tissue is very rich in estrogen, and estrogen breaks down testosterone (a process known as aromatization). In fact, testosterone levels will naturally rise simply from losing significant weight. Twenty three percent of persons with cardiovascular disease
(CVD) have hypogonadism. One study reported that a low testos- terone level by itself may be a stronger predictor of the degree of coronary artery disease than blood pressure, cholesterol, diabetes, smoking, and obesity. Increasing T levels in men with CVD has been shown to im-
prove coronary artery blood flow, reduce exercise-induced myo- cardial ischemia and angina symptoms, reduce the inflammatory chemicals seen in CVD, reduce the risk of arterial plaque formation, and decrease mortality rates. Men with diabetes have significantly lower free and total T lev-
els. Testosterone treatment has been shown to slash the risk of death from Type II diabetes. In one 2011 study 578 men with Type II DM were followed for 6 years. Over that time period, 20% with low T levels died, compared to only 9% with normal levels. Among those men with low T who were given T, only 8.6% died. Testosterone treatment has also been shown to improve insulin sensitivity and to decrease hemoglobin A1c and C-reactive protein (C-RP, a marker of inflammation) levels. The risk of Alzheimer’s disease can be significantly reduced (by some estimates by as much as 80%) by optimizing T levels. Higher T levels are associated with increased mental performance in the elderly, and T has been shown to reduce the production and deposi- tion of the beta-amyloid proteins that cause the brain plaques seen in AD. There are profound implications for preventive medicine, well- ness, and longevity with testosterone supplementation to optimal levels.
Symptoms of Low Testosterone The most obvious, and most commonly associated, side effect
of low T is low libido, or low sex drive. Gradual and subtle declines in T levels may be manifested by a slowly, sometimes, perhaps, even imperceptible, decreasing interest in sex. More overt symptoms in- clude difficulty obtaining or maintaining an erection, and decreased morning erections.
Other symptoms of low T include:
• Decreased overall energy • Decreased sense of well-being • Increased irritability • Decreased exercise performance or tolerance • Slower recovery from exercise • Decreased strength
• Decreased muscle mass / increasing fat mass • Decreased concentration or ability to maintain focus • Depression or, more subtly, a decreased enjoyment of life
Testosterone Supplementation Treatment with T should be done only under the supervision of
a physician trained in its use. While inherently safe (as long as blood levels are maintained in the proper range), knowledge of the proper application, potential side effects, and risk factors is imperative. All T treatment needs to start with a thorough history and physi- cal exam, including a range of blood work (the details of the medical workup are beyond the scope of this article). Based on the results
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