Is Your Sex Drive in Park?
by Kathryn Grosz, M.A.
Copyright 1998 Kathryn Grosz. Nothing in these articles in whole or in part may be duplicated in any way.
Testosterone is the hormone responsible for sex drive in both men and women. I lost my sex drive at menopause because my adrenal glands were not producing enough testosteone. I have no interest in sex unless I replace the testosterone. After having had no testosterone replacement for several weeks and no interest in sex, I got my testosterone injection. The next morning I woke up dreaming about sex with my partner. Men lose their ability to get and maintain erections and lose sexual functionality as testosterone levels decline with age.
Is testosterone the answer to it all? No. All sexual problems are not hormone problems. For instance, if a man~s erection problems are due to vascular deterioration or disease, the testosterone would not help at all. If a woman avoids sex because she was molested, testosterone probably would not help.
Testosterone is a hormone. Hormones are chemical substances that are produced by glands or organs. They circulate through the body via the blood and stimulate production of other hormones or stimulate activities. Testosterone is one of the androgens that is responsible for development and maintenance of the male secondary sexual characteristics.
Testosterone is produced in the tissue of the testes and the cortex of the adrenal glands in men. In women, it is produced in the ovary and in the adrenal cortex, mostly in the latter. This is significant for women because only about 30% lose their sex drives at menopause due to the fact that most of the testosterone is coming from the adrenal glands, which continue to function when the ovaries stop. However, women with weakly functioning adrenals who no longer get testosterone from the ovaries can lose their sex drives (like I did).
Where does it come from?
Testosterone is produced from cholesterol. Surprise! - cholesterol is not all bad; in fact, it is very important! The cholesterol is converted by various enzymes to pregnenolone, then into DHEA (dehydro-epiandrosterone) and later into various steroids, including testosterone. The average man makes about 7 mg of testosterone a day. Some of the testosterone is then converted into estradiol (estrogen). About 3/4 of the estrogen produced by men is made from the testosterone.
The most important thing to remember about testosterone is that it is the free testosterone, not the total testosterone, that is important. Free testosterone is that which has not been bound to other chemicals and is thus freely circulating and available to the receptors. About 98% of testosterone is bound, and only about 2% is free. Obviously it doesn~t take much. The production of testosterone peaks in men around age 40. By the time they are 80, their total testosterone has dropped by 50% and the free testosterone has dropped even more, by 2/3. A study discussed at the ESM showed that about 51% of older males are functionally impotent. That must take a tremendous toll on the self image, self esteem, and feeling of power and aliveness in a man. The reduction in testosterone levels may even be one of the reasons that some men are not as productive after 55 or 60 years of age. A lot of these problems could be resolved by testosterone replacement therapy.
What are the functions of testosterone?
Testosterone accelerates growth in tissues that have testosterone receptors. Receptors are cell components that combine with the hormone to alter the function of the cell. There are testosterone receptors in the hypothalamus (the gland that regulates your entire endocrine system), in the skin, and in muscle. Since men have more testosterone, they have more muscle. Studies are currently being conducted to see if, and to what degree, testosterone affects both muscle mass and bone mass in men. Per George Debled, M.D., most of the tissues of the body have at least some androgen receptors
Testosterone stimulates blood flow, precipitates aggressive behavior, determines fat distribution in men, causes deep voice, causes beard and pubic hair development, affects sex drive in both men and women, and affects sexual desire, thought, and fantasy. It also affects the volume of ejaculate in men, their strength, length and frequency of erections, their penile sensation, and their refractory period (the length of time it takes before they can be sexual again after having ejaculated). Testosterone affects many metabolic activities, as well as vigor and enjoyment of life.
Men produce testosterone in a 24 hour pattern. The highest levels are in the morning. No surprise to women being awakened by someone poking them. As men get older, they lose the 24 hour pattern. Keep in mind that many things are not affected by testosterone. Men can still have orgasms and ejaculate with a flaccid penis. This includes 95% of impotent men. Testosterone does not affect the penile smooth muscles, nor does it help with vascular problems.
Even though testosterone is important and does great things, it is not a panacea. Too much can have negative effects. Large doses can stop sperm production. Testosterone supplements inhibit the natural production of testosterone. It can change serum cholesterol levels. It can cause damage to the liver. It may increase the risk of male breast and prostate cancer. Men may experience excessive frequency and duration of penile erections. Aggressive behavior can result. (Is that why more men commit violent crimes than women?) In women, there can be a permanent lowering of the voice, excessive hair growth, acne, clitoral enlargement, and menstrual problems. There can be excessive retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates. There can be problems with blood clotting factors and excessive bleeding. The insert in the testosterone cypionate box lists two long pages of information everyone should read before embarking on any hormone replacement therapy.
Symptoms of Low Testosterone
The symptoms of androgen deficiency can occur gradually as testosterone production declines gradually with age. These symptoms are easily be mistaken for other things. Only a test of androgen levels will deter-mine if testosterone deficiency is the reason. The symptoms of androgen deficiency include: loss of libido and potency, tiredness, lack of ambition and drive, hot flushes, and depression. Collapsing posture, muscle weakness, loss of axillary and pubic hair (Jacques Her-toghe 2/25/92) are also symptoms. In women, abdom-inal and hip obes-ity, abnormally large breasts, muscular degeneration, and lack of assertiveness and self- confidence may be clues (Thierry Hertoghe 2/25/92).
Obesity can also be a symptom. Androgen deficiency appears to affect sugar metabolism negatively by creating a vicious cycle leading to excessive weight gain. The lowered testosterone creates hyperglycemia (an increase in blood sugar levels) which triggers an outpouring of insulin that excessively lowers the blood sugar level. Then the person overeats in an attempt to feel better since food intake will increase the sugar levels. But because of the testosterone deficiency, the levels increase beyond normal again. The man becomes fat. The theory is that the muscles are taking up too little sugar because the are not being stimulated to build due to lack of testosterone. The risk of death increases with increased weight. (George Debled 2/25/92)
There are problems with collagen. (Collagen is the protein found in connective tissue in skin, bone, ligaments, and cartilage. Collagen represents 30% of total body protein.) Collagen tissue is made by collagen fibers connected by bridges. Collagen is elastic. Glucose (sugar) goes into the bridges and makes them stiff. The loss of male hormones leads to hyperglycemia (increased sugar levels), and these bridges pick up more glucose and become stiff. Dr. Debled joked that middleaged men become stiff, but not in the right place.
In men, urination can become difficult. Per Dr. Debled, the bladder neck and posterior urethra must open to urinate properly. When the mechanism is stiff (due to low testosterone levels), it does not open properly and leads to defects in the urethra. The problem is difficult to diagnose. In fact, it was difficult to understand the entire process that Dr. Debled was describing in his lecture because I am not familiar enough with medicine. (George Debled 2/25/92)
Consequences of Low Testosterone
All of the items listed under symptoms are, of course, conse-quences of low testosterone levels. Some of the other consequences are: the rate of sexual intercourse for men drops dramatically with age. Lack of testosterone leads to osteoporosis. (George Debled 2/25/92) Depressed men have significantly lower levels of testosterone than nondepressed men. (George Debled 2/25/92) Muscle weakness results from lack of testosterone because the me- tabolism of the muscle is influenced by testosterone. Higher levels of testosterone allow more glycogen (sugar) to enter and provide fuel and energy for the muscles cells. Large amounts of testosterone are consumed during exercise. Dr. Debled cited the example of how male athletes over 40 really cannot compete with the younger athletes because of their lowered testosterone levels. The more exercise you get, the more you lower your testosterone. (George Debled 2/25/92) A study of 250,000 Americans showed that male blood pressure increases with age. Arteries need testosterone to contract properly. Without tes-tosterone the arteries become more fibrous and thus stiff and less elastic. Varicose veins also become more common. (George Debled 2/25/92) There is a correlation between cholesterol metabolism and tes-tosterone levels. When any of the types of testosterone are low, there is a positive correlation with coronary heart disease. The prostate becomes fibrous with declining testosterone. Dr. Debled said that maintaining testosterone levels may help to prevent prostate problems and prostate cancer and perhaps other cancers because testosterone helps to stimulate immunity. He added that in fifteen years he has not had any cases of prostatic cancer in the people he has treated with androgen replacement. Exercise and stress both reduce testosterone levels, ~After age 40 every man will be affected, at one time or another, by the male climacteric.~ Yes, there is a male menopause.
How do you know what your testosterone level should be? How much testosterone do you need to bring your levels to an acceptable range. The answer has some twists. You need to know that the ~normal~ range is wide. Men~s levels vary widely over the course of 24 hours. One thing to ask your doctor to consider when testing you is how the so called ~normal~ ranges should be viewed. If all men have a decline of 50% in their testosterone production by age 80, at age 80 the ~normal~ is actually a deficiency. Maybe the levels between the ages of 20 - 40 are what we might want to aim for and consider optimal. When you get your testosterone levels tested, it is wise to be consistent and always be tested at the same time of day. This is because the 24 hour testosterone production cycle in men means that their testosterone levels vary widely over the day. Since it is highest in the morning, testing then would show if it was within the maximum optimal limits. You may not want to try to keep it at the maximum for a range. That could easily be too much for you. Remember, each person is unique and their personal hormonal needs must be identified.
Citizens of the United States have fewer choices of testosterone treatments than do persons in other countries. As mentioned earlier, there are injectable forms that typically last 10 - 14 days. The absorption rate is high when injected and drops off with time. Citizens of the United States have fewer choices of testosterone treatments than do persons in other countries. As mentioned earlier, there are injectable forms that typically last 10 - 14 days. The absorption rate is high when injected and drops off with time. The replacement amount of injectable testosterone for women is about 25 - 50 mg based on experimentation by physicians I have talked to. The replacement amount for men is about 50 - 400 mg based on information supplied by The Upjohn Company. Injections can be every 1 to 4 weeks. More frequent administration would mean much smaller doses.
Compounded creams can be prescribed, but the amount applied, and thus the dose, is hard to control. The suspension medium affects absorption a great deal. Scrotal patches are available. They are worn 22 hours per day and the peak testosterone level is at 3 - 5 hours. They are not particularly comfortable to wear. Pellets are not available in the United States. In other countries they are inserted under the skin. They last 4 - 6 months but peak at 2 - 3 weeks.
Soon there will be testosterone patches available for men in the United States. The average man would wear two patches per day, which would release approximately 5 mg of testosterone and cost about one dollar a day. They may be worn in various places, including the back. They are said to mimic fairly well the male 24 hour testosterone production cycle. Another option that may be available sometime in the future are testosterone microspheres. They will be administered via injection and would be kind of time released as each little sphere containing testosterone is coated with the material used in dissolvable sutures. These injections are supposed to last 70 - 90 days.
DHEA - An Alternate Treatment
There are many treatments for androgen deficiency. Here in the United States most doctors will prescribe the use of testosterone supplements. DHEA replacement is also an alternative for androgen deficiency. Both Dr. Thierry Hertoghe and Dr. Jacques Hertoghe recommend this. DHEA is an androgen, one of the hormones in the chain that eventually produces testosterone. Everyone~s level of this important hormone drops with age, resulting in the previously discussed symptoms of androgen deficiency. If DHEA is taken, it will eventually be converted to needed testosterone by your body. In addition, the DHEA itself is very important for good health.
Dr. Jacques Hertoghe recommended that women take about 20 mg/day of DHEA (DHEA base, not DHEA sulfate) with breakfast. His range was 15 - 25 mg/day. For men he recommended 50 mg/day of DHEA base, up to 100 mg/day, with breakfast. His expected response to DHEA replacement therapy is better muscle tone, more energy, more mental self-assurance, greater resistance to disease, and axillary and pubic hair growth.
Low thyroid level can result in low androgen production, which can often be corrected by correcting the thyroid levels. (Jacques Hertoghe 2/25/92)
The amino acid, L-arginine, stimulates nitric oxide production, which signals erections.
Another product that helps is avena-sativa, an oat extract. Remember the saying about sowing your wild oats. Well, in theory at least, this stuff binds with the sex hormone binding globulin that ties up your testosterone and thus lets more of it be free and unbound and available to enhance your sex drive. If the theory is correct, you will not make more testosterone, but you may have more left. I have tried the product Vigorex in capsule form. It does work.
Both deprenyl and L-dopa (prescription drugs) increase dopamine (a neurotransmitter that affects brain functioning) and can increase sex drive.
Vitamin B-5 can increase your stamina and endurance. It helps your body produce lots of energy and reduces muscular fatigue dramatically.
Information on Testosterone
Information on testosterone is hard to come by. The only book that I know of that is devoted to testosterone is titled The Virility Factor by Robert Bahr. His book is easy to read and interesting and provides many examples of personal experiences. It does not, however, discuss much about treatment options. NSS sells this book through mail order. To order it, contact NSS Seminars, Inc., PO Box 620628, Woodside, CA 94062 or call (415) 851-4751.
This sample article on testosterone is a much shortened version of the original. For a complete copy, including various charts and graphs, send $8 plus $5 shipping to Freedom Enterprises, PO Box 5001, Ben Lomond, CA 95005. Include your name and mailing address.
The Manual of Endocrinology and Metabolism edited by Norman Lavin, M.D., Little, Brown and Company, Boston/Toronto. De-cember, 1990.
Taber's Cyclopedic Medical Dictionary edited by Clayton L. Thomas, M.D., M.P.H., F.A. Davis Company, Philadelphia, Edition 16, 1989.
Behavioral Endocrinology edited by Jill B. Becker, S. Marc Breedlove, and David Crews, The MIT Press, Cambridge, Mass-achusetts, 1993.
The Virility Factor by Robert Bahr, Factor Press, Mobile, Alabama, 1992.
Lectures and poster sessions at the Endocrinology Society Meeting in Las Vegas, Nevada June, 1993.
Package Insert for Upjohn's DEPO-Testosterone.
Video Tape of Lectures from the Broda O. Barnes, M.D. Research Foundation, Inc. February 25, 1992 lecture presentation by Thierry Hertoghe, M.D., Jacques Hertoghe, M.D., and George Debled, M.D.
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