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A Safe and Effective Treatment for Male Hypogonadism That Preserves Fertility

Male hypogonadism is a condition in which your body doesn’t produce enough testosterone, the hormone that plays a key role in masculine growth and development during puberty, or enough sperm, or both. Testosterone is produced by specialized cells in your testicles (gonads) known as Leydig cells, and is a type of hormone known as an androgen. Very small quantities of testosterone are also produced by your adrenal glands, which sit atop your kidneys. Androgens are a class of hormones responsible for the development of secondary male sex characteristics such as the growth of facial and body hair, deepening of the voice, and growth of the testicles and penis, as well as bone and muscle development.

A deficiency in testosterone can initially present as a decrease in your sex drive, fatigue, decreased energy, and even depression. If not treated, testosterone deficiency can lead to the loss of the ability to have an erection, decreased sperm production, a loss of muscle and bone mass, and can even lead to the development of breast tissue, known as gynecomastia. First, let’s look at the causes and types of male hypogonadism, plus how it’s diagnosed. Then we’ll take a look at treatments, ending with an interesting and relatively new compound Androxal, that unlike many other testosterone-based treatments, does not negatively affect sperm.

Causes of Hypogonadism - Two Types

There are many causes of male hypogonadism but there are two basic types: primary and secondary. Primary hypogonadism stems from a problem with the testicles and is sometimes referred to as testicular failure. Secondary hypogonadism is actually a problem in a part of the brain, either the hypothalamus or the pituitary gland. The hypothalamus releases gonadotropin-releasing hormone which travels to your pituitary gland and triggers it to release another substance known as luteinizing hormone, known as LH. The LH then goes to your testicles where it stimulates the production and the release of testosterone.

The level of testosterone in your bloodstream is controlled by an elegant feedback loop that works like this: as the level of testosterone in your bloodstream rises, it damps down the production of gonadotropin-releasing hormone made by your hypothalamus and this helps to maintain a normal level of testosterone in your body. This means that if any of these areas; your hypothalamus, your pituitary gland or your testicles themselves, are not functioning as they should, that dysfunction can cause low testosterone.

Another reason for low testosterone is the use of anabolic steroids, commonly used by some bodybuilders in an effort to build muscle bulk, as steroids can not only decrease the function of the testicles, leading to low testosterone levels and actual shrinkage of the testicles, these steroids can also cause a decrease in sperm production.

Low testosterone levels due to hypogonadism is not a rare condition, with one study showing 11.8 percent of males (in 3219 men studied) between the ages of 49 to 79 having secondary hypogonadism, meaning a problem in the hypothalamus or pituitary. Another study showed 38.7 percent of males (in 2162  men studied) 45 years of age or older had primary hypogonadism, meaning there was a problem with the testicles. Hypogonadism is seen much more commonly in older men as well as men who are obese or who have type 2 diabetes.

Diagnosis and Treatment

Male hypogonadism is diagnosed by a combination of a physical exam and a blood test, usually taken in the morning when testosterone levels are highest. If your testosterone levels are low, then further testing can be required to determine if it’s primary or secondary hypogonadism. These tests can include additional hormone testing, a semen analysis, imaging studies of the pituitary gland and may also include genetic testing and a testicular biopsy. Treatment of primary hypogonadism may involve prescribing pituitary hormones to stimulate the production of sperm, or if a pituitary tumor is found, this may necessitate surgical removal, radiation, or medication, plus replacement of additional hormones for which the pituitary is responsible.

Testosterone Replacement Therapy

Treatment of secondary hypogonadism in adult males commonly involves testosterone hormone replacement therapy, known as HRT. Testosterone replacement therapy is not given orally, as oral preparations can cause liver problems, and they do not keep the levels of testosterone at a steady state. There are various ways to administer testosterone that bypass the oral route and these include gels, patches, injections, implantable pellets, and gum, as well as a nasal gel.

Testosterone replacement therapy does come with some risks which include enlargement of the prostate gland, enlarged breasts, the development of acne, an increase in the production of red blood cells, a decrease in sperm production with subsequent infertility, and sleep disturbances. The testicles may also decrease in size, known as testicular atrophy. Men on long term administration of testosterone may completely lose their ability to produce testosterone naturally and may have to rely on an artificial source for life.

Treatment with hCG

In an attempt to preserve fertility in men with low sperm counts who still wish to have children, an injectable hormone known as hCG (Ovitrelle) is sometimes used. This hormone may also work to prevent testicular atrophy, and is used alone (known as hCG monotherapy) or in combination with testosterone injections. HCG works to stimulate the Leydig cells in the testicles, resulting in testosterone production. Side effects of hCG can include breast enlargement, stomach pain, nausea and vomiting, and pain, redness and swelling at the site of the injection.

Treatment with Clomid

Some physicians use clomiphene citrate (trade name Clomid) as an off-label drug to treat male hypogonadism in men who want to try to preserve their fertility. Off-label use simply means the use of a drug for a condition for which it is not formally approved, and is a fairly common practice in the medical community. Clomid is approved for use in women to induce the ovaries to produce eggs but can also be effective in men to increase blood testosterone levels by increasing the levels of the hormones LH and FSH, both produced in the pituitary gland. Clomid has an interesting way of working by making your brain think there is not enough testosterone and forcing the body to increase its natural production. Like any other drug, Clomid comes with its list of possible side effects including blurry vision, mood swings, acne, weight gain, and chest tenderness. Although Clomid may improve sperm motility (movement) in some men, it also may reduce total sperm count.

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Treatment with Androxal

Another treatment for male hypogonadism is enclomiphene citrate (trade name Androxal) works to increase the body’s natural production of testosterone, rather than simply attempting to replace it. Androxal increases blood testosterone levels by increasing the levels of the hormones LH and FSH, both produced in the pituitary gland. One of the big advantages of enclomiphene citrate is that it does not negatively affect sperm. Enclomiphene is actually part of the drug Clomid, which is composed of two isomers: zuclomiphene citrate and enclomiphene citrate. An isomer is simply a compound that has the same chemical formula (the same number of atoms) but those atoms are arranged differently.

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In studies comparing zuclomiphene citrate, enclomiphene citrate and Clomid, which is a combination of the two isomers, zuclomiphene had persistent side effects that were not seen with enclomiphene citrate alone. In fact, the research data showed that zuclomiphene was found to actually work against the desired treatment effects. In addition, the way the two isomers perform in the body is very different, as the two compounds have very different biological half-lives. The half-life of a drug is simply the time required for half the amount of the drug to be eliminated by the body. Enclomiphene reaches a peak concentration in the blood in 4 hours with a half-life of 8 hrs, while zuclomiphene takes nearly twice as long to reach peak blood concentration and has a considerably longer half-life of greater than 40 hours. These marked differences in pharmacology between the two isomers were responsible for medical researchers to call for the development of the pure compound enclomiphene as a treatment for male hypogonadism.

In one study, mild side effects of enclomiphene, including headache and nausea, were seen in fewer than 4 percent of patients who participated. Other possible side effects can include increased sex drive (libido) and acne. In a randomized Phase III clinical trial, where enclomiphene was compared with testosterone gel in men with low testosterone and low or normal levels of LH, the men who received enclomiphene received either 12.5 mg or 25 mg of the drug daily. The group who got testosterone replacement received AndroGel 1.62 percent and all patients were followed for five months.

Enclomiphene citrate appears to be a safe and effective solution in younger men with hypogonadism who do not wish to compromise their fertility. For older men, enclomiphene could be used as a standalone therapy, especially if the risks of testosterone are judged to be too high for some individuals. Androxal comes in 12.5 mg or 25 mg doses to be taken by mouth.

The results for the men who received Androxal were impressive, as blood testosterone levels were restored to normal after 16 weeks and LH and FSH increased. At the same time, the drug maintained the men’s sperm concentrations. Addroxal’s effects on both LH and total testosterone persisted, even after the study ended and treatment was stopped. The Androgel group’s testosterone levels were also normalized but their sperm concentrations declined, due to suppression of their testicular function. In addition, LH and FSH levels decreased in the Androgel group.

References -

Tajar A, Forti G et al. Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab. 2010 Apr;95(4):1810-8. doi: 10.1210/jc.2009-1796. Epub 2010 Feb 19. PMID: 20173018.

Mulligan T., Frick M.F., Zuraw Q.C., Stemhagen A., McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006 Jul 1; 60(7): 762–769. doi: 10.1111/j.1742-1241.2006.00992.x

NIDA. 2021, April 12. What are the side effects of anabolic steroid misuse?. Retrieved from https://nida.nih.gov/publications/research-reports/steroids-other-appearance-performance-enhancing-drugs-apeds/what-are-side-effects-anabolic-steroid-misuse on 2022, October 3

 

Genchi VA, Rossi E, Lauriola C, D’Oria R, Palma G, Borrelli A, Caccioppoli C, Giorgino F, Cignarelli A. Adipose Tissue Dysfunction and Obesity-Related Male Hypogonadism. International Journal of Molecular Sciences. 2022; 23(15):8194. https://doi.org/10.3390/ijms23158194

Krzastek SC, Sharma D, Abdullah N, et al. Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism. J Urol. 2019;202(5):1029-1035. doi:10.1097/JU.0000000000000396

  Wiehle R & Fontenot GK. Clomid has got a bright side and a dark side. What do we really know after all these years? Evidence for toxicity. Fertility and Sterility – Vol 104( 3), Supplement, E12, September 01, 2015 DOI:https://doi.org/10.1016/j.fertnstert.2015.07.037

Rodriguez, K. M., Pastuszak, A. W., & Lipshultz, L. I. (2016). Enclomiphene citrate for the treatment of secondary male hypogonadism. Expert opinion on pharmacotherapy, 17(11), 1561–1567. https://doi.org/10.1080/14656566.2016.1204294

Huang ES, Miller WL. Estrogenic and antiestrogenic effects of enclomiphene and zuclomiphene on gonadotropin secretion by ovine pituitary cells in culture. Endocrinology. 1983;112(2):442-448. doi:10.1210/endo-112-2-442

Helo, S., Mahon, J. et al. MP76-08 Serum Levels Of Enclomiphene And Zuclomiphene In Hypogonadal Men On Long-term Clomiphene Citrate Treatment. The Journal of Urology, April 2016, Vol 195, Is 4s, pp. e1009-e1010. https://doi.org/10.1016/j.juro.2016.02.1859

 

Kim ED, McCullough A, Kaminetsky J. Oral enclomiphene citrate raises testosterone and preserves sperm counts in obese hypogonadal men, unlike topical testosterone: restoration instead of replacement. BJU Int. 2016;117(4):677-685. doi:10.1111/bju.13337

Earl JA, Kim ED. Enclomiphene citrate: A treatment that maintains fertility in men with secondary hypogonadism. Expert Rev Endocrinol Metab. 2019 May;14(3):157-165; https://pubmed.ncbi.nlm.nih.gov/31063005/

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What Is Testosterone? Get The Facts On This Muscle-Building, Fat-Blasting Hormone

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Testosterone is a hormone that is produced by the testes, which are located below the male bladder and in front of the penis. The primary functions of testosterone are to regulate men’s sexual development and to promote certain male characteristics

What is Testosterone?

Testosterone is a hormone that is produced mainly in the testicles. It is responsible for the development of male characteristics, such as muscles and deep voice. Testosterone levels typically decline with age, which can lead to a decrease in muscle mass and strength.

Effects of Low Testosterone

Low testosterone can have a number of effects on the body, including:

-Decreased muscle mass
-Decreased bone density
-Increased body fat
-Decreased sex drive
-Depression and moodiness

If you think you may be suffering from low testosterone, talk to your doctor. There are treatment options available that can help improve your symptoms.

Side Effects of High Testosterone Levels

If you’re experiencing any of the following side effects of high testosterone levels, it’s important to consult with your doctor. They may be able to recommend a treatment plan that can help:

1. Acne

2. Mood swings

3. Aggression

4. Difficulty sleeping

5. Increased appetite

6. Weight gain

How to Increase Low Testosterone Levels

There are a number of ways that you can increase your testosterone levels if they are low. You can try natural methods like changing your diet or exercising more, or you can try medical treatments like testosterone replacement therapy.

Some foods that are high in testosterone-boosting nutrients include oysters, eggs, and beef. You might also want to try taking supplements like vitamins D and zinc. Exercising regularly, especially lifting weights, can also help increase your testosterone levels.

If your doctor diagnoses you with low testosterone, they may recommend testosterone replacement therapy. This treatment involves taking artificial hormones to supplement the ones your body is not producing enough of. Testosterone replacement therapy can be done through injections, gels, or patches.

Increasing your testosterone levels can have a number of benefits, including increased muscle mass and strength, improved bone density, and reduced body fat. If you think you might have low testosterone levels, talk to your doctor to see if treatment is right for you.

Benefits of Increasing Testosterone Levels

Testosterone is the hormone responsible for muscle growth, fat loss, and increased strength. It’s no wonder that so many men are interested in increasing their testosterone levels.

There are several benefits of increasing your testosterone levels. First, higher testosterone levels lead to increased muscle mass. If you’re looking to bulk up, then increasing your testosterone is a great way to do it.

Second, higher testosterone levels also lead to increased strength. So if you’re looking to get stronger, then again, increasing your testosterone is a great way to do it.

And third, perhaps most importantly, higher testosterone levels lead to decreased body fat. Testosterone helps to burn fat and build muscle, so if you’re looking to lose weight, increasing your testosterone is a great way to do it.

If you’re interested in increasing your testosterone levels, there are several ways to do it. You can lift weights regularly, eat a healthy diet, and get enough sleep. You can also take supplements like creatine or Tribulus terrestris. And finally, you can use anabolic steroids.

Anabolic steroids are the most effective way to increase your testosterone levels quickly and significantly

Conclusion

Testosterone is a powerful hormone that plays a key role in muscle growth, fat loss and overall health. If you’re looking to boost your testosterone levels, there are a few things you can do, including exercise, diet and supplementation. By following these tips, you can optimize your testosterone levels and reap the benefits of this amazing hormone.

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What Is Testosterone Replacement Therapy (TRT)?

Testosterone is a hormone that stimulates sperm production, muscle growth, and development of male secondary sex characteristics. Although testosterone levels can decline for many reasons, the most common cause is aging. Hypogonadism, or low testosterone levels, may result in mood changes, erectile dysfunction (ED), reduced sexual desire and capacity for pleasure, depression, fatigue, decreased bone density and increased fat mass.

What is Testosterone?

Testosterone is a hormone that is produced by the testicles. It is responsible for the development of male sexual characteristics, such as a deep voice and facial hair. It also plays a role in fertility, bone and muscle mass, and red blood cell production. Testosterone levels naturally decline with age, which can lead to some of the symptoms associated with low testosterone, such as decreased sex drive, fatigue, and depression. Testosterone replacement therapy (TRT) is a treatment used to help manage these symptoms.

Why Should You Have Testosterone Replacement Therapy (TRT)?

Testosterone replacement therapy (TRT) can be an effective treatment for men who have low testosterone levels. TRT can help improve a man’s sex drive, energy levels, bone density, and red blood cell count. TRT can also help alleviate some of the symptoms of low testosterone, such as depression and irritability. TRT is not right for every man, however. Men with certain medical conditions should not have TRT, and it’s important to talk to your doctor about the potential risks and benefits of TRT before starting treatment. If you’re considering TRT, here are a few things to keep in mind: 1. TRT is most effective when started early. If you wait until you’re experiencing severe symptoms of low testosterone, TRT may not be as effective. 2. You may need to take testosterone shots or use a topical gel daily for several weeks before you notice any changes. 3. TRT is not a cure for low testosterone. Once you stop treatment, your testosterone levels will likely return to their previous levels. 4. There are potential side effects of TRT, such as acne, sleep apnea

Types of TRT Treatment

There are several types of testosterone replacement therapy available, and the type that’s best for you will depend on your individual needs. Here are some of the most common types of TRT: Injections: Testosterone injections are the most common type of TRT. They’re typically given every two to four weeks, and they can be self-administered or done by a doctor. Gels: Testosterone gels are applied daily to the skin, and they’re typically used in conjunction with injections. Patches: Testosterone patches are also applied daily, and they can be an alternative to gels for those who can’t tolerate them. Pellets: Testosterone pellets are implanted under the skin, and they release testosterone over a period of three to six months. This is generally considered to be the longest-acting form of TRT.

Side Effects and Risks of TRT

As with any medical treatment, testosterone replacement therapy (TRT) comes with potential side effects and risks. It’s important to be aware of these before starting TRT, so that you can make an informed decision about whether or not the treatment is right for you. Some of the most common side effects of TRT include acne, increased hair growth, and irritability. These are typically mild and go away after a few weeks of treatment. More serious side effects are rare, but can include blood clots, sleep apnea, and enlargement of the breasts. There are also some risks associated with TRT. The most serious is an increased risk of prostate cancer. However, this risk is only significant in men who already have a history of prostate cancer or who have other risk factors for the disease. In general, the benefits of TRT outweigh the risks for most men.

Who Should Get Testosterone Replacement Therapy (TRT)?

Testosterone replacement therapy (TRT) is a treatment used to address low levels of testosterone in men. It can be used to treat a wide range of symptoms related to low testosterone, including decreased sex drive, fatigue, and muscle weakness. TRT is typically only recommended for men who have symptomatic low testosterone levels that are confirmed by blood tests. In addition, TRT is not appropriate for all men with low testosterone levels. There are certain health conditions that may contraindicate the use of TRT, such as heart disease or prostate cancer. Ultimately, the decision to start TRT should be made by a man and his healthcare provider after a thorough discussion of the risks and benefits of the therapy.

How to Improve Low T Symptoms and Achieve a Healthy Level of Testosterone

If you’re a man with low testosterone levels, you may be interested in testosterone replacement therapy (TRT). TRT is a treatment designed to help improve symptoms of low testosterone and achieve a healthy level of the hormone. There are a number of different ways to approach TRT, and the best approach for you will depend on your individual situation. Here are some general tips to help you get started: 1. Work with your doctor to identify the cause of your low testosterone levels. There are many potential causes, and identifying the root cause can help guide your treatment. 2. Make lifestyle changes that can help improve your testosterone levels. This may include getting regular exercise, maintaining a healthy weight, managing stress, and getting enough sleep. 3. Consider supplements that can support healthy testosterone levels. Some examples include vitamin D, zinc, and ashwagandha. 4. Try natural therapies such as acupuncture or massage therapy. 5. If lifestyle changes and supplements don’t seem to be enough, talk to your doctor about TRT options. There are a number of different ways to provide testosterone replacement, and your doctor can help you find the best option for you.

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Testosterone Therapy: What You Need To Know

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Testosterone therapy has been the subject of a lot of hype and controversy over the past few years. What are some issues with testosterone therapy? When should you consider it? What are some side effects to watch out for?

What is testosterone therapy?

Testosterone therapy is a treatment used to help men with low testosterone levels. Testosterone is a hormone that plays a key role in many body functions, including sexual function, bone and muscle mass, and red blood cell production. Low testosterone levels can cause problems such as low energy levels, moodiness, and reduced sex drive. Testosterone therapy can help to improve these symptoms and may also have other benefits.

Who benefits from testosterone therapy?

Testosterone therapy can be beneficial for men who have low testosterone levels. Testosterone therapy can help improve mood, increase energy levels, and improve sexual function. Testosterone therapy can also help build muscle mass and reduce body fat. Testosterone therapy is not for everyone, and it is important to talk to your doctor to see if it is right for you.

How do I get a prescription for testosterone therapy?

If you’re interested in testosterone therapy, the first step is to talk to your doctor. They can help you determine if testosterone therapy is right for you, and if it is, they can write you a prescription. To get a prescription, you’ll likely need to have your blood test results and a physical examination.

Is there any side effects of testosterone therapy?

Yes, there are potential side effects of testosterone therapy. These include an increased risk of heart disease, stroke, and liver problems. There may also be an increased risk of sleep apnea and prostate cancer. Testosterone therapy can also cause mood swings, acne, and enlarged breasts in men.

What are the dosages of hormone replacement therapy?

There are a few different types of hormone replacement therapy, and the dosage will vary depending on the type that you choose. For testosterone therapy, the typical dosage is between 200 and 400mg per week. This can be taken as a shot, a gel, or a patch, depending on your preference.

Conclusion

If you’re considering testosterone therapy, it’s important that you understand the potential risks and benefits. Testosterone therapy can be an effective treatment for some men, but it’s not right for everyone. Be sure to talk to your doctor about all of your options before making a decision.