Testosterone Replacement for Older Men

Wondering what people here think about testosterone replacement therapy for men in their 60s with low (below range) total and free T, and low, but within normal range SHBG, FSH and LH. Is this a good idea, generally? I’ve seen some men here say they avoid it and instead try other interventions to increase testosterone. My husband has seen various doctors about this since November and will be making a decision soon about whether to start testosterone replacement. He also takes metformin for diabetes and low-dose atorvastatin, both of which I understand can decrease testosterone, plus 5 mg rapamycin per week, among other meds and supplements.

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High testosterone is good for healthspan but not optimal for lifespan. Though, in my opinion, the biggest disadvantages from TRT are from increased 5ar activity which leads to BPH and can potentially raise risk of cardiovascular diseases and prostate cancer.

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No doubt you’ll find a variety of opinions. No different than full carnivore or full vegetarian… diets.

There are people that are absolutely against testosterone replacement. And there are those that embrace it, but won’t mention it on this forum. Because of the negative blowback,

I get ample PMs saying so. I’ve been one of those that have been on it for 4 years. And I think it’s the best thing I’ve ever done in combination with rapamycin for my health span and I do believe lifespan. Based on all my blood panels,results… my bone strength and muscle maintenance. Helps with weight issues too. My biological markers are all off the chart for youth. And I have energy and strength. And enjoy going to the gym. Mental alertness
In general excellent. … body and spirit.

I just did a full panel workup which will show my testosterone, blood composition and will be doing all my tests in the next four weeks. I will have a complete review of where I am right now at sixty six years old and i’m going to share it with anybody interested.

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I think it’s a no brainer. Low testosterone is far more dangerous.

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It’s complicated and there are things to try before jumping in to testosterone replacement. Seeing an expert who understands all the nuances and doesn’t just throw men on TRT in this situation is pretty important. It might be the right answer, but it might not. However, having solid Free T or Bioavailable T is the healthiest situation … how you get there is very important and requires an expert. It is a mess getting men off of injections that they never needed to begin with. See someone truly experienced, not a “Low T clinic” as those individuals are generally not experts, they simply put everyone who meet criteria on injections and don’t look at the global picture.

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My husband has only seen conventional urologists and an endocrinologist, no T clinics.

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This gives a good overview of the risks of TRT for longevity. From what I have read, the evidence is generally not positive for lifespan, but TRT can have benefits for healthspan if free T is very low. Still better to exercise frequently.

https://novoslabs.com/testosterone-replacement-therapy-and-anti-aging/

I only take a DHEA supplement occasionally

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Excellent, I like the situation where the incentives aren’t to Rx, but are to give best care.

The one risk is the focus on medical necessity rather than lifespan and health span.

The issue isn’t whether to normalize this, the issue is how it is done.

Glad you have good specialty access!

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I guess my questions are, have they just tested levels or have they tried anything to bring your husbands testosterone up? There are options to be explored before using exogenous testosterone. I agree with Dr. Fraser, that getting your own system working is the best option, if possible.

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I would be really interested in seeing this, as I have just started TRT last week

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I don’t know of any good, reliable options to bring up testosterone when it’s already below the reference ranges, do you? He did lose 25 lbs and is within 5 lbs of his ideal weight. He takes acarbose and has gotten his blood glucose under good control. He started rapamycin in February. He takes ashwagandha and has reduced his dosages of metformin and atorvastatin. I don’t want to add weird supplements like Tongkat Ali, because we just don’t know enough about their long-term safety. He needs to build more muscle and does lift some weights a couple of times a week, but he’s not super motivated like most of you here. Don’t like the idea of clomid and none of his doctors have suggested it, either. Not sure what else is left to try. He’ll be 67 this month so doesn’t have a lot of time to waste.

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It is great that he has been working on his health and weight loss. That can certainly help. Does he have symptoms of low T or is it just the number that is concerning?
I would not rely on supplements to change his issues. Doctors can try different things, and identify where the “chain is broken.” There are several medications that a doctor could use, such as HCG, HMG, FSH, Proviron, Clomiphene, etc. to help make a diagnosis. I am not a doctor, but I would want to get to the root cause of the deficiency before getting on replacement. In the end. he may truly be a good candidate for replacement, but that is a lifetime commitment that should be taken seriously.

If testosterone replacement therapy (TRT) is not an option or preferred, there are some medications and lifestyle changes that may help increase testosterone levels naturally or address underlying issues contributing to low testosterone. Here are some options:

  1. Clomiphene citrate (Clomid): This medication stimulates the body’s own production of testosterone by increasing the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. It’s often used off-label for treating low testosterone in men.
  2. Human chorionic gonadotropin (hCG): Similar to Clomid, hCG can stimulate the testes to produce more testosterone. It’s sometimes used in combination with other treatments.
  3. Selective estrogen receptor modulators (SERMs): Medications like tamoxifen may be used to block estrogen receptors in the body, which can increase testosterone production by reducing the negative feedback loop on the hypothalamus and pituitary gland.
  4. Aromatase inhibitors: These medications block the conversion of testosterone to estrogen, potentially increasing testosterone levels indirectly.
  5. Weight loss and exercise: Obesity is associated with lower testosterone levels, so losing weight through diet and exercise can help increase testosterone levels. Resistance training, in particular, has been shown to boost testosterone levels.
  6. Dietary changes: Consuming a balanced diet rich in protein, healthy fats, and micronutrients like zinc and vitamin D can support testosterone production. Zinc and vitamin D are especially important for testosterone synthesis.
  7. Stress reduction: Chronic stress can lower testosterone levels, so techniques like mindfulness, meditation, and relaxation exercises may help improve testosterone levels.
  8. Sleep improvement: Getting enough quality sleep is crucial for testosterone production. Aim for 7-9 hours of sleep per night and maintain a consistent sleep schedule.

It’s important to note that the effectiveness of these approaches may vary depending on individual factors such as the underlying cause of low testosterone and overall health. It’s best to consult with a healthcare professional to determine the most appropriate treatment plan.

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This is the key obstacle to an optimal solution. But @RickCohenMD says a short term pharma boost can help with this.

Here are some notes from my interview

  • Get sleep, move, lift heavy things, get off of toxic foods, don’t over-train…quick fixes. Lifting heavy and sprinting are the big levers.
  • Sometimes people need a short treatment of medication to stimulate natural T production to boost motivation and mood so that they can do what is needed to do to increase testosterone production back to normal without drugs. Enclomiphene. hCG.
  • Supplements mentioned: Akarkara root, Pine pollen, Tongat Ali
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There is a good podcast on this topic:

Also many discussions in the past. You may want to search on testosterone using the search button in the upper right corner of the page.

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I’ve done that and listened to that podcast, and was just hoping for feedback more focused on my husband’s situation. Listened to couple of good Peter Attia podcasts too. Thank you.

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Another possibility, if his DHEA level is low, is to take a DHEA supplement in the range of 25mg to 50mg - not forever but until a blood test shows DHEA back within the reference range. DHEA is important in its own right, and its levels usually drop significantly with age. The body can metabolize DHEA into testosterone and/or estradiol - taking chrysin as a supplement should have some effect of reducing conversion of DHEA to estradiol. As a 70+ male who takes low-dose metformin (250mg) and atorvastatin (5mg) daily, and 10mg rapamycin once weekly, I’ve seen modest increases in testosterone from taking DHEA - differences are I’m non-diabetic and in the middle of the reference range for T.

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No easy answers here. Biology is complicated, obviously. That said, the data I have seen suggests that increasing testosterone levels from low to normal increases life expectancy and reduces heart attack risk.

See for example, this paper: https://doi.org/10.1093/eurheartj/ehv346

If that link doesn’t work try Googling “Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men”

I think some of the bad rap for testosterone comes from people taking it to go from normal levels to abnormally high levels. For instance, body builders often do this. We refer to this as steroid use rather than TRT, and we have plenty of examples of very muscular young men looking quite good in their caskets. Which is terribly sad and unfortunate.

My view is if he is low, work with qualified doctors to start treating the problem in some way (either TRT or some other approach depending on the root cause of the problem).

Good luck!

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I think I probably agree with you completely on this, depending…. We really need to put some numbers to the phrase “high testosterone”. Depending on what you mean by that, I might not agree at all.

I think it is probable that increasing testosterone levels from, say, 150 to 900 ng/dL improves both healthspan and lifespan (in men). However, increasing levels from, say, 500 to 2,000 ng/dL probably statistically reduces lifespan.

Like many things, there is probably a U-shaped curve, and there is a level that is too low such that increasing is helpful, and a level that is too high, such that decreasing is helpful.

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I have been experimenting the last 4 weeks to raise my free testosterone via supplements and DHEA, avoiding injections at this point… all I am after is a little bump nothing significant.

Supplements – Long Jack, Ashwagandha, Fenugreek; all have been show to raise T, I take these every other day and only one type and rotate them

DHEA – 20mg cream, 10mg tablets; I take these every other day and alternate them, not on the same days as the supplements… I take 30mg of tablets and it gives me a boost, I apply the cream to my rectum/perineum area as it absorbs readily there and it gives me a boost.

I don’t take any of these the day I take Rap!

So my schedule is something like this Saturday Long Jack, Sunday DHEA cream, Monday Fenugreek, Tuesday 30mg of DHEA pills, Wednesday Ashwagandha, Thursday Cream, Friday is Rap day.

I can say it has improved my muscle tone and strength while doing my daily strength training, improved energy and mood, have not had a chance yet to test it out downstairs but that happen next month when I visit my gf overseas Lol

Plan to get blood workup soon to see where I am at.

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hope @desertshores weighs in, he has done quite a lot of experimenting in this area, including trying out meds from India