Testosterone -Anti-Aging

Women are commonly known to be affected by hormonal changes. The fact that this is also the case with men is much less well known. This concerns the male hormone testosterone, which plays an important role in many functions of the body. 

A shortage of testosterone is quickly noticeable; it can result in a reduced sense of sex, reduced potency, but also symptoms such as irritability, reduced muscle mass and muscle strength. A shortage of testosterone is also called a testosterone deficiency or 'Low T'. In this article you can read more about testosterone, the causes of a testosterone deficiency, how to recognise it, the different treatment methods and how to prevent it.

Testosterone is the most important male sex hormone. It is produced in both the male and female body. In men, this is particularly the case in the testicles. Women's ovaries also produce testosterone, albeit to a much lesser extent.  

Testosterone plays an important role in many functions of the body. 

Growth  
it affects the development of sexual characteristics. In the case of an embryo, it ensures the development of the male genitalia, and in puberty, it causes the penis and scrotum to grow and hair to form on the genitalia, the face and the rest of the body. The lowering of the voice (the beard on the throat), and the development of muscles are also controlled by testosterone. 

Sexuality 
In a mature man, testosterone maintains the male characteristics and ensures the production of sperm. In addition, testosterone has an important role in the sense of sex (the libido). This applies to both men and women. The fact that men have much higher testosterone production than women explains why they are more focused on sex. 

Other functions 
Testosterone regulates the control and storage of fat, blood sugar and blood pressure, it stimulates the production of bone marrow and has an influence on the firmness of the bone (bone density) and the growth of muscles;  

Testosterone plays a role in the speed at which a hair grows and falls out in some men and some women. The extent to which a person is sensitive to this is hereditary. 

In general, there are two types of causes. 

1. The testicles can produce less testosterone than necessary: the cause of this can be in the testicles (primary), for example due to a not descended testicle, or in the brain (secondary). The brain controls testosterone production, and when a disorder occurs, causing the stimulation of testosterone production to be insufficient, a testosterone deficiency occurs. 
2. Testosterone deficiency can also have a natural cause: the amount of testosterone in the blood decreases with age. This starts at about your 40th birthday. At the age of 75, men's testosterone levels are on average 65% of the amount of young adult men. In some men, the amount of testosterone decreases too quickly and complaints may arise. This is called 'late hypogonadism' or 'late-onset hypogonadism'. 

There are three forms of testosterone deficiency (hypogonadism), of which there is only a real condition in the first two forms; primary hypogonadism and secondary hypogonadism. The form 'late onset hypogonadism' (LOH, or adropause) refers to natural development. 

In primary hypogonadism, the problem lies in the testicles themselves, for example, through: 

• An uncultivated testicle 
• An inflammation 
• Irradiation 
• Influence of certain medicinal products on the testicle 
• Klinefelter's congenital syndrome 

In secondary hypogonadism, the problem lies in the brain, which no longer sends signals to the testicle to produce testosterone. This can be congenital or arising after: 

• A brain tumor 
• Irradiation 
• A brain trauma 
• Malnutrition 
• Anorexia nervosa  

The third form is the so-called late onset hypogonadism (LOH, sometimes called andropause). This can occur in the ageing man, where the function of the testicles deteriorates with age. Only a small number of men develop effective hypogonadism because, in most men, as the reproductive function decreases, stimulation from the brain increases. 

As the complaints caused by (natural) testosterone reduction are quite common, and can also apply to many other conditions, it can be difficult to make a diagnosis. Common symptoms due to testosterone deficiency can be: 

• Decrease in physical energy
• Decrease in the sense of lovemaking and sometimes less good erections
• Reduction of muscle strength and muscle mass
• Increase in fat mass (more belly fat)
• Bone decalcification (low bone density)
• Reduction of body hair (such as less beard growth)
• Depressivity

Testosterone deficiency can easily be determined by means of a blood test. You can have a blood sample taken from your family doctor or at a blood sampling point. This should preferably be done in the morning (between 8 a.m. and 10 a.m.). A testosterone deficiency in the morning means that this will certainly be present in the course of the day. A testosterone value above 12 nmol/l is considered normal, a value below 8 nmol/l means a deficiency. In the case of the intermediate values, there may or may not be a deficiency. To get a good impression of testosterone production, the testosterone value is measured more than once. 

By adapting your lifestyle, you have a number of opportunities to improve testosterone production yourself. Below we mention some possibilities with a short explanation: 

• Power training, with a focus on short and powerful. Make sure that you train all your muscle groups and that you take extra intensive care of your largest muscle groups (thigh, back and pectoral muscles). 
• Avoid being overweight. Excess weight causes your hormone levels and hormone production to plummet, as well as your testosterone level. 
• A healthy lifestyle; healthy, varied, balanced & sufficient food, no smoking, moderate alcohol consumption and sufficient exercise. 
• Drink enough. Preferably drink tap water, mineral water, green tea and white tea. Above all, do not drink sugar-rich drinks or light drinks with synthetic sweeteners; and avoid alcohol and caffeine. Drinks containing alcohol, caffeine and sugar inhibit the production of testosterone, either immediately or over time. 
• Keep your insulin level low. If the insulin level of your blood rises, the testosterone level drops. That is why it is important to keep your insulin low. 

To remedy the male hormone deficiency, testosterone can be administered by injecting it into the muscle (with a few weeks between each injection) or with a gel on the skin (daily). In secondary hypogonadism, the cause of the testosterone deficiency must also be addressed. 

In the following cases, a man may not be given testosterone: 

• Prostate cancer  
• Untreated enlargement of the prostate 
• Breast cancer 
• Polycythemia (blood disease characterised by an excess of red blood cells) 

Older men, who often have some prostate problems, should therefore be very careful when administering testosterone. First, other causal factors, such as being overweight, will be addressed. Only in case of serious complaints (reduced libido, impotence, no more morning erections) a test treatment with testosterone will be started. If the result is positive, this will be continued. 

Testosterone supplements are available in the form of tablets, capsules, gels, injections and plasters. 

• Tablets are relatively easy and well tolerated. There is a risk of loss of liver function. With modern medicines, this risk is minimal and there is no need for laboratory checks. 
• Administration through the gum mucous membrane is also a possibility that works fine. There are no risks involved. The slow dissolving tablet that sticks to the gums is not tolerated by many people. 
• It is also possible to give a deposit injection once every three months. This will be well tolerated. 
• For most people, daily application of a gel to the skin is the most popular. The effect is excellent and there are no side effects. In some cases it results in annoyingly sticky skin. 
• The application of a plaster is also a possibility. This causes skin irritation for 27% of users. Rarely does hair loss or oily skin occur as a side effect. 

A number of lifestyle changes are necessary to help support testosterone production. Some of them are: 

• A healthy lifestyle in which you eat healthy, varied, balanced and sufficient. 
• Stop smoking. 
• Strength training with extra attention to your largest muscle groups. 
• Avoid being overweight. 
• Keep your insulin level low. If the insulin level of your blood rises, the testosterone level drops. That is why it is important to keep your insulin low. 
• Food: oily fish, vitamin D, zinc. 
• Not eating (or eating in moderation): soy and soy products (increases the production of female oestrogen and reduces the production of male testosterone). 
• Drink enough. 

Reported side effects of testosterone are: 

• Frequency unknown: progression of subclinical prostate cancer. Nervousness, hostility, fear, sleep apnea. Generalised paraesthesia. Seborrhoea, increased hair growth. More frequent erections, priapism, urinary tract obstruction. Jaundice. 
• At high doses, spermatogenesis is temporarily absent or reduced and the size of the testicles may decrease. Water and salt retention with oedema can occur with high doses or prolonged administration. In addition, a few liver tumours have been described in treatment with excessive doses of testosterone. 
• In prepubescent boys, premature sexual maturation, penis enlargement, more frequent erections and premature closure of the epiphyseal plates have been reported. 

In addition, testosterone is on the international doping list of the World Anti-Doping Agency. Too much testosterone in the blood can also cause brain cells to destroy themselves, causing serious and sometimes irreparable damage to your brain. 

For elderly users, a dose adjustment is not necessary; take into account the decrease in physiological testosterone levels as age increases. 

Do not apply gel to the genitals. Preferably do not have a bath or shower for two or six hours (depending on the brand) after application. Incidental bathing or showering between 2 and 6 hours after the application of the gel (Androgel) has no influence on the course of the treatment. To prevent testosterone transfer to others: wash hands with soap and water after application, cover treated areas with clothing after the gel has dried (after 3-5 minutes) and take a shower before physical contact. Avoid the use of body lotion and sunscreen products at the point of application at the time of and just after application of the gel. 

Pregnant women should avoid any contact with surfaces where the gel has been applied due to possible virilisation of the fetus. If contact does take place, immediately cover the affected area with soap and water. 

Máxima Medical Centre (2018) Testosterone deficiency, consulted on 22 November 2018, at https://www.mmc.nl/urologie/aandoening-en-behandeling/testosterontekort/ 

Gezondr (z.j.), Men: 12 tips to raise your testosterone level, consulted on 22 November 2018, at https://gezondr.nl/tips-testosteronspiegel-verhogen/ 

Urology Slingeland (z.j.), Low testosterone content, consulted on 22 November 2018, at https://urologie.slingeland.nl/kenniscentrum/Behandelingen/testosteron/lage-testosteron/31/432/433 

Health and Science (31 May 2018), Shortage of male hormone testosterone and treatment (hypogonadism) patients directive, consulted on 22 November 2018, at https://www.gezondheidenwetenschap.be/richtlijnen/tekort-aan-mannelijk-hormoon-testosteron-en-behandeling-hypogonadisme  

Dutch Care Institute (z.j.), Testosterone, consulted on 22 November 2018, at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/t/testosteron