What is Testosterone

Testosterone is produced by the gonads (by the Leydig cells in testes in men and by the ovaries in women), although small quantities are also produced by the adrenal glands in both sexes. It is an androgen, meaning that it stimulates the development of male characteristics.

Present in much greater levels in men than women, testosterone initiates the development of the male internal and external reproductive organs during feotal development and is essential for the production of sperm in adult life. This hormone also signals the body to make new blood cells, ensures that muscles and bones stay strong during and after puberty and enhances libido both in men and women.

Testosterone is linked to many of the changes seen in boys during puberty (including an increase in height, body and pubic hair growth, enlargement of the penis, testes and prostate gland and changes in sexual and aggressive behavior). It also regulates the secretion of luteinising hormone and follicle stimulating hormone. To effect these changes, testosterone is often converted into another androgen called dihydrotestosterone.

Testosterone is a 19 carbon steroid hormone and  can be broken down into the following three sub-types:


1. Free Testosterone.

This is testosterone in its purest form. The reason it is called “free” is because there are  no proteins attached to it. Unbound to other molecules, free Testosterone can enter cells and activate receptors in order to work its virile magic on your body and mind.This makes up to 2-3% of your total testosterone level.

Below are the best male hormone boosters on the market to boost your testosterone levels:

  1. TestoGen
  2. TestoFuel
  3. PrimeMale
  4. Nugenix
  5. Ageless Male
  6. Cellucor P6

2. SHBG-bound Testosterone.

This makes up  40 to 60 percent of our total testosterone is bound to a protein called sex hormone-binding-globulin (SHBG). SHBG is produced in our livers and plays an important role in regulating the amount of free testosterone in our bodies.

3. Albumin-bound Testosterone.

The rest of your testosterone is bound to a protein called albumin. Albumin is a protein produced in the liver, and its job is to stabilize extra-cellular fluid volumes. Albumin-bound testosterone is bound weakly and can easily be broken down in order to create free testosterone.


Testosterone production


The Testosterone Level Test

I called up 10 male friends above 40 years old and asked them if they ever had a Testosterone ( T) Level Test .

“ A whatttttt?” was the answer , and I was not surprised. I explained and they went like “ Oh…….ok” .

Granted maybe they were in super healthy conditions and had no medical problems whatsoever , hence never needed to do a T –Test .

Testosterone testing is used to diagnose several conditions in men, women, girls, and boys.

These conditions include :

  • Decreased sex drive in men and women
  • Erectile dysfunction in men
  • Infertility in men and women
  • Testicular tumors in men
  • Pituitary disorders
  • Delayed or early puberty in boys
  • Excessive body hair in girls and women
  • Masculine physical characteristics in girls and women

A testosterone test measures the amount of testosterone in the blood. It is also called a serum testosterone test as it measures the total amount of the hormone in the serum , the amount of Free T in the serum and the bioavailable amount – which is the combination of free T and albumin-bound T.


Measuring Testosterone


The best time to take a Testosterone level test is between 7am and 10am when the T level is the highest.

daily testosterone level

Daily Testosterone Level


How is the T level Test Done?

Its just a simple test where a small amount of blood is drawn . You will usually have to wait for a few days for the results.

Alternatively, there is also a home DIY kit to have your own T level checked by checking your saliva. Reliability of such test  is  debatable  .The saliva test only tests free T . In any case if the results are not normal , it is advisable to do a proper blood serum test for T level.

Home DIY kits :

Blood Spot Test Kit

Testosterone Hormone Balance Level Test – Blood Spot

  • Measures “Total” Testosterone (T) hormone levels in men and women.
  • Everything is included, including a prepaid mailer. No additional fees.
  • The blood spot sample is collected with a finger stick at home, then sent to the lab for analysis. High Tech, accurate, reliable.
  • Men who also want to test “Free” testosterone can add a saliva testosterone test.
  • Blood Spot Test Kits cannot be sent to New York State.


saliva test

Testosterone Level Hormone Balance Test Kit – Saliva

  • 1 test – measures “free” testosterone in saliva.
  • Collect saliva sample at home, send to the lab in convenient prepaid mailer.


We will discuss Testosterone levels in the next post . Meantime…have you taken your T level Test ?


Testosterone Level By Age

Now that you have taken your Testosterone (T) level test , what does the result mean ?

Before we go any further , lets clarify the measurements used here.

T levels are either stated in nmol/L  ( nanomoles per liter ) or ng/dL ( nanograms per deciliter  ).

Conversion rate :

1 ng/dL =  0.0347 nmol/L

1 nmol/L = 28.818 ng/dL


Normal range of Testosterone in men is about 300 to 1200 ng/dL  and varies with age. The normal Testosterone level in women is just about 15-70 ng/dL . Now you know what makes a MAN !

The bad news is that Testosterone level decreases with age and decreases as much as 1% per year after age 30 . Worse still, the free testosterone decreases at a faster rate of 1.2% ! Studies have shown that total testosterone levels decrease by approximately 30% in healthy men between the ages of 25 and 75. Free testosterone levels decline even more significantly with decreases of approximately 50%

In order to regain our testosterone levels, it is must to follow testosterone boosting exercises or by taking testosterone pills. Some of the best testosterone boosters on the market are TestoGen, PrimeMale, TestoFuel.

The following table by A.Vermeulen (1996) shows total testosterone levels by age as well as free testosterone and Sex Hormone-Binding Globulin (SHBG) by age.




Testosterone levels above or below the normal range are considered by many to be out of balance.

While Testosterone is generally associated with sexual characteristics of men , many people are not aware that T is  also responsible for  healthy libido, building muscle mass, and maintaining energy level. See image below on the effects of T.

Therefore an extreme deviation from the  normal T level should be investigated by a medical doctor.

Testosterone level below 300 ng/dL may generally be considered LOW . Low T level may result in a decline in physical energy, strength, stamina, and diminished mental aggressiveness. Moreover, men may experience more aches and pains in the bones and joints and they may also have a decline in libido and erections.

Men who have Testosterone levels that are higher than average may experience both benefits and drawbacks. The benefits, which are modest, include normalizing blood pressure and lowering the likelihood of obesity and heart attack. However, there is a tendency for such men to consume more alcoholic beverages, and they are more likely to smoke, and more likely to get injured. According to some researchers, the higher the testosterone level, the more likely men are to participate in risk-taking behavior (sexual, injury risk, and even criminal activity). Problem of high T are obviously rare and infrequent with middle aged and elderly men . for this age group it is more common to see a problem of low T rather than high T.



Effects of Testosterone


So how should you monitor your T level ?  Doctors have recommended that T level tests shoud be done every 5 years after age 35 . However if you are on some T therapy , the levels must be monitored closely , at least once in 6 months.

Anyone out here with high T ? Would really love to have a chat with you !


Causes of Low Testosterone

So you have been diagnosed of having  low Testosterone ( Low T ) and you go like “Huh ?! How did that happen ? “

There are many things in our everyday life that can lower testosterone and it just takes one weak link to do it . have a read and see if you are “guilty” of any of the following:

1. Stress


Who does not have stress ,you say. Oh well , apart from being the cause of of many other ailments , stress is highly associated with low T. Stress increases cortisol , which has been associated to lowering T.

2. Overweight


You don’t need to look like Santa Claus to know you are overweight but those unwanted , extra pounds and kilos are strongly related to low T.

Fat cells contain aromatase and, as you gain weight, those fat cells enlargen and build up extra aromatase, the enzyme that converts testosterone to estradiol.  Yes, that means that an overweight or obese man will tend to have more estradiol, the “bad” estrogen, and less of his precious testosterone.

3. Lack of Sleep

Lowering sleep quantity or quality will leads to increased cortisol and a corresponding testosterone decrease . Because your body produces most of its testosterone while you sleep, interrupting that cycle with insufficient or poor quality sleep can result in 20% to 30% less testosterone floating around your bloodstream than if you’d gotten enough shut-eye.
Who says only women need their “beauty sleep “ ?

4. Depression


This could well be a result of stress, as it also leads to increased cortisol and inevitably low T. But then again , depression leads to Low T  and Low T also leads to depression – duh ! I call it a complicated relationship !

5. Excessive alcohol Consumption


The bar might be a great place to meet your buddies or unwind after work , but more than a few drinks isn’t going to do great things for your testosterone level. As your liver processes alcohol, it produces compounds that inhibit the release of testosterone, reducing its overall level in your body and preventing you from doing things like building muscle mass. While even one or two drinks will cause a minor, temporary dip in your T levels, this is a bigger worry for individuals who drink heavily multiple times per week.

6 . Over Exercising

over exercising

If exercise is good for overall health , more exercise should be better , right ? Wrong ! Do not over train . I used to wonder why the salesmen of the cross trainers do not recommend over 45 minutes training on the machine !  A study by the University of British Columbia found that male marathon runners who pounded over 40 miles of pavement per week had distinctly lower T levels than their short-distance running counterparts.

7. Vitamin A Deficiency

There’s a fair amount of research showing that low Vitamin A levels result in lower levels of available testosterone, and that Vitamin A is also crucial in the production of testosterone. Eating the ludicrously high levels of protein that many bodybuilders do will deplete Vitamin A levels and will depress your testosterone levels.

8. Vitamin D Deficiency

Studies have shown that men with adequate vitamin D – 30.0 mcg/L or more – have significantly more testosterone than men whose vitamin D levels fall from 20.0-29.9 mcg/L.

This could be the reason why you may feel more frisky in summer than winter ! wink

9. Varicocele

A varicocele is an enlargement of the veins within the loose bag of skin that holds the testicles (scrotum). A varicocele is similar to a varicose vein that can occur in your leg.

Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to fail to develop normally or shrink.

10. High blood sugar level

When blood sugar levels are high, the pituitary gland produces less LH ( luteinising hormone )     than it normally would. As testosterone is only produced when LH is secreted from the pituitary, this reduces the amount of testosterone produced by a man’s body.

11.Health Conditions

Certain health conditions will lead to low T .

  • Obesity
  • Diabetes
  • Changes in thyroid function
  • Kidney damage
  • Prostrate cancer

Why would such problems affect testosterone? When fighting off a chronic health issue or an infection, for example, your body may simply put less effort into testosterone production. In essence, your body turns its attention toward the more serious problem, explains Alan Shindel, MD, director of men’s health at the University of California, Davis, Health System in Sacramento.

Does this help shed any light on your T level ?  Do share your thoughts .


Low Testosterone Treatment

There are several options available  to treat Low Testosterone .While some Testosterone Replacement Therapies (TRT) seem effective and easy to administer, each as its own pros and cons .

It is best to consult your doctor about it to find out the most suitable option.

1.Injectable Testosterone

testosterone injection

Intramuscular testosterone has been used for years due to its effectiveness and low cost.

The most commonly used testosterone esters are :

1.Testosterone cypionate

2.Testosterone Enanthate

Though most people do not find any difference between the two,  Cypionate is known to have a “slower release” and stays active longer.

The usual adult dose  in men is 200 mg every two weeks, to a maximum of 400 mg per month.

The injections are administered into large muscles (usually the buttocks or thigh).  Injections can be given in the clinic or you can be taught by our nurse how to administer them yourself.

2.Topical Testosterone Gels

2.Topical Testosterone Gels

Advantages include more constant levels with daily dosing, high patient satisfaction, and avoidance of needles.  Disadvantages include increased cost compared to injectables, the poten­tial for transference of the gel to others (e.g., women and young children) through contact with your skin or clothes, messiness of gel application, and potential skin irritation.  Topical options are listed below:

AndroGel ( also known as TestoGel in some countries ): Testosterone gel (varying strengths).

Testosterone gel

  • AndroGel 1%.  Single-use packets containing 50mg of testosterone in 5g of alcohol-based gel OR metered-dose pump which dispenses 12.5mg of testosterone in 1.25g of alcohol-based gel per pump.  The usual starting dose is 1 packet or 4 pumps daily (about the size of 2 quarters) applied to the shoulders, upper arms, and abdomen.


  • AndroGel 1.62%.  Single-use packets containing 40.5mg of testosterone in alcohol-based gel OR metered-dose pump which dispenses 20.25mg of testosterone in alcohol-based gel pump.  The usual starting dose is 1 packet or 4 pumps daily (about the size of 2 quarters) applied to shoulders, upper arms, and abdomen.
    Area of application for T Gel

    Area of application for T Gel



  • Testosterone gel (1%).  Single-use tubes, each containing 50mg of testosterone in 5g of oil-based gel.  The usual starting dose is 1 tube daily (about the size of 2 quarters) applied to the shoulders and upper arms.




  • Testosterone solution (2%).  Metered-dose pump/applicator which dispenses 30 mg of testosterone in 1.5 cc solution per pump.  The usual starting dose is 1 pump (about the size of 2 quarters) applied to each underarm daily.



  • Testosterone gel (2%).  Metered-dose pump which dispenses 10mg of testosterone in 0.5g gel per pump.  The usual starting dose is 6 pumps daily (about the size of 2 quarters) applied to the thighs.






Any time you medically increase hormone levels, there’s a risk for side effects. Specifically, testosterone gel may cause:

  • headaches
  • dry skin or acne
  • hot flashes
  • insomnia (which may be caused by hot flashes at night)
  • anxiety or depression
  • muscle pain and weakness
  • further decrease in libido
  • reduced sperm count

While many of these symptoms aren’t severe, they can become bothersome. It’s important to tell your doctor about any side effects if they persist for more than a few days.

3.Implantable Testosterone



Developed in the 1940s, implantable testosterone is the oldest form of TRT. Pellets, each containing 75 mg of crystalline testosterone, are implanted subcutaneously to provide slow release over 4 to 6 months. Depending on the dose required, 2 to 6 pellets are implanted under the skin of the lower abdomen, upper thighs, deltoid, or gluteal muscles every 3 to 6 months.

Pellets tend to provide stable physiologic levels of testosterone. Although implantable testosterone, like the injectable forms, can cause levels to peak initially, the decline is gradual, over 6 months, so that mood swings and energy fluctuations are seldom recognized by the patient.


Because pellets require surgical implantation, their use can be painful. They also have a high rate of extrusion. Furthermore, since their duration of action is long and reversibility is difficult, testosterone pellets are unsuitable for treating elderly patients, in whom adverse effects are more common. Testosterone pellets are not often used in the United States.

The advantages of this therapy include convenience and decreased frequency of dosing.  As this requires a short office procedure, there are risks including bleeding, infection, and pellet extrusion in less than 1% of cases.

Testopel (Subcutaneous Testosterone Pellets):

Cylindrical pellets that are about the size of a grain of rice.  Each pellet contains 75mg of testosterone.  The usual starting dose is 10-14 pellets implanted underneath the skin in the office under sterile condi­tions once every 4 months.

4.Transdermal Testosterone Patch: (i.e. Androderm)


Transdermal testosterone comes as a patch to apply to the skin. It is usually applied each night between 8:00 p.m. and midnight and left in place for 24 hours. Apply testosterone patches at around the same time every evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use testosterone patch(es) exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor.

Areas to apply T Patch

Areas to apply T Patch

Choose a spot on your back, stomach, thighs, or upper arms to apply your patch(es). Be sure that the spot you have chosen is not oily, hairy, likely to perspire heavily, over a bone such as a shoulder or hip, or likely to be under pressure from sitting or sleeping. Do not apply the patch(es) to the scrotum or to a skin area with open sores, wounds, or irritation. Also be sure that the patch will stay flat against the skin and will not be pulled, folded, or stretched during normal activity. Choose a different spot each night and wait at least 7 days before applying another patch to a spot you have already used.


All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Acne; bitter or strange taste in mouth; change in sex drive; fatigue; gum or mouth irritation; gum pain; gum tenderness or swelling; hair loss; headache.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast growth or pain; change in the size or shape of the testicles; dark urine or light-colored bowel movements; depression or mood changes; dizziness; gingivitis; interrupted breathing while sleeping; loss of appetite; nausea; painful or prolonged erection; stomach pain; swelling of the ankles or legs; urination problems; weight gain; yellowing of the skin or eyes.


Who Should Not Take Testosterone?

As stated previously, some men shouldn’t take testosterone treatments because they can aggravate symptoms or cause certain health conditions to worsen. Men who have prostate cancer, breast cancer, sleep apnea that is untreated, too many red blood cells (polycythemia), and poorly controlled heart disease should not take testosterone treatments.