Page 4 - Testosterone Replacement Monitoring Tests

Table of Contents What is a PSA Test? Elevated Prostate Specific Antigen The Significance of Free PSA What if the Test Shows an Elevated PSA level? Getting Tested The PSA Controversy The Prostate-specific antigen or PSA test is a blood test that can be used as a measurement of prostate health.  According to a March 2009 European study published in the New England Journal of Medicine (1), the PSA test is not only a valid screening test for prostate cancer but could also significantly reduces mortality from this disease in middle-aged men.    What is a PSA Test? The PSA test was initially approved by the US Food and Drug Administration (FDA) in 1986 to track the progression of prostate cancer in individuals who have been previously diagnosed with the disease. In 1994, the use of the PSA test, together with a digital rectal exam (DRE) was approved by the FDA to test asymptomatic men for prostate cancer. Men who experience prostate symptoms will usually undergo a PSA test (with a DRE) to help a urologist determine what’s causing the problem.   Elevated Prostate Specific Antigen Prostate-specific antigen (PSA) is a protein secreted by healthy, as well as cancerous cells in the prostate gland. A PSA test is commonly used to measure the level of this protein in someone’s blood. This test is conducted by taking a blood sample and sending it to a laboratory for analysis. PSA test results are typically recorded as nanograms of PSA per milliliter (ng/mL) of blood. In men with prostate cancer, the blood level of PSA is frequently elevated. Although research does indicate that having an elevated PSA level does not always mean that a man has prostate cancer (2). PSA levels may also become elevated because of benign enlargement of the prostate gland as well as prostatitis (inflammation of the prostate) due to infection. It’s crucial to emphasize that a PSA test is not a specific prostate cancer test, but it’s a critical first step in checking for the possible presence of prostate cancer. There are other factors that could cause your PSA levels to increase (3):   Advancing age; PSA levels tend to rise with age. Inflammation of the prostate gland, from either infection or some other undetermined cause. Benign prostatic hyperplasia (BPH); also called an enlarged prostate.  A larger prostate has more cells secreting PSA, increasing the odds for an elevated PSA level. Prostate cells could be inflamed by a urinary tract infection, causing PSA levels to go up. Ejaculation can cause a mild elevation in the PSA score, but levels return to normal after only a few days. The recommendation is that men abstain from sex for at least 48 hours before PSA testing Anything that might cause trauma to the prostate like; bike riding, catheter insertion into the bladder, prostate biopsy, or cystoscopy can temporarily increase PSA levels.   GET A PSA TEST HERE   Conversely, some medicines (Proscar, Avodart, Propecia) (4) could lower your PSA.  If you’re taking any of these medications, you should advise your doctor.  A PSA level of less than 4.0 ng/mL is considered to be normal, but changes of more than 2.0 ng/mL over a year may indicate that prostate cancer is present (5).   The Significance of Free PSA PSA circulates through the body in two ways; bound to other proteins or by itself. Unbound PSA is called free PSA. A free-PSA test will measure the percentage of unbound PSA while a PSA test is used to measure the total of free and bound PSA in the blood (6). The free PSA is a defective variant of normal PSA that can no longer bind to other proteins and so circulates in the blood in the free form. Although the reason why is poorly understood - patients with cancer may have lower free PSA levels than those with a benign prostate condition (6).   GET A FREE PSA/TOTAL PSA RATIO TEST   What if the Test Shows an Elevated PSA level? If someone who isn’t experiencing the symptoms of prostate cancer decides to take a PSA test and discovers that he has an elevated PSA level the urologist could advise him to take another PSA test to confirm the original result. When results show that the PSA level is still elevated, the doctor could then recommend that he continue to be tested and digitally examined at regular intervals to detect changes (if any) over time (6). When the PSA level continues to rise or if a lump is detected during a digital examination, additional tests could be prescribed to discover possible causes (7). These tests can include:   Urine test to check for a urinary tract infection Transrectal ultrasound X-rays  Cystoscopy   If the doctor suspects prostate cancer is present, then a prostate biopsy may be recommended. This procedure is used to collect multiple samples of prostate tissue by inserting hollow needles into the prostate gland and then withdrawing them. Frequently, the needles will be inserted through the wall of the rectum in a procedure called a transrectal biopsy. A pathologist then studies the collected prostate tissue with a microscope. An ultrasound may also be used to view the prostate during the biopsy, although ultrasound alone can’t be used to make a prostate cancer diagnosis.   Getting Tested The accepted recommendation is that once a man reaches 40 years of age, he should begin having his prostate checked to establish a baseline for future monitoring. With a baseline set, the doctor can act quickly if PSA level changes indicate a potential problem (8). Unfortunately, many men underestimate the importance of setting a PSA baseline from a younger age. Establishing your baseline PSA level means that if there is even a small change in PSA levels - your doctor can quickly begin the necessary procedures to find out what may be causing the change and commence proper treatment if it’s indicated, possibly saving your life (9).   The PSA Controversy The PSA test is not a cancer test. The test is only used to determine the level of PSA in a man’s blood. A high PSA score may indicate the presence of prostate cancer – but there are many factors that can cause PSA levels to be elevated, from infection to resent ejaculation. Another problem is that the PSA test also cannot distinguish between elevated PSA as a result of benign cancer that will pose no threat in the course of a normal lifetime or from the presence of an aggressive tumor that poses a much more immediate threat (10). Regardless, current research still indicates that PSA is a valid and proven marker that can be used together with other variables for determining the chance that aggressive prostate cancer is present (10).   References   1) SchröderFH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality in a randomized European study, N Engl J Med, 2009, vol. 360 13(pg. 1320-1328).   2) O'Shaughnessy M, Konety B, Warlick C. Prostate cancer screening: issues and controversies.MinnesotaMedicine, August 2010.   3) Mayo Clinic Staff. PSA Test. (N.D.). https://www.mayoclinic.org/tests-procedures/psa-test/details/risks/cmc-20200313   4) Pannek J, Marks LS, Pearson JD, Rittenhouse HG, Chan DW, Shery ED, Gormley GJ, Subong EN, Kelley CA, Stoner E, Partin AW. Influence of finasteride on free and total serum prostate-specific antigen levels in men with benign prostatic hyperplasia. The Journal of Urology. 1998.   5) Carter, H. Ballentine et al. “Detection of Life-Threatening Prostate Cancer with Prostate-Specific Antigen Velocity During a Window of Curability.” Journal of the National Cancer Institute 98.21 (2006): 1521–1527. PMC. Web. 24 Nov. 2017.   6) Mione R1, Barioli P, Barichello M, Zattoni F, Prayer-Galetti T, Plebani M, Aimo G, Terrone C, Manferrari F, Madeddu G, Caberlotto L, Fandella A, Pianon C, Vianello L, Gion M. Prostate cancer probability after total PSA and percent free PSA determination. Int J Biol Markers. 1998 Apr-Jun;13(2):77-86.   7) Wilt, Timothy J et al. “Prostate Cancer: Epidemiology and Screening.” Reviews in Urology 5. Suppl 6 (2003): S3–S9. Print.   8) Larsen, Signe Benzon et al. “Baseline PSA Measurements and Subsequent Prostate Cancer Risk in the Danish Diet, Cancer and Health Cohort.” European journal of cancer (Oxford, England: 1990) 49.14 (2013): 3041–3048. PMC. Web. 24 Nov. 2017.   9) Weight, Christopher J. et al. “Men (Aged 40–49 Years) With a Single Baseline Prostate-Specific Antigen Below 1.0 ng/mL Have a Very Low Long-Term Risk of Prostate Cancer: Results from a Prospectively Screened Population Cohort.” Urology 82.6 (2013): 1211–1217. PMC. Web. 24 Nov. 2017.   10) H Ballentine Carter. Differentiation of lethal and nonlethal prostate cancer: PSA and PSA isoforms and kinetics. Asian Journal of Andrology. 2012 May; 14(3): 355–360.

Testosterone Replacement Therapy (TRT) has changed the lives of many men around the world.  Like any therapy, it can have great benefits if properly managed but negative side effects if not monitored.  This article will briefly and simply review the different TRT tests that most physicians use to monitor your progress while minimizing potential side effects.   Table of Contents How to Know if You Need TRT Follow Up Lab Tests After Starting TRT Avoiding or Lowering High Hematocrit on TRT Avoiding Low Ferritin and Iron Monitoring the PSA Test on Testosterone Monitoring Estradiol Test on Testosterone Avoiding High Blood Pressure and Water Retention on TRT Monitoring Kidney Function Avoiding High Liver Enzymes Monitoring Thyroid Tests Maintaining Good HDL Levels on TRT Prolactin in Men with Low Testosterone: The Forgotten Hormone Where to Buy Your Own TRT Tests: How to Know if You Need TRT The first thing doctors actually measure before you get on testosterone replacement is your total and free testosterone blood levels to find out if you have low testosterone. They will also ask you a few questions to see if you have low testosterone or hypogonadal symptoms. They include low sex drive, erectile dysfunction, fatigue, low mood, and issues with cognitive capacity and function. So, testosterone replacement therapy includes anything to increase testosterone levels with either injections or creams, gels, pellets, oral, nasal, and other TRT options. Follow Up Lab Tests After Starting TRT Once you get on testosterone replacement, your doctor will have you come back either at week six or eight to run another blood test to see if your dosage needs to be adjusted and/or you may require other medications to monitor or to modulate or change levels like estradiol, hematocrit, etc. The first one obviously is testosterone total and free. You come back at week six or eight, and your total testosterone is not over 500 nanograms per deciliter, your doctor will probably choose to increase your dosage or your frequency of injections in the case of injections. Free testosterone is usually around 2% of total or higher. If you have lower than 2%, your doctor will probably focus on any issues related to high sex hormone binding globulin (SHBG), which is a protein that binds to testosterone and does not free it up for action. Avoiding or Lowering High Hematocrit on TRT Hematocrit is the proportion of red blood cells in the blood. Testosterone tends to increase red blood cells.  Some men don't have that issue, but most men at least have a two to a three-point increase in hematocrit after starting TRT. Hematocrit increases a lot more in men on TRT who have sleep apnea and in smokers since these two can cause oxygen starvation.  High hematocrit can increase the viscosity of the blood and may cause cardiovascular issues. So, the magic number to go for is a hematocrit of 53 or below. When you're getting close to 53, you have to basically donate blood or go for what we call a therapeutic phlebotomy to bring down the red blood cell amount in the blood. And that's very important because as hematocrit goes up, your blood becomes more and more viscous, and your cardiovascular system gets compromised.  It's also very important not to let it go too high because above 52, most blood centers would not accept you as a donor, so you would have to require a special prescription for a therapeutic phlebotomy from your doctor for the blood centers to take your blood and dispose of it later. Keep in mind that donating more frequently than every three months may decrease your ferritin and iron stores considerably, which can cause fatigue and other issues. Here are some hematocrit lab panels, or you can buy them as part of the CBC panel. Avoiding Low Ferritin and Iron When your hematocrit is over 53, and you donate blood frequently than every three months, you can deplete your iron stores which makes you tired, depressed, and with no libido. Blood donations should not be happening that frequently because you'll lose iron. Some doctors will test your iron and your ferritin, and if you have low levels, they will put you on an iron supplement. Discounted Labs sells a blood donation panel that is designed to inform you if you can safely donate blood. Monitoring the PSA Test on Testosterone High PSA, prostate-specific antigen, is the only contraindication for testosterone replacement therapy if it is 4 or above. Obviously, physicians get very concerned that a man with higher PSA may have prostatic cancer, although it could be caused by an infection of your prostate (prostatitis) that could be easily treatable with an antibiotic. So, all high PSA tests do not mean you have cancer, but it could mean that you could have a treatable prostatic infection.  Your doctor may prescribe antibiotics and retest your PSA after your antibiotic cycle is finished.  He or she may need to refer you to a urologist if your high PSA test does not come down.  But if you do have a PSA of four or higher, you are not going to be allowed to use testosterone replacement unless your doctor can actually prove that it's an infection that will eventually be treated so that your PSA can come down. Monitoring Estradiol Test on Testosterone Estradiol (E2) is a very important hormone for men. We need it because estradiol is actually linked to bone health, cognitive functioning, cardiovascular health, even sex drive, and decreased fat mass. Having very low estradiol of under 20 pg/mL is actually not good for you since it can decrease bone density and cause other issues. Having very high estradiol in relation to your testosterone blood level may also have some consequences.  Several studies have different opinions and conclusions on what high estradiol means. About 0.3 to 0.4% of testosterone gets converted into estradiol by the aromatase enzyme. So obviously, the body increases the amount of estradiol as your testosterone goes up. There's nothing wrong with that. Estradiol balances testosterone to keep a better lipid (cholesterol) profile and to keep healthy sperm counts, just to name a few benefits. But what level of estradiol in men is too high? For example, if you have a testosterone level after you start TRT of 700 nanograms per deciliter, obviously, your estradiol is going to be higher than when before you started TRT. Is that cause for concern? Most men on testosterone replacement therapy do not need to take medications to lower estradiol. Estrogen blocker medications like anastrozole (Arimidex) are being overprescribed by many TRT clinics.  Men with a history of gynecomastia or breast enlargement may have issues with gynecomastia again if your estradiol's over 50 pg/ml, but in most studies where men with gynecomastia were followed, a lot of those men had low testosterone while they had high estradiol. A large study in adolescent boys showed that most of the ones with gynecomastia also had high IGF-1.  Some studies have shown that the ratio of testosterone to estradiol is really the important factor to monitor, with ratios over 12 being needed for healthy sperm production in men. But the management of estradiol in men is a very controversial topic as there is not a lot of agreement in the field.  Some doctors insist on keeping an E2 level of 20 to 40 picograms per milliliter no matter how high testosterone levels reach. We have learned in the past three years that the old immunoassay-based estradiol test tends to overestimate estradiol in men. Two studies have shown that the real estradiol value is better tested with a liquid chromatography-mass spectrometry sensitive estradiol assay. So, make sure that if your doctor is going to check your estradiol, you're using the right LC/MS E2 test. Discounted Labs offers several lab panels that contain sensitive estradiol.  Another concern of high estradiol is that some men feel that water retention is an issue, although that has not been proven by any studies. Most men with TRT-related water retention assume that their estradiol is high but fail to get it tested. Avoiding High Blood Pressure and Water Retention on TRT Some men on testosterone replacement therapy tend to have increased blood pressure related to water retention. There are some central nervous system effects that increase blood pressure and heart rate. These men can gain considerable weight during the first weeks of TRT.  Most lose most of that weight after a few weeks of therapy.  Some studies have shown that testosterone may decrease sodium excretion by the kidneys, which makes the body retain water to keep that sodium diluted. Ways to improve blood pressure are to lose weight, take a blood pressure medication, exercise, and decrease excessive sodium intake. Many men assume that their estradiol is high when they experience water retention. That assumption has not proven to be correct. Monitoring Kidney Function The estimated glomerular filtration rate, or eGFR, is a way to measure your kidney function. It's part of what we call a CMP blood test panel, and we are aiming at an eGFR over 60. Anything below that is indicative of a slowdown in the way your kidneys are filtrating toxins from your body. TRT does not really cause a decrease in eGFR. However, a lot of men taking creatine, exercising heavily, or eating very high protein intake tend to probably have artificial increases in creatine that decrease eGFR. You can Google eGFR formula and see how that's calculated. Avoiding High Liver Enzymes Current testosterone replacement therapy options have not been shown to increase liver enzymes; only the old oral forms of TRT used to cause that problem. However, doctors obviously follow it up. A very important distinction to make is that men that are exercising heavily with weights at the gym may artificially  increase in AST and ALT that has nothing to do with toxicity to the liver. Monitoring Thyroid Tests TSH, thyroid stimulating hormone, is also something else that most doctors follow up, although some actually do not. Low thyroid function (hypothyroidism or high TSH) may have the same symptoms as low testosterone. TRT medical guidelines groups around the world recommend different schedules for monitoring men on TRT, and a few of them agree with each other. Rarely do any guidelines mention thyroid function monitoring in men on TRT. TSH levels above 2.5 may indicate that you have hypothyroidism. If you have high TSH, doctors usually tend to use a comprehensive thyroid panel that includes free T3 and free T4, along with antibodies, to see if you have an autoimmune disease like Hashimoto's that may be inducing hypothyroidism. Maintaining Good HDL Levels on TRT High-density lipoprotein or HDL is another one of the variables most affected by testosterone replacement, especially at higher doses. When I say higher doses, anybody using 200 milligrams of testosterone replacement per week — cypionate or enanthate — tend to have a lowering of HDL. Low HDL has been shown to cause cardiovascular issues, so your doctor will always follow your lipids. Testosterone replacement has not really been shown to increase LDL, and there are some studies that show that TRT improves triglyceride blood levels because testosterone tends to improve the way the body metabolizes carbohydrates. There's very little we can do to increase HDL besides aerobic exercise, losing weight, decreasing TRT dose, and taking a supplement. Niacin supplementation is one of the ways to increase HDL, but some people get flushing of the skin and face. Last but not least, the use of anastrozole, an estradiol blocker, can also decrease HDL since estradiol is known to protect HDL levels. Prolactin in Men with Low Testosterone: The Forgotten Hormone Prolactin is not a hormone that is usually measured at TRT baseline or even at follow-up unless you have severe erectile dysfunction, even with good levels of testosterone. Men that have low testosterone at baseline, and I mean low testosterone, very low — under 150 nanograms per deciliter — are probably the best candidates to get a prolactin test. It is a hormone that women and men produce – obviously, women that are lactating produce it at higher concentrations in their bodies because it helps lactation. It also has some other benefits; otherwise, men would not have it. Prolactin has some immune-enhancing benefits and some cardiovascular benefits that are starting to show up in studies. So, prolactin is not an evil hormone, but it can, at higher concentrations, cause erectile dysfunction. The reason for high prolactin could be a benign tumor called pituitary adenoma (diagnosed by MRI), which can be producing a lot of pituitary output for prolactin, and that could actually impair your testosterone replacement therapy benefits. So, it's a hormone that is hardly looked at unless you are a man that has very low testosterone blood levels at baseline or do not respond well (unresponsive erectile dysfunction) after eight weeks or ten weeks of testosterone replacement therapy and/or you are having high prolactin symptoms, like lactation. That's actually a very rare symptom that actually occurs in men with pituitary adenomas. Where to Buy Your Own TRT Tests: DiscountedLabs.com provides very low-cost blood testing in most US states. You don't need to see a doctor because the company has in-house physicians that provide a prescription. After ordering your lab test online, you receive an email with the lab request form that you take to the closest lab near you. Once you go to a lab and get your blood drawn, you receive an email with your results within five to seven business days, depending on the blood test. For more information, visit DiscountedLabs.com   Visit ExcelMale.com to download Nelson's latest book: Beyond Testosterone   Click here for TRT Resources

Table of Contents What is aldosterone? The ALD test What is Renin? Hypertension and the renin test What is Adrenal Corticotropic Hormone (ACTH)? The ACTH test References A frequent cause of high blood pressure and water retention is when levels of certain hormones in the body are unbalanced or functioning poorly. The hormones that are frequently at fault are secreted by the kidneys and the pituitary or adrenal glands. They are called aldosterone, ACTH, and renin What is aldosterone? Aldosterone (ALD) is one of a group of connected hormones. They form the renin–angiotensin–aldosterone system (1); this system is activated when there is a decrease in blood flow to your kidneys following a drop in blood volume or blood pressure such as during heavy bleeding, or sodium levels fall below healthy levels (1). Aldosterone is a mineralocorticoid, which means that it adjusts the mineral levels in our cells, particularly sodium and potassium (2). It regulates both fluid levels and blood pressure in the body. Stress is a factor that can increase the release of aldosterone and cause sodium levels to rise. Regardless why, an increase in aldosterone results in edema (water retention) and high blood pressure (3). Someone experiencing high aldosterone levels may also experience (4): Low potassium levels (causing muscle cramps) Abnormally increased blood volume Unusually alkaline blood (because aldosterone promotes acid secretion) People experiencing high blood pressure and edema may be advised to check their aldosterone level with an aldosterone (ALD) test. When the level of this hormone is too high, it can cause damage to the cardiovascular system. If levels are too high, medicines can be prescribed that will lower aldosterone to healthy levels. The ALD test An ALD test is frequently used to diagnose both fluid and electrolyte disorders (5) that may be caused by: Diabetes Adrenal disease Heart problems Kidney failure An ALD test may help diagnose problems like (6): Over-secretion of aldosterone Underactive adrenal glands (adrenal insufficiency) Low blood pressure caused by standing up (orthostatic hypotension) Hard to control high blood pressure or high blood pressure that occurs at a young age What is Renin? Renin is also called angiotensinogenase; it’s an enzyme produced by the kidneys to control aldosterone production (7). It’s also essential in the renin–angiotensin aldosterone system (RAAS) which maintains your body’s fluid balance and blood pressure. This system regulates blood plasma volume, lymph and interstitial fluid (the fluid which surrounds the cells in the body) and controls constriction of the arteries and blood vessels (7). Three factors stimulate the secretion of renin (8): When a drop in arterial blood pressure is detected by pressure-sensitive receptors in the arteries When a drop in salt level is detected in the kidneys When activity is detected in the sympathetic nervous system activity Renin’s primary function is to increase blood pressure to maintain healthy blood flow to the kidneys. It’s secreted by specialized kidney cells that can detect changes in blood pressure through stretch receptors in the vascular walls (8). Renin starts a chain reaction that makes the hormone called angiotensin, which makes small blood vessels narrower and stimulates the adrenal glands to secrete aldosterone. Aldosterone signals the kidneys to hold on to fluid and salt. Both can increase blood pressure. When this process is out of balance, blood pressure can rise to dangerous levels. Hypertension and the renin test If you experience high blood pressure (hypertension), your doctor needs to find out the reason why to prescribe the correct treatment. A renin test is used to discover what’s happening in the body that may be causing it. The doctor might order this kind of test if high blood pressure starts when you’re young or medication hasn’t kept it under control. Because renin is involved in aldosterone metabolism, an ALD test may be conducted at the same time (9). Your test results will tell the doctor if your renin levels are high, low, or healthy. Either high or low levels could help explain why your blood pressure is too high. What the renin and ALD test results may mean (10, 11): Excess renin with normal aldosterone levels could mean that you’re salt-sensitive Low renin and excess aldosterone may indicate that your adrenal glands aren’t functioning properly If both renin and ALD are high, it may be a sign of kidney trouble Whatever the results are, they will help the doctor decide which drugs or treatments are best to get your blood pressure under control. What is Adrenal Corticotropic Hormone (ACTH)? Adrenocorticotropic hormone is a hormone secreted in the anterior (front) pituitary gland in your brain (12). The role of ACTH is to maintain appropriate levels of the stress hormone cortisol, which is released by the adrenal glands. Cortisol is our body’s natural alarm system. As our body’s primary stress hormone, it works with different parts of the brain to influence our fear, mood, and motivation (13). Cortisol is best known for fueling the body’s “fight-or-flight” response in a crisis. But, cortisol also has a critical role in a variety of things the body does, like (13): Controlling the sleeping and waking cycle Boosting energy levels to better handle stress (and restore normal levels afterward) Influences how the body uses carbs, proteins, and fats Reducing inflammation Regulating blood pressure Increasing blood sugar Symptoms of high cortisol can include; high blood pressure, obesity, high blood sugar levels, and edema. Low cortisol levels can cause weight loss, fatigue, low blood pressure, and muscle weakness (14). The ACTH test If you’re experiencing the symptoms of a cortisol imbalance, your doctor may order an ACTH test to measure the levels of both ACTH and cortisol in the blood (15). The ACTH test will help your doctor detect the diseases that are associated with too much or too little cortisol in the body (15). Your doctor might also perform a physical examination before making a firm diagnosis. If it’s determined that an ACTH secreting tumor (sometimes located on an adrenal gland) is the cause of your cortisol imbalance, then surgery may be indicated (16). You may also be prescribed a drug like cabergoline to normalize your cortisol levels (17).   GET THE ALDOSTERONE LAB TEST HERE   References 1) Manrique C, Lastra G, Gardner M, Sowers JR. The Renin Angiotensin Aldosterone System in Hypertension: Roles of Insulin Resistance and Oxidative Stress. The Medical clinics of North America. 2009;93(3):569-582. doi:10.1016/j.mcna.2009.02.014. 2) Aldosterone and Mineralocorticoid Receptors in the Cardiovascular System Funder, John W. Progress in Cardiovascular Diseases , Volume 52 , Issue 5 , 393 – 400 3) Yoo HD, Choi KS, Jung MH, et al. A Study of the Renin-Angiotensin System and the Blood Volume in the Nephrotic Syndrome. The Korean Journal of Internal Medicine. 1986;1(1):72-77. doi:10.3904/kjim.1986.1.1.72. 4) https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/adrenal-gland-disorders/hyperaldosteronism 5) Balcı AK, Koksal O, Kose A, et al. General characteristics of patients with electrolyte imbalance admitted to emergency department. World Journal of Emergency Medicine. 2013;4(2):113-116. doi:10.5847/wjem.j.issn.1920-8642.2013.02.005. 6) Sau-Cheung Tiu Cheung-Hei Choi Chi-Chung Shek Ying-Wai Ng Fredriech K. W. Chan Chiu-Ming Ng Alice P. S. Kong. The Journal of Clinical Endocrinology & Metabolism, Volume 90, Issue 1, 1 January 2005, Pages 72–78, https://doi.org/10.1210/jc.2004-1149 7) Hall JE. Control of blood pressure by the renin-angiotensin-aldosterone system. Clin Cardiol. 1991 Aug;14(8 Suppl 4):IV6-21; discussion IV51-5. 8) Persson PB. Renin: origin, secretion and synthesis. The Journal of Physiology. 2003;552(Pt 3):667-671. doi:10.1113/jphysiol.2003.049890. 9) Rayner BL, Opie LH, Davidson JS. The aldosterone/renin ratio as a screening test for primary aldosteronism. S Afr Med J. 2000 Apr;90(4):394-400. 10) https://www.uclahealth.org/endocrine-center/renin-test 11)https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=aldosterone_renin_blood 12) Lim CT, Khoo B. Normal Physiology of ACTH and GH Release in the Hypothalamus and Anterior Pituitary in Man. [Updated 2017 Oct 24]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279116/ 13) Fujiwara, Toshihiko et al. Role of cortisol in the metabolic response to stress hormone infusion in the conscious dog. Metabolism - Clinical and Experimental , Volume 45 , Issue 5 , 571 – 578 14) https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310 15) https://medlineplus.gov/ency/article/003696.htm 16) Chiara Dall'Asta Luigi Santambrogio Massimo Castellani Bruno Ambrosi. Difficulties in diagnosis and treatment of ectopic ACTH-producing tumors of the chest. European Journal of Cardio-Thoracic Surgery, Volume 21, Issue 1, 1 January 2002, Pages 149–151. 17) Ferriere A, Cortet C, et al. Cushing's disease: a large retrospective multicenter study. Eur J Endocrinol. 2017 Mar;176(3):305-314. doi: 10.1530/EJE-16-0662. Epub 2016 Dec 22.

Table of Contents High hematocrit: the main side effect of Testosterone Replacement Therapy (TRT) What are the symptoms of high hematocrit? What are factors that increase the risks of TRT polycythemia ? How to Lower Hematocrit? How to Manage Increased Hematocrit Caused by Testosterone Replacement Therapy High hematocrit: the main side effect of Testosterone Replacement Therapy (TRT) Testosterone replacement therapy (TRT) is one of the most effective ways to combat low testosterone levels, but it's vital that you understand the risks associated with the treatment. As with any form of hormone replacement therapy, there are a few downsides to receiving regular injections of testosterone. But do these risks outweigh the benefits? That's a decision you'll have to make for yourself! Note: Remember the purpose of TRT: to restore testosterone to NORMAL, healthy levels in the body. Ideally, testosterone levels should be normal after TRT. Even at normal levels, there is a risk of side effects. One of the primary risks of testosterone that is you need to be aware of is called polycythemia. This is a condition where your body produces too many red blood cells, also known as high hematocrit level. Hematocrit refers to the red blood cell content in your blood. If your hematocrit levels rise, your blood will become too thick or viscous. This can, in turn, make it more likely that you will develop strokes, heart attacks, and clotting events. Polycythemia is serious and potentially life-threatening if untreated.   What are the symptoms of high hematocrit? In recent years, there has been an increased association between TRT and polycythemia. With TRT becoming a more mainstream treatment, more people are experiencing the symptoms of polycythemia, which include: Weakness Fatigue Headache Itching redness of the skin bruising joint pain dizziness abdominal pain shortness of breath breathing difficulty when you lie down numbness, tingling, or burning in the hands, feet, arms or legs Turning very red or "flushing" after workout When polycythemia occurs, the blood becomes very thick. But instead of being able to carry MORE oxygen, the increase of red blood cells can be dangerous. The risk of clotting increases as a result of the red blood cell count increase. Note: While there is a risk of hematocrit increase, there is no proof that TRT increases the risk of clotting events. It's vital to be aware of the potential risk, so doctors need to be careful when prescribing TRT to men with high hematocrit levels, red blood cell disorders, and obstructive pulmonary disease. All of these things increase the risk of clotting events as a result of the hematocrit increase caused by TRT.   What are factors that increase the risks of TRT polycythemia ? There are a number of factors that can increase your risk of developing this problem. According to Dr. Michael Scally, polycythemia "occurs quite frequently in people who are on replacement testosterone." Age also plays a role in your polycythemia risk. Young men are far less likely to experience this problem than older men. The mode of delivery and the dose of testosterone affect the increase in your hematocrit levels. Men who receive formulations of pharmacokinetically steady-state delivery hormones are far less likely to develop the problem than men who receive intramuscular injections of testosterone. Topical preparations only cause the problem in up to 20% of cases. 5 to 15% of those who use testosterone patches develop polycythemia, while 10 to 20% of those using the testosterone gel develop the problem. Of course, the amount of testosterone delivered per day (50 to 100 milligrams) also affects the risk of developing polycythemia. Testosterone injections may increase hematocrit more than gels, patches, pellets, nasal or oral testosterone formulations.  Smaller injection doses given more frequently may increase hematocrit less rapidly than larger dose injections, but data are lacking to prove that fact. Men with sleep apnea or those who smoke are at the highest risk of high hematocrit since their bodies are trying to compensate for the decreased oxygen level by producing more red blood cells.  TRT enhances that red blood cell production.   How to Lower Hematocrit? So what can you do about the problem? Is there any way to manage it? Those undergoing TRT must be aware that polycythemia is a real risk, as do their doctors. They must keep a close eye on their hemoglobin and hematocrit levels. If hematocrit rises above 52%, further examinations may be necessary. Some doctors counsel reducing or stopping testosterone treatment. However, for those who are undergoing TRT as a means of restoring healthy hormone levels, this may not be an option. Some means of managing and reducing the risk of high hematocrit levels include: Scaling back on the amount of testosterone gel delivered per day (50mg or less) or injection dose. Changing the method of administration (using more frequent injections with smaller doses, or using a testosterone gel or cream) Making sure that you are hydrated when you get your blood drawn for lab tests Stopping smoking Getting sleep apnea diagnosed and treated with a CPAP machine to enhance oxygen saturation levels when sleeping. If these options do not work, a therapeutic phlebotomy (blood donation) may be the answer. Removing just one unit of blood can help to lower hematocrit by as much as 3%. For those with very high hematocrit levels, the therapy may continue for months, gradually reducing hematocrit to safe levels over time. Some physicians even prescribe regular phlebotomies (no more frequently that every 56 days is the safe frequency to avoid iron loss) as a means of preventing overly high hematocrit levels. While phlebotomies are not covered by your insurance, they can be performed at any blood bank. Even if your insurance company won't cover the cost, you can solve the problem by donating blood (provided you are free of hepatitis, HIV, and other blood-borne infections). Experts agree that donating every 2.5 to 3 months is safe, and it's a good way to keep your hematocrit levels under control. It is important to note that hematocrit can stabilize in men on longer term TRT, so many men do not have to donate blood after a few months on TRT. Warning: Donating more than 1 unit of blood more frequently than every 2.5 months can lower your iron and ferritin levels. This can cause fatigue. Make sure to replace the lost iron with a supplement in order to prevent anemia. You can check your iron and ferritin with this iron blood test. It's recommended that you donate when you are in the 51-52% hematocrit range. However, some organizations (like the Red Cross) will reject blood with a hematocrit higher than 53%, so it is good to avoid that hematocrit high level if you want to donate blood. Hematocrit is included in the CBC and other panels: Get Your Hematocrit Test Now Testosterone, Hematocrit, Ultrasensitive Estradiol and Prolactin Panel Hematocrit + Total and Free Testosterone   To find out more information, click  How to Manage Increased Hematocrit Caused by Testosterone Replacement Therapy

Table of Contents Brain Aromatase and Why It’s Not a Good Idea to Reduce Its Activity Estrogen and its beneficial effects in bodybuilding Estrogen function in men and why inhibiting its production can be detrimental.  High estrogen levels and prostate cancer Testosterone’s conversion to estrogen is important to eliminate anxiety and depression Testosterone activity in the brain High estradiol levels are not correlated with erectile dysfunction Estradiol improve endothelial function in healthy men Estradiol and libido, erectile function and reproduction How estradiol works when testosterone levels are low Estradiol and its influence in eugonadal men (men with normal testosterone levels.) Analyzing the role of estradiol on hypogonadal men who undertake testosterone replacement therapy Aromatase inhibition can decrease insulin sensitivity The relationship between estrogen and bodybuilding Estradiol and DHT can make you age more slowly Symptoms of low estradiol in men Estradiol and reproductive function in men Brain Aromatase and Why It’s Not a Good Idea to Reduce Its Activity Every man has free and bound testosterone circulating through his bloodstream. The bound testosterone is attached to either sex hormone-binding globulin or albumin. The free testosterone is available in small quantities in comparison with the bound testosterone. A small portion of it is converted to estrogen using the enzyme called “aromatase”. Although estrogen is a female sex hormone, it plays an important role in a male’s body too. For example, estradiol, a type of estrogen, is vital for proper sexual functioning and libido in men. However, too much estrogen can be detrimental, leading to poor sexual functioning, poor erections, accumulation of fat in the abdominal area and male boobs (gynecomastia). During testosterone replacement therapy (TRT), some men take drugs to inhibit aromatase and prevent it to convert too much testosterone into estrogen. these drugs inhibit the aromatase enzyme. Although this might sound like a good idea at first, altering the normal production of aromatase can lead to brain inflammation, studies suggest. The levels of aromatase and estrogen have been measured in injured brains and it has been discovered that the aromatase enzyme increased to protect the damaged neurons and the connections between them. Evidence concludes that inhibiting the normal levels of aromatase can lead to inflammation in healthy brains and more injury to already damaged brains. This happens because the aromatase/estrogen expression is moved from neurons to astrocytes which are a different type of brain cells. Astrocytes act as a cushion for neurons and they are usually more active when brain injury is detected. These cells can help with the healing process, but if they stay active for too long, this can lead to further damage to the brain. Studies also show that an insufficient amount of brain aromatase can indicate neurodegenerative diseases such as Alzheimer's. Low amounts of aromatase can increase plaque development which damages the brain. That’s why it is recommended to be careful when taking an aromataseinhibitor during testosterone replacement therapy as this drug might mess with the normal levels of aromatase and lead to brain complications.   Estrogen and its beneficial effects in bodybuilding Estrogen, one of the most important female sex hormone, is vital for professional athletes who aim at increasing their muscle mass. For example, estrogen can increase the anabolic response by modifying the way glucose is processed in muscle tissue. This hormone can influence the amounts of glucose 6-phosphate dehydrogenase which is directly correlated to muscle growth and repair. In other words, having adequate amounts of estrogen can maximize muscle gains and strength. In studies performed on rats, estrogen has also been correlated with a whopping 480% increase in methyltrienolone which is an androgen connected to the levator ani muscle. The production of growth hormone and IGF-1 (insulin-like growth factor) are also influenced by estrogen. This female sex hormone can increase the proliferation of IGF-1 in body tissues and liver which leads to greater muscle gains and protein synthesis. Estrogen also plays an important role when it comes to serotonin production. Serotonin is known for regulating the sleep/waking cycle. Bodybuilders who take aromatase inhibitors as drugs might have low levels of estrogen in the body. This can alter the serotonin production and lead to a thing called “steroid fatigue”. This is usually characterized by a general feeling of tiredness which can interfere with training regimes and prevent the athlete from performing at his peak. Maximizing muscle gains can be difficult in this case. Estrogen function in men and why inhibiting its production can be detrimental.  The aforementioned aromatase inhibitors are taken orally while one of them can be injected. There haven’t been studies assessing the short-term symptoms of these drugs on the physiology of an athlete. However, although drugs which inhibit aromatase and subsequently reduce estrogen levels are not usually used for a long period of time, they can cause problems when the estrogen drops under the normal range limit. Estrogen, particularly estradiol, is a powerful hormone which influences multiple body processes in both men and women. For example, estrogen can be anabolic in certain tissues such as bone and fat. It directly impacts bone density and can influence how much fat the body accumulates, particularly in the abdominal area. Estrogen can also have a stimulatory role and it influences protein production in the liver. It has a metabolic effect in the endocrine system and influences the binding globulins for vitamin D. Estrogen is also a neurosteroid influencing neurotransmitters in the brain. This can have an effect on emotions, motivation, and other functions. Since estrogen is so important in the human body, it is safe to assume that reducing it to dangerously low levels using drugs can have negative consequences on health. Similarly, having estrogen levels above the normal limit can also be detrimental for a male’s body. The key is to maintain balance when it comes to estrogen levels and make sure that estradiol E2 doesn’t drop below 20pg/mL.   The effects of aromatase inhibition on bone mineral density in older men A study was conducted at a tertiary care academic center in Boston, MA, measuring the levels of testosterone and estradiol of 69 men over 60 years of age. The participants had borderline or low testosterone levels and the study included a placebo group. The purpose of the study was to determine the effect of aromatase inhibition on bone mineral density and bone turnover. Each participant received 1 mg of an aromatase inhibitor daily or a placebo drug. At the end of the study, the serum testosterone increased from 319 ± 93 ng/dl at baseline to 524 ± 139 ng/dl in month 3 and dropped slightly after one year. The estradiol levels also decreased from 15 at baseline to 12 after 3 months and remained there. The bone mineral density decreased in the aromatase inhibitor group in comparison with the placebo group. Taking aromatase inhibitors reduce the amount of testosterone which is converted to estradiol and because participants had less estradiol in their bloodstream, their bone mineral density also dropped. This concludes that estradiol is important for bone mineral density, particularly in older men. Is anastrazole for men a good idea?   High estrogen levels and prostate cancer Some studies conclude that high levels of estrogen might help develop prostate cancer cells, but men who already have prostate cancer don’t have high levels of estrogen in the bloodstream. Other studies show that a sharp increase in estrogen levels might lead to prostate cancer, but more information is required to reach a definitive conclusion. A small part of the free testosterone which circulates through the bloodstream is converted into estrogen. This hormone is required for maintaining proper health and avoiding cardiovascular diseases as well as diabetes type 2. On the other hand, low testosterone levels have also been associated with an increase in prostate cancer cells. A significant body of evidence indicates that high estrogen levels might be dangerous for men and affect their prostate only when testosterone levels are too low. Increasing testosterone levels through TRT (testosterone replacement therapy) will also increase estrogen levels in a natural way, but this doesn't automatically mean that the risk of prostate cancer will be higher. Approximately 50 years of studies show that testosterone administration alone doesn’t lead to prostate cancer.   Testosterone’s conversion to estrogen is important to eliminate anxiety and depression It is estimated that approximately 20 million adults in the United States are affected by depression each year. Many of these people receive antidepressants and anti-anxiety drugs, but this medicine can have different effects on certain people and they don’t come without side effects. Testosterone plays an important role in reducing anxiety and depression feelings in men, while estrogen and progesterone also act together as a protective mechanism against depression in women. Women, in particular, are 70 percent more predisposed to depression during their lifetimes, in comparison with men. However, certain low-testosterone males also develop depression and antidepressants seem to be inefficient for them. New evidence suggests that the conversion of testosterone to estrogen is necessary to reap the antidepressant effects of testosterone. Professor Mohamed Kabbaj reached this conclusion during his studies which were promoted by the National Institute of Mental Health. It has been discovered that there is a link between testosterone conversion to estrogen and depression in animal studies, but this link might be valid in human studies as well. This might lead to new antidepressants which impact the brain differently and are more efficient for low-testosterone men. Testosterone influences a plethora of pathways in the brain and it can have multiple side effects. That’s why it is important to develop a drug which acts only on the pathways responsible with anxiety and depression. Some of the side effects caused by antidepressants include heart problems and these should be avoided. Better drugs are necessary to impact the brain differently and safely treat anxiety and depression feelings. Dr. Kabbaj discovered that the antidepressant effects of testosterone happen only after this hormone has been converted to estrogen. The conversion process is regulated by a special enzyme in the brain. Dr. Kabbaj inhibited this enzyme in the hippocampus area of the brain. This area is responsible for mood regulation and has a strong influence on how a person feels. When this enzyme has been inhibited, the antidepressant effects of testosterone weren’t present. This leads to the conclusion that the conversion of testosterone to estrogen is very important. Testosterone impacts the MAPK pathway in the brain to produce these positive and beneficial antidepressant effects. However, this pathway is also implicated in multiple other body processes, including cell growth and cancer. More work is required to find out ways to get the antidepressant effects of testosterone without increasing the risk of cancer. Testosterone activity in the brain Tests have been done on rats to discover the behavior of testosterone when it enters the brain. Castrated rats have been injected with estradiol instead of testosterone and the recovery process of intromission and ejaculation worked normally. The estradiol was injected into the hypothalamus. However, when DHT was injected instead of testosterone (DHT is a powerful androgen which doesn’t convert to estrogen), no recovery process was detected. This concludes that testosterone converts to estrogen when it is injected into the hypothalamus and facilitates sexual behavior. The aromatase enzyme is present in this part of the brain as well as estrogen receptors. It has also been discovered that injecting drugs which block the aromatization process of testosterone to estrogen can change the behavioral effects of testosterone and significantly influence sexual function. This means that testosterone must convert to estrogen to enable proper male sexual behavior. Further studies show that inhibiting the aromatization process in monkeys can interfere with their sexual behavior. Men who have a congenital deficiency of aromatase also have a low sex drive and they can benefit greatly from small doses of estradiol to improve sexual functioning. The testosterone’s effects on male sexuality are twofold. This hormone influences libido directly with the help of androgen receptors and indirectly using estrogen receptors. However, more work is necessary to determine the exact differences between these effects.   High estradiol levels are not correlated with erectile dysfunction Contrary to the popular belief, high estradiol levels are not associated with poor sexual function in males. A study was conducted on low testosterone centers in the United States, comprising more than 34,000 men. The participants had different ages, some of them being younger than 25 while others being older than 65. Estradiol levels were measured using electro-chemiluminescence immunoassay and it has been discovered that having too much estradiol in the bloodstream doesn’t lead to poor sex drive and erectile dysfunction. It has also been discovered that those with low or normal estradiol levels have a higher incidence of poor sex drive and potential erectile dysfunction.   Estradiol improve endothelial function in healthy men Studies show that estradiol (sometimes written as oestradiol) can improve endothelial function in healthy men. The endothelium is a very thin membrane which lines up the insides of your blood vessels and heart. It can also be found on lymph vessels. Its role is to release substances which help relax or constrict the blood vessels, depending on various factors. The endothelium is also important for controlling platelets, blood clotting and to regulate immune function in men and women. It is already known that supplementing with estrogen (particularly estradiol) is linked to a reduced incidence of cardiovascular disease in women who are deficient in this hormone. The purpose of the study is to determine if estrogen can also be beneficial for the endothelial function in healthy men. The study included 23 men aged 32 years, give or take up to 8 years. They were split into three groups. One group was given testosterone supplements alone, one group received a combination of testosterone and 10mg of estradiol and the third group received testosterone and 20mg of estradiol. These participants were measured one month and six months after multiple tests were performed to determine the influence of estradiol on their health. The study concluded that those who received estradiol supplementation had a better endothelial function. This means that administering estradiol to healthy men can improve their cardiovascular system.   Estradiol and libido, erectile function and reproduction Estradiol impacts multiple processes in a human body and it can have a strong influence on the brain. This hormone can directly influence the brain and dictate the sexual behavior of mammals, creating arousal states and moods which are conducive to reproduction. This is done by the release of pheromones. These substances can increase activity in the area anterior to the hypothalamus. Neurons play an important role in converting testosterone to estrogen using the aromatase enzyme. There are billions of neurons in the brain and they transmit electrical information 24/7, helping humans function correctly. Another important brain cell is the astrocyte. These cells help the neurons transfer information from one part of the brain to the other. They are star-shaped cells which play an important role, particularly when the brain is injured and they also use the aromatase enzyme to convert testosterone to estrogen. The anterior area of the hypothalamus contains numerous estrogen receptors. These receptors work similarly to selective serotonin reuptake inhibitors which are known for lowering sex drive. This might indicate that estrogen can significantly influence sexual functioning and behaviors in men.   How estradiol works when testosterone levels are low Having low testosterone levels can definitely lead to poor sexual functioning and lack of libido. To determine the efficacy of estradiol in men and what influences it has, it is important to analyze it in people who have normal as well as low testosterone levels. Studies have been done on men with low testosterone. They received doses of estradiol and reported an increased sexual drive. These human studies are supported by the ones performed on rats. Castrated rodents were given estrogen and it has been discovered that this increased their sexual activity. Another important finding consists of patients who had prostate cancer and received androgen deprivation therapy. This type of therapy is known to slow down or completely stop the advancing of prostate cancer since the cancerous cells require testosterone to grow. When the androgen levels reached a critical point, the patients reported symptoms which are commonly found in people who have a low sex drive and erectile dysfunction such as hot flashes and other adverse effects. It has also been discovered that androgen receptor blockers are more efficient in maintaining sexual activity in comparison with castration. This might happen as a result of testosterone conversion to estrogen. It is possible that supplementing with estradiol might make patients who undertake androgen deprivation therapy have increased brain activity in those areas responsible with sexual behavior.   Estradiol and its influence in eugonadal men (men with normal testosterone levels.) Eugonadal means men with healthy testosterone levels. Estradiol has been proven beneficial for people with low testosterone levels, increasing libido, and sexual desire. However, some studies show that the same positive results don't apply to eugonadal men. One study was performed on men with healthy testosterone levels. They received estradiol on a regular basis and they reported a decrease in sexual functioning, libido, masturbation, and erections. On the other hand, another study reported that administering estradiol to 50 men aged between 20 and 40 years didn’t influence their sexual function and libido at all. More research is required to understand how estradiol affects eugonadal men, but administering this hormone exogenously can be beneficial for people who have testosterone levels, increasing their libido and sexual desire.   Analyzing the role of estradiol on hypogonadal men who undertake testosterone replacement therapy Testosterone supplementation therapy aims to improve the quality of life of hypogonadal men as well as increase the levels of circulating testosterone in their bloodstream. This therapy also tries to increase the number of testosterone metabolites such as estradiol which is known for playing a vital role in sexual desire. In a test performed on men with secondary hypogonadism, c l o mi phene was used to increase the levels of testosterone by influencing the estrogen receptors directly. Secondary hypogonadism means that the testicles function correctly, but there is a scarcity of luteinizing hormone produced by the pituitary gland and this translates into low testosterone levels. The clomiphene citrate managed to increase testosterone levels in men with secondary hypogonadism as well as increasing the conversion of testosterone to estrogen. Other studies show that clomiphene citrate can increase sexual desire and libido. Another study performed in 2013 looked at the role of testosterone in healthy men and how it can influence sexual behavior. Some of the study participants received testosterone in combination with aromatase inhibitors, while others received testosterone without aromatase inhibitors. As a result, the sexual function was impaired when aromatization was inhibited. Other studies show that sexual desire increased significantly when men received testosterone supplementation therapy and had estradiol levels above 5 ng/dl. Even when testosterone levels were below 300 ng/dl and the estradiol levels were higher than 5 ng/dl, the sexual desire was increased. Yet another study looked at the sexual behavior of men who received l etr ozole which is a powerful aromatase inhibitor. These men had low testosterone levels and after being given le tro zole, their estradiol level dropped even lower. The result was that libido was significantly decreased. This means that both testosterone and estradiol are important in people who have testosterone deficiency to achieve and maintain healthy sexual desire and libido.   Aromatase inhibition can decrease insulin sensitivity Insulin sensitivity is extremely important when it comes to diseases such as diabetes type 2. Those who have low insulin sensitivity are more predisposed to become diabetic in the future. Inhibiting the aromatase enzyme through different types of drugs can have a significant influence on insulin sensitivity in both humans and rats. A study conducted at a clinical research facility tested 17 healthy men with ages between 18 and 50 years. This was a double-blind, controlled study. Each participant received an aromatase inhibitor, or a placebo drug for 6 weeks. The study concluded that inhibiting aromatase can lead to poor insulin sensitivity, particularly when it comes to peripheral glucose disposal.   The relationship between estrogen and bodybuilding It is well known that estrogen gives you a feeling of wellbeing and the lack of it can lead to depression, mood swings, emotional instability, and even depressive thoughts. Aromatase inhibitors can reduce the amount of estrogen the body produces and it usually makes a person feel lethargic and unhappy. For example, menopausal women seem to become more emotionally unstable and being haunted by feelings of anxiety and depression. Studies show that this can also be the case for bodybuilders and top athletes who regularly take aromatase inhibitors to convert less testosterone to estrogen. Estrogen is vital when it comes to sexual drive and libido as well and it is a well-known fact that aromatase inhibitors can negatively impact sex drive. A study on two groups of men reached the conclusion that estrogen is very important for libido. The first group received testosterone treatment alone while the second group received testosterone and an anti-estrogenic agent. At the end of the test, the group who received only testosterone treatment had better sexual drive and libido. Researchers also believe that lowering the estrogen levels too much in healthy men can lead to anxiety feelings, depression and even osteoporosis.   Estradiol and DHT can make you age more slowly Another study performed in Australia looked at the link between telomere length and the amount of serum estradiol and DHT in men. Telomeres are sequences of nucleotides at the end of each chromosome. They are used as a biomarker for aging. Having shorter telomeres means that the biological age is higher, regardless of the actual age of the person. Having longer telomeres correlated with a smaller biological age which basically means that the person is younger than his or her real age. The study performed in Australia looked at the telomere lengths of men aged 53, give or take approximately 15 years. The conclusion of the study was that estradiol and DHT correlate with telomere length and a small reduction in estradiol can amount to an approximate age increase of a decade. Estradiol alone can influence telomere length and that’s why it is important not to reduce it too much using aromatase inhibitors.   Symptoms of low estradiol in men A study performed in a medical center on several hundred men concluded that lack of estradiol can give certain vasomotor symptoms similar to those menopausal women have. These symptoms include hot flashes, sweats and flushes. The study participants were healthy men with ages between 20 and 50 years. They had normal serum testosterone levels and were split into two groups The first group of men was administered goserelin acetate which stops gonadal steroids. After 4 weeks, they received placebo drugs or different doses of testosterone gels. The second group of men received a treatment similar to those in the first group, but they also received an inhibitor of the aromatization of testosterone to estrogen. The study concluded that those who received aromatase inhibitors and had low estradiol levels experienced vasomotor symptoms such as night sweats and hot flashes. Similarly, those who received high doses of testosterone gel (approx 10 grams daily), as well as aromatase inhibitors, didn't experience the same symptoms. This means that when high amounts of testosterone are administered, it can suppress the effect of the aromatase inhibitor and leave estrogen levels intact.   Estradiol and reproductive function in men The sexual function in males is directly influenced by a mix of multiple substances and organs including testosterone, estradiol, estrogen receptors, testes, penis, and brain. The aromatase enzyme and estrogen receptors have a similar location in the brain and they are important in the development of sexual function early in life. They also influence sexual behavior in adulthood in combination with other substances called pheromones. Estrogen influences the mood and libido of a man, enabling him to alter his cognition for a mental state conducive to reproduction. Spermatogenesis is another important part of male reproduction. The creation of sperm cells relies on estradiol and these cells contain estrogen receptors and the aromatase enzyme. Men who undertake testosterone supplementation therapy should also be monitored for their estrogen levels. This is because an estradiol level below 5ng/dl can cause a significant drop in sex drive and libido.   Conclusion The role of estrogen in the male body is unquestionably important. Bodybuilders, professional athletes, and patients who undertake testosterone replacement therapy should be careful when it comes to managing estradiol levels since this hormone can significantly impact their wellbeing, sex drive, and bone density.   Get Your Estradiol Blood Test and Find Out More!

Table of Contents Today's Young Men Have Almost 30 Percent Less Testosterone Sleep Disruption: Stress and Fatigue Can Reduce Testosterone Levels Carrying Too Much Weight Can Reduce Testosterone Levels Poor Diet and Consumption of Marijuana Might Be a Problem Lack of Physical Exercise Leads to a Decrease in Testosterone Levels Check Your Testosterone Levels Often References: There is no need to emphasize the considerable importance of testosterone in the human body, especially for men. This hormone helps build muscle, maintains healthy bones, improves cognition, and enhances sleep quality, not to mention its essential role in fertility. However, recent studies show an alarming drop in testosterone levels, particularly for young men. In other words, today's teenagers have less testosterone circulating through their bloodstream than the youngsters of 15-20 years ago. If you're curious to learn the causes of this drop in testosterone levels, keep reading this article. You'll find insightful answers to questions you already have about testosterone and know what lifestyle changes you can make to increase the production of this vital hormone. Today's Young Men Have Almost 30 Percent Less Testosterone It might be hard to believe, but recent studies show that men between 15 and 39 have almost thirty percent less testosterone compared to men within the same age group of 15-20 years ago. More specifically, if the average testosterone level was around 600 nanograms per deciliter of blood almost two decades ago, now it's about 400 nanograms per deciliter for men aged 15-39. That's a significant decrease caused by multiple lifestyle and environmental factors. Let's look at some of these causes and see why today's young adults experience this significant drop in testosterone levels. Sleep Disruption: Stress and Fatigue Can Reduce Testosterone Levels One of the most important causes of testosterone decrease is excessive stress. Today's young adults are very busy, and they're constantly bombarded with information and stimulation from social media and other platforms. They are sleeping less and exposing themselves to light from electronics late at night. This light can disrupt sleep patterns.  Several studies have shown that most hormones, including testosterone, peak during the sleep cycle.  A disrupted sleep cycle and circadian rhythm negatively affects testosterone, growth hormone, thyroid, and other hormones. This makes the adrenal glands release more cortisol which is the main stress hormone in the body. Too much cortisol coupled with fewer hours of sleep per night results in testosterone levels that can plummet faster than ever. Ideally, adults should sleep around 7 hours per night and engage in activities that decrease cortisol levels in the bloodstream. One of the best ways to reduce your stress levels is to go to the gym, walk or run, practice yoga, or play a musical instrument, not to mention spend more time with people you love. Carrying Too Much Weight Can Reduce Testosterone Levels Obesity and being overweight is another important factor that can explain the testosterone decrease in young men. Several studies show that higher body mass index (BMI) can result in lower testosterone levels.  There is an obesity epidemic in the US and most countries not only in adults but also teenagers and children. At the same time, being overweight increases your chances for chronic diseases, reduces your stamina and energy levels, as well as makes the body produce more toxic hormones. Do your best to exercise at least three times a week and your testosterone levels will eventually get back to normal. Poor Diet and Consumption of Marijuana Might Be a Problem Eating a diet that lacks nutritional value is hands-down one of the key factors when it comes to testosterone production. In other words, if you eat a lot of junk food, drink many fizzy beverages, and don't take a multivitamin supplement, your testosterone levels might significantly decrease each year. You should provide your body with vitamins, minerals, and other nutrients to help it function optimally. Try to eat more vegetables, fruit, and lean meats such as chicken and turkey, as well as healthy fats coming from seeds and olive oil. The Mediterranean Diet is one of the best ways to increase testosterone levels and longevity. At the same time, an increasing body of evidence suggests that excessive marijuana consumption is associated with a decrease in testosterone levels. The occasional joint might not do too much harm but smoking every day can have an impact on your hormones, particularly your testosterone. Lack of Physical Exercise Leads to a Decrease in Testosterone Levels As mentioned earlier, doing just three or four workouts per week for a minimum of thirty minutes can prevent a decrease in testosterone levels. Today's young adults spend a lot of time in front of their computers doing their work or getting entertained. This sedentary lifestyle is one of the most important causes of disease in the United States and throughout the entire world. It also makes testosterone levels drop at an alarming rate. The solution is not to quit your IT job and go work in a field. Instead, you should compensate by consciously engaging in physical activities a few times per week. Go for a jog, take your friends, and play squash or another racket-based sport. If you love it, go for a swim, as this is a wonderful cardiovascular activity that works the entire body. The bottom line is not to get stuck in front of your computer or on your sofa all day long. Work out a few times weekly to help your blood move better throughout your body and improve your testosterone levels. Check Your Testosterone Levels Often You might be happy to find out that checking your testosterone levels is very easy these days. You don't even need to talk to your doctor. You can order a direct-to-consumer lab test from trustworthy providers such as DiscountedLabs.com. When you do this, you get a form that you use to visit a nearby clinic to draw blood. Your blood is analyzed in a certified laboratory by medical experts, and your results will be emailed in a few business days. The process is fast, confidential, and secure. Checking your testosterone levels often helps you to see where you stand. You can compare the results against reference values and see if you need to readjust your lifestyle. For example, most experts agree that normal testosterone levels should be between 350 and 1,000 nanograms per deciliter of blood. Go to DiscountedLabs.com today and order your own testosterone test today! This test is the most affordable in the U.S. for a gold standard accurate test based on liquid chromatography, the most trusted test by top physicians and clinics.   ============= References: Alarming Drop in Testosterone Levels Stress and Fatigue Affect Testosterone Obesity Decreases Testosterone Levels Testosterone Information | Mount Sinai - New York