMCs obtained during the treatment period produced significantly more brain-derived neurotrophic factor (BDNF) and platelet-derived growth factor (PDGF-BB).Depression often correlates with reduced libido, and conversely, low sex drive can exacerbate depressive symptoms.In contrast to the anxiolytic effects of androgens in adulthood, organizational effects of gonadal steroids may be anxiogenic, at least in some animal models.Because many of the symptoms of hypogonadism are not specific, the diagnosis is usually confirmed with measurement of morning serum testosterone levels.Low testosterone can significantly impact physical health, emotional well-being, and quality of life.Research has shown that testosterone-replacement therapy comes with some rewards and some risks. During the test, you’ll sit in a chair while a healthcare provider checks your arm for a vein. “We try to recreate as much of a normal day-to-day process as we can. On average, it’s estimated to cost between $70 and $200. The cost of a testosterone test can vary based on where you live, the type of test, and whether you have insurance. Hypergonadotropic hypogonadism, which is not a contraindication to begin testosterone therapy, can result from a number of conditions, including congenital abnormalities (KS being the most common), iatrogenic causes (e.g., bilateral orchiectomy, testicular radiation, chemotherapy), testicular trauma, infection, or autoimmune damage. Men who have had exposure of their testes during radiation therapy, either through direct or scatter radiation, are possibly at risk for low testosterone and the Panel recommends total testosterone measurement in such patients. A retrospective review of 399 men (mean age 37 years) with a mean total testosterone of 308 ng/dL found that 35% of patients had BMD at osteopenic levels and 3% had osteoporosis. Recent studies have explored the association between varicocele and low testosterone levels, and while there is no definitive evidence that varicocele presence is a cause of low testosterone, accumulating data suggest that ligation surgery might increase serum testosterone levels. People with low testosterone may experience persistent feelings of sadness or irritability, and in some cases, this can lead to more severe mood swings. Testosterone has a direct influence on how fat is distributed in the body. This condition, known as osteopenia, is often a precursor to osteoporosis, a serious condition that increases the risk of broken bones. This can lead to overall weakness, making it more difficult to perform everyday activities or engage in physical exercises. Testosterone plays a crucial role in maintaining physical health, particularly in terms of muscle mass and bone density. Symptoms must be accompanied by decreased serum concentrations of total testosterone (TT) or free T level to support a diagnosis of symptomatic hypogonadism (Level 2, Grade A). The diagnosis of hypogonadism requires the presence of characteristic symptoms and signs (Level 2, Grade A) in combination with decreased serum concentration of testosterone. This systematic review, based on all relevant existing data, highlights the current lack of clarity regarding the definition and management of age-related declines in testosterone levels. To answer this question, we first require rigorously performed studies comparing the signs and symptoms of hypogonadism in aging men to the results of standardized testosterone assays to determine whether a correlation exists. However, if serum testosterone levels are maintained within the mid-adult male range, testosterone replacement therapy does not appear to cause OSA . These studies suggest that normalizing testosterone levels may be helpful in improving some of the metabolic dysfunction in men who are obese, have type 2 diabetes and hypogonadism. Testosterone replacement therapy improves sexual function (libido and erectile function) when testosterone levels are restored to the normal range in younger hypogonadal men 31-33. Because many of the symptoms of hypogonadism are not specific, the diagnosis is usually confirmed with measurement of morning serum testosterone levels. In this therapy, your body is surgically refueled with healthy testosterone levels. It is important, therefore, that evaluation and treatment of reduced serum testosterone should also include improving sleep duration in combination with weight management. For others, though, their libido may lag even with normal testosterone levels. Some people have a healthy libido even with relatively low testosterone levels. Hormone replacement therapy (HRT) is a treatment option that involves replacing or supplementing hormones, including testosterone, through medication. Hormone replacement therapy (HRT) is a common approach that involves supplementing testosterone levels through medication. Thresholds for low testosterone were not universal. Of these, 14 biopsies (54%) revealed no cancer, and no patients required additional biopsy for clinical concerns.357 Of these, 14 biopsies (54%) revealed no cancer, and no patients required additional biopsy for clinical concerns.357PSA Monitoring. All patients had PSA and digital rectal exams every three months and biopsies annually. Three others did stop testosterone in response to the PSA bounce, two of whom had negative prostate biopsies. People who suffer from depression often report a lack of energy, low motivation, and fatigue—symptoms that are also common in those with low testosterone. Cortisol is often called the "stress hormone" because it helps your body respond to stress. These factors often work together, meaning that improving one area, such as increasing physical activity or eating a healthier diet, can have positive effects on others. The more body fat a person has, especially around the belly, the more testosterone is converted to estrogen. Mental health is another area where low testosterone can have a significant impact. Additionally, low testosterone may contribute to weight gain or difficulty losing weight, which can further impact overall health. It can also affect cardiovascular health, increasing the risk of heart disease. Healthy hormonal levels also help ensure that your body can effectively turn food into energy. Among other important roles, balanced hormones allow for positive energy levels throughout the day. However, patients who have multiple pituitary abnormalities should undergo MRI for evaluation. Thyroid levels and iron levels need to be evaluated for other causes of low testosterone. Even with an abnormally low level that is replicated on a repeat test, the decision to begin testosterone replacement therapy and the proper dose requires a careful conversation with your doctor. It's best to measure free testosterone levels in the morning. Men and women need the proper amount of testosterone to develop and function normally. Because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at higher than average risk of having undiagnosed prostate cancer. As surprising as it may be, women can also be bothered by symptoms of testosterone deficiency. Testosterone is an androgen, a kind of sex hormone, that’s found in the highest concentrations in men and people AMAB (though it’s found in smaller amounts in women and people assigned female at birth). A growing body of research indicates that American men and people assigned male at birth (AMAB) have seen a gradual decline in testosterone over many decades. Until an established benefit for testosterone therapy in elderly men has been demonstrated, it appears that the FDA and physicians should approach this treatment option with caution. Examples of these conditions include AIDS, end-stage renal and liver disease, hemochromatosis, obesity, chronic opiate use, vasculitis, infarction, glucocorticoid therapy, and anabolic steroid abuse.28 The Healthy Man Study by Sartorius et al. examined men with self-reported excellent or very good health and measured their T, DHT, E2 and documented co-morbidities including BMI and smoking status. Gonadotropin-releasing hormone (GnRH) is released in a pulsatile manner, the periodicity and amplitude of which determines the pattern of secretion of the gonadotropins, LH and FSH, from the anterior pituitary.20 Decreased production of GnRH by the hypothalamus with aging has been demonstrated in both human and animal studies. Testosterone regulates sex differentiation and divergence in early human prenatal development.11 The anogenital distance (AGD), measured either from the anus to the posterior fourchette (AGD-AF) or the anus to the clitoral surface (AGD-AC) (Figure 1),12 provides a convenient, easily measurable proxy for androgen levels present during the early “programming window” of fetal development in both sexes. Literature for the review was collected through comprehensive searches that focused on the diverse roles of prenatal and postnatal testosterone in endometriosis and its correlates. In this article, we review and describe this new evidence, explain how it provides a novel and productive framework for understanding the etiology of endometriosis, and discuss implications of these findings for treatment. However, androgen receptors are also widely distributed in female tissues including the uterus, breasts, endometrium, ovary, brain, bone, and muscle. Its causes are largely unknown, although the important roles of hormones, inflammation and cytokines are recognized. Subjects heterozygous for the SHBG allele containing an rs6258 SNP have lower serum SHBG steroid-binding capacity (Y-axis) when compared to the concentrations of SHBG measured by immunoassay (X-axis). The size of the data markers is proportional to the weight (inverse of the variance) of each study. At near confluence, cells were washed with PBS and cultured in serum-free SFM4CHO medium (Thermo Scientific HyClone, Logan, UT) for four days before the SHBG-containing medium was harvested. It's one of several androgens (male sex hormones) in females. For example, the genitals may not enlarge, facial and body hair may be scant, and the voice may not deepen normally. Adolescent boys with too little testosterone may not experience normal masculinization. A "feedback loop" closely regulates the amount of hormone in the blood. When your thyroid doesn’t function properly, you either get too much thyroid hormone (a disease called hyperthyroidism), or too little thyroid hormone (a disease called hypothyroidism). Reference ranges vary regionally and have been trending downward, reflecting broader public health concerns. Often, general practitioners refer patients to local endocrinology services, where adherence to BSSM guidelines is inconsistent. Despite this clear guidance, Testosterone Deficiency remains poorly understood among many UK doctors, making access to treatment via the NHS challenging. “Serum testosterone should be measured between 7 and 11 AM on at least two occasions, preferably four weeks apart, using a reliable method and not during acute illness.” Polycystic ovary syndrome (PCOS) is very common in women with subfertility and oligomenorrhea 1–3.If hypogonadism is confirmed, you may be offered testosterone replacement therapy to help restore normal levels of the hormone and relieve the symptoms.Sometimes the cause of low testosterone in a man is unknown, and many men have several different causes.In the case of studies reporting data on two unequal groups (33, 34), we used study-specific scaling factors that were calculated as 2.18/x where x is the difference in mean testosterone (in sd units) between the unequal groups.Diazinon also stimulates producing serotonin that inhibits the action of both LH and FSH, thereby decreasing testosterone levels.This latter point relates to the androgen receptor (AR) mediating the peripheral effects of testosterone.Anything that affects this system can contribute to declining testosterone levels.Though the symptoms of weight gain can be caused by a large number and variety of factors, low testosterone level is one of them. Treating sleep apnea with continuous positive airway pressure (CPAP) therapy can improve sleep quality, which in turn can help restore testosterone levels. Adopting healthier habits can help improve testosterone production naturally, and in some cases, may reduce the need for medical treatments. Treatment options are aimed at improving testosterone levels in the body and helping individuals regain a better quality of life. Cholesterol is the precursor of all sex hormones including testosterone.For example, women with untreated low testosterone may feel less motivated, have trouble enjoying activities they once loved, or feel persistently sad.Together, these data reveal that AR's activation by testosterone may be responsible for androgen-induced alteration of cholesterol liver uptake.As testosterone is affected by age, Model 1 used only age as the adjustment variable.The two charts below list the general normal ranges of testosterone based on age and sex.Poor sleep or sleep disorders can affect the balance of your hormones, including testosterone. Some of these medications are actually used to treat conditions of high testosterone in women, such as polycystic ovarian syndrome (PCOS). If you are experiencing symptoms of low testosterone you should speak to your doctor or another medical professional. TRT should not be confused with testosterone boosters, which are supplements purported to increase testosterone and improve symptoms such as low libido and erectile dysfunction. Low testosterone can be treated with testosterone replacement therapy (TRT) which is available in a variety of forms including injections, gels and patches. It can take several months to work and for symptoms to be alleviated but it isn’t an effective treatment for every woman. The normality of the variables’ distributions was confirmed in the groups and subgroups using the Kolmogorov‐Smirnov test and the Q‐Q plot analysis29. Comparisons among the groups were also performed according to body mass index using standardized BMI classification for overweight (25.0 ≤ BMI 2) and obesity (BMI ≥ 30.0 kg/m2). Serum TT values were initially presented as a continuous variable, using the assay reference range (264 to 916 ng/dL),7, 27 and TT quartiles were determined to characterize the TT profile of the study population. Reference interval for adult males was determined by the laboratory based on standardization of the assay to the CDC reference method, calculated as 264 ‐ 916 ng/dL7, 27 (labcorp.com/assets/11476). Interventional trials have shown a neutral effect of physiological testosterone replacement on the major clotting factors (Smith et al 2005) but supraphysiological androgen administration can produce a temporary mild pro-coagulant effect (Anderson et al 1995). There is a positive correlation with tissue plasminogen activator (tPA) which is one of the major fibrinolytic agents (Glueck et al 1993). No trial of sufficient size or duration has investigated the effect of testosterone replacement in primary or secondary prevention cardiovascular disease. Visceral adiposity could also provide the link between testosterone and insulin resistance (Jones 2007). A full review of the relationship between testosterone, insulin resistance and diabetes can be found elsewhere (Kapoor et al 2005; Jones 2007). How Is Hypogonadism Diagnosed? Androgens were also reported to modulate the function of human skin mast cells (MCs) by reducing IL-6 production .Further, Bolat et al revealed that the prevalence of MetS in patients with PE (51%) was significantly higher than in controls (24%).The clinical implications of this study are not completely certain but point to the importance of assessing endogenous testosterone levels in middle-aged and elderly men as a potential marker of general health; such assessment should be performed properly, generally in the morning and with a good-quality assay (42).Testosterone levels are temporarily boosted by exercise, but levels are decreased by excessive body fat, particularly abdominal fat.We source research from peer-reviewed medical journals, top government agencies, leading academic institutions, and respected advocacy groups.This brief review will expand on the etiology, diagnosis, and treatment options for hypogonadism in the young adult male. While effective, these treatments need to be closely monitored by a healthcare provider to minimize potential side effects. This can involve testosterone patches, creams, or injections that help restore levels to a healthy range. Testosterone contributes to maintaining muscle mass, bone density, energy levels, mood stability, and sexual health. Overall, the option chosen at present to regulate menses should depend on factors such as the degree of weight excess or IR/glucose intolerance, the presence of other PCOS issues requiring management (hirsutism or infertility), and patient and/or physician preferences based on a careful discussion. Because of the central role IR plays in PCOS, it is understandable that improving insulin sensitivity can restore normal menstrual function. One appealing aspect of this is that women can often plan their menses to avoid vacations, etc. For those women who might prefer not to cycle every month, periodic progesterone withdrawal is an option. Clinicians should be aware that a period of time should elapse after RT and before initiating testosterone therapy in order to allow the patient adequate time to regain functional endogenous testosterone production. A total of 651 men (mean age 62.9 years) received oral, transdermal, or IM testosterone, while 433 men received placebo for a period of 12 weeks to 36 months. Men were eligible for inclusion in the study if they had testosterone in the normal range, an unremarkable reproductive history and physical exam, and 2 semen samples with a sperm concentration of ≥20 million/mL. Patients who had shorter treatment duration, were on shorter-acting testosterone preparations, and had higher sperm concentrations and lower LH levels at baseline had better spermatogenesis recovery. Gender socialization may affect testosterone by encouraging men but not women toward behaviors that increase testosterone. Hypogonadism is a condition in men where the body doesn't produce enough testosterone or sperm. This condition, known as hypogonadism, can impact a man's overall health and well-being. In women, hypogonadism may cause infertility. This is called combination hormone therapy. The pulsatile secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus stimulates LH and follicle-stimulating hormone (FSH) production and secretion by the anterior pituitary gland. Additionally, one must carefully consider testosterone replacement therapy (TRT) in the younger population as it could interfere with spermatogenesis and fertility. Diagnosis of hypoandrogenism in healthy adolescents can be challenging, as the symptoms that correlate with a decreased T level are different than in the elderly population. It is estimated that ~70% of children with hypogonadism will be misdiagnosed if based on serum gonadotropin measurement (10). When you have a primary testosterone deficiency, that means that you don’t have enough testosterone due to a problem in the organs that make testosterone. Testosterone levels are measured in nanograms per deciliter (ng/dL). Once a man is over 40, his testosterone level will drop by as much as 2% per year. While there can be many reasons for testosterone deficiency, the condition primarily affects older men. Adverse cardiovascular effects have not been seen in studies of transdermal testosterone therapy in women. Despite the crucial role of testosterone and the high circulating concentrations of this hormone relative to oestradiol in women, studies of its action and the effects of testosterone deficiency and replacement in women are scarce. And if you have male hypogonadism, your endocrinologist may prescribe testosterone replacement therapy (TRT) – a form of hormone replacement therapy (HRT). If a teenage male is leading an unhealthy lifestyle, they are much more prone to having lower than usual levels of testosterone. Lifestyle plays an important role in the health and testosterone levels of teenagers than many people realise. Currently published studies have not demonstrated an increased risk of biochemical cancer recurrence in post-RP patients who are on testosterone therapy, nor does it define the optimal timing for commencement of testosterone therapy. While the lack of a baseline semen analysis before commencement of the initial exogenous testosterone therapy is a possible weakness of this study, the methodology mirrors the clinical scenario for a large percentage of men starting exogenous testosterone with no prior semen testing.For men already on exogenous testosterone who are planning future reproduction, testosterone cessation should occur in advance of initiation of any effort to conceive. The presence of ASCVD risk factors is not a contraindication to starting testosterone therapy; however, the optimization of modifiable risk factors in such patients using lifestyle and medical management strategies is recommended and may be best addressed by the patient's primary care provider. The relationship between testosterone status and mood, particularly depression, remains unresolved.This guide aims to provide a thorough understanding of low testosterone in females, empowering women to take control of their health and well-being.Recognizing the symptoms and seeking appropriate medical advice is crucial for effective management.When buccal tablets are used, the testosterone level should be assessed immediately prior to the next application.The study found that the treatment group demonstrated significant short-term improvements in spatial and verbal memory.56 However, this study did not have long-term follow-up, nor did it analyze whether the effects were due to increased testosterone, increased estradiol, or both.Dhindsa et al (2004) studied 103 male patients who had type 2 diabetes mellitus using free testosterone (done by equilibrium dialysis) or calculated free testosterone which takes SHBG levels into account.This means that by the time a man reaches his 70s or 80s, his testosterone levels might be significantly lower than when he was in his 20s.The significance of these results is unclear as the study was not designed or powered to assess CV-outcomes and the CV events consisted of both minor events (edema and hypertension) and major events (MI and stroke). Interestingly, in the study by Reinhardt et al., in patients after KTx, testosterone levels increased but FSH and LH levels stayed unchanged while prolactin and estrogen levels diminished significantly . Earlier studies reported that successful kidney transplantation restores normal function of the hypothalamic-pituitary-gonadal axis, lowers PRL concentrations, and usually normalizes testosterone levels 84,116. It's normal for testosterone levels to decrease with age. However, it should be recognized that when only studies using IIEF-EFD as outcomes were considered, no significant advantage in either placebo-controlled or not controlled studies was observed (Table 3). Since the effects of PDE5i or TRT alone in subjects with diabetes are limited, the present results suggest that a combination therapy should be suggested in more complicated subjects or at least in those with diabetes mellitus. In addition, meta-regression analysis of those data shows that the combined effects were significantly higher in those trials including a larger amount of diabetic patients (Fig. 4). In a more recent meta-analysis, including 8 placebo-controlled RCT—encompassing 913 patients with a mean follow-up of 10.8 weeks—Zhu et al. concluded that the combined therapy was superior when compared to PDE5i alone in improving erectile function. The same study also documented that the combined therapy significantly improved penile arterial flow as detected by penile color Doppler ultrasound . A 2021 study found that men with higher concentrations of testosterone scored better on measures of verbal memory and mental processing speed compared to men with lower concentrations.7 Without enough testosterone, blood may not be able to enter the penis and allow it to get rigid enough for sex. Researchers suspect the reason for this is that testosterone acts as a vasodilator, allowing more blood flow into the penis, says Calvert. Other symptoms of low testosterone can chip away at your sex drive, too, like low energy or weight gain. Biologically active testosterone can then bind androgen-binding protein within Sertoli cells to maintain intratesticular testosterone for spermatogenesis Jarow et al. 2001, convert to more potent androgens in nontesticular tissue such as dihydrotestosterone via 5α-reductase enzyme, or convert to estrogen via aromatase enzyme. The remainder is tightly protein bound by sex hormone-binding globulin (SHBG) and is physiologically inactive Rosner, 1991. In addition, because the risks of TRT in this population are higher than in younger men, the risk profile of TRT becomes a driving force in the decision to treat or observe. Be sure to discuss your questions and concerns about low testosterone and drug use with a knowledgeable professional. Seventy-four percent of the men who were using long-acting opioids had low testosterone, compared with 34 percent of men who used short-acting opioids. Investigators in a Kaiser Permanente study compared use of short-acting and long-acting opioids in 81 men being treated for chronic pain for at least three months. Farting During Sleep: Causes and Tips for Reducing It Men with a family history of low testosterone should be proactive in monitoring their hormone levels and making lifestyle adjustments to optimize their testosterone production. Other factors, including environment, diet, exercise, and overall health, play a significant role in determining whether someone will experience clinically low testosterone levels. The Sex Hormone Binding Globulin (SHBG) gene plays a critical role in regulating testosterone levels in the bloodstream. Understanding the hereditary aspects of low testosterone can help men assess their risks and take proactive steps toward maintaining optimal hormone levels. As your body converts testosterone to DHT, if you have low levels of testosterone, you’ll have lower-than-normal levels of DHT as well. Recently, our lab has implicated this pathway in the antidepressant actions of testosterone in the hippocampus of male rats and is presented below in further detail. In addition, these non-genomic actions can enhance the classical genomic effects of testosterone and estrogen (reviewed in Vasudevan and Pfaff, 2008). This is the general process by which testosterone mediates slower genomic effects that proceed over the course of hours to days. Steroid hormones can have long-lasting genomic effects through actions at intracellular steroid receptors, often referred to as the “classical” effects of steroids. However, other studies found no association between prenatal androgen exposure and polycystic ovary syndrome in female offspring (Hickey et al., 2009). Furthermore, fetal testosterone concentrations differ by fetal gender and by gestational age (Troisi, Potischman, Roberts, Siiteri et al., 2003). The literature also indicated that testosterone and cortisol are related to infant health and development. The findings may be explained based on gender-difference theories that male brain is more sensitive to testosterone than female brain. Males are more active than females, and these differences increase with age (Campbell & Eaton, 1999). They can monitor your levels and discuss possible side effects. The most commonly prescribed fix for low testosterone is testosterone replacement therapy (TRT). Around 66 percent of men diagnosed with low testosterone have experienced one or more symptoms.16 Additionally, many men claim that their brain fog lifts when they start testosterone replacement therapy, says Calvert. Low testosterone occurs when the body does not produce enough of this hormone. He blogs about men’s health topics, including steroids, testosterone, and male infertility, on the Turek Clinic’s website. Low testosterone in women can cause symptoms like mood changes, depression, decreased sex drive, fatigue, and hot flashes. One small model study showed titanium dioxide caused a decrease in testosterone synthesis, but more research is needed to determine just how titanium dioxide affects testosterone levels in humans. “Anything that negatively affects overall health can diminish testosterone levels,” says Dr. Hakim. Excessive alcohol use can lead to damage to the Leydig cells in your testes and may also interfere with the release of certain hormones that affect your testosterone production. Even though the exact mechanism of elevated testosterone levels in people who smoke is not known, there is some concern that the temporary boost or “false elevation” in testosterone levels from smoking may actually be masking undiagnosed hypogonadism. The study found that lower levels of androgens contributed to decreases in lean muscle mass, strength, and size in the first group. The first cohort was given goserelin acetate to suppress endogenous androgen production and randomly assigned to receive testosterone gel or placebo for 16 weeks. Sex hormones play a crucial role in the maintenance and growth of bone in both men and women. These include less desire for sex, less energy, less facial and body hair, and loss of muscle mass and bone mass. If tests show low testosterone, further testing can help find the cause. So blood testing is usually done between 8 and 10 a.m. Testosterone levels are most often highest in the morning. This can make bones increasingly fragile, and vulnerable to damage, such as fracture. If left unattended, low testosterone in men can often lead to degradation in bone density. Testosterone is also essential for well-being and the maintenance of health, and the prevention of a condition known as osteoporosis in men. In males, this anabolic steroid plays a key role in the development of the male reproductive tissues, including testis and prostate. Low levels of testosterone can also put men at risk for depression, insulin resistance, reduced muscle mass, metabolic syndrome and osteoporosis. Testosterone is the quintessential androgen or male hormone in the human body. In this article, I will be discussing prescribed medication that lower testosterone levels in men and how to clinically diagnose and treat the issue effectively. Currently, three large pharmaco-epidemiologic studies, sponsored by the National Institute on Aging (NIA), are examining the association between testosterone treatment and adverse outcomes. Once a diagnosis of hypogonadism is made, the decision to treat with testosterone or not will depend upon individual patient characteristics, particularly given conflicting reports on the association of testosterone treatment with mortality and serious adverse CV outcomes. Men who are treated with testosterone replacement therapy are monitored closely by their doctors. There is no convincing evidence that shows testosterone replacement therapy causes any type of cancer. In general, testosterone therapy should not be used in men with prostate cancer or breast cancer, or those planning to father a child. Prostate examinations to check for prostate cancer may also be conducted, depending on your age and whether any other risk factors for prostate cancer are present. The combination of these factors creates a cycle that lowers testosterone even further, making it harder to manage metabolic syndrome. Each component of metabolic syndrome can affect testosterone production in different ways. Men with metabolic syndrome are at a higher risk of having low testosterone. Combining regular exercise with a balanced diet can reduce body fat and improve hormone balance. Studies have shown that even modest weight loss can significantly boost testosterone production. Air pollution is another environmental factor that can affect testosterone levels. Certain jobs expose people to chemicals that can harm their bodies, including lowering testosterone levels. These chemicals can mimic or block hormones in the body, interfering with normal hormone functions. Understanding how environmental factors play a role in lowering testosterone is important for keeping hormone levels balanced. What Is Low Libido (Low Sex Drive)? The increase in PSA will be greatest in men with marked testosterone deficiency and least (or absent) in men with milder degrees of hypogonadism . After initiation of TRT, patients should be monitored for prostate disease with measurement of serum PSA at 3–6 months, 12 months and at least annually thereafter (Level 2, Grade B). Therefore, prior to starting TRT, a patient's risk of PCa must be assessed using, at a minimum measurement of serum prostate-specific antigen (PSA). In an observational, prospective registry studies in 1023 patients receiving long-term TRT with a median follow-up of 5–6 years, the incidence of prostate cancer remained well below the incidence reported in screening studies in the general population . By identifying limitations in existing studies and suggesting directions for future investigations, we hope to encourage the research community to pursue more robust and methodologically sound studies that will further strengthen the evidence base.Many studies have linked lower testosterone levels to higher AD risk 28, 29 and poorer cognitive function 30–32 in healthy aging men; however, results have not always been consistent 32–34.When SHBG is lower, the level of free testosterone (i.e., testosterone not bound to SHBG) increases.The potential mechanisms through which plastic-originated agents and other endocrine-disrupting chemicals can induce hypogonadism and ED are presented in Figure 5.Grover S, Mattoo SK, Pendharkar S, Kandappan V. Sexual dysfunction in patients with alcohol and opioid dependence.In this study all former AAS abusers exhibited plasma SHBG within the normal reference range and excludes that oral AAS were abused in this group while injections with testosterone could possibly still have been used.In some cases, doctors might also recommend tests to measure other factors that could affect testosterone levels, such as overall health, diet, and lifestyle.Administration of one to three months of testosterone treatment has also been shown to improve symptoms of angina and exercise test performance (Wu and Weng 1993; English et al 2000; Malkin, Pugh, Morris et al 2004). However, the sensitivity of the hair follicles to DHT is not caused by testosterone or DHT but by genetics. Gels are rubbed onto and absorbed through your skin, though a potential side effect of the treatment is skin irritation and transference of the medication to another should they rub up against the treatment area. Biotin, or vitamin B supplements, can be taken while taking testosterone to maintain the strength of the hair follicles. Vitamin deficiencies typically are not the root cause of hair loss, but they can help promote healthy hair and regrowth. It also contributes to the overall well-being of females, especially during their younger years when their bodies are still developing and changing. Replica trials utilising longer-term interventions with longer-term follow-up would be the next logical step to interrogate the therapeutic utility of this treatment method for this population. This may partly explain the observed increase in muscle mass but not strength in Pasiakos and colleagues , assessed after only 28 days of treatment. For example, strength benefits when supplementing with testosterone enanthate are typically observed after 6 weeks of administration with ergogenic muscle mass increases preceding strength benefits. The finding of a low blood testosterone needs to be confirmed by an endocrinologist prior to beginning treatment. Most cases of low testosterone are treatable, and being aware of the symptoms can help a person receive an early diagnosis and treatment. There are really only three things that have been proven to naturally raise testosterone levels. Exposure to endocrine-disrupting chemicals (EDCs) can lead to reduced testosterone levels in men. Testosterone helps stimulate the production of semen, and reduced semen levels can indicate a reduction in testosterone. Here’s a rundown of some of the biggest symptoms of low testosterone in men, so that if you’re experiencing them, you can get help. Fortunately, once they’re diagnosed with low testosterone, the symptoms are treatable. Many studies have described Low T as a problem that is often not reported by many patients and frequently ignored by providers. Diminished sex drive and erectile dysfunction are only two possible symptoms of low testosterone. While insurance coverage varies greatly, especially when it comes to deductibles, do not let the possibility of high costs for Low T treatment deter you from getting an accurate diagnosis. Women with low testosterone often experience a loss of muscle mass and muscle tone, no longer seeing the results they expect when they lift weights. In minor cases, women may feel more overloaded and have more difficulty managing a busy schedule that they used to handle with ease. If you suddenly experience bouts of anxiety, especially if you have never had anxiety issues in the past, you may want to consider being tested for low testosterone. Mood-related symptoms, like anxiety and depression (discussed in the section above), occur because hormonal fluctuations often cause changes in brain chemistry that affect mood and neuropsychiatric regulation. Anxiety connected to low testosterone is usually more of a mild irritation, but it could be strong enough to cause panic attacks in some cases. Their data is derived from the EVOS (European), CaMos (Canada), Rotterdam (Netherlands), Dubbo (Australia), Rochester (USA), and Hiroshima (Japan) studies. Despite this, osteoporosis research has been highly female dominant, but an increasing awareness, insightful research, and greater appreciation of the importance of male bone quality continues to contribute to our understanding of male hypogonadal osteoporosis. Although the prevalence of osteoporosis amongst males ≥ 50 is significantly lower than the female population, male osteoporosis and osteopenia and its clinical consequences are significant. For individuals under age 50, the BMD Z-score, which uses an age- and a gender-specific reference, is used. For simplicity, it has been advocated by the WHO and others to use the traditional standard female-only reference population. Klinefelter syndrome is caused by a chromosome abnormality in which boys have 2 X chromosomes and 1 Y chromosome. Primary hypogonadism occurs when there is a problem in the testes. The pituitary gland secretes the hormones follicle-stimulating hormone and luteinizing hormone, which are called gonadotropins. For example, chronic illnesses, such as kidney disease, liver disease, or diabetes, can disrupt hormone production and lead to lower testosterone levels. These medications may interfere with the endocrine system or directly affect the production of hormones, leading to lower testosterone levels. Similarly, hyperthyroidism, where the thyroid produces too much hormone, can also interfere with normal testosterone levels. While estrogen is the primary hormone involved in female reproductive health, testosterone also plays a role in sexual development and function. Low testosterone levels in young females can lead to various health problems, some of which may not be immediately obvious. In women, the ovaries produce some testosterone in response to stimulation by LH produced in the pituitary. By far the commonest causes of low testosterone in men relate to reduced production of LH from the pituitary gland. Importantly, testosterone exerts negative feedback on both the testes, to inhibit further testosterone production, and the pituitary, to inhibit LH production. The Panel urges clinicians to use their clinical judgment in the management of such patients. The Panel recommends that clinicians use the same laboratory with the same method/instrumentation for serial total testosterone measurement. Establishing total testosterone thresholds for a diagnosis of testosterone deficiency is challenging considering the heterogeneity that exists in the testosterone deficiency literature. It is bound to albumin (50%, loosely-bound), sex hormone-binding globulin (SHBG, 44%, tightly-bound), corticotropin-binding globulin (4%, loosely-bound), and approximately 2% circulates as free testosterone.9 The free and loosely-bound testosterone fractions combined are known as bioavailable testosterone.Testosterone assays are plagued by variability in results. Testosterone is the predominant androgen in males and is involved in a multitude of physiological and biochemical processes throughout the body. Steroids of similar structure to testosterone have been shown to cause assay interference with some assays. As a group, these inventories have been shown to have high sensitivity in diagnosing a testosterone deficient state, but lack specificity for the condition13. Testosterone levels have been shown to vary with many pathological and physiological processes. Interindividual variability in testosterone measurements has been demonstrated within the same week6. Free testosterone is the amount not bound to proteins and is available to be used by your body. Total testosterone is the amount of testosterone in your blood, including testosterone bound to proteins. The most common way to diagnose low testosterone is through a blood test. Diagnosing low testosterone can be a bit tricky because many of the symptoms are similar to those of other conditions. 1 The influence of testosterone on anxiety- and depressive-like measures in male animal models Although oral testosterone is available in India, Canada, Europe, and some other countries, it is not available in the USA . Testosterone is administered in the body through oral, buccal, intramuscular, subcutaneous, and transdermal routes 282,283. PFOS and PFOA may induce cortisol production, which leads to ROS generation, ultimately resulting in suppression of the hormonal activity of Leydig cells. BPA-mediated ROS generation may also suppress testosterone activity and spermatogenic processes directly. The testosterone level also naturally drops with age. Certain health conditions, medicines, or injury can lead to low testosterone. In females, the ovaries produce most of the testosterone. The majority of observational studies of testosterone and mortality have reported a significant association of low testosterone with mortality in community cohorts and also in specific medical conditions including renal disease, diabetes, erectile dysfunction and men with prostate cancer who are treated with ADT. In testosterone-treated men who were less than 65 years old, the risk for MI was limited to those who had a history of heart disease, with a HR of 2.90 (1.49–5.62). Subjects served as their own control and the rate of MI for 3 months following testosterone treatment was compared to the rate of MI for 12 months before treatment. It helps replenish the hormone in your body to bring levels back into the optimal range. If your test results confirm low testosterone, there are several evidence-based treatment options to help restore your levels and improve your overall well-being. A men’s health specialist like Bazel will begin with a full review of your symptoms and medical history, followed by a physical exam and blood tests. Experiencing several of these symptoms at once is a strong indicator that it may be time to get your hormone levels checked. Female hypogonadism in premenopausal age groups (younger than 45) occurs in an estimated 1 percent of the population, with an estimated 5 percent experiencing early menopause, according to a report in the October 2019 Frontiers in Endocrinology. This could amount to testosterone replacement therapy or lifestyle changes that will make your body more friendly to testosterone production. If you are ready to treat the symptoms and underlying cause of low testosterone in teenage males, then there are a few steps that you need to take. Testosterone treatment has helped countless men boost their testosterone levels and get rid of unpleasant low T signs. Testosterone levels also naturally drop with age. Certain health conditions, medicines, or injury can lead to low testosterone (low-T). If you suspect that your testosterone is low, talk to your doctor about any symptoms that you’re having, Dr. Nall urges. Substance and drug abuse, such as alcohol, opioids, and anabolic-androgenic steroids, can affect testosterone production and interfere with testicular and hypothalamic-pituitary function, research shows. Male hypogonadism: Symptoms and treatment Studies have confirmed an indirect link between hypothyroidism (an underactive thyroid condition) and testosterone levels. The thyroid gland is involved in a wide range of bodily functions, such as metabolism and the production and concentration of hormones in the body. The adrenal glands also secrete the male sex hormones DHEA and testosterone. High testosterone in women can sometimes go beyond simple hirsutism and cause other symptoms to develop in a process called virilization. There are various conditions that cause fluctuations in female hormone levels. On the other hand, several placebo-controlled testosterone replacement studies did not show a testosterone-placebo difference distinguishable with respect to mood.150,164,167,168 No relationship between testosterone level and depressive symptoms was found in the Massachusetts Male Aging Study (MMAS).14 This discrepancy in the results of the effects of testosterone replacement therapy on mood may be explained by the genetic polymorphism in the androgen receptor which defines a vulnerable group in whom depression is expressed when testosterone levels fall below a particular threshold.169,170 Restoring testosterone levels to within the normal range by using testosterone replacement therapy can improve many of the effects of hypogonadism. The selection of the preparation should be a joint decision of an informed patient and physician.58 Short-acting preparations may be preferred over long-acting depot preparations in the initial treatment of patients with LOH.59 It has been recommended that the optimal serum testosterone level for efficacy and safety should be in the mid range to lower young-adult-male serum testosterone levels as the therapeutic goal.60 However, older males need higher levels to obtain a therapeutic benefit. How to prevent hair loss while taking testosterone Serum interleukin 6 (IL-6) levels were measured in duplicate by high-sensitivity enzyme-linked immunosorbent assays (BIOSOURCE, Camarillo, Calif). Serum ferritin and soluble transferrin receptor (sTfr) levels were measured in duplicate using chemiluminescent immunoassays (Abbott Diagnostics, Abbott Park, Ill, and Nichols Institute Diagnostics). Folic acid and cyanocobalamin (vitamin B12) levels were measured by a radioimmunologic assay (ICN Pharmaceuticals, New York, NY). Erythropoietin (EPO) was measured in duplicate by Quest Laboratories (Baltimore, Md) using the Advantage EPO chemiluminescence immunoassay (Nichols Institute Diagnostics, San Clemente, Calif), which has a sensitivity of 1.2 mU/mL, and a CV of lower than 6%. The study by Snyder et al., which included 788 patients with low testosterone concentrations showed that the testosterone supplementation with gel reversed anaemia in around 20% of patients even those with a previous diagnosis and treatment . The administration of testosterone in patients with hypogonadism resulted in an increased lean body mass, muscle mass, muscle strength, and physical performance 10,68. Further studies are required in order to observe if the reduction of leptin levels in obese individuals may positively affect hypogonadism by the rise of testosterone concentrations. The study of Rosano et al., has shown that testosterone levels correlate inversely with the severity of coronary artery disease . In patients with hypogonadism, the treatment with testosterone improved insulin sensitivity and reduced glucose and HbA1C concentrations . Haemodialysis does not remove testosterone from the circulation; therefore, it cannot be the cause of hypogonadism in dialysis patients . In patients with CKD, the ability of testosterone binding and SHBG concentrations are correct, but the concentrations of free and total testosterone are reduced . Low testosterone levels are connected with increased receptor-activator nuclear factor-kappa ligand (RANKL) which elevates the proliferation and activation of osteoclasts. Moreover, in a large placebo-controlled randomised study of 1007 patients, Wittert et al., observed that testosterone supplementation may prevent the development of diabetes in overweight men . In males with hypogonadism, testosterone supplementation positively affected lipid profile 24,25. A few minor studies have investigated sperm counts and morphology in current AAS abusers only and noted severe impairment 35, 36. To our knowledge, no studies have previously investigated the fertility or biomarkers of Sertoli-cell function in former AAS abusers. A larger proportion of participants (37%) in their study reported that less than 12 months had elapsed since AAS cessation. Furthermore, it is possible that post-cycle therapy may have reduced the frequency of impaired spermatogenesis in the group of former AAS abusers. These results indicate that a considerable proportion of former AAS abusers exhibited persistent ASIH features, such as biochemical and functional hypogonadism, years after AAS cessation. Don't ignore symptoms like persistent fatigue, mood changes, or changes in your physical appearance. Early diagnosis and treatment can make a significant difference in managing the condition and improving your quality of life. But if another condition is causing your symptoms, that needs to be addressed instead. Getting an accurate diagnosis is crucial because it determines the treatment plan. What is considered "normal" can vary widely, so a level that is low for one person might be normal for another. The best time to obtain monitoring blood tests for IM testosterone has not been definitively established. In general, smaller dosages at more frequent intervals are preferred over high, less frequent administrations to limit the duration of time spent outside (above or below) the normal reference range. In a study directly comparing the pharmacokinetics of 2 doses of SQ testosterone enanthate injected weekly (50 or 100 mg) and 1 concentration of IM testosterone enanthate injected once (200 mg), the IM testosterone achieved the highest peak testosterone (mean 2,261 ng/dL) followed by SQ 100 mg (1,345 ng/dL) and SQ 50 mg (622 ng/dL).437 The time-to-peak level was slightly faster with IM testosterone (33 hours) compared to SQ 100 mg (36 hours) and SQ 50 mg (45 hours). The pharmacokinetics of short-acting testosterone therapy depends on the dose, interval, and method of delivery (SQ versus IM). Testosterone upregulates the beta-adrenoreceptor number; activates adenyl cyclase to produce cyclic adenosine monophosphate which, in turn, stimulates hormone-sensitive lipase to accelerate lipolysis; and decreases total body fat mass.28 The increased oestrogens formed from aromatisation causes a negative feedback at hypothalamo-pituitary level, further lowering testosterone levels.28 Obesity-induced increase in levels of leptin, insulin, proinflammatory cytokines and oestrogen can cause a functional hypogonadotrophic hypogonadism with the defect present at the level of the hypothalamic gonadotrophin-releasing hormone (GnRH) neurons. Low testosterone in women can cause symptoms like mood changes, depression, decreased sex drive, fatigue, and hot flashes. There is also short of a comprehensive estimation of the relationship between circulating testosterone level and T2DM risk in men. Therefore, it is still unclear whether circulating testosterone level has an obvious impact on T2DM risk among men. However, evidence is less convincing and somewhat controversial for the impact of testosterone on T2DM risk among men. Elabbay and coworkers found T2DM patients tended to have significantly lower testosterone level when compared with non-diabetic individuals (7). Therefore, further studies of the pathogenesis and risk factors of T2DM are still necessary to copy with the epidemic of T2DM.