Men's Health: Detailed Explanation of the Physiological Functions of Male Hormones (Testosterone), the Effects of Deficiency, and Scientific Supplementation Plans

Androgens and Men's Health

Why does a little boy grow into a strong, imposing man? Why do eunuchs in the imperial palace lose their masculine charm after having their testicles removed, becoming delicate and developing a high-pitched, feminine voice? These changes are closely related to androgens.

(I) Physiological Functions of Androgens

Androgens are a class of steroid hormones secreted by the human body, with testosterone as the representative. The vast majority of androgens in a man's body are synthesized and secreted by the interstitial cells of the testes, with a small portion originating from the adrenal cortex. Testosterone exists primarily in plasma as protein-bound testosterone, with free testosterone accounting for only about 30%. Protein-bound testosterone acts as a carrier of testosterone, protecting it from destruction and transporting it to various target cells in the body to exert its effects. Testosterone that functions in the body is primarily free testosterone, but it disappears rapidly from plasma, with a half-life of only 10-20 minutes. Therefore, it needs to be continuously separated from protein-bound testosterone and replenished. Testosterone is mainly degraded and inactivated in the liver; 95% of testosterone is converted into physiologically inactive metabolites through reduction and binding reactions and excreted in the urine.

Androgens play a crucial role throughout a man's life.

1. During the embryonic period, androgens promote fetal sex differentiation. Insufficient androgen levels at this time can cause pseudohermaphroditism.

2. During puberty, androgens promote the development and maturation of sex organs and spermatogenic cells. Insufficient secretion at this time can lead to incomplete development of the external genitalia, a short penis, and feminization phenomena such as a high-pitched voice, delicate skin, and muscle weakness.

3. Insufficient androgen levels in middle-aged and elderly men can cause changes in mood and personality, and even male menopause syndrome.

4. Androgens can promote protein metabolism and utilization in the body. By promoting a positive nitrogen balance, protein synthesis and metabolism increase, improving the utilization rate of dietary protein components, resulting in strong and well-developed muscles and bones, and increased weight. Appropriate androgen therapy can achieve significant therapeutic effects for negative nitrogen balance caused by prolonged illness, bedridden status, or trauma.

5. Androgens promote the body's immune function. Injection of androgens accelerates antibody formation, enhancing the body's resistance to various diseases and bacterial infections. This effect of androgens is related to their promotion of immunoglobulin synthesis.

6. Androgens also promote erythrocyte production and maintain normal blood cell composition.

7. Androgens can accelerate calcium deposition in bones. Promoting bone development and growth during puberty, and effectively preventing decalcification and osteoporosis in middle-aged and elderly individuals.

8. Previous views held that while estrogen had a protective effect on the cardiovascular system, androgens were beneficial for the development of cardiovascular diseases. However, recent studies have shown that male hormones not only do not induce heart disease in men, but also have a protective effect on the coronary arteries, reducing and preventing the occurrence of heart disease in men. Research by Professor Phillips of Columbia University in the United States has demonstrated that men with higher levels of male hormones in their plasma also have correspondingly higher levels of high-density lipoprotein (HDL). HDL plays an important role in preventing coronary artery hardening and stenosis; therefore, an increase in HDL can reduce and prevent the occurrence of heart disease.

(II) The Effects of Male Hormone Deficiency on Men

A decline in male hormone levels can cause many clinical symptoms, such as delayed puberty, male infertility, endocrine impotence, and male menopause syndrome. This section mainly discusses the effects of male hormone deficiency on middle-aged and elderly men.

With age, not only do men's total testosterone levels decrease, but the level of free testosterone also decreases significantly, while the content of protein-bound testosterone relatively increases. This can significantly affect the normal physiological function of testosterone, leading to a series of clinical symptoms and manifestations of testosterone deficiency, such as weakness, fatigue, lack of energy, low mood, personality changes, irritability, and sexual dysfunction. Currently, clinically reported testosterone levels represent the total amount of testosterone in plasma, including both bound and free testosterone. The test results do not reflect the proportion of each of these two forms of testosterone in the body. For some middle-aged and elderly men, even if testosterone levels are normal, the ratio of these two forms cannot be guaranteed to be normal, and there may be a problem with low free testosterone. Furthermore, experimental studies have shown that with age, the level of free testosterone in men decreases, while the content of protein-bound testosterone relatively increases. Even if both forms of testosterone are normal in middle-aged and elderly men, their current testosterone levels may be much lower than when they were younger, and they may still have androgen deficiency, leading to a series of clinical symptoms. Therefore, for men over 40, when testosterone levels gradually decline, appropriate supplementation with exogenous male hormones is necessary. This plays an important role in maintaining a healthy and robust physique. The key issue is mastering the timing and dosage of male hormone supplementation.

(III) How to Choose Male Hormones

The use of sex hormones should be approached with caution. Avoid indiscriminate use. It is best to first undergo necessary examinations at a hospital and consult a specialist to determine if hormone therapy is necessary.

Currently, common male hormone preparations in China include: methyltestosterone, testosterone propionate, and testosterone undecanoate. Methyltestosterone is an oral preparation that needs to be taken daily. It is inexpensive and has some efficacy, but long-term use is harmful to the liver and carries a risk of liver cancer. Therefore, it has been largely phased out. Testosterone propionate is a short-acting injectable preparation, injected five times a week, and blood testosterone levels are unstable. Testosterone undecanoate is available in both oral and injectable forms. Following injection of testosterone undecanoate, serum testosterone levels rise sharply, but plasma concentrations remain unstable. This non-physiological increase almost completely inhibits endogenous androgen production, which is highly detrimental to patients with already low testosterone levels.

An effective, safe, and stable oral androgen preparation with stable plasma concentrations is Andriol. This is an oral formulation of testosterone undecanoate, dissolved in oleic acid and encapsulated, exhibiting good lipid solubility. After oral administration, it is unaffected by gastric acid and absorbed via the intestinal lymphatic system, entering the bloodstream directly through the thoracic duct. This avoids the destructive effects of gastric acid and liver, significantly enhancing efficacy and eliminating liver toxicity. Peak serum concentration is reached on average 4 hours after oral administration. Daily oral administration metabolizes it into natural testosterone, allowing for complete androgen action with stable plasma concentrations without non-physiological fluctuations. At the recommended dosage, it does not inhibit endogenous androgen production, and long-term use has no side effects. A study observed 50 patients who had been taking hormones for over 10 years, and no significant changes were observed in any of the clinical indicators (bilirubin, alkaline phosphatase, γ-GT, SGOT, SGPT, LDH, α-FP, clotting time, acid phosphatase, testosterone, urine flow, etc.).

Clinically, many middle-aged and elderly patients have experienced increased energy, physical strength, improved mood, and enhanced libido after taking appropriate doses of androgens. Therefore, when middle-aged and elderly individuals experience unexplained changes in personality and mood, or become irritable, easily agitated, or have difficulty controlling their emotions, they should consult a specialist for necessary examinations. If problems are found, appropriate androgen supplementation may be considered.