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The mean testosterone concentration was 421 ng/dL.436 In a 90-day open label trial of 306 testosterone deficient men using two actuations (11mg) of the drug applied three times daily, results were reported for 73 men at day 90. The product is provided in a metered pump that supplies 5.5 mg of testosterone per actuation. An intranasal testosterone gel applied topically into the nose was approved by the FDA in 2014. The progressive hydration tablet with a matrix containing 30 mg of testosterone is placed in position on the gum above the right or left canine and is held in position for approximately 30 seconds. The most common adverse effect with patches is application site reactions, which have been historically reported in up to 60% of patients.181 Other adverse effects include pruritus, application site vesicles, and back pain.431 Compared to topical gels and solutions, the rate of transference is likely minimal.
Currently published studies have not demonstrated an increased risk of biochemical cancer recurrence in post-RP patients who are on testosterone therapy, nor does it define the optimal timing for commencement of testosterone therapy. It is the opinion of this Panel that until there is definitive evidence demonstrating that testosterone therapy is not safe for use in prostate cancer patients, the decision to commence testosterone therapy in men with a history of prostate cancer is a negotiated decision based on the perceived potential benefit of treatment. Given the reproductive profile of the study population, the spermatogenesis results might not be generalizable to patients with testosterone deficiency.332A study of 66 males who presented with infertility while on exogenous testosterone therapy revealed several interesting findings.333 The authors used a total motile sperm count (TMSC) of 5 million as the benchmark for spermatogenesis recovery. Testosterone deficient patients should be informed that low testosterone levels place them at risk for these major cardiovascular events and clinicians should assess all testosterone deficient patients for ASCVD risk factors, both fixed (e.g., older age, male gender) and modifiable (e.g., dyslipidemia, hypertension, diabetes, current cigarette smoking).
Men who seek medical care for possible testosterone therapy often present with non-specific symptoms, such as low energy and fatigue, which can be manifestations of other conditions, such as chronic stress, chronic fatigue, and depression. The rate of remission was also higher in a statistically significant manner among dysthymic men receiving testosterone therapy (53%) compared to placebo (19%).317, 318 One trial with three years of follow-up showed near linear, time-dependent improvements in BMD.202 These findings are similar to other prospective, controlled data, which report an estimated 5% per year increase in BMD in men on testosterone therapy.309 Declining bone density may necessitate additional medical intervention, such as weight bearing exercise, calcium, vitamin D, or bisphosphonate medications.
When body of evidence strength Grade C is used, there is uncertainty regarding the balance between benefits and risks/burdens, alternative strategies may be equally reasonable, and better evidence is likely to change confidence. When body of evidence strength Grade B is used, benefits and risks/burdens appear balanced, the best action also depends on individual patient circumstances, and better evidence could change confidence. When body of evidence strength is Grade A, the statement indicates that benefits and risks/burdens appear balanced, the best action depends on patient circumstances, and future research is unlikely to change confidence. Testosterone therapy refers to all forms of treatment that are aimed at increasing serum testosterone, including exogenous testosterone as well as alternative strategies, such as selective estrogen receptor modulators (SERMs), human chorionic gonadotropin (hCG) or aromatase inhibitors (AIs). The Panel explicitly uses the term testosterone therapy rather than testosterone replacement therapy or testosterone supplementation to be in keeping with the beliefs of the current thought leaders in the field. Thus, a patient is considered testosterone deficient and a candidate for testosterone therapy only when he meets both criteria. Ultimately, the AUA and the Testosterone Panel were committed to creating a Guideline that ensures that men in need of testosterone therapy are treated effectively and safely.
Human research is less extensive, but studies suggest that ginger may improve sperm count, quality, and motility, as well as boost testosterone levels. Ginger has a long history of being able to increase testosterone levels in animal subjects. Taking it, especially after a workout, may increase free testosterone levels. It’s an Ayurvedic remedy for low T, and it can increase total and free testosterone when compared to patients taking a placebo. Longjack (E. longifolia or Tongkat Ali) is an herbal remedy that promotes healthy testosterone levels.
It is worrisome that two supplements had greater than the UL of zinc. The FDA does not issue RDA and upper tolerable limit data for herbal supplements. However, it is even more concerning that some of these supplements may in fact decrease serum T.
This article is based on scientific evidence, written by experts and fact checked by experts. However, it’s not appropriate for everyone, so it’s important to talk with a healthcare professional before adding ashwagandha to your routine. Ashwagandha is an ancient medicinal herb with various possible health benefits. Always check with a healthcare professional before using ashwagandha. The effects of ashwagandha will take time to appear, so a healthcare professional may recommend taking one dose daily. It’s important to check with a healthcare professional before taking ashwagandha to ensure it’s safe for you and that you use a safe dose. Consult a healthcare professional if you have questions regarding ashwagandha dosing.
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