Page 4 - TRT Blood Tests

What Are the Symptoms of Low Testosterone (Deficiency)? Hypogonadism is the medical term for a male condition caused by the body not producing sufficient amounts of testosterone. Most people don’t realize that, in addition to sexual desire, testosterone also affects lean body mass, strength, bone density, mental focus, mood, fat loss, and other essential factors in both males and females. Common complaints for men with hypogonadism include lower sexual desire (libido), erectile dysfunction (softer erections or lack of erections), depression, low energy and appetite, changes in body composition (lower lean body mass and higher abdominal fat), lower strength, reductions in body and facial hair, less mental focus, decreased height, and osteoporosis (decrease in bone density). A list shows that normalizing testosterone in people with lower-than-normal levels has dramatic benefits, including increased sexual desire, lean body mass, bone density, strength, mood, motivation, mental focus, and stamina. However, these benefits can be erased if proper monitoring, dose adjustment, and an appropriate choice of testosterone replacement option are not accomplished. Benefits of Normalizing Testosterone Restored sexual desire Improved erectile function Improved mood or sense of wellbeing Increased lean body mass, strength, and stamina Improved bone density Decreased fat mass Determining If You Have Testosterone Deficiency In addition to blood tests and physical examinations, researchers at St. Louis University have also developed a brief screening instrument to aid in diagnosing hypogonadism. Known as the Androgen Deficiency in the Aging Male (ADAM) Questionnaire: Do you have a decrease in sex drive? Do you lack energy? Have you experienced a decrease in strength and endurance? Do you feel shorter? Have you lost height? (Lower bone density can decrease size.) Have you noticed a decreased enjoyment of life? Are you sad and grumpy? Are your erections less strong or gone? Has it been more challenging to maintain your erection throughout sexual intercourse? Are you falling asleep after dinner? Has your work performance deteriorated recently?   Other questions that are usually not asked by doctors but which I’ve found to be important are the following:   Are you relating well to the people around you? • Are you able to pay attention when someone talks to you? • Are you loving your lover or life partner? Are you able to pay attention when someone talks to you? Several of the abovementioned problems can be caused by many other issues unrelated to low testosterone. Depression, anxiety, stress, medications, and sleep disorders can cause nine of those ten symptoms (a decrease in height would be the only item unrelated to bone loss or back surgery). This questionnaire is not a perfect predictor of low testosterone and should not replace tests for testosterone blood levels. The benefit of this questionnaire is that it may encourage some men to seek medical advice.  Then they can get their testosterone checked and have a physical examination to help determine whether they are indeed hypogonadal. Causes of Testosterone Deficiency Hypogonadism is caused when the testicles fail to produce normal levels of testosterone. Testosterone levels are low in one type of hypogonadism, while LH and FSH are elevated. In another, there is not enough secretion of LH and FSH needed to tell the testicles to produce the required testosterone. Some commonly used medications, such as Megace (an appetite stimulant), Nizoral (an anti-fungal agent), Prednisone (an anti-inflammatory corticosteroid), and Tagamet (an antacid), can also lower testosterone production. Illness and aging can cause a decrease in testosterone and an increase in sex hormone-binding globulin (SHBG). Furthermore, high prolactin hormone levels may suggest a pituitary tumor, causing a decline in testosterone production. It is essential that your doctor measure hormones in the HPGA cascade to diagnose what kind of hypogonadism you have. The most common type of hypogonadism presents low testosterone with normal or elevated FSH and LH levels, which indicates that your testicles are not responding to the signals of both LH and FSH. This is what is called primary hypogonadism.   There are several reasons why testosterone levels may be low: SHBG is binding too much free testosterone. This would be especially apparent if a male’s total testosterone level is in the high reference range but his free testosterone (unbound) level is low. As previously mentioned, aging and illness increase SHBG. The pituitary gland, which controls testosterone production through the production of LH, is not secreting enough LH to stimulate the production of testosterone by the testicles. In this case, total testosterone would be low. The hypothalamus is not functioning correctly. LH levels of less than two ng/mL suggest a lesion in this part of the HPGA. The testicles have lost their ability to produce testosterone, despite adequate LH. In this case, the level of LH would be high (greater than ten ng/mL) despite a low testosterone level. Dehydroepiandrosterone (DHEA) levels are abnormally low. DHEA is a hormone produced by the adrenal glands that has many of the same benefits as testosterone. It is also a precursor to testosterone in women. Disease or infection. Street drugs, prescription or over-the-counter medications (more on this later) Lab error. High prolactin levels may indicate the presence of a pituitary tumor that impairs the production of hormones that tell your testicles to produce testosterone (rare condition but worth mentioning!) Defects in genes that affect LH and FSH production. Buy Testosterone Lab Tests on DiscountedLabs.com    

Embarking on the path of Testosterone Replacement Therapy (TRT) often evokes a blend of enthusiasm and concern among men. The allure of renewed vigor, heightened sexual desire, and robust muscle growth is enticing. However, there are a lot of less well-known aspects that your healthcare provider might not immediately disclose. For instance, were you aware that TRT could affect your fertility or exacerbate your sleep apnea? While TRT heralds a new dawn for many, it doesn’t offer a universal remedy. In light of this, we have meticulously curated a comprehensive list of 18 pivotal aspects that might elude your doctor's attention but are indispensable for you to grasp. Venture further to unearth the profundities of TRT. Low Blood Levels of Testosterone and Associated Risks: < 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome Reference: Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192. PubMed < 400 ng/dl (15.3 nmol/l) - Venous leakage (internal penile damage) risk Reference: Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed < 350 ng/dl (11.9 nmol/l) – All-cause death risk and anemia risk Reference: Khaw, K. T., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luben, R., ... & Day, N. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 116(23), 2694-2701. PubMed < 300 ng/dL (10.2 nmol/L) - Lowered libido, weight gain & Diabetes risk increased Reference: Traish, A. M., Saad, F., & Guay, A. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction Journal of Andrology, 30(1), 10-22. PubMed < 300 ng/dL (10.2 nmol/L): Quartile risk of fractures (osteoporosis), memory-related issues and depression risk increases Reference: Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E.,... & Cummings, S. (2006). Testosterone and estradiol are common among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed < 250 ng/dl (8.5 nmol/l): Arterial plaque (arteriosclerosis) & sleep quality affected Reference: Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men Atherosclerosis, 233(1), 278-283. PubMed < 235 ng/dl (8.0 nmol/l) hardening of arteries (dialysis patients) Reference: Carrero, J. J., Qureshi, A. R., Parini, P., Arver, S., Lindholm, B., Bárány, P., ... & Stenvinkel, P. (2009). Low serum testosterone increases mortality risk among male dialysis patients. Journal of the American Society of Nephrology, 20(3), 613-620. PubMed < 200 ng/dl (6.8 nmol/l) morning erections decrease Reference: O'Connor, D. B., Lee, D. M., Corona, G., Forti, G., Tajar, A., O'Neill, T. W., ... & EMAS Study Group. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1577-E1587. PubMed < 150 ng/dl (5.1 nmol/l) - Increased inflammation (TNF-alpha) Reference: Malkin, C. J., Pugh, P. J., Jones, R. D., Kapoor, D., Channer, K. S., & Jones, T. H. (2004). The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 89(7), 3313-3318. PubMed The Unspoken Implications of TRT Your doctor might overlook mentioning certain ramifications when you commence Testosterone Replacement Therapy (TRT): Fertility and TRT Sperm Count Drop: TRT lowers the levels of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), two hormones that help make sperm. If preserving fertility is a priority, discuss with your healthcare provider incorporating Clomiphene or hCG into your TRT regimen. Hematological Effects Blood Viscosity Increase: TRT can escalate your blood's hematocrit level, thereby increasing its viscosity. Although some practitioners may advise halting TRT, this side effect can be managed adeptly through blood donations or therapeutic phlebotomy. Beware; frequent blood donations might deplete iron levels and induce fatigue. Impact on Natural Testosterone Production Suppression of Endogenous Testosterone: TRT suppresses your body’s natural testosterone synthesis, which may rebound anywhere between a few weeks and six months post-cessation. The Multifaceted Benefits and Varied Efficacy of TRT Muscle Mass, Fat Reduction, and Sexual Health Sex Drive and Physique Enhancement: TRT predominantly augments libido, muscle mass, and fat metabolism in men. However, its effectiveness varies, and meticulous dosage and frequency adjustments along with side effect management are imperative. It’s not a panacea. Administration Techniques Methods of Injection: Contrary to what most people think, testosterone can be injected superficially (IM) or deeply (subcutaneously) into the muscle using a 1/2-inch, 27-29-gauge insulin syringe. Topical Testosterone Efficacy of Gels and Creams: Testosterone gels and creams are efficacious but often under-dosed by physicians. More concentrated compounded products or dosage adjustments based on blood levels can rectify this. Dosage Frequency Optimized Injection Schedules: Shifting from biweekly 200mg injections to weekly 100mg or twice-weekly 50mg dosages can often yield better results. Addressing Concerns and Optimizing TRT Outcomes Sleep Apnea and TRT Sleep Apnea Dynamics: TRT could exacerbate central sleep apnea but might alleviate obstructive sleep apnea over time as weight loss occurs. Erectile Function Erectile Function and Libido: TRT enhances erectile function and libido in a majority of men. Some may benefit from adjunctive low-dose daily Cialis, which also harbors cardiovascular advantages. Self-Monitoring and Telemedicine Monitoring Blood Tests: Companies like DiscountedLabs.com enable self-monitoring of blood tests without a doctor visit. Moreover, telemedicine facilitates access to testosterone doctors nationwide, albeit mostly without insurance coverage. Debunking Misconceptions and Enhancing TRT Knowledge Prostate Health and Cardiovascular Effects Prostate Cancer and Heart Attacks: Contemporary evidence refutes the notion that TRT triggers prostate cancer or heart attacks, though vigilant monitoring is crucial for optimal cardiovascular outcomes. Community Support and Knowledge Sharing Leveraging Online Communities: Engage with seasoned TRT users on platforms like the ExcelMale forum or Testosterone Replacement Discussion Facebook group to broaden your understanding. Comprehensive Testing Holistic Blood Analysis: Ensure your doctor conducts a thorough blood analysis encompassing total and free testosterone, DHT, thyroid function, and prolactin (especially for those with extremely low T levels) to rule out pituitary adenomas. Insurance, Professional Expertise, and Addressing Common Hurdles Insurance and TRT Insurance Coverage: Insurance coverage for TRT products is often restrictive, but utilizing a compounding pharmacy can be a viable alternative. Expertise in TRT Management Urologists Leading the Charge: The burgeoning expertise of urologists in TRT management is notable, with extensive TRT-centric discussions now a staple at urology conferences. Identifying and Addressing Co-morbidities Co-morbid Conditions: Men with co-existing health issues may encounter challenges in reaping TRT benefits, warranting a thorough cardiovascular assessment for those experiencing water retention and hypertension. Estradiol Management Misconceptions About Estradiol: People often get the wrong idea about this hormone, which plays a big part in libido, bone health, and brain function, because it is not given enough attention when it comes to management. Emerging evidence suggests aromatase inhibition might be unnecessary in TRT management. Armed with this extensive knowledge, you’re now better positioned to make informed decisions on your TRT journey. Remember, individualized consultation with healthcare professionals is indispensable for optimizing your TRT experience.    

Introduction Most men would not believe that estradiol is a male hormone, as they are unaware of the role that estradiol (E2) plays in the maintenance of men's health. E2 is important for many things, including the quality and quantity of sperm [1,] controlling the GH-IGF-1 axis [3,] bone growth and keeping bones healthy [4,] body composition and glucose metabolism [5,] vasomotor stability [6,] and brain function [8]. Estradiol is a hormone more abundant in women than men that is produced by the aromatization of testosterone in the liver, fat, and other cells [1]. It has been shown to be responsible for healthy bone density [2], but its role in men's sex drive, body composition, and other variables is debated [3]. High estradiol blood levels can cause gynecomastia in the presence of low testosterone [4]. Anastrozole, a blocker of estradiol production, is prescribed to men who start testosterone replacement therapy (TRT) [5]. However, there is no data on how high is too high when it comes to estradiol in men [6].   Table of Contents Introduction The Essential Role of Aromatase in the Production of E2 E2 and the Function of the Male Reproductive System The Effect of E2 on the Growth Hormone-IGF-1 Axis The Effects of E2 on the Development and Health of Bones and Skeletons The Influence of E2 on the Composition of the Body as well as Glucose Metabolism Regulation of Vasomotor Stability by E2 and Its Effects The Role of Nitric Oxide in Vasodilation The Effects of Estrogen on NO Production and Vasodilation The Need for Further Research Potential Side Effects of Testosterone Therapy and the Role of Aromatase Inhibitors A Critical Review of Current Evidence Potential Risks of Overuse of Aromatase Inhibitors The Case for Individualized Treatment Approach Estradiol: Overview and Effects Impact of High Estradiol Levels Low Estradiol: Risks and Treatment Testosterone and Estradiol: A Complex Relationship Estradiol's Role in Physiology Estradiol in Hypogonadism Studies and Findings Estradiol and Chronic Heart Failure Estradiol's Impact on Bone Density Estrogen in Men: Studies Conclusion References: The Essential Role of Aromatase in the Production of E2 Aromatase is an enzyme that converts androstenedione and testosterone into E2 in males [3]. According to the research that has been done, the hormone E2 is critically important in the control of a variety of different elements of male health [6]. E2 and the Function of the Male Reproductive System The modulation of spermatogenesis is one of the key functions that E2 performs in the male reproductive system. Working as a paracrine factor, it does its job in the Sertoli cells of the testis, where it helps germ cells mature and divide [1]. It also changes the hypothalamic-pituitary-gonadal axis, which controls the production of testosterone and the making of sperm [1, 7]. The Effect of E2 on the Growth Hormone-IGF-1 Axis It has been proven that E2 plays a significant role in the regulation of the GH-IGF-1 axis in men [3]. In healthy men, there is a positive correlation between the levels of E2 and the levels of serum IGF-1. It is possible that E2 uses negative feedback to limit GH secretion. The Effects of E2 on the Development and Health of Bones and Skeletons E2 is a crucial hormone for the growth and upkeep of men's bones, as well as their overall skeletal health. It does so by promoting osteoblast differentiation and activity and suppressing osteoclast differentiation and activity [4] [11]. In this way, it exerts an indirect influence on these features. The Influence of E2 on the Composition of the Body as well as Glucose Metabolism E2 has an effect on both the makeup of a man's physique as well as his glucose metabolism. It appears to selectively accelerate the accumulation of body fat in subcutaneous regions while at the same time limiting the accumulation in visceral regions [5]. Additionally, it has been demonstrated that E2 can improve glucose metabolism in hypogonadal men [5]. Regulation of Vasomotor Stability by E2 and Its Effects Additionally, E2 contributes to the regulation of vasomotor stability in males. People think that the production of nitric oxide (NO) plays a role in how ethyl ester affects blood vessels. The Role of Nitric Oxide in Vasodilation Nitric oxide, often known as NO, is an important physiological mediator that plays a role in a wide variety of biological activities, some of which are associated with the cardiovascular system. In the setting of the vascular system, NO plays an important function in vasodilation, controlling blood pressure, preventing blood clots, and stimulating angiogenesis [1, 2, 5]. The Effects of Estrogen on NO Production and Vasodilation It has been demonstrated that estrogens, in general, can have an effect on the generation of NO and, as a result, can mediate vasodilation. They can use both direct and indirect processes to achieve the desired vasodilatory effects. There are direct mechanisms that involve attaching to estrogen receptors on endothelial cells and making more NO. This, in turn, causes the blood vessels to become more dilated. One of the indirect ways that could be at work is by changing the production and release of other vasoactive chemicals, like prostaglandins, which could have an effect on NO production. The Need for Further Research Please be aware that despite the fact that the idea that NO synthesis mediates the vasodilation effects of E2 is reasonable based on the known actions of estrogens and NO, further research is required to determine the particular role that E2 plays in this process. Because of this, to get a better understanding, it would be important to look at the original research papers or more recent studies that focus on the part that E2 plays in changing NO production and vasodilation. Potential Side Effects of Testosterone Therapy and the Role of Aromatase Inhibitors When men undertake testosterone therapy (TTh), their estrogen levels may increase, and this may, in some instances, result in the development of nipple or breast soreness or even gynecomastia (the formation of male breast tissue in males). This can be a clear indicator that aromatase inhibitors should be used to reduce the amount of estrogen in the body. A Critical Review of Current Evidence Even so, there is not enough proof to support the regular use of aromatase inhibitors along with TTH when there are not any signs of estrogen overload. Although testosterone levels returned to normal after therapy with an aromatase inhibitor, the symptoms of low testosterone did not improve, according to the findings of one randomized controlled trial. Potential Risks of Overuse of Aromatase Inhibitors In addition, decreasing estrogen levels below a key threshold may raise the likelihood of developing osteoporotic changes and decrease insulin sensitivity, particularly in people who are receiving TTH. These risks may be increased in people who are already at higher risk for developing osteoporosis. The Case for Individualized Treatment Approach The study did not find any evidence to support the claim that taking TTH with aromatase inhibitors or other medicines would lead to lower levels of estrogen that would be better than taking TTH by itself. On the other hand, it was shown that certain TTH-treated men who had elevated estrogen levels but did not experience any clinical improvements from TTH did respond to actions taken to lower estrogen levels. These efforts included either a reduction in the amount of testosterone or the use of aromatase inhibitors. When this occurs, DXA monitoring is an option that should be examined. Estradiol: Overview and Effects Estradiol is a hormone more abundant in women than men that is produced by the aromatization of testosterone in liver, fat and other cells [1]. It has been shown to be responsible for healthy bone density [2], but its role in men's sex drive, body composition, and other variables is debated [3]. Impact of High Estradiol Levels High estradiol blood levels can cause gynecomastia in the presence of low testosterone [4]. Anastrozole, a blocker of estradiol production, is prescribed to men who start testosterone replacement therapy (TRT) [5]. However, there is no data on how high is too high when it comes to estradiol in men [6]. Low Estradiol: Risks and Treatment Low estradiol can be associated with higher fat mass and lower sexual function in men [7], so it is important to be careful when a clinic wants to put you on this drug without first justifying its use [8]. The most important details are that many clinics may be using the wrong estradiol test [9], and that most men on testosterone replacement therapy (TRT) do not develop gynecomastia even without using anastrozole [10]. Testosterone and Estradiol: A Complex Relationship Some physicians monitor estradiol blood levels after 6-8 weeks of TRT initiation using the sensitive estradiol test to determine if anastrozole use is warranted [11]. After 4-6 weeks on anastrozole, its dose can be adjusted to ensure that estradiol is not under 20 pg/ml [12]. The body of evidence suggests that after aromatase P450 inhibitors biotransform testosterone in the tissues, the ERs (estrogen receptors) in men mediate its effects [13]. Estradiol's Role in Physiology Some of the things that estrogen does are control LH feedback, skeletal homeostasis, lipid metabolism, cardiovascular physiology, brain development, and spermatogenesis [14]. Estradiol in Hypogonadism Estradiol serum concentration in adult males is around 20-30 pg/ml, with a production rate of 45 g/d [15]. Low levels of estradiol are associated with increased fat and decrease in sexual desire and erectile function compared to higher levels [16]. Studies and Findings This study found that estradiol levels of 21.80 pg/ml and > 30.11 pg/ml resulted in greater mortality in men with hypogonadism, suggesting that estrogen deficiency is largely responsible for some of the key consequences of male hypogonadism [17]. Estrogens have a fundamental role in the regulation of body fat and sexual function, and this suggests that measuring estradiol might be helpful in assessing the risk of sexual dysfunction, bone loss, or fat accumulation in men with hypogonadism [18]. Estradiol and Chronic Heart Failure A study examined the relationship between serum concentration of estradiol and mortality in men with chronic heart failure and reduced left ventricular ejection fraction (LVEF) [19]. Results showed that men in the lowest and highest estradiol quintiles had increased mortality, while those in the highest quintile had increased survival rates [19]. Estradiol's Impact on Bone Density Estradiol below 11 pg/ml was associated with increased bone loss [20]. Estrogen deficiency is common in men with chronic HF and is associated with increased morbidity and mortality [21]. Estrogen appears to play an important role in determining bone mineral density in men, but it is unclear if it also affects bone   Estrogen in Men: Studies Estradiol is a hormone more abundant in women than men that is produced by the aromatization of testosterone in liver, fat and other cells [1]. It has been shown to be responsible for healthy bone density [2], but its role in men's sex drive, body composition and other variables is debated [3]. High estradiol blood levels can cause gynecomastia in the presence of low testosterone [4]. Anastrozole, a blocker of estradiol production, is prescribed to men who start testosterone replacement (TRT) [5]. However, there is no data on how high is too high when it comes to estradiol in men [6]. Low estradiol can be associated with higher fat mass and lower sexual function in men [7], so it is important to be careful when a clinic wants to put you on this drug without first justifying its use [8]. The most important details are that many clinics may be using the wrong estradiol test [9], and that most men on testosterone replacement therapy (TRT) do not develop gynecomastia even without using anastrozole [10]. Some physicians monitor estradiol blood levels after 6-8 weeks of TRT initiation using the sensitive estradiol test to determine if anastrozole use is warranted [11]. After 4-6 weeks on anastrozole, its dose can be adjusted to ensure that estradiol is not under 20 pg/ml [12]. The body of evidence suggests that testosterone in men is mediated by the ERs (estrogen receptors) after its biotransformation by the aromatase P450 inhibitors in the tissues [13]. These estrogen-mediated actions include feedback regulation of LH, regulation of skeletal homeostasis, lipid metabolism, cardiovascular physiology, and brain and spermatogenesis [14]. Estradiol serum concentration in adult males is around 20-30 pg/ml, with a production rate of 45 g/d [15]. Low levels of estradiol are associated with increased fat and decrease in sexual desire and erectile function compared to higher levels [16]. This study found that estradiol levels of 21.80 pg/ml and > 30.11 pg/ml resulted in greater mortality in men with hypogonadism, suggesting that estrogen deficiency is largely responsible for some of the key consequences of male hypogonadism [17]. Estrogens have a fundamental role in the regulation of body fat and sexual function, and this suggests that measuring estradiol might be helpful in assessing the risk of sexual dysfunction, bone loss, or fat accumulation in men with hypogonadism [18]. A study examined the relationship between serum concentration of estradiol and mortality in men with chronic heart failure and reduced left ventricular ejection fraction (LVEF) [19]. Results showed that men in the lowest and highest estradiol quintiles had increased mortality, while those in the highest quintile had increased survival rates [19]. Estradiol below 11 pg/ml was associated with increased bone loss [20]. Estrogen deficiency is common in men with chronic HF and is associated with increased morbidity and mortality [21]. Estrogen appears to play an important role in determining bone mineral density in men, but it is unclear if it also affects bone loss in elderly men [22]. Another study assessed longitudinal rates of change in bone mineral density in young and elderly men and related these to circulating total and bioavailable estrogen and testosterone levels [23]. The rate of increase in bone mineral density at the forearm sites in the young men was significantly correlated to serum total and bioavailable estradiol and estrone levels, but not with total or bioavailable testosterone levels [23].  Elderly men with bioavailable estradiol levels below the median had significantly higher rates of bone loss and levels of bone resorption markers than men with bioavailable estradiol levels above 40 pmol/liter [23]. Ranjith Ramasamy and Larry Lipshultz conducted a study of 423 men on TRT and found that those with high testosterone and estradiol levels had significantly greater libido than those with low levels [24]. The results are expected to be presented at the American Urological Association annual meeting in Orlando [24]. Hyperestrogenism is believed to be harmful to male sexuality [25]. A study screening 34,016 men in Low T Centers revealed that 7,215 (20.2%) had high estradiol levels [26]. The age distribution of those with high estradiol levels was as follows: 132/989 (13.3%) were older than 65 years, 3,753/16,955 (22.1%) were between 45 and 65 years, 2,968/15,857 (18.7%) were between 25 and 44 years, 7/215 (3.3%) were younger than 25 years [26]. The correlation coefficient of serum estradiol to age was .53 [26]. Low blood levels of estradiol (E2) are associated with brittle bones in old men, according to a new study [27]. Age-adjusted models showed that E2 and free E2 but not testosterone (T) associated significantly inversely with cortical porosity [28]. Free E2 also associated significantly with trabecular bone volume fraction, but this association did not remain significant after further adjustment [28]. Low serum E2 may reduce cortical bone strength and increase fracture risk in older men [29]. Conclusion The hormone estradiol, also known as E2, has emerged as a key player in a myriad of biological functions in males. It is involved in the regulation of sperm health, the growth hormone-insulin-like growth factor-1 axis, bone health, body composition, glucose metabolism, vasomotor stability, and brain function. The key enzyme aromatase, which facilitates the conversion of androstenedione and testosterone to E2, is integral to these processes. Understanding the role of E2 in male physiology helps shape our approach to health issues like low testosterone and the potential side effects of testosterone therapy. While the use of aromatase inhibitors can sometimes be beneficial in managing the effects of elevated estrogen levels, more evidence is needed before they can be recommended for routine use alongside testosterone therapy. It is also crucial to consider the balance between testosterone and E2 in the male body, as overly suppressing estrogen levels might lead to unintended consequences such as osteoporotic changes and decreased insulin sensitivity. As we deepen our understanding of E2's role in the body, it becomes clear that a nuanced, individualized approach to treatment is needed to balance the benefits and risks. Finally, there are still many open questions about the specific mechanisms through which E2 influences different aspects of male health. For example, the relationship between E2 and nitric oxide in mediating vasodilation remains to be fully elucidated. Therefore, more research is required to continue building a comprehensive understanding of E2's role in men's health. As we continue to learn, our approach to male hormonal health will evolve, bringing about new strategies for maintaining and improving men's health.   Buy the best-priced  gold standard ultrasensitive estradiol test on DiscountedLabs.com.   References:   1 https://www.healthline.com/health/estrogen-in-men 2 https://www.medicalnewstoday.com/articles/estrogen-in-men 3  https://academic.oup.com/ejendo/article/181/1/R23/6654090 4 https://tctmed.com/estrogen-in-men/ 5 https://www.news-medical.net/health/The-Role-of-Estrogen-in-Mene28099s-Health.aspx 6 https://my.clevelandclinic.org/health/body/22353-estrogen 7 https://eje.bioscientifica.com/downloadpdf/journals/eje/181/1/EJE-18-1000.pdf 9 https://www.testosteronewisdom.com/role-of-estradiol-in-men-and-its-management-2/ 10  https://www.news-medical.net/health/What-does-Estradiol-do.aspx 11  https://eje.bioscientifica.com/view/journals/eje/181/1/EJE-18-1000.xml  

Although testosterone frequently overshadows estradiol, a hormone more commonly associated with women, estradiol plays a significant role in men's health. Derived from testosterone through a process known as aromatization, estradiol contributes to various physiological aspects in men. Although it's crucial for maintaining bone density, its role in sexual health, body composition, and other health parameters is subject to ongoing discourse. Here, we delve into the dynamics of estradiol in men, its implications, and the importance of accurate measurement. Understanding Estradiol in Men The hormone estradiol, although present in smaller quantities in men compared to women, is produced through the aromatization of testosterone in liver, fat, and other cells. This conversion is nature’s design, hinting at a purpose behind it. Besides promoting bone health, estradiol’s influence on men's libido, body composition, and other factors is a hot topic among researchers. Excessive levels of estradiol, especially alongside low testosterone levels, could lead to conditions like gynecomastia (enlarged breasts in men). Hormonal Balance: The HPT Axis The Hypothalamic-Pituitary-Testicular (HPT) axis is a hormonal cascade that adjusts testosterone production based on the levels of testosterone and estradiol in the body. When either hormone level goes up too high, the HPT axis responds by decreasing the production of testosterone to keep hormone levels in balance. Aromatase Inhibitors: Boon or Bane? Aromatase inhibitors (AIs) stop the production of estradiol and are often given to people who are getting testosterone replacement therapy (TRT) to help them look younger and stay healthy. While higher estradiol levels could potentially cause gynecomastia and water retention, there's speculation, albeit without scientific backing, linking high estradiol levels to erectile dysfunction. The use of AIs is thought to mitigate these issues by lowering estradiol levels. However, the exact threshold of estradiol levels in men, beyond which it could be detrimental, remains undefined. Unveiling the Optimal Range Recent studies have started to shed light on estradiol's optimal range. For instance, levels below 20 pg/ml have been associated with increased bone loss, higher fat mass, and diminished sexual function in men. It is very important to get a correct reading of estradiol, and it is better to use a sensitive estradiol test (LC/MS assay) instead of the more common ECLIA-based test to avoid getting wrongly high estradiol readings from things like CRP (C-reactive protein). Estradiol’s Diverse Effects: A Closer Look 1. Bone Density: A study showed that estradiol levels below 11 pg/ml were linked to increased bone loss in men, emphasizing estradiol's role in bone health (Source). 2. Libido and Erectile Function: One groundbreaking study revealed that lower estradiol levels were correlated with increased body fat and a decrease in sexual desire and erectile function (Source). 3. Mortality Rate: A study highlighted that men with estradiol levels either below 21.80 pg/ml or above 30.11 pg/ml had a higher mortality rate, indicating a potential sweet spot for estradiol levels (Source). 4. Testosterone Therapy: In men undergoing TRT, elevated estradiol levels were associated with heightened libido, suggesting a nuanced interplay between testosterone and estradiol (Source). Conclusion The journey to demystify estradiol's role in men is ongoing. While its importance in bone health is well acknowledged, the hormone's broader impact on male physiology is gradually being unraveled. Accurate estradiol measurement and a deeper understanding of its optimal range could pave the way for enhanced men's health management, particularly for those undergoing testosterone replacement therapy.     Here is a more detailed discussion on estradiol in men: Click here   How to Get a sensitive estradiol test  

The prostate gland plays a pivotal role in men’s health, and its well-being is often a topic of great concern, especially when it comes to prostate cancer, a leading cause of death among men in the United States. This article delves into the intricacies of prostate health, detection methods for prostate cancer, and the debated connection between testosterone replacement therapy (TRT) and prostate cancer. Prostate Cancer Prevalence and Detection As men age, the occurrence of small, hidden prostatic lesions increases, which could potentially turn cancerous over time. The prevalence of these lesions is around 30% in American men aged over 45, and this figure soars to over 80% for those above 80 years of age. The transformation of these lesions into cancerous cells is often linked to genetic factors and lifestyle conditions, including diet. To detect prostate cancer, healthcare providers employ a variety of methods: Prostate-Specific Antigen (PSA) assays Digital Rectal Examination (DRE) Transrectal Ultrasound It's advisable for men, especially those above 40 or with a family history of prostate cancer, to undergo a DRE before commencing testosterone replacement therapy and every six months thereafter. While DRE may be uncomfortable, it's a small price to pay for ensuring good health. Any abnormal rectal exam findings, a PSA increase of more than 2 ng/mL, or a PSA level over 4 ng/mL usually necessitate further evaluation by a urologist, often involving an ultrasound and prostate biopsies. However, the PSA and DRE methods lack sensitivity and specificity. In some instances, benign prostatic hyperplasia (BPH), a non-cancerous inflammation, may falsely elevate PSA levels, while 25% of prostate cancer patients show normal PSA levels. As it turns out, needle biopsies can find hidden prostatic lesions in men whose PSA levels and ultrasound results are normal. Testosterone Replacement Therapy and Prostate Cancer: Unveiling the Connection The role of Testosterone Replacement Therapy (TRT) in PSA elevation or prostate cancer development has been a topic of considerable debate. Prostate cancer is initially androgen-dependent; thus, TRT is discouraged for men diagnosed with prostate cancer. However, a comprehensive analysis encompassing data from 18 studies revealed no significant link between blood levels of androgens and an increased risk for prostate cancer (Journal of the National Cancer Institute, 2008). Intriguingly, some emerging data suggest that high doses of testosterone may be beneficial in treating certain types of prostate cancer. A different study that looked at 149,354 men who were diagnosed with prostate cancer between 1991 and 2007 found that those who were treated with TRT did not have higher rates of death or use of Androgen Deprivation Therapy (ADT). The study, published in the Journal of Sexual Medicine (2014), concluded that TRT, post-prostate cancer diagnosis and treatment, doesn't exacerbate mortality rates or the necessity for ADT, even with prolonged TRT duration. Conclusion The dialogue surrounding prostate cancer, its detection, and the implicated role of TRT is complex. While the journey towards unambiguous understanding continues, regular screenings and open discussions with healthcare providers remain crucial for maintaining prostate health and making informed treatment decisions.   Reference: Kaplan, A. L., Lenis, A. T., Shah, A., Rajfer, J., & Hu, J. C. (2014). Testosterone Replacement Therapy in Men with Prostate Cancer: A Time-Varying Analysis. Journal of Sexual Medicine. For more insights on this topic, refer to: Does Testosterone Cause Prostate Cancer? Can Men Treated for Prostate Cancer Use TRT?

Starting Testosterone Replacement Therapy (TRT) is a significant decision that can have a profound impact on your health and well-being. While it offers numerous benefits, like enhanced mood, improved sexual performance, and increased muscle mass, there are also potential side effects and nuances that your healthcare provider might not fully explain. Below, we delve into critical aspects of TRT that every man should be aware of. But first, did you know that you can easily and affordably monitor your testosterone levels through DiscountedLabs.com? It's an excellent way to keep track of your health without the hassle of a doctor's visit. Table of Contents Impact on Sperm Count How TRT Affects Your Fertility Blood Viscosity and Hematocrit Managing Increased Red Blood Cells Shutdown of Natural Testosterone Production Recovery Post TRT Dose and Effectiveness TRT is Not a Magic Bullet Different Injection Methods Subcutaneous vs. Intramuscular Testosterone Gels and Creams Topical TRT: Right Dose, Right Results Optimal Injection Frequency The Shift Towards Frequent Dosing Sleep Apnea TRT and Sleep Quality Erectile Function and Libido The Added Benefits and Limitations Monitoring Your Blood Tests Taking Charge of Your Health Telemedicine for TRT Access to Expertise Prostate Cancer and Heart Attacks Debunking the Myths Community Support You're Not Alone Important Blood Tests Beyond Total Testosterone Insurance Limitations Navigating the System Consult a Urologist The Go-To Experts on TRT Comorbidities Risks and Workarounds The Estradiol Obsession Re-Thinking Estradiol Management Impact on Sperm Count How TRT Affects Your Fertility One aspect of TRT that is often overlooked is its effect on fertility. TRT reduces levels of LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone), which are crucial for sperm production. If you plan on having children, it's essential to discuss fertility preservation options with your healthcare provider. Treatments like clomiphene or the addition of hCG can be useful. Blood Viscosity and Hematocrit Managing Increased Red Blood Cells TRT may lead to an increase in hematocrit, or the amount of red blood cells in your blood, thereby making it thicker. While some doctors may suggest pausing TRT, this condition can be managed through blood donations or therapeutic phlebotomy. However, frequent blood donations can lead to iron depletion and fatigue. Learn more about managing high hematocrit here. Shutdown of Natural Testosterone Production Recovery Post TRT Once you're on TRT, your natural testosterone production will decline. Usually, your body can recover its testosterone levels within a few weeks to six months after stopping TRT, but it's essential to know that this therapy isn't a temporary commitment. Dose and Effectiveness TRT is Not a Magic Bullet Though TRT can dramatically improve quality of life by enhancing sex drive, muscle mass, and fat loss, the effectiveness varies from person to person. Factors like dose, frequency, and side effect management play a crucial role. Learn about the average time to see benefits. Different Injection Methods Subcutaneous vs. Intramuscular There's a common misconception that testosterone must be injected deep into the muscle. However, you can also use a 1/2 inch 27-29 gauge insulin syringe for subcutaneous injections. Read more about injection methods here. Testosterone Gels and Creams Topical TRT: Right Dose, Right Results Gels and creams offer a less invasive way to administer testosterone, but the effectiveness depends on the right dose and concentration. Doctors often miss this, so make sure you monitor your levels closely. Optimal Injection Frequency The Shift Towards Frequent Dosing Traditionally, doctors prescribed testosterone injections at 200 mg every two weeks. However, many are moving towards more frequent dosing schedules, like 100 mg per week or even 50 mg twice per week, using insulin syringes. Sleep Apnea TRT and Sleep Quality Be cautious if you have central sleep apnea, as TRT can worsen this condition. However, weight loss achieved through TRT may improve obstructive sleep apnea over time. Erectile Function and Libido The Added Benefits and Limitations While TRT generally improves libido, the results regarding erectile function are mixed. Some men also use low-dose Cialis for additional cardiovascular benefits. Read more about the benefits of Cialis. Monitoring Your Blood Tests Taking Charge of Your Health One of the great advantages of modern technology is that you can monitor your own blood tests via DiscountedLabs.com, without needing a doctor's appointment. Telemedicine for TRT Access to Expertise For those living in areas without easy access to a TRT specialist, telemedicine is a viable option. Just note that most telemedicine doctors don't accept insurance. Prostate Cancer and Heart Attacks Debunking the Myths Contrary to common belief, TRT has not been proven to cause prostate cancer or heart attacks. Proper monitoring of hematocrit, HDL, and blood pressure is crucial, however. Community Support You're Not Alone Don't underestimate the value of community support. Platforms like Excel Male Forum offer a wealth of shared experiences and advice from men who have been on TRT for years. Important Blood Tests Beyond Total Testosterone Many doctors only measure total testosterone and often neglect other important markers like free testosterone, DHT, and thyroid function. Ensure these are part of your monitoring plan. Insurance Limitations Navigating the System Most insurance companies have limitations on which TRT products they cover. You can bypass insurance restrictions by going through a compounding pharmacy. Consult a Urologist The Go-To Experts on TRT Urologists are becoming increasingly knowledgeable about TRT, making them an excellent resource for anyone considering this treatment. Comorbidities Risks and Workarounds Some men might not see the benefits of TRT due to other health issues, such as metabolic disorders that can lead to water retention and high blood pressure. A full work-up with a cardiologist is advisable for these men. The Estradiol Obsession Re-Thinking Estradiol Management Many men obsess about their estradiol levels and are often prescribed high doses of aromatase inhibitors, which may not be necessary. Learn more about the role of estradiol in men here. In conclusion, TRT is a multifaceted treatment that requires proper understanding and management. Keep yourself informed and consider using DiscountedLabs.com for your testosterone level monitoring. Take control of your health today!

Table of Contents What are Estradiol and Aromatase? When aromatase is unbalanced, estradiol becomes an issue Low estrogen levels in men, not testosterone increases risk of heart disease Androgen deprivation therapy can cause cognitive decline Does estradiol restore cognitive function during ADT? Should high estradiol levels be treated? What are Estradiol and Aromatase? Estradiol is a form of the female hormone estrogen. Although estradiol production is typically considered a female concern, men also need to maintain healthy levels of this hormone for optimal health. Since men lack ovaries (where most estradiol is produced in women), estradiol in men is created by a process that uses an enzyme called aromatase (1) in testicles, liver and fat cells. Aromatase converts a very small portion of testosterone levels into estradiol, and health problems can arise when aromatase levels are too high or too low (1). When aromatase is unbalanced, estradiol becomes an issue As men age, they can experience excess aromatase activity, raising estradiol levels and reducing testosterone to unhealthy levels. Low T levels will adversely impact quality of life by reducing libido, ability to maintain an erection, mood, and muscle mass, among other health factors (2). However, when the body produces too little aromatase, men can experience other, potentially serious health problems. Men with diminished aromatase levels will have an estradiol deficit, which can create problems similar to low-T; diminished sex drive, loss of bone mass, and increased body fat (3). Men on testosterone replacement therapy (TRT) taking higher doses of aromatase inhibitors can also experience estradiol deficit. Let’s look at recent studies finding that low estradiol can play a critical role in increasing the risk of cognitive decline and increase the odds of experiencing cardiovascular disease. Low estrogen levels in men, not testosterone increases risk of heart disease A study led by Elaine Yu, MD, MSc, addresses the suspicion held by many medical professionals that testosterone can promote cardiovascular disease in men, and that estradiol provides protection against it (4). The researchers sought to determine whether it was estradiol or testosterone that regulated men’s cardiovascular risk factors by comparing two groups whose hormone levels were changed using a combination of medications (4). They looked at 400 healthy men, between the ages of 20 and 50. Study participants were weighed, had fasting blood tests for markers of heart disease and diabetes, and also had a thigh scan using quantitative computed tomography (CT scan) to measure muscle fat content before and after the study (4). Yu’s team found that while higher levels of testosterone reduced these men’s levels of healthy (HDL) cholesterol, changes in estradiol levels had no effect at all on HDL(4). However, they also discovered that low estradiol levels did increase the markers for diabetes, like increased insulin resistance, increased fat in the muscles, and higher fasting blood sugar levels(4). Diabetes is a major risk factor for heart disease (5). Additionally, the study found that neither estradiol nor testosterone affected the levels of LDL (unhealthy) cholesterol. According to Yu, these findings indicate that in men, it’s higher testosterone levels combined with lower estradiol levels that can worsen cardiovascular risk factors, somewhat explaining differences in the incidence of heart disease between men and women. Some studies have shown that it is the ratio of testosterone to estradiol that is important, not just the level of each of those hormones. As testosterone increases with TRT, so does estradiol to balance the effects of testosterone on lipids, mood and insulin action. Androgen deprivation therapy can cause cognitive decline Androgen deprivation therapy (ADT) is an often used method to slow the growth of prostate cancer. It’s also used for men transitioning to women (6, 7). ADT is typically prescribed on an open-ended (no fixed period) basis to help treat advanced prostate cancer. An estimated 44 percent of men with prostate cancer will undergo ADT at some point as part of a strategy to slow tumor growth (6). ADT therapy is used specifically to block the male hormones, particularly testosterone, from stimulating prostate cancer cell growth. Research has confirmed that ADT can cause significant cognitive decline in women with breast cancer (8), but few studies have investigated cognitive impairment following ADT for men being treated for prostate cancer. Using formal tests, scientists recently compared the cognitive ability of 58 prostate cancer patients receiving androgen deprivation therapy to 84 prostate cancer patients who did not receive ADT, and 88 cancer-free men (9). They found that those treated with ADT were 70 percent more likely to develop cognitive impairment after six months, and over twice as likely to have significant cognitive impairment after one year(9).   Does estradiol restore cognitive function during ADT? A 2018 study published in Current Neuropharmacology has examined whether estradiol supplementation is an effective way to prevent this side effect (9). Researchers performed a literature search using PubMed and Google Scholar to identify studies on this topic and discover any evidence that estradiol supplementation has a cognitive benefit for men on ADT. They examined studies involving the effects of estradiol treatment on cognitive function in three androgen-deprived male populations; prostate cancer patients, male-to-female transsexuals, and castrated male animals (9). A review of the literature found that while some studies show that estradiol supplementation resulted in cognitive improvement (especially in spatial ability), They couldn’t determine (9): Whether estradiol will improve cognition after long-term ADT How early or delayed estradiol treatment post-castration will affect cognition If estradiol affects memory retention They conclude that for androgen-deprived males, there is some evidence that estradiol supplementation may improve both verbal and visual memory (9). However the variability between the reviewed studies resulted in significant inconsistencies, making further study necessary to determine what estradiol treatment protocol can best maximize cognitive improvement for men using ADT (9). Should high estradiol levels be treated? Men on testosterone replacement therapy can experience an increase in estradiol that can sometimes reach clinically elevated levels (10). A study published in the Journal of Sexual Medicine (11) looks at the phenomenon of increased estradiol levels in men undergoing TRT to discover whether high estradiol levels in this population should be treated. Researchers comprehensively reviewed the published literature on the role of estradiols in male sexual function and testosterone deficiency to answer this question. The study findings reveal that (11): Although estradiol have been used at pharmacologic doses to suppress serum testosterone, there is no evidence that naturally occurring elevations of estradiol will cause a reduction in testosterone levels Absent testosterone deficiency, study findings suggest that elevated estradiol levels don’t seem to be harmful. Once again, monitoring and treating the ratio of testosterone to estradiol may be more important than either hormone alone. Estradiol could help maintain some sexual function in castrated men Given the evidence uncovered by this review study, researchers report that, although further research is needed, the existing evidence doesn’t support the treatment of elevated estradiol for men on testosterone therapy (11). WATCH LECTURE ABOUT ESTRADIOL IN MEN    BUY YOUR SENSITIVE ESTRADIOL TEST   References 1) Stocco, Carlos. “Tissue Physiology and Pathology of Aromatase.” Steroids 77.1-2 (2012): 27–35. PMC. Web. 11 June 2018. 2) Araujo, Andre B., and Gary A. Wittert. “Endocrinology of the Aging Male.” Best practice & research. Clinical endocrinology & metabolism 25.2 (2011): 303–319. PMC. Web. 11 June 2018. 3) Bulun, Serdar E. “AROMATASE DEFICIENCY.” Fertility and sterility 101.2 (2014): 323–329. PMC. Web. 11 June 2018. 4) Men's heart disease risk linked to high testosterone and low estrogen. The Endocrine Society. 5) Zhang PY. Cardiovascular disease in diabetes. Eur Rev Med Pharmacol Sci. 2014;18(15):2205-14. 6) Perlmutter, Mark A, and Herbert Lepor. “Androgen Deprivation Therapy in the Treatment of Advanced Prostate Cancer.” Reviews in Urology 9.Suppl 1 (2007): S3–S8. Print. 7) Unger, Cécile A. “Hormone Therapy for Transgender Patients.” Translational Andrology and Urology 5.6 (2016): 877–884. PMC. Web. 11 June 2018. 8) Wu, Lisa M., and Ali Amidi. “Cognitive Impairment Following Hormone Therapy: Current Opinion of Research in Breast and Prostate Cancer Patients.” Current opinion in supportive and palliative care 11.1 (2017): 38–45. PMC. Web. 11 June 2018. 9) Wibowo E. Cognitive Impacts of Estrogen Treatment in Androgen-Deprived Males: What Needs to be Resolved. Curr Neuropharmacol. 2017;15(7):1043-1055. 10) Tan RS, Cook KR, Reilly WG. High estrogen in men after injectable testosterone therapy: the low T experience. Am J Mens Health. 2015 May;9(3):229-34. doi: 10.1177/1557988314539000. Epub 2014 Jun 13. 11) Ravi Kacker, Abdulmaged M. Traish, Abraham Morgentaler. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency. The Journal of Sexual Medicine. (2012): Volume 9, Issue 6, Pages 1681–1696

Testosterone, a vital hormone predominantly found in males, plays a crucial role in various physiological processes such as sexual development, muscle growth, bone density, and overall well-being. Recent studies have raised concerns about a decline in serum testosterone levels among adolescents and young adult men in the United States. This article aims to explore the potential causes, implications, and scientific evidence surrounding this phenomenon. Factors Contributing to Declining Testosterone Levels in Young Men Lifestyle Changes Sedentary behavior, unhealthy dietary patterns, and an increase in screen time have been linked to lower testosterone levels. Lack of physical activity and poor nutrition can lead to weight gain, which is associated with reduced testosterone production [1]. Endocrine Disruptors Exposure to endocrine-disrupting chemicals (EDCs) such as phthalates, bisphenol A (BPA), and pesticides has been suggested as a potential contributor to declining testosterone levels. These chemicals, commonly found in plastics, personal care products, and certain foods, can interfere with hormonal balance and disrupt testosterone synthesis [2]. Stress and Mental Health Chronic stress and mental health disorders, including depression and anxiety, may negatively impact testosterone production. Elevated cortisol levels, often associated with stress, can suppress testosterone synthesis [3]. Obesity and Insulin Resistance The rising prevalence of obesity and insulin resistance among adolescents and young adults has been linked to lower testosterone levels. Excess body fat can promote the conversion of testosterone into estrogen, leading to hormonal imbalances [4]. Implications of Declining Testosterone Levels Sexual and Reproductive Health Testosterone is essential for normal sexual function, including libido, erectile function, and sperm production. Declining testosterone levels may contribute to sexual dysfunction and reduced fertility in affected individuals. Physical Health Testosterone plays a crucial role in maintaining muscle mass, bone density, and overall physical well-being. Decreased testosterone levels may lead to decreased muscle strength, increased risk of osteoporosis, and compromised overall health. Psychological Well-being Testosterone influences mood, cognition, and overall psychological well-being. Low testosterone levels have been associated with symptoms such as fatigue, depression, irritability, and reduced quality of life. Scientific Evidence and Studies A study published in the Journal of Clinical Endocrinology & Metabolism in 2006 analyzed data from the National Health and Nutrition Examination Survey (NHANES) and found a significant decline in testosterone levels among men aged 20-74 years between 1988 and 2004 [5]. Another study published in JAMA Internal Medicine in 2020 examined testosterone levels in over 4,000 young men aged 15-39 years from 2009 to 2016. The findings indicated a substantial decline in testosterone levels during this period [6]. Research published in the journal Environmental International in 2020 explored the association between phthalate exposure and testosterone levels in young men. The study suggested that higher urinary phthalate metabolite concentrations were associated with lower testosterone levels [7]. Conclusion The decline in serum testosterone levels among adolescents and young adult men in the USA is a concerning trend with potential implications for sexual and reproductive health, physical well-being, and psychological functioning. Lifestyle factors, endocrine disruptors, stress, obesity, and insulin resistance are among the factors contributing to this decline. Further research is needed to understand the extent of the issue and develop strategies to address and mitigate the potential consequences. Buy the most affordable testosterone test in the country on DiscountedLabs.com References: Araujo AB, Dixon JM, Suarez EA, et al. Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2011;96(10):3007-3019. Haider A, Yassin A, Doros G, Saad F. Effects of long-term testosterone therapy on patients with "diabesity": results of observational studies of pooled analyses in obese hypogonadal men with type 2 diabetes. Int J Endocrinol. 2014;2014:683515. Morales A, Bebb RA, Manjoo P, et al. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. CMAJ. 2015;187(18):1369-1377. Almeida OP, Hankey GJ, Yeap BB, et al. Low free testosterone concentration as a potentially treatable cause of depressive symptoms in older men. Arch Gen Psychiatry. 2008;65(3):283-289. Travison TG, Araujo AB, O'Donnell AB, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab. 2007;92(1):196-202. O'Connor DB, Archer J, Wu FC. Effects of testosterone on mood, aggression, and sexual behavior in young men: a double-blind, placebo-controlled, cross-over study. J Clin Endocrinol Metab. 2004;89(6):2837-2845. Hammoud A, Gibson M, Peterson CM, et al. Impact of male obesity on infertility: a critical review of the current literature. Fertil Steril. 2008;90(4):897-904.

Table of Contents SHBG and the Free Testosterone Relationship What Causes High SHBG? Other factors that can contribute to high SHBG include:   Get Your Levels Checked: SHBG Test, Free & Total Testosterone Test How to Lower SHBG Levels: Very Low SHBG : Low SHBG has also been associated with: Is SHBG an Enemy of Hormone? - Emerging Studies References: Testosterone is the primary and dominant male hormone. It is responsible for numerous functions within the human body in men and women, and when levels are too low, it can lead to multiple health issues. Unfortunately, as many know, testosterone levels naturally decline as we age. Numerous external factors can contribute to lower levels of testosterone. In either case, age or external, symptoms occur, problems arise, and solutions are needed to stop the decline. For many men, testosterone replacement therapy (TRT) is the answer to this problem.  Men should ensure that their testosterone free and total, estradiol and other hormone factors are within normal levels. One of those hormone tests to monitor is the Sex Hormone Binding Globulin (SHBG) test.   SHBG and the Free Testosterone Relationship   When our body produces testosterone or provides it exogenously, a set level of testosterone flows through the body. This testosterone blood level can be measured precisely through a simple blood test aptly referred to as the Total Testosterone blood test. For most adult men, when testing their total testosterone, if it falls in the 350 ng/dl to 1100 ng/dl range, this will be considered medically optimal. Such individuals, even exhibiting low testosterone symptoms, will often not be prescribed TRT. In some cases, this may be a correct diagnosis; in other cases, symptoms exist for different reasons, but in most cases, something else is at play, which makes SHBG important.   While useful, measuring total testosterone is only useful with also measuring Free Testosterone. Free testosterone is a small fraction of your total testosterone. It is often referred to as "unbound," meaning the testosterone your body will use for its intended androgenic function. Free testosterone is so important that if your total testosterone levels are within range, if free testosterone levels are low, in most cases, the man will be symptomatic of low testosterone. This issue is often due to high levels of SHBG in the body.   For this reason, many men will attempt to lower their SHBG or even fret over it. However, SHBG serves an essential purpose. As is with estrogen, too much can be problematic, but so can too little. SHBG is no different.   Of all the testosterone flowing through your body, only 2% is what we can refer to as unbound or free testosterone. From a layman's perspective, to increase free and unbound testosterone, they'd need to increase their total testosterone. Unfortunately, it doesn't always work that way – it often helps and often fixes the issue, but not always – and here's why: our testosterone is bound to albumin and sex hormone-binding globulin (SHBG). Approximately one-third of total testosterone binds to albumin, and the rest to SHBG.   Albumin is a protein that binds testosterone, and we can say it does so loosely. This protein carries testosterone through the bloodstream and releases it as needed. The testosterone detaches and becomes what's often referred to as bioavailable or free testosterone. The testosterone that separates from albumin becomes the testosterone that influences your body's functions from sex organs, muscle tissue, brain function, and a host of other areas of bodily function. Testosterone attached to SHBG cannot do this; it is attached and does not detach.   What Causes High SHBG?   As testosterone attached to SHBG is relatively useless, if SHBG levels increase within the body, there will be more attaches and less free testosterone to circulate. Conversely, lower levels of SHBG are associated with higher levels of free testosterone, which is often associated with positive influences on bodily functions, such as libido, mood, muscle mass, etc.   Numerous factors influence how much sex hormone-binding globulin we have in our bodies. Age is one of the primary factors that affect SHBG. Often as we age, SHBG levels increase, and as a result, free testosterone levels go down. Even if our total testosterone levels remain high or optimal, our bioavailable testosterone decreases if SHBG levels increase.   Other factors that can contribute to high SHBG include: Fatty Liver Excessive or what we might call chronic alcohol consumption can lead to a fatty liver and impending higher levels of SHBG and corresponding lower levels of free testosterone. The disease can also be a factor, such as cirrhosis or cancer. Thyroid issues An underactive and overactive thyroid can lead to elevated SHBG, not to mention issues associated with the thyroid. Overactive thyroid or hyperthyroidism is often associated with graves' disease, thyroid nodules, or thyroiditis. It can also exist due to abuse of thyroid medications, such as Cytomel (T3). Underactive thyroid or hypothyroidism may be caused by inflammation of the thyroid gland, pituitary damage, too little iodine in the diet, or genetic factors, along with other possible reasons. Elevated estradiol High levels of estradiol can occur for numerous reasons, which are not limited to using certain antibiotics, some mental health medications, obesity, and abuse of exogenous testosterone. Obesity & High triglycerides While not as expected of a factor for increasing SHBG, being overweight with a low lipid profile can negatively impact. Inflammation While some level of inflammation is necessary for general health in the fight against disease or injury, what we might call chronic inflammation can lead to increases in SHBG and corresponding lower levels of free testosterone   Get Your Levels Checked: SHBG Test, Free & Total Testosterone Test   Testing your SHBG levels along with both total and free testosterone is particularly important if one wants to get to the bottom of hypogonadism (low testosterone) symptoms they may be experiencing. Remember, a total testosterone test alone, which some physicians will run, is not enough. For most adult men, SHBG levels will run between 10 nmol/L and 60 nmol/L if in the optimal range. If SHBG levels are greater than 60 nmol/L and your free testosterone is less than 2% of your total testosterone, there is a good chance your SHBG levels are too high.   Discounted Labs sells several lab test panels that measure SHBG levels that you can buy without a doctor's visit:   Testosterone (Total and Free), SHBG, CBC - Hematocrit, Ultrasensitive Estradiol and PSA   Testosterone, Free, Bioavailable and Total (Upper Limit T 1,500 ng/dL) plus SHBG   CBC, CMP, TT, FT, Lipids, Prolactin, Ultra-Sensitive Estradiol, and SHBG   Testosterone, Free, Bioavailable, and Total, LC/MS (No Upper Limit) plus SHBG   As we now understand SHBG, our next question is what can be done to lower it, increasing free testosterone in the body? There is nothing we can do about aging. As each day passes, we grow older, but there are still things we can do that will improve this factor.   How to Lower SHBG Levels:   The most obvious answer to the problem of low free testosterone and high levels of SHBG is to increase testosterone. Exercise more, consume a cleaner diet, and lose weight; all of these things will increase your testosterone levels. Your levels may not increase massively, but some increase means a higher total to pull from and a greater amount of free testosterone based on the 2% fraction. If this isn't enough - perhaps you're not reaching a 2% fraction due to elevated SHBG – one may need to consider talking to their doctor about testosterone supplementation. However, even if supplementing with exogenous testosterone, the habits mentioned are good for overall health and can only have a positive impact.   Another possible solution, and one of the more commonly needed, is lowering estradiol levels in the body. We tend to think estrogen hormones are needed for females only, but they are also crucial for men, granted in smaller amounts. As it pertains to estrogen, too much estradiol can lead to elevated levels of SHBG. If testosterone levels are also low, this can lead to even more negative factors. But it's important not to get carried away as estradiol that's too low will bring with it numerous symptoms; in fact, your life could be miserable in that regard.   Many men who are at least somewhat familiar with testosterone have been wrongly been told that too much testosterone can lead to gynecomastia due to elevated levels of estrogen in the body due to the aromatization of testosterone to estrogen. But low levels of testosterone in the body with present high levels of SHBG and estradiol can have the effect of causing gynecomastia. In order to combat high levels of estradiol, avoiding certain foods, especially those that are soy-based, will be important. Equally important is living a healthy lifestyle and incorporating what was mentioned above: adequate exercise, a healthy diet, and getting enough sleep. These things will help lower estradiol. Some men will also need medical help through medications known as aromatase inhibitors if they have gynecomastia, although most men on TRT do not need an AI. Too many men have relied on aromatase inhibitors out of fear for too many years. In reality, most men who supplement with exogenous testosterone can, in fact, control estrogen via non-medicated factors.   Some studies have shown that supplementation with DHEA (Dehydroepiandrosterone) may also lower SHBG. However, more study is needed to understand this properly, as too much DHEA can prove problematic. High doses of DHEA supplements have been associated with increased estradiol, so you must speak to your doctor first before beginning such a supplementation regimen.   Very Low SHBG :   We are then left with one factor we've yet to discuss much because it isn't all that common: low SHBG, or rather, levels of SHBG that are too low. Levels of SHBG that are too low may be an indicator of other underlying health issues. This may be an indicator of a metabolic problem. Low levels of SHBG are a standard indicator of those with diabetes. It doesn't appear, as data suggests, that insulin resistance is caused by low SHBG, but it may be a useful marker. More data is currently needed on this topic.   An A1c test will be needed to know with certainty in terms of your diabetic health.   While low SHBG is not a common concern for most men, new data has produced interesting results and information. A recent study published in the Journal of Clinical Endocrinology and Metabolism provides such information.   The process showed a man with undetectable levels of SHBG and low levels of testosterone accompanied by nearly a decade of hypogonadism symptoms. They discovered a family with a missense mutation in the SHBG gene from studying this individual. Interestingly enough, they found this issue did not interfere with the individual's spermatogenesis or general gonadal development. This leads the study to conclude SHBG may not play a significant role in the maturation of the male species physiologically or sexually.   More interesting than the JCEM study is things that new data suggest may negatively impact all men. Low levels of SHBG have recently been associated with three medical conditions that are known to be the silent killers of many men: heart disease, metabolic syndrome, and diabetes. Again, currently, it is being viewed as a marker and not as direct causation, but this new information is important as it acknowledges that more studies must be done.   Low SHBG has also been associated with:   Obesity Obesity is a factor we all well understand and is an issue that leads to problems in many health areas, and often in numerous possible directions. Cushing Disease It is associated with extended exposure to high levels of cortisol. Hypothyroidism It is associated with an under-active thyroid. Excessive levels of growth hormone Exceedingly rare for most, although possible via genetic factors or abuse of exogenous forms. Abuse through anabolic steroids     Is SHBG an Enemy of Hormone? - Emerging Studies   As we mentioned, androgens like testosterone and DHEA and estrogens are transported to the sex hormone binding globulin (SHBG). SHBG is believed to keep sex hormones inactive and to control the amount of free hormones that enter cells by passive diffusion. Contrary to the free hormone hypothesis, some researchers have demonstrated that megalin, a receptor in ovaries and testicles, acts as a pathway for cellular uptake of biologically active androgens and estrogens bound to SHBG. We will see more data on this newly found receptor that actually enables the body to use hormones bound to SHBG in the near future.   In endocrinology, the body has no “harmful” or “good” hormone. Their balance and harmony with each other matters for the best health.     References:   Ding et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. The New England Journal of Medicine. Aug 2009. Vos et al. Sex Hormone Binding Globulin Deficiency Due to a Homozygous Missense Mutation. Journal of Clinical Endocrinology and Metabolism. Sept 2014 SHBG and Free Testosterone - Everything You Need to Know Hammes et al. Role of Endocytosis in Cellular Uptake of Sex Steroids. Cell. Sept 2005