Millions of Americans use testosterone prescriptions to restore normal levels of the hormone and for them to feel more alert, young, energetic, sexually functional, and mentally sharp. An overwhelming body of clinical research has shown that testosterone replacement therapy helps treat signs and symptoms of testosterone deficiency or medically known as hypogonadism. Depending on the nature and severity of testosterone deficiency, doctors may prescribe testosterone in the form of injections, pellets, tablets, patches, or gels.
Hypogonadism or testosterone deficiency is a condition in which the body does not produce sufficient levels of testosterone as a result of an underlying medical condition or other causes. It is likely that testosterone deficiency is underdiagnosed and is often mistaken for other medical conditions due to the fact that its signs and symptoms resemble other diseases, especially psychiatric disorders.
Testosterone deficiency is classified according to the location of its cause:
Hypogonadism may be present at birth (congenital) or may develop later in life (acquired). Congenital causes of hypogonadism include the following:
Acquired causes of testosterone deficiency include the following:
In men, the sex hormone testosterone is produced by the testicles. It plays several important roles in the body including regulation of sex drive, production of sperm and red blood cells, distribution of fat, and maintenance of muscle mass and strength.
The levels of testosterone change from hour to hour and vary from person to person. They tend to be highest in the morning (that’s why early morning erections are common) and lowest at night. In general, the normal testosterone levels in males range from 270 to 1070 ng/dL. From the age of 30 onwards, total testosterone levels in men decrease by 1% per year.
As men reach andropause, sometimes called male menopause (usually between the ages of 40 and 80 above), they can experience a number of symptoms related to the natural decline in testosterone levels. One of the most common symptoms of low testosterone levels in men is a decrease in sexual function. They experience reduced sex drive and fewer erections. Other physical changes include increased body fat, decreased muscle mass and body hair, fragile bones, swelling or tenderness in the breast tissue, increased fatigue, and abnormal cholesterol levels. They can also experience decreased energy levels, sleeping problems, depression, low mood, and an overall decrease in the sense of well-being.
A growing number of scientific evidence shows that testosterone replacement therapy does have a positive effect in improving the mood of men suffering from anxiety, depression, stress, and other mood disorders:
A number of convincing studies suggest that testosterone exerts its anti-diabetic effects by improving blood sugar levels
Several studies report that testosterone is beneficial in preventing cognitive decline related to ageing and brain disorders:
Studies also suggest that testosterone is integral for bone health and can help prevent various bone disorders:
Several studies report that testosterone is integral for maintaining muscle mass and strength, which makes it beneficial for age-related muscle changes and various muscular disorders:
Numerous studies suggest that HIV-infected men with testosterone deficiency can benefit from testosterone replacement therapy:
Evidence suggests that testosterone is beneficial in treating sexual dysfunction:
Metabolic syndrome (MetS) is a cluster of conditions including high blood pressure and blood sugar level, abnormal cholesterol levels, and excess body fat around the waist. Studies show that men with this condition can benefit from testosterone replacement therapy:
Several lines of evidence suggest that testosterone can protect against cardiovascular disease:
Studies suggest that testosterone can be beneficial in men with high blood pressure:
Studies also support the beneficial effects of testosterone on cholesterol levels:
Evidence also shows that testosterone can reduce symptoms of rheumatoid arthritis through its anti-inflammatory effects:
Testosterone has also been found to have beneficial effects on the sleep quality of men with sleeping problems:
Studies suggest that testosterone can help protect against obesity and can help improve body composition:
A good deal of evidence supports the anti-ageing effects of testosterone on the skin:
A number of studies suggest that the anti-ageing properties of testosterone can help fight hair loss in men:
Studies suggest that the beneficial effects of testosterone on the different aspects of health can help improve quality of life:
Testosterone can be used to improve one’s performance. In sports, testosterone shots or creams are supposed to be magic bullets that spur athletes to run, jump, swim and to recover faster, and to become more aggressive and focused. However, it is considered to be a form of doping in most sports.  Anabolic steroids (including testosterone) have also been taken to build muscles, enhance strength, or endurance. They work directly by increasing the protein synthesis of the muscles, leading to large muscle fibers and enhanced repairing ability. 
After a series of scandals and publicity such as Ben Johnson’s improved performance at the 1988 Summer Olympics, the use of anabolic steroids was banned by many sports organizations. In 1990, the United States Congress prohibited testosterone and other anabolic steroids and were designated as a “controlled substance”, resulting in the creation of the Anabolic Steroid Control Act. 
Some female athletes may have naturally higher levels of the hormone testosterone than others, and may be asked by certain sports regulating body to consent to a “therapeutic proposal”, either surgery or drugs, to decrease testosterone levels to an acceptable level to compete fairly with others. 
There is a significant difference between testosterone boosters and steroids. Testosterone boosters are consist of natural ingredients and supplements such as those from plants,  while steroids are synthetic substances that are created in a laboratory and are usually prescribed by doctors to treat a variety of health-related issues.  However, the use of steroids for the purpose of muscle building or enhancing an athlete’s performance without a prescription, are actually illegal. There are two common steroids in the market: anabolic and androgenic steroids. Anabolic steroids are designed to promote muscle growth while androgenic steroids are designed to assist with sexual dysfunction such as decreased libido and erectile dysfunction.  Most anabolic steroids are taken orally, through a pill while others are injected.
Anabolic steroids did not receive a worldwide recognition until the 20th century but the use of pure testosterone can be traced back to the original Olympic Games.  Early Olympic athletes were known to ingest animal testicles before a competition to improve their performance.  In 1935, researchers in the Netherlands were the first to isolate a few pure milligrams of testosterone. They named the substance “testosterone” from the words testicle, sterol and the suffix of ketone.  Also during this year, Butenandt and Hanisch created the first synthetic version of testosterone from cholesterol.  It was made available to the medical community for experimentation and treatment purposes. Later, during World War II, it was found that this artificial form of testosterone can help malnourished soldiers gain weight and improve performance during combat.  After the war, athletes began to use steroids to have an edge over other competitors.
In the 1956 Olympics in Moscow, Soviet wrestlers performed at exceptionally high levels after using the male anabolic steroid testosterone.  After learning about this incident, an American physician named John Bosley Ziegler created a more selective form of what we know as anabolic steroids.  From that point until the early 1970’s, the use of anabolic steroids became increasingly popular among Olympic athletes and professional sports players. In 1975, the International Olympic Committee finally prohibited the use of steroids and other performance-enhancing drugs in Olympic competition.  However, black market sales continued to increase in the following years. In 1988, the Anti-Drug Abuse Act was introduced in order to stiffen the penalties for the sale and possession of anabolic steroids. In 1990, the United States Congress prohibited anabolic steroids and other performance-enhancing drugs, and placed certain anabolic steroids on Schedule III of the Controlled Substances Act (CSA).  Previously, the use of steroids was controlled only by state laws. Today, illegal sales of steroids are still prevalent among athletes, bodybuilders and even adolescents.
The user generally experiences an increase in muscle mass and strength very quickly. They experience heightened ability to lift heavier weights and train for more often and for longer periods of time because of their improved recovery rate. [330-331] In addition to this, testosterone use can improve mood, cognition, blood sugar levels, bone mineral density, sexual function and well-being. Large retrospective or prospective studies failed to demonstrate any serious side effects related to testosterone use. 
Recently, there has been a paradigm shift whereby testosterone replacement therapy administration in prostate cancer patients has increased. Many longitudinal studies focusing on the relationship of blood testosterone levels and subsequent risk of prostate cancer failed to find any association. 
In a large meta-analysis of 18 prospective studies involving 3886 men, there was no association between the risk of prostate cancer development and serum concentrations of testosterone.  In another study, Morgentaler et al. proposed a saturation theory which explains why testosterone does not directly cause prostate cancer. According to his model, normal prostate cells and even cancer cells seem to have a saturation point and are not affected as testosterone levels increase. 
In the latest meta-analysis presented in the American Urological Association 2015 Annual Meeting, Dr. Peter Boyle reported that testosterone, whether occurring naturally or taken as replacement therapy, does not cause prostate cancer or stimulate increases in the levels of prostate-specific antigen (PSA) in men. 
Cardiovascular diseases are associated with insufficient level of the sex hormone testosterone.  In the largest study to date, Khaw et al. investigated the effects of testosterone levels and mortality among 11 606 healthy men aged 40 to 79 years old over a 6 to 10-year follow-up period and observed a significant association between low levels of testosterone and increased risk of cardiovascular diseases. 
In the most recent study, Dr. Barua, an assistant professor of medicine at the University of Kansas School of Medicine, and his colleagues reported that testosterone supplementation can reduce the risk of myocardial infarction (MI), stroke, and all-cause mortality at normal levels.  In hopes of providing some answers to testosterone and cardiac disease association, the study team retrospectively examined national data on 83,010 men (aged 50 and above) with documented low testosterone levels who received care from the Veteran’s Administration between 1999 and 2014. The results of the study showed that treated men with testosterone levels at normal range were 56% less likely to die during the follow-up period, 24% less likely to suffer a myocardial infarction, and 36% less likely to have a stroke.
Symptoms associated with low testosterone level may resemble other medical conditions such as thyroid problems, hormonal imbalance, side effects of medications and illegal drugs, and mental problems. To determine what’s causing these symptoms, it is recommended to schedule an appointment with your doctor for a blood test. Test to determine testosterone levels should be done in the morning between 7:00 and 10:00 am.  For normal results, the test should be repeated to make sure that the result is accurate. In healthy men, the levels of testosterone can change a lot from day to day, so a second test is required.
After the decision to restore testosterone levels has been made, the next step is deciding on the most effective route of administration. There are several different modes in which testosterone can be delivered, but the best method varies from person to person. A number of factors should be considered when selecting a specific testosterone modality for replacement therapy. These factors include the following: 
A testosterone test or also called serum testosterone test measures the amount of testosterone in the blood. This test is ordered to determine if a person has low levels of testosterone. It is important to inform your doctor about your current medications as it may affect the result of the test. Medications that can alter testosterone test results are steroids, anticonvulsants, barbiturates, clomiphene and estrogen therapy. 
The levels of testosterone in the blood can be measured in terms of total, bio-available, or free testosterone and there are various tests which can be used to measure each type of testosterone:
The different methods of testosterone delivery are the following:
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