Why do testosterone levels decline with age?

Testosterone levels generally decline from age 35 onwards due to natural aging processes.

What are the benefits of testosterone therapy according to the testosterone trials?

Testosterone therapy improves sexual function, walking distance, mood, reduces depressive symptoms, anemia, and increases bone density.

What is the main risk associated with testosterone therapy?

Testosterone therapy can increase non-calcified coronary artery plaque volume, raising heart attack risks.

When should a diagnosis of low testosterone be made?

The diagnosis should only be made when there are consistent symptoms and unequivocally low testosterone blood levels.

How can lifestyle changes improve testosterone levels?

Losing weight and engaging in resistance exercise can significantly increase testosterone levels.

What is the recommended treatment approach if testosterone therapy is necessary?

The process involves safety checks like prostate cancer screening and managing heart disease risks before prescribing therapy.

What therapies are suggested as safer alternatives to testosterone therapy?

Using GLP-1 for weight loss and resistance exercise are suggested safer alternatives.

Why should testosterone therapy not be used for healthy men with normal testosterone levels?

Guidelines strongly recommend against its use due to unnecessary risks and side effects.

What molecule is being researched as a potential new therapy for men?

17 Alpha estradiol is being studied as it may extend lifespan and improve muscle size.

What safety measures are taken during testosterone therapy?

Patients are regularly screened for prostate cancer, and their blood pressure, sugar, and cholesterol levels are managed.

Why I Prescribe Testosterone Replacement Therapy

00:06:22

https://www.youtube.com/watch?v=-HCpJxMIwPU

Zusammenfassung

TLDRThis video explores testosterone therapy for men whose testosterone levels generally decline after age 35, leading some to use therapy to restore levels. The testosterone trials show therapy improves sexual function, walking distance, mood, anemia, and bone density. However, risks include increased coronary artery plaque and prostate-specific antigen levels, potentially leading to heart attacks and cancer. The Endocrine Society advises therapy only for men with consistent symptoms and low testosterone levels. Non-surgical options include weight loss and resistance exercise, reducing the need for supplements. For men needing therapy, a cautious approach with safety checks and regular screenings is crucial. A promising new molecule, 17 Alpha estradiol, is being researched for potential benefits. Clinicians must ensure accurate diagnosis and follow strict guidelines to avoid risks while maximizing benefits.

Mitbringsel

🧪 Testosterone therapy can improve multiple health aspects but carries cardiovascular risks.
📉 Testosterone naturally declines after 35, influencing libido and mood, among others.
🩺 Accurate diagnosis of low testosterone levels is crucial for therapy consideration.
🏋️ Weight loss and resistance exercise are safe methods to boost testosterone.
🔍 Regular health screenings are vital during testosterone therapy for safety.
🔥 Increased levels of non-calcified arterial plaque are a serious risk of the therapy.
💪 Lifestyle changes, like diet and exercise, significantly impact testosterone levels.
🌟 17 Alpha estradiol shows potential as a new treatment for muscle and lifespan enhancement.
❌ Misuse of testosterone therapy in healthy men is discouraged.
📊 Managing cholesterol, blood pressure, and sugar levels is crucial during therapy.

Zeitleiste

00:00:00 - 00:06:22
The video discusses testosterone therapy and its implications, focusing on how testosterone levels decline with age, leading many men to seek treatments to boost their levels. Testosterone acts as three different hormones and plays a crucial role in muscle building, sexual function, and bone density. Studies known as the testosterone trials showed that while testosterone therapy can improve symptoms in older men with low testosterone, it also poses risks like increased coronary artery plaque and higher prostate-specific antigen levels. The guidelines recommend ensuring low testosterone diagnosis through clinical symptoms and consistent testing before considering therapy, emphasizing lifestyle changes, weight loss, and exercise as safer alternatives. New exciting treatments like 17 Alpha estradiol, which could extend lifespan and improve muscle mass, are also introduced as future possibilities.

Mind Map

Video-Fragen und Antworten

Why do testosterone levels decline with age?
Testosterone levels generally decline from age 35 onwards due to natural aging processes.
What are the benefits of testosterone therapy according to the testosterone trials?
Testosterone therapy improves sexual function, walking distance, mood, reduces depressive symptoms, anemia, and increases bone density.
What is the main risk associated with testosterone therapy?
Testosterone therapy can increase non-calcified coronary artery plaque volume, raising heart attack risks.
When should a diagnosis of low testosterone be made?
The diagnosis should only be made when there are consistent symptoms and unequivocally low testosterone blood levels.
How can lifestyle changes improve testosterone levels?
Losing weight and engaging in resistance exercise can significantly increase testosterone levels.
What is the recommended treatment approach if testosterone therapy is necessary?
The process involves safety checks like prostate cancer screening and managing heart disease risks before prescribing therapy.
What therapies are suggested as safer alternatives to testosterone therapy?
Using GLP-1 for weight loss and resistance exercise are suggested safer alternatives.
Why should testosterone therapy not be used for healthy men with normal testosterone levels?
Guidelines strongly recommend against its use due to unnecessary risks and side effects.
What molecule is being researched as a potential new therapy for men?
17 Alpha estradiol is being studied as it may extend lifespan and improve muscle size.
What safety measures are taken during testosterone therapy?
Patients are regularly screened for prostate cancer, and their blood pressure, sugar, and cholesterol levels are managed.

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Untertitel

Automatisches Blättern:

00:00:00
there are specific circumstances when I
00:00:02
prescribe testosterone and given that
00:00:03
there's so much confusion about this
00:00:05
topic we'll have a deep dive into the
00:00:07
research we know that testosterone
00:00:09
levels generally decline from the age of
00:00:11
35 and onwards which has led many men to
00:00:14
want to measure their testosterone
00:00:15
levels and then use testosterone
00:00:17
therapies to bring their levels back up
00:00:19
because testosterone has many different
00:00:21
biological effects particularly because
00:00:23
it acts as three different hormones
00:00:25
testosterone itself stimulates protein
00:00:27
synthesis so it helps to build muscles
00:00:30
it's also converted into
00:00:31
dihydrotestosterone and estradiol and
00:00:34
it's estradiol that seem to cause the
00:00:36
benefits for our bones as well as
00:00:38
decreasing fat mass and for normal
00:00:40
sexual function but more about estradiol
00:00:42
later if men have low levels of
00:00:44
testosterone that's associated with low
00:00:46
libido depression low bone mineral
00:00:48
density anemia reduced muscle strength
00:00:51
and increased fat Mass so given that
00:00:53
testosterone levels generally decline
00:00:55
from the age of 35 and we lose the early
00:00:57
morning rise in testosterone many men
00:00:59
have elected to use testosterone
00:01:01
therapies to boost their levels but is
00:01:04
this a good idea do the benefits
00:01:05
outweigh the risks to explore this
00:01:07
concept a series of studies were done
00:01:09
called the testosterone trials which
00:01:11
only included older men with symptoms of
00:01:13
low testosterone and consistently low
00:01:15
blood testosterone levels and these
00:01:18
trials found overwhelming evidence that
00:01:20
testosterone therapy it does improve
00:01:21
sexual function walking distance mood
00:01:24
depressive symptoms anemia and bone
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density so there are tangible benefits
00:01:29
but what about the risks and the biggest
00:01:31
risk is that we do see a greater
00:01:33
increase in non-calcified coronary
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artery plaque volume these other blood
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vessels around the heart so this study
00:01:39
it looked specifically at the blockages
00:01:41
in those blood vessels and they could
00:01:43
see over a one year period when
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testosterone therapy was used those men
00:01:47
who were using that therapy they had
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further blockages in their blood vessels
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compared to Placebo which is very
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concerning because this is non-calcified
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plaque what that means is that it can
00:01:57
easily break away and cause heart
00:01:59
attacks there will was also a clear
00:02:00
increase in the prostate-specific
00:02:02
antigen in the blood so this is a common
00:02:04
marker for prostate cancer because of
00:02:06
these concerns the endocrine Society
00:02:08
they recommend that we should only make
00:02:10
a diagnosis of low testosterone in men
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who have consistent symptoms and signs
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and unequivocally low testosterone blood
00:02:17
levels so before I talk about the
00:02:19
process of prescribing testosterone to
00:02:21
men that have got low levels of blood
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testosterone and have symptoms I want to
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go through the lifestyle factors that
00:02:27
significantly increase testosterone and
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are very safe we know that obese men who
00:02:31
manage to lose weight they have
00:02:33
significant increases in testosterone so
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in addition to a healthy diet we've got
00:02:37
the game-changing weight loss
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medications called glp-1 which is a
00:02:41
medication that I'm commonly prescribing
00:02:43
in the clinic we also know that
00:02:44
testosterone levels are greatly elevated
00:02:46
following resistance exercise so for
00:02:49
most men if they're a healthy weight and
00:02:50
they're doing resistance exercise they
00:02:52
don't need to worry about their
00:02:53
testosterone levels because their
00:02:55
testosterone levels will be at a healthy
00:02:57
range but if I see a male at the clinic
00:02:59
who is of a healthy weight and is doing
00:03:01
resistance exercise but still have signs
00:03:03
and symptoms of low testosterone and
00:03:05
they've got a low blood testosterone
00:03:06
level then we consider testosterone
00:03:08
therapy here's the approach based on the
00:03:10
clinical guidelines if there are signs
00:03:12
and symptoms of testosterone deficiency
00:03:14
we arrange an early morning blood
00:03:16
testosterone level if that initial
00:03:18
measurement is low we repeat it but we
00:03:20
also add on LH FSH and prolactin then I
00:03:24
get in contact with a local
00:03:25
endocrinologist because depending on how
00:03:27
low the levels of testosterone are they
00:03:30
may want to do pituitary Imaging so
00:03:32
that's a gland in the brain and if it's
00:03:34
decided that that patient would benefit
00:03:35
from testosterone therapy we need to do
00:03:37
some safety checks we need to make sure
00:03:39
that they don't have prostate cancer and
00:03:42
that we exclude polycythemia so
00:03:44
polycythemia is a high red blood cell
00:03:46
count once we've done all of that then I
00:03:49
prescribed the testosterone therapy and
00:03:50
I've seen firsthand how much it can
00:03:52
radically improve a patient's life and
00:03:55
we usually use a testosterone gel
00:03:57
because they typically result in normal
00:03:58
and relatively stable people blood
00:04:00
testosterone levels and most patients
00:04:02
prefer them to other preparations while
00:04:04
patients are on this therapy we need to
00:04:06
do everything that we can to minimize
00:04:08
the risks I regularly screen my patients
00:04:10
for prostate cancer and we do what we
00:04:12
can to protect them from heart disease
00:04:14
for example we control their blood
00:04:16
pressure we make sure that their blood
00:04:18
sugar levels are pristine and that their
00:04:20
cholesterol levels are at a healthy
00:04:21
range to clarify Statin medications
00:04:24
which are commonly used to lower
00:04:25
cholesterol levels they have no impact
00:04:28
on testosterone levels and the other
00:04:30
cholesterol lowering medications that
00:04:31
we've got available are pcsk9 Inhibitors
00:04:34
and acetamine by thinking about and
00:04:36
managing the risks of testosterone
00:04:38
therapy we can maximize the benefits to
00:04:41
summarize there has been a dramatic
00:04:43
increase in the inappropriate use of
00:04:45
testosterone therapy and healthy
00:04:47
middle-aged and older men it is
00:04:49
important for clinicians to understand
00:04:50
that the diagnosis of testosterone
00:04:52
deficiency should only be made on the
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basis of clinical symptoms and signs
00:04:57
consistent with low testosterone levels
00:04:59
and consistently low blood testosterone
00:05:02
concentrations between 8 AM and 10 AM
00:05:05
for men that do not have a low
00:05:07
testosterone level the guidelines
00:05:08
strongly recommend against the use of
00:05:11
testosterone and this is in line with
00:05:13
the endocrine Society guidelines as well
00:05:15
for most men we've got safer ways to
00:05:17
boost testosterone levels we can use
00:05:19
medications such as glp-1 to make sure
00:05:21
that patients are at a healthy weight
00:05:23
and if we combine that with resistance
00:05:26
exercise most men do not need to worry
00:05:28
about their testosterone levels however
00:05:30
there are a select few men that do need
00:05:32
testosterone replacement therapy and
00:05:34
I've seen firsthand the significant
00:05:36
benefits that those men can get but
00:05:38
there's something bigger on the horizon
00:05:40
and that's a molecule called 17 Alpha
00:05:42
estradiol this is a so-called
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non-feminizing estrogen and when it was
00:05:47
tested in male mice it extended their
00:05:49
lifespan by a whopping 19 plus those
00:05:52
mice had larger muscles so I'm very
00:05:55
excited for human studies to look into
00:05:57
17 Alpha estradiol because that might be
00:05:59
a therapy that most men should be on
00:06:01
time will tell just remember when you
00:06:03
are doing resistance exercise make sure
00:06:05
you're getting enough protein and I've
00:06:07
got a video about the protein research
00:06:09
here a massive thank you to do not
00:06:11
age.org for their ten thousand dollar
00:06:13
donation to my rapamycin study they are
00:06:15
a health research organization and to
00:06:17
benefit from their ingredients as well
00:06:19
as the 10 discount code check out the
00:06:21
pinned comment