Page 4 - TRT Monitoring

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

Here are Some Important Things That Your Doctor May Fail to Tell You Before You Start Testosterone Replacement Therapy (TRT):       1- TRT decreases your sperm count.     Some doctor prescribe Clomiphene alone or hCG with TRT to preserve your fertility     2- TRT may increase your blood viscosity due to increased hematocrit, the amount of red blood cells in the blood.     Some doctors may want to stop your TRT when this happens, but this side effect can be managed easily with blood donations or therapeutic phlebotomy.   Just be careful: frequent blood donations can deplete iron and cause fatigue.     3- TRT shuts down your own testosterone production.     It may take up to 6 months for your testosterone to return to baseline after you stop.     4- TRT works to improve your sex drive, muscle mass, and burn fat.     But it does not work for everyone and dose/frequency are important along with other factors like side effect management.   TRT is not a magic bullet.     5- Testosterone can be injected under the skin (Most doctors think you should inject deeply into muscle)     6- Testosterone gels and creams are effective but some doctors do not adjust the dose based on your blood level and symptoms.     7- Many doctors still prescribe testosterone injections at 200 mg every two weeks.     Many are moving towards recommending 100 mg/week or 50 mg twice per week with an insulin syringe.     8- TRT can worsen sleep apnea.     Apnea can improve with weight loss and can be treated with a CPAP machine.     9- TRT improves erectile function in some men but not all.     It improves libido in most men regardless of age, though.     10- You can monitor your own blood tests via companies that sell discounted labs without a doctor visit.     11- You can access a testosterone doctor via telemedicine if you don’t have one close by.     However, most of them do not take insurance.     12- TRT does not cause prostate cancer or heart attacks.     Cardiovascular outcomes depend on proper monitoring of hematocrit, HDL, and blood pressure.     13- Many men do not know that they ask questions to TRT-experienced men by visiting the ExcelMale forum.     14- In follow up visits, some doctors only measure blood levels of total testosterone but forget to include free testosterone, DHT (metabolite), and thyroid function tests.     15- Most insurance companies only pay for certain TRT products but not others.     And most refuse to pay if your testosterone is over 350 ng/dL.     16- You can buy affordable TRT options with a prescription at compounding pharmacies like Empower Pharmacy.     17- Urologists are quickly becoming the most knowledgeable doctors of TRT management.     18- Some men fail to achieve benefits from TRT. Comorbidities and other issues can be to blame.     GO TO: DiscountedLabs.com/Resources for   Free Testosterone Book Doctor's Referrals Forums & More

Table of Contents Does Testosterone Increase Risks of Heart Disease? What is the Effect of Testosterone Therapy in Older Men? What Can You Do to Prevent Heart Disease While on Testosterone Replacement Therapy? BUY A TESTOSTERONE BLOOD TEST PANEL Reference:  Does Testosterone Increase Risks of Heart Disease? There is widespread misinformation that testosterone supplementation increases the risk of heart disease. There is no evidence to support this belief in men younger than 65 years of age. Testosterone administration to middle-aged men is associated with decreased visceral fat, triglycerides, lower blood sugar concentrations, and increased insulin sensitivity. Several studies have shown that low total and free testosterone concentrations are linked to increased intra-abdominal fat mass, the risk of coronary artery disease, and type 2 diabetes mellitus. Testosterone has also been shown to increase coronary blood flow. Similarly, testosterone replacement retards the build-up of plaque in experimental models of atherosclerosis. In 1994, Phillips and colleagues studied 55 men with angina. They found a strong correlation between very low levels of testosterone and increased severity of coronary artery disease as measured by arteriograms, suggesting that testosterone may have a protective effect. This is consistent with the observation that the risk for atherosclerosis increases with age in men, while testosterone levels decrease. Two other smaller studies found that the administration of testosterone decreased risk factors for coronary artery disease. The prospective European investigation into cancer in Norfolk (EPIC- Norfolk) Prospective Population Study examined the prospective relationship between the body’s own (endogenous) testosterone concentrations and mortality due to all causes, cardiovascular disease, and cancer in a nested case-control study based on 11,606 men aged 40 to 79 years surveyed in 1993 to 1997 and followed up to 2003. Among those without prevalent cancer or cardiovascular disease, 825 men who subsequently died were compared with a control group of 1489 men still alive, matched for age and date of baseline visit. Lower endogenous testosterone (the body’s own) concentrations at baseline were linked to mortality due to all causes (825 deaths), cardiovascular disease (369 deaths), and cancer (304 deaths). So this study found that in men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes and that low testosterone may be a predictive marker for those at high risk of cardiovascular disease.   What is the Effect of Testosterone Therapy in Older Men? But there are some emerging contradicting data from a much smaller study that showed that older men who have higher endogenous testosterone (without taking testosterone) might have a higher incidence of heart disease. A large U.S. multicenter study showed that older men with higher testosterone levels are more likely to have a heart attack or other cardiovascular disease in the future. The results were presented at The Endocrine Society’s 92nd Annual Meeting in San Diego in June 2010. Study participants were age 65 or older and included 697 community-dwelling men who were participating in the National Institutes of Health-funded study, called the Osteoporotic Fractures in Men (MrOS). None of these men were receiving testosterone therapy, according to the study abstract. All subjects had blood tests to determine their testosterone levels. The investigators then divided the men into quartiles, or four groups, of testosterone range to observe trends in rates of coronary heart disease events. This type of heart disease results from plaque-clogged or narrowed coronary arteries, also called atherosclerosis. A coronary heart disease event included a heart attack; unstable angina, which is chest pain usually due to atherosclerosis and which doctors consider a prelude to a heart attack; or angioplasty or bypass surgery to clear blocked arteries. During an average follow-up of nearly four years, 100 men, or about 14 percent, had a coronary disease event, in particular, heart attacks. After the researchers adjusted for other potential contributing risk factors for heart disease, such as elevated cholesterol, they found that higher total testosterone level relates to an increased risk of coronary disease. Men whose total testosterone was in the highest quartile (greater than or equal to 495 nanograms per deciliter, or ng/dL) had more than twofold the risk of coronary disease compared with men in the lowest quartile (below 308 ng/dL). So, this is contradictory data that may be concerning, but does it say anything about the cardiovascular risks of supplementing testosterone to men with testosterone deficiency? A report published in the New England Journal of Medicine in June 2010 about a study researching the use of testosterone gel in older men showed that such study was stopped early due to a higher incidence of side effects in men treated with the gel. Participants in this trial called the Testosterone in Older Men with Mobility Limitations, or TOM, were non-institutionalized men aged 65 and older who had difficulty walking two blocks or climbing ten steps and whose serum testosterone was 100 to 350 ng/dl (very low levels). So, these were frail older men. The goal was to recruit 252 men, but only 209 subjects had been enrolled by the time the trial, which started in 2005, was stopped on December 2010. Testosterone use had the desired effect of improving the men’s muscle strength and mobility. But they also experienced a high rate of adverse effects — not just cardiovascular problems but respiratory and skin problems. Unfortunately, they did not report hematocrit, estradiol, and bioavailable testosterone. I dream of the day when a study will be done the right way to include all of those variables. Only then we can draw the right conclusions about who is more prone to side effects. Managing high hematocrit with blood donation/phlebotomy and high estradiol with anastrozole can probably eliminate some of the reported side effects in older men, but there is only one way to find out: To have proper studies using those management strategies. To date, no study listed in clinicaltrials.gov is following men who are taking testosterone and who have access to phlebotomy or estrogen blockers to manage the two main side effects that may affect cardiovascular health in older men: high hematocrit and estradiol. Previous studies have shown that in general, older men have more side effects when using testosterone (polycythemia, gynecomastia, high blood pressure, prostatic hyperplasia) and more comorbid conditions. High hematocrit and estradiol increase clotting and viscosity, so it is not surprising to me that older men who use testosterone would have more cardiovascular risks if monitored poorly by their physicians. It amazes me how many older men using TRT are walking around with hematocrit over 54 and estradiol levels above 100 pg/dl without being offered phlebotomy or estrogen blockers. This is one of the main reasons I felt compelled to write this book. Older men also require more testosterone to reach normal levels since they have more sex hormone binding globulin that attaches to testosterone and renders it useless. So, physicians should carefully monitor these patients if they decide to provide testosterone replacement. The age cut off when the risk-to-benefit ratio of testosterone changes is not known yet. There are several studies that are currently being performed to provide more answers. A U.S.-based study showed that testosterone therapy does not increase men's risk for heart attack. The study, conducted by researchers at the University of Texas Medical Branch at Galveston, examined 25,420 Medicare beneficiaries 66 years or older treated with testosterone for up to eight years. It appeared in the July 2, 2012 issue of the Annals of Pharmacotherapy. So, the jury is still out. But if no complicating factors like high cholesterol, blood pressure or strong family history of heart disease are present, many doctors opt for prescribing testosterone to older men who need it to have a better quality of life. And most doctors keep an eye on hematocrit but few on estradiol. Hopefully, this will change as more doctors wake up to the risks associated with poor monitoring and management of TRT. It is the excessively high doses of testosterone used by athletes and recreational bodybuilders that are linked to significant decreases in the plasma concentration of HDL (high-density lipoprotein - the good cholesterol) and increases in LDL (low-density lipoprotein – the bad cholesterol). Replacement doses of testosterone have been shown to have only a modest or no effect on plasma HDL in placebo-controlled trials. Testosterone supplementation has been shown to decrease triglycerides, a dissolved fat that can lead to cholesterol increases and metabolic syndrome. In spite of these studies, some physicians continue to think that testosterone replacement can dramatically increase cholesterol levels.   What Can You Do to Prevent Heart Disease While on Testosterone Replacement Therapy? Given the state of the modern diet, all of us should have our doctor check our fasting cholesterol and triglycerides (another lipid-linked with heart disease risk). If you think that you have low testosterone, you may already have a problem with your lipids. The recommendations of exercise and diet (low in sugars and animal fats) apply for everybody but are especially important for men who have high LDL and high triglycerides at the time of starting testosterone replacement. Testosterone therapy can be an important part of your health regimen but don’t start it thinking that it will cure high cholesterol. Sometimes high lipids are related to poor diet, sedentary lifestyle, medication side effects, and bad genes. Your treatment for high cholesterol and triglycerides can also include statin and fibrates drugs prescribed to you by your doctor. I would try to modify your diet and to exercise before you jump on taking these medications since they may have muscle related side effects and do not correct the root cause of the problem, which is a metabolic abnormality that could be addressed with good adherence to lifestyle modifications. The key word is “adherence,” which seems elusive is many people who rather take a pill than watch their diet and exercise. For more on diet and exercise, refer to the chapter “ Miscellaneous Health Tips to Support Healthy Testosterone.” NOTE: I think you’re getting why I’m telling you that you need doctor’s supervision when on testosterone. So far you’ve read about the potential impact on hemoglobin and hematocrit, blood pressure, and estradiol, all of which can negatively affect your cardiovascular health. Imagine the even greater risk of those using testosterone at higher than replacement doses that usually buy it from underground sources and do not have a doctor who monitors them. No wonder testosterone and anabolic steroids get such a bad reputation. I tell bodybuilders that do not have a doctor to follow them to at least decrease their risks by getting a bodybuilder panel on DiscountedLabs.com that do not require a prescription. There are many around the United States, and you can find them by visiting DiscountedLabs.com . Of course, this is not the best solution and in no way a replacement for the supervision of a doctor. Irresponsible bodybuilders do more self-inflicted damage when their mistakes fuel the hysteria surrounding hormones in the United States. This hysteria has made it difficult for many men who need TRT to get it. Over-the-counter “testosterone boosters” may present problems with lipids, so do not think that because you are buying something at a health food store, that makes that product safe. Let your doctor know if you are taking any of those. Most do not work and those that did where banned by the FDA and taken off the market.   BUY A TESTOSTERONE BLOOD TEST PANEL   Reference:  From the book “Testosterone: A Man’s Guide” by Nelson Vergel (available on Amazon.com)

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. 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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