Frequently Asked Questions
What is testosterone?
Natural testosterone is a term used to describe the hormone testosterone that is naturally produced by the testes and ovaries of humans and animals.
This hormone in its pure form is not produced anywhere in the plant kingdom.
Testosterone, or rather the effects of testosterone, has long been recognized as exerting a significant effect on the human body.
For centuries the testes have been identified as the primary source of testosterone production in men. With the advent of pharmaceutical chemistry pure testosterone was first manufactured synthetically in the late 1930's.
Today natural testosterone and synthetic analogues with testosterone-like actions are manufactured for pharmaceutical purposes from soya and wild yam substrates.
Testosterone is classified as an androgen. Androgens are a group of hormones that control masculine sex characteristics. They play a role in maintenance of systemic anabolic effects, particularly metabolism of salts, fluid balance and bone growth.
Testosterone has significant effects on libido, mood and depression.
Both sexes produce testosterone. Men produce far greater quantities of testosterone than women. The amount secreted by women is small and it does not have a strong masculising effect.
Testosterone is crucial for the development and maintenance of the male sex organs and the male secondary sex characteristics. These include muscle bulk, facial and axillary hair, changes in fat distribution and deepened voice.
It also produces systemic anabolic effects which include retention of nitrogen, calcium, sodium, potassium, chloride and phosphate. This leads to an increase in water retention and bone growth.
Testosterone makes the skin more vascular and less fatty.
Causes of Testosterone Deficiency.
Male hypogonadism is the medical phrase used to describe men with severe testosterone deficiency. The degree of severity of the condition can vary from individual to individual, but there is universal similarity of symptoms in testosterone deficient males - these include fatigue, lethargy, mood changes, ill tempered, sexual dysfunction, poor erectile function, loss of sexual interest, diminished muscle strength, osteoporosis and anaemia.
Male hypogonadism is most frequently due to primary testicular disease e.g. Klinefelter's syndrome, but may result from malfunctioning of the pituitary gland or hypothalamus in the brain.
Male hypogonadism is estimated to have a prevalence of 5 per 1000 men making it one of the commonest forms of hormonal deficiencies in men.
Physiological androgen replacement aims to restore circulating testosterone concentration to normal in men with hypogonadism. The use of testosterone in the management in ageing men without specific causes of hypogonadism, commonly referred to as ADAM (the Androgen Deficient Aging Male), is one of the most rapidly expanding area of medical practice.
Common causes for reduced testosterone production that results in a deficiency state includes:
- Testicular disorders
- Klinefelter's syndrome
- Cryptorchidism and defects of testis development (Twisted or strangulated testes)
- Orchitis (Inflammation of the testes resulting in permanent damage)
- Orchidectomy (surgical removal of the testes)
- Toxin exposure (radiation, chemotherapy or radiotherapy, domestic, industrial or environmental poisons)
- Brain disorders (Hypothalamic-pituitary dysregulation)
- Kallmann's syndrome (a genetic disorder)
- Other genetic causes
- Pituitary gland tumour and treatment (surgery and/or irradiation)
- Haemochromatosis (Blood iron disorder)
- Craniopharyngioma (benign tumour of the brain)
- External factors
- Acute critical illness, burns, major trauma or surgery
- Drug use (eg, opiates, glucocorticoids, anabolic steroids)
- Chronic disease and its treatment
- Alcohol abuse
- Smoking
- Ageing
Regardless of the underlying cause of the testosterone deficiency the treatment is universally testosterone supplementation.
Testosterone replacement therapy (TRT) aims to restore circulating testosterone concentration to normal in men with all degrees of hypogonadism.
TRT is highly effective in restoration of blood testosterone levels to the normal ranges and safely and effectively resolves all symptoms associated with testosterone deficiency.
The use of testosterone in the management in ageing men who exhibit symptoms associated with lowered testosterone levels, commonly referred to as the ADAM (Androgen Deficient Ageing Male) or late-onset hypogonadal male, is one of the most rapidly expanding area of medical practice.
It is the ADAM male that is the largest underdiagnosed group of all testosterone deficient individuals. Symptoms are often non-specific, can be confounded by pre-existing medical conditions (obesity, chronic illness) and include lethargy, sleep disturbances, loss of libido, irritability, anxiety, reduced concentration and depressed mood.
Self Assessment Questionnaires.
The diagnosis of hypogonadism can be facilitated through the use of questionnaires such as the ADAM questionnaire (simple) or the AMS (Aging Males' Symptoms) rating scale (detailed).
- Androgen Deficiency in the Ageing Male (ADAM) questionnaire (simple)
- Ageing Male Symptoms (AMS) questionnaire (recommended)
The ADAM questionnaire is a 10 question yes/no checklist to a limited range of andropausal symptoms. It has limited use as a specific diagnostic tool, but rather gives an indication that testosterone deficiency is likely.
- To take the ADAM questionnaire click here.
Far more specific and more highly recommended is the Ageing Males Symptoms (AMS) questionnaire. This is a 17 question self-rating symptoms based questionnaire with three key domains of assessment - mind (5 questions), body (7 questions) and sexual (5 questions). Responses to each question are assigned a rating 1-5 (none to extremely severe) and the total sum of all subscales provides a total score. Scores can range from a total low of 17 to a maximum of 85, with a complaint score measuring greater than 50 considered severe.
The AMS is well suited to assist in both the diagnosis of testosterone deficiency and for the monitoring of treatment in patients using testosterone replacement therapy.
- To take the AMS questionnaire click here.
- To evaluate the results of the AMS questionnaire click here.
What is the Testosterone Cream Treatment?
Testosterone has been used for many decades for the treatment of testosterone deficient males.
Topical transdermal testosterone creams require daily application, and provide physiological replacement with few problems and satisfactory efficacy. Well designed studies show the efficacy and safety of this mode of administration to be high when given for an average of 36 months follow-up. Creams have to a large extent replaced the previously mentioned forms of testosterone due to their patient friendly mode of application and flexibility with regards to dose.
Scrotal application of the cream does not meet with discomfort in patients, whereas the alcohol-based gel creates a burning sensation when applied to the genitalia.
A recent medical paper established which compared the cost effectiveness versus efficacy of currently available testosterone treatments determined that the testosterone cream, was the most affordable and effective testosterone therapy currently available.
To view our Testosterone Creme Producs Click Here
Identify symptoms
- Complete ADAM or AMS (recommended) questionnaire
- Exclude other factors that may cause symptoms
- Have prostate gland checked.
- Commence three month trial of testosterone
- Have regular monitoring of treatment
Specialized Conditions
- Kleinfelter's Syndrome
- Kallman's Syndrome
- Androgen Insensitivity
- Castrate
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