Testosterone

Testosterone is essential for maintaining muscle strength, bone density, stamina, libido, and sexual function in both men and
women. Optimal levels of testosterone are essential for optimal health and quality of life. Testosterone levels decline with age
in both sexes.
Men lose their testosterone gradually after age 25, causing fatigue, depression, decreased
strength, loss of libido, and mental slowing.
Because male andropause is gradual and is less drastic than female
menopause, men think that they are "just getting old", so they don't grasp the hormone connection and the need for
hormone replacement. In men, testosterone restoration to higher levels with the reference ranges
improves mood, energy,
strength, muscle mass, and stamina.
Studies show that higher levels of testosterone within the reference range protect
against cardiovascular disease, diabetes, dementia, hypertension, abdominal obesity and arthritis. Several studies have
shown that testosterone replacement by injection helps reverse metabolic syndrome in men.
Nearly every study of
testosterone and heart attacks shows that men with lower levels of testosterone have higher risk.
Indeed, when
men with prostate cancer are treated with androgen deprivation therapy--where their testosterone level is lowered to that of a
woman and their estradiol levels become extremely low--they develop heart disease, diabetes, and metabolic syndrome.
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Much has been made of recent retrospective studies showing that men's risk of a heart attack is increased after they have
been prescribed testosterone. These studies are low-quality evidence--not even close to the gold standard of randomized,
placebo-controlled trials.
A close review of the Vigen study revealed that errors were made with the statistics--and the authors
have already made two corrections. In fact, the rate of heart attacks in men taking testosterone was
half the rate of those not
given testosterone. Whereas the study reported the opposite result.
If the effect that any of these 3 studies found is real, it
can only be due to the way in which testosterone is being delivered, because all other evidence, accumulated over the
past decades, indicates that higher natural  testosterone levels are protective against heart disease and heart attacks.
One possibility is that transdermal gels and bi-weekly testosterone injections can both produce rapid increases in estradiol,
and unnaturally high estradiol levels.
Estradiol is very good for men in the long-term, as it is for women. It offers protection
against atherosclerosis and heart attacks, diabetes, dementia,and other health problems. However, estradiol does have
mild pro-clotting effects. If a man has already has atherosclerosis and unstable plaque in his coronary arteries, then he is a
heart attack waiting to happen. He is vulnerable to the formation of a clot on the unstable plaque. Men with low
testosterone levels are more likely to have atherosclerosis. In such a person, a sudden rise in estradiol may be enough
to cause a clot to form and a heart attack to occur--earlier rather than later. So while testosterone replacement by any
dose or route may reduce the long-term risk of atherosclerosis and heart attack, it may increase the short-term risk--but this
is not yet know for certain.
. For this and other reasons, Dr. Lindner decided years ago to prescribe testosterone only by
weekly, self-administered subcutaneous injections. This method alone produces the full benefits of testosterone
restoration, stable levels, and natural testosterone/estradiol/DHT ratios. Given these recent studies, he also recommends
that for older men with very low testosterone levels and possible atherosclerosis, testosterone injections be started at a low
dose, and the dose gradually increased to a full replacement dose that produces testosterone levels in the upper half of the
reference range, as averaged over the week. Dr. Lindner also always recommends that patients take fish oil (2500mg/day
of EPA+DHA) which reduces the blood's clotting tendency.
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Women's testosterone levels are 20 times lower than men's, but testosterone is essential to their health and
quality of life too.
Testosterone brings the same benefits to women as it does to men, only on a smaller scale. It not only
restores their libido, but also improves sleep, mood, mental function, bone mass and muscle strength. Women have higher
free testosterone in the follicular phase of their menstrual cycle than free estradiol! Women's testosterone levels drop by
50% between the ages of 20 and 40. The majority of women in their 40s and 50s are suffering from low testosterone levels.
Unfortunately lab reports state that the "normal" free testosterone for a woman is 0-2.2pg/ml, or a total of 2 to 45ng/dL. So a
physician practicing
Reference Range Endocrinology will tell her that she's "normal" even if there is no detectable
testosterone
in her blood! Optimal levels for most women are in the middle to upper part of the ranges.

The loss of libido with loss of testosterone can have a devastating effect upon relationships. The partner whose
libido is low may think that they are just no longer attracted to their spouse. They may still be excited by other persons
because they are new, unknown, or have other qualities their spouse lacks (a superstimulus). On the other hand, the partner
who has not lost their libido will think that the other partner is no longer attracted to him/her.
Dr. Lindner has seen
relationships improve when testosterone and libido are restored to one or both partners.
For certain, if the libido
is healthy, one is happy to "love the one you're with"! When couples enjoy sex with each other again, all aspects of the
relationship improve. Postmenopausal women also need estradiol to restore youthful vaginal/genital health and lubrication.
Estradiol also plays a role in normal libido.

The conventional population reference ranges cannot be used to diagnose testosterone deficiency in men as levels decline
with age, and the
reported range includes almost all men in that age group. Therefore the lower limits are far too low
for both health and quality of life. For instance, a typical range for free testosterone for a middle-aged man is 6 to 18 pg/ml.
That's a
three-fold difference from bottom-to-top! Surely a man will feel very different with 1/3 his previous levels or 3
times his current low levels! For younger men, the upper limit is not 18 but 26.5 pg/ml. In Dr. Lindner's experience, men feel
and function much better with free testosterone levels of around 20 pg/ml.

Contrary to popular opinion,
scientific studies show that higher levels of testosterone Do Not cause prostate
enlargement or prostate cancer
. Studies of men on testosterone replacement have consistently shown there is no
increased risk of prostate cancer.
In fact, the evidence is clear: It is LOW testosterone levels that increase the risk
of prostate cancer!
(See Testosterone for Life by Dr. Abraham Morgentaler.)  The misconception that higher testosterone
levels cause prostate cancer is due to the fact that an existing prostate cancer will grow more slowly if testosterone levels are
brought very low by castration or drugs. This is an issue of cancer management, not of cancer prevention.

As with other hormones, conventional medical opinion about testosterone is lagging way behind the scientific evidence. Here
again, as with the female hormones, lay persons and most medical professionals think that the problems caused by artificial
hormone substitutes also occur with natural, physiological hormone restoration. "Roid rage" and liver disease are caused by
non-bioidentical anabolic steroids and oral 17-alkylated testosterone substitutes. Contrary to popular misconceptions,
testosterone restoration does not cause aggression or anger. It makes men more patient, more sociable, and less prone to
anger. They have more affection for, and patience with, half of the human race! They feel more energetic and vital.

For men, Dr. Lindner prescribes weekly testosterone cypionate or enanthate injections. These are self-administered
subcutaneously, not intramuscularly. This is the best way to restore optimal testosterone levels/effects, it best mimics normal
testicular production. The testosterone-containing creams and gels are more expensive, very difficult to monitor, produce an
abnormal DHT/testosterone/estradiol ratios, and can result in transfer to other persons..
For Health and Quality of Life