Testosterone Replacement Therapy

Edited By Ross B. Macdonald

The first sign of low Testosterone(T) is a loss of libido which may be followed by erectile dysfunction (ED). There are five basic causes of low T: Conversion of T to estrogen by a process called aromatase , especially in men with excess belly fat; pituitary gland is failing to produce enough luteinizing hormone (LH); T is being bound by SHBG (Sex Hormone Binding Globulin); Testicles have lost their ability to produce T and finally abnormally low DHEA.

The next step after deciding to use T replacement therapy is a blood test. The test should include and results be between:

Total T (700-900 ng/dL)
Bioavailable T (with in normal range)
Free T (20-25 pg/mL)
Estradiol (E2) (20-30 pg/mL)
LH within normal range
SHBG—( important !!) within normal range
DHEA-S (350- 400 ug/dL)

The results of these tests will help determine the proper course of treatment. (Check with a doctor that is knowledgeable about this subject first)

Examples from Life Extension Foundation:

Low Free T – High Estradiol—Mid Total T-= aromatase ( see appendices for discussion)
High Total T –Low Free T— = Free T being bound by SHBG
Low Total T-- = pituitary gland not producing enough LH
Low Total T—low LH = testicles not producing enough T
Abnormally LOW DHEA-S

There are several vitamin/supplements recommended for T therapy which are listed at the bottom of this report.


Injections, Pills, Gels/Creams, Pellets and Patches.

The general consensus among doctors is apparently:

Injections work well for short time periods as they give a boost but then drop off quickly. They are not consistent. Injections are needed about every two weeks by a doctor or yourself.

Pills are easy to use but are absorbed by the stomach and liver rapidly. The effect is therefore minor.

Pellets require surgery by a doctor periodically, and this is expensive.

Patches work well but can cause skin rashes and be uncomfortable or embarrassing as they are worn near the scrotum.

Gels/Creams are the most highly recommended especially the GEL. A 50 mg daily dose is applied to the upper area of the body (do not rub in). Gels produce a serum profile which varies throughout the day as it does normally in a healthy young man. GELS are better at treating sexual dysfunction than are injections etc. Gels are more absorbable than Creams and the T sinks into the skin with in an hour. Put the gel on the inside of forearms and rub them together or rub the forearms up and down against your upper sides. Do not rub with the palms of your hands.

“The constant variability of serum androgens provided by the Testosterone gels mimic the hormones of a young man; the stable daily level provided by injections mimic the hormones of an old man, those of implanted pellets mimic the hormones of no man”. Dr. John Crisler.


AROMATASE solutions: The primary thing to do to stop the conversion of Testosterone into Estrogen is To LOSE fat, especially belly fat (adipose fat). A supplement known as Calcium D Glucarate can help.

If, however, the blood tests continue to show a possible high conversion rate then the medicine to use is ARIMIDEX.(available without a prescription in Mexico). Start with 1/2 mg twice a week. Then after a month get another blood test. If it is still high increase dose to 3 times per week or more if necessary as blood tests show. ARIMIDEX is the drug used to control excess Estrogen in women's breast cancer.

Life Extension Foundation recommended vitamins /supplements for low testosterone: Chrysin, Piperine, Zinc, Muira Puama, Quercetin, Fish Oil, Nettle Root, Pygeum, and DHEA. For boosting sexual function: Selenium, Vitamins E and D, Protein, Acetyl L Carnitine, Tribulis and Maca Extract.


Life Extension Foundation : various articles from their magazines over the last 5 years.
Testosterone Replacement Therapy, Dr. John Crisler.
Testosterone for Life, Dr. Abraham Morgenthaler, Harvard Medical School
Un of Texas Health Science Center
Stanford Medical School
Dr. Michael Miller, Professor, Un of Maryland
N.E. Journal of Medicine
Dr. Phillip Lee Miller
Journal of the American Heart Assoc.
Harvard Medical School Publications.
Johns Hopkins Un. Medical School-- BPH