Testosterone and estrogen are among many critical hormones that play an important role in making you feel normal.
Composed of 3 different forms, estradiol (E2) plays a critical role in how men feel. When levels become elevated relative to testosterone levels, estrogenic side effects become noticeable.
Every patient is unique; HormoneMD looks to symptoms, feelings, and labs to gauge health. Note that normal E2 tests overestimate estradiol in men due to the test being designed for women.
The main androgen secreted by the testes is testosterone. However, the main testosterone signal comes from DHT. DHT sends signals to your brain, central nervous system, skin, genitals, and more. Testosterone is converted to the active androgen DHT by the 5-alpha-reductase (5-AR) enzyme. DHT is more anabolic in nature as it binds more strongly to androgen receptors than testosterone. Note that transdermal testosterone increases DHT more than injectable testosterone.
DHT makes your voice deep, puts hair on your chest, and develops your genitals during puberty
DHT is essential for proper brain chemistry and sexual function. We monitor DHT to keep you feeling great.
Prolactin is a hormone found in your bloodstream that interferes with testicular function, lowering testosterone levels. High prolactin levels are associated with gynecomastia. In extremely rare cases, unusually high levels of prolactin may indicate pituitary adenoma; a benign tumor that may cause vision problems and headaches if left untreated.
Defined as excess breast tissue that has been present for over 2 years, the over-development of the male breast is a growing epidemic in Western society. Studies estimate that 60% of all men are affected by gynecomastia. Some men are oversensitive to the conversion of testosterone to DHT and develop mild gland growth around the nipple. This happens in a small subset of men. Medications are available to block estrogen from binding to breast tissue to prevent gynecomastia. If caught late, surgery is another viable option.
Erythrocytosis is not polycythemia, a blood-thickening disorder commonly confused with erythrocytosis. Understand that erythrocytosis caused by testosterone therapy is no different than living at high altitudes, which also causes erythrocytosis. There's a reason the Olympic Training Center is in Colorado. And why Colorado has the longest life expectancy, 3rd lowest cardiovascular rate, and 8th lowest mortality rate in the United States.
Polycythemia involves all blood cells being elevated, including platelets. The most prominent feature of polycythemia is elevated absolute red blood cell mass because of uncontrolled red blood cell production. This action causes hyperviscosity and the potential for heart attacks and strokes.
Over 400 million people live at high altitudes and experience erythrocytosis. No treatment is necessary for these individuals. In fact, athletes train at high altitudes to increase red blood cell counts to increase their exercise endurance at sea level.
Pregnenolone is a neuroactive neurosteroid that has neuroprotective capabilities by enhancing learning and memory while increasing the amount of deep sleep one gets. It plays an important role in memory, cognition, alertness, and mood.
Pregnenolone is produced in three main organs: the brain, gonads, and adrenal glands. All other steroids including progesterone, cortisol, cortisone, aldosterone, DHEA, testosterone, dihydrotestosterone, estradiol, estrone, and allopregnanolone are derived from pregnenolone.
Pregnenolone is the main steroid hormone produced from cholesterol. When endogenous production of testosterone is shut down due to exogenous testosterone entering the system, you interfere with steroidogenesis (the transport of cholesterol into the inner mitochondrial membrane) and the expression of the P450 cholesterol side chain cleavage enzyme which catalyzes the conversion of cholesterol into pregnenolone.
Optimal serum levels are between 80-180 ng/dL for men. A typical supplemental dose is between 30-60mg per day.
The potential negative side effects of the downstream conversion of pregnenolone to progesterone and potentially estradiol are avoidable if supplementation is unnecessary.
Testosterone therapy inhibits endogenous testosterone production through negative feedback inhibition of LH levels. This suppresses FSH levels, which leads to azoospermia, the suppression of sperm production. Testosterone therapy can and likely will shrink your testicles, potentially interfering with fertility. As exogenous testosterone inhibits the HPTA, the pituitary stops receiving signals from the hypothalamus and stops producing LH which causes intratesticular testosterone (ITT) levels to plummet. As ITT levels drop, sperm count decreases rapidly.
There are two methods to accomplish maintained ITT levels. Human chorionic gonadotropin (hCG) can be injected, which replaces LH as a near-perfect mimic of the LH that is normally produced by the pituitary. hCG will directly stimulate the Leydig cells to produce testosterone, keeping ITT levels high and driving sperm production. In some men, this is enough. Others require additional FSH to optimize the testes' environment for sperm production. FSH supplementation can be met via SERMs or Human Menopausal Gonadotropin (hMG).
hCG will also provide your testicles with an increase in size or fullness.
Please refer to HormoneMD's write-up on Testosterone Therapy and Fertility
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