Intact singers

Fig. 13.3 Longevity of intact and castrated singers (50 in each group) born between 1580 and 1859 (matched pairs of intact and castrated singers with similar birth dates were formed) (Nieschlag etal. 1993).

of testosterone, possibly mediated through changes in lipid metabolism. Hence it may be asked whether testosterone may have a life-shortening effect on patients with hypogonadism under testosterone treatment. Appropriate controlled studies to answer this question directly are not available and are unlikely to be performed since it would be unethical to withhold testosterone lifelong from a hypogonadal control group. However, there are two retrospective historical studies available addressing the problem.

A retrospective analysis of the life expectancy of inmates of an institution for the mentally handicapped in the USA came to the conclusion that early castration would lead to a longer life expectancy (Hamilton and Mestler 1969). However, this could be explained by the preference of castration as treatment for the physically more active inmates, whereas lack of mobility is the major predictor of shortened life expectancy among institutionalized men. In contrast, the retrospective comparison of the life expectancy of singers born between 1580 and 1858 and castrated before puberty in order to preserve their high voices, to intact singers born at the same time did not reveal a significant difference between the lifespan of intact and castrated singers (Nieschlag etal. 1993) (Fig. 13.3). In contrast, among singers who died in the 20th century, basses had a tendency to live longer than tenors (67.4 ± 12.4 vs. 66.0 ± 14.4 years) (Basses have higher testosterone/estradiol ratios than tenors

(Meuser and Nieschlag 1977)). Sopranos, who are more estrogenized, lived significantly longer than altos, who are more androgenized (72.1 ± 14.3 vs. 67.5 ± 13.5 years) (Nieschlag et al. 2003). These findings can be interpreted that overall, a preponderance of isosexual hormones in the spectrum of sex steroids tends to extend life rather than shorten life.

Since neither the inmates nor the historical singers can be considered representative for the present population, these controversial studies can only provide hints but no conclusive answer. There is, however, no proof that testosterone is a life-shortening agent. Preventing a hypogonadal patient from receiving the necessary substitution would force him to continue a life of low quality. If testosterone in physiological doses should cause "side" effects, these would indeed be the normal biological effects. The risks inherent to testosterone, be it of endogenous or exogenous origin, would then appear to be the tribute men have to pay for being men.

13.8 Key messages

• The primary indications for testosterone therapy are the various forms of male hypogonadism. For substitution, testosterone preparations should be used that can be converted to 5a-dihydrotestosterone (DHT) as well as to estradiol in order to develop the full spectrum of testosterone action.

• Injectable, oral and transdermal testosterone preparations are available for clinical use. The best preparation is the one that replaces testosterone serum levels at as close to physiologic concentrations as possible.

• In six decades of clinical use testosterone has proven to be a very safe medication. No toxic effects are known. The only important contraindication is the presence of a prostate carcinoma which should be excluded before substitution is initiated.

• Testosterone therapy should be monitored by patients' well-being, alertness and sexual activity, by occasional measurement of serum testosterone levels, hemoglobin and hematocrit, by bone density measurements and prostate parameters (rectal examination, PSA and transrectal sonography).

• Testosterone can be used to initiate puberty in boys with constitutional delay of pubertal development. Careful dosing does not lead to premature closure of the epiphysis and reduced height.

• High-dose testosterone treatment in early puberty may prevent expected overtall stature in boys. Negative long-term effects of this treatment have not become evident to date.

• No evidence has been provided that testosterone treatment of male idiopathic infertility leads to higher pregnancy rates and it should therefore not be used for this indication.

• The risks inherent to testosterone, be it of endogenous or exogenous origin, appear to be the tribute men have to pay for being men.


Adamopoulos DA, Nicopoulou S, Kapolla N, Vassipoulos P, Karamertzanis M, Kontogeorgos L (1995) Endocrine effects of testosterone undecanoate as a supplementary treatment to menopausal gonadotropins or tamoxifen citrate in idiopathic oligozoospermia. Fertil Steril 64:818-24

Adamopoulos DA, Nicopoulou St, Kapolla N, Karamertzanis M, Andreou E (1997) The combination of testosterone undecanoate with tamoxifen citrate enhances the effects of each agent given independently on seminal parameters in men with idiopathic oligozoospermia. Fertil Steril 67:756-62

Ahmed SR, Boucher AE, Manni A, Santen RJ, Bartholomew M, Demers LM (1988) Transdermal testosterone therapy in the treatment of male hypogonadism. J Clin Endocrinol Metab 66:546:551

Albanese A, Stanhope R (1995) Predictive factors in the determination of final height in boys with constitutional delay of growth and puberty. J Pediatr 126:545-550 Albanese A, Kewley GD, Long A, Pearl KN, Robins DG, Stanhope R (1994) Oral treatment for constitutional delay of growth and puberty in boys: a randomized trial of an anabolic steroid or testosterone undecanoate. Arch Dis Child 71:315-317 Arver S, Dobs AS, Meikle AW, Caramelli KE, Rajaram L, Sanders SW, Mazer NA (1997) Long-term efficacy and safety of a permeation-enhanced testosterone transdermal system in hypogonadal men. Clin Endocrinol 47:727-737 Atkinson LE, Chang Y-L, Snyder PJ (1998) Long-term experience with testosterone replacement through scrotal skin. In: Testosterone: Action, deficiency, substitution, 2nd edition Nieschlag E, Behre HM (eds) Springer Verlag, Heidelberg, pp 365-388 Bagatell CJ, Heimann JR, Rivier JE, Bremner WJ (1994) Effects of endogeneous testosterone and estradiol on sexual behaviour in normal young men. J Clin Endocrinol Metab 78:711716

Bagchus WM, Hust R, Maris F, Schnabel PG, Houwing NS (2003) Important effect of food on the bioavailability of oral testosterone undecanoate. Pharmacotherapy 23:319-325 Bals-Pratsch M, Langer K, Place VA, Nieschlag E (1988) Substitution therapy of hypogonadal men with transdermal testosterone over one year. Acta Endocrinol 118:7-13 Behre HM, Nashan D, Hubert W, Nieschlag E (1992) Depot gonadotropin-releasing hormone agonist blunts the androgen-induced suppression ofspermatogenesis in a clinical trial ofmale contraception. J Clin Endocrinol Metab 74:84-90. Behre HM, Bockers A, Schlingheider A, Nieschlag E (1994a) Sustained suppression of serum LH, FSH testosterone and increase of high-density lipoprotein cholesterol by daily injections ofthe GnRH antagonist cetrorelix over 8 days in normal men. Clin Endocrinol 40:241-248 Behre HM, Bohmeyer J, Nieschlag E (1994b) Prostate volume in testosterone-treated and untreated hypogonadal men in comparison to age-matched normal controls. Clin Endocrinol 40:341-349

Behre HM, von Eckardstein S, Kliesch S, Nieschlag E (1999) Long-term substitution therapy of hypogonadal men with transscrotal testosterone over 7-10 years. Clin Endocrinol 50:629-635

Behre HM, Simoni M, Nieschlag E (1997a) Strong association between leptin and testosterone.

Clin Endocrinol 47:237-240 Behre HM, Kliesch S, Leifke E, Link TM, Nieschlag E (1997b) Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab 82:23862390

BettendorfM, Heinrich UE, SchonbergDK, Grulich-Henn J (1997) Short-term, high dose testosterone treatment fails to reduce adult height in boys with constitutional tall stature. Eur J Pediatr 156:911-915

Bhasin S, Buckwalter JG (2001) Testosterone supplementation in older men: a rational idea whose time has not yet become. J Androl 22:718-731 Bhasin S, Singh AB, Phong Mac R, Carter B, Lee MI, Cunningham GR (2003) Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl 24:299-311 Bojesen A, Juul S, Gravholt CH (2003) Prenatal and postnatal prevalence of Klinefelter syndrome:

a national registry study. J Clin Endocrinol Metab 88:622-626 Brocks DR, Meikle AW, Boike SC, Mazer NA, Zariffa N, Audet PR, Jorkasky DK (1996) Pharmacokinetics of testosterone in hypogonadal men after transdermal delivery: influence of dose. J Clin Pharmacol 36:732-739 Brown D, Butler CGE, Kelnar CJH, Wu FCW (1995) A double blind, placebo controlled study of the effects of low dose testosterone undecanoate on the growth of small for age, prepubertal boys. Arch Dis Child 73:131-135 Buchter D, Behre HM, Kliesch S, Nieschlag E (1998) Pulsatile GnRH or human chorionic gonadotropin human menopausal gonadotropin as effective treatment for men with hypogo-nadotropic hypogonadism: a review of 42 cases. Eur J Endocrinol 139:298-303 Buena F, Swerdloff RS, Steiner BS, Lutchmansingh P, Peterson MA, Pandian MR (1993) Sexual function does not change when serum testosterone levels are pharmacologically varied within the normal male range. Fertil Steril 59:1118-1123 Burris AS, Banks SM, Carter CS, Davidson JM, Sherins RJ (1992) A long-term prospective study of the physiologic and behavioural effects of hormone replacement in untreated hypogondadal men. J Androl 13:297-304 Butler GE, Sellar RE, Hendry RF, Qalker M, Kelnar CJH, Wu FCW (1992) Oral testosterone undecanoate in the management of delayed puberty in boys: pharmacokinetics and effects on sexual maturation and growth. J Clin Endocrinol Metabol 75:37-44 Carani C, Bancroft J, Granata A, Del Rio G, Marrama P (1992) Testosterone and erectile function: nocturnal penile tumescence and rigidity, and erectile response to visual erotic stimuli in hypogonadal men. Psychoneuroendocrinology 17:647-654 Carey PO, Howards SS, Vance ML (1988) Transdermal testosterone treatment of hypogonadal men. J Urol 140:76-79

Charny CW, Gordon JA (1978) Testosterone rebound therapy: a neglected modality. Fertil Steril 29:64-68

Clopper RR, Voorhess ML, MacGillivray MH, Lee PA, Mills B (1993) Psychosexual behavior in hypopituitary men: a controlled comparison of gonadotropin and testosterone replacement. Psychoneuroendocrinology 18:149-161

Comhaire F, Schoonjans F, Abelmassih R, Cordts S, Campo R, Dhont M, Milingos S, Gerris J (1995) Does treatment with testosterone undecanoate improve the in-vitro fertilizing capacity of spermatozoa in patients with idiopathic testicular failure? (Results of a double blind study). Hum Reprod 10:2600-2602 Cunningham GR, Cordero E, Thornby JI (1989) Testosterone replacement with transdermal therapeutic systems. JAMA 261:2525-2530 Cunningham GR, Hirshkowitz M, Korenman SG, Karacan I (1990) Testosterone replacement therapy and sleep-related erections in hypogonadal men. J Clin Endocrinol Metab 70:792-797 Davidson JM, Camargo CA, Smith ER (1979) Effects of androgen on sexual behavior in hypogonadal men. J Clin Endocrinol Metab 48:955 Decker R, Pratsch C-J, Sippell WG (2002) Combined treatment with testosterone (T) and ethinylestradiol (EE2) in constitutionally tall boys: is treatment with T plus EE2 more effective in reducing final height in tall boys than T alone? J Clin Endocrinol Metab 87:1634-1639 de Lange WE, Snoep MC, Doorenbos H (1979) The effect of short-term testosterone treatment in boys with delayed puberty. Acta endocrinol 91:177-183 Depenbusch M, von Eckardstein S, Simoni M, Nieschlag E (2002) Maintenance of spermatogenesis in hypogonadotropic hypogonadal men with hCG alone. Europ J Endocrinol 147:617-624 Depenbusch M, Nieschlag E (2004) (ed) Stimulation of spermatogenesis in hypogonadotropic men. In: Winters S (ed) Male hypogonadism: basic, clinical and therapeutic principles, Contemporary Endocrinology, Humana Press, Totowa NJ Devogelaer JP, de Cooman S, Nagant de Deuxchaisnes C (1992) Low bone mass in hypogonadal males. Effect of testosterone substitution therapy, a densitometric study. Maturitas 15:17-23 De Waal WJ, Vreeburg JTM, Bekkering F, de Jongt FH, de Muinck Keizer-Schrama SMPF, Drop SLS, Weber RFA (1995) High dose testosterone therapy for reduction of final height in constitutionally tall boys: does it influence testicular function in adulthood? Clin Endocrinol 43:87-95

Drop SLS, WJ de Waal, de Muinck Keizer-Schrama SMPF (1998) Sex steroid treatment of constitutionally tall stature. Endocr Rev 19:540-558 Endres W, Shin YS, Rieth M, Block T, Schmiedt E, Knorr D (1987) Priapism in Fabry's disease during testosterone treatment. Klin Wschr 65:925 Findlay JC, Place VA, Snyder PJ (1989) Treatment of primary hypogonadism in men by the transdermal administration oftestosterone. J Clin Endocrinol Metab 68:369-373 Franchi F, Luisi M, Kicovic PM (1978) Long-term study of oral testosterone undecanoate in hypogonadal males. Int J Androl 1:270-278 Franchimont P, Kicovic PM, Mattei A, Roulier R (1978) Effects of oral testosterone undecanoate in hypogonadal male patients. Clin Endocrinol 9:313-320 Friedler S, Raziel A, Strassburger D, Schachter M, Bern O, Ron-El R (2001) Outcome of ICSI using fresh and cryopreserved-thawed testicular spermatozoa in patients with non-mosaic Klinefelter's syndrome. Hum Reprod 16:2616-2620 Getzoff PL (1955) Clinical evaluation of testicular biopsy and the rebound phenomenon. Fertil Steril 6:465-474

Gooren LJG (1987) Androgen levels and sex functions in testosterone-treated hypogonadal men. Arch Sex Behav 16:463-473

Gooren LJG (1994) A ten year safety study of the oral androgen testosterone undecanoate. J Androl 15:212-215

Hajjar RR, Kaiser FE, Morley JE (1997) Outcomes of long-term testosterone replacement in older hypogonadal males: a retrospective analysis. J Clin Endocrinol Metab 82:3793-3796 Hamilton JB, Mestler GE (1969) Mortality and survival: comparison of eunuchs with intact men and women in a mentally retarded population. J Gerontology 24:395-411 Jain P, Rademarker AW, McVary KT (2000) Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J Urol 164:371-375 Jockenhovel F, Blum WF, Vogel E, Englaro P, Müller-Wieland D, Reinwein D, Rascher W, Krone W (1997) Testosterone substitution normalizes elevated serum leptin levels in hypgonadal men. J Clin Endocrinol Metab 82:2510-2513 Jordan WP (1997) Allergy and topical irritation associated with transdermal testosterone administration: a comparison of scrotal and non-scrotal transdermal systems. Am J Cont Dermat 8:108-113

Kamischke A, Nieschlag E (1999) Analysis of medical treatment of male infertility. Hum Reprod 14: Suppl.11, 1-23

Kaplan JG, Monshant T, Bernstein R, Parks JS, Bingiovanni AM (1973) Constitutional delay of growth and development: Effect of treatment with androgens. J Pediatr 82:38-44 Kloer H, Hoogen H, Nieschlag E (1980) Trial of high-dose testosterone undecanoate in treatment of male infertility. Int J Androl 3:121 Knussmann R, Christiansen K, Kannmacher J (1992) Relations between sex hormone levels and character of hair and skin in healthy young men. Am J Phys Anthropol 88: 59-67 Lamensdorf H, Compere D, Begley G (1975) Testosterone rebound therapy in the treatment of male infertility. Fertil Steril 26:469-472 Lee KK, Berman N, Alexander GM, Hull L, Swerdloff RS, Wang C (2003) A simple self-report diary for assessing psychosexual function in hypogonadal men. J Androl 25:688-698 Leifke E, Körner HC, Link TM, Behre HM, Peters PE, Nieschlag E (1998) Effects of testosterone replacement therapy on cortical and trabecular bone mineral density, vertebral body area and paraspinal muscle area in hypogonadal men. Eur J Endocrinol 138:51-58 Lemcke B, Zentgraf J, Behre HM, Kliesch S, Bramswig JH, Nieschlag E (1996) Long-term effects on testicular function of high-dose testosterone treatment for excessively tall stature. J Clin Endocrinol Metab 81:296-301 Luboshitzky R, Aviv A, Hefetz A, Herer P, Shen-Orr Z, Lavie L, Lavie P. (2002) Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab 87:3394-3398.

Luisi M, Franchi F (1980) Double-blind group comparative study of testosterone undecanoate and mesterolone in hypogonadal male patients. J Endocrinol Invest 3:305-308 Maisey NM, Bingham J, Marks V, English J, Chakraborty J (1981) Clinical efficacy of testosterone undecanoate in male hypogonadism. Clin Endocrinol 14:625-629 Matsumoto AM, Sandblom RE, Schoene RB, Lee KA, Giblin EC, Pierson DJ, Bremner WJ (1985) Testosterone replacement in hypogonadal men: effects on obstructive sleep apnea, respiratory drives, and sleep. Clin Endocrinol 22:713-721

Meikle AW (1998) A permeation-enhanced non-scrotal testosterone transdermal system for the treatment of male hypogonadism. In: Nieschlag E, Behre HM (eds). Testosterone: Action, deficiency, substitution, 2nd edition, Springer, Heidelberg, 389-422 Meikle AW, Arver S, Dobs AS, Adolfsson J, Sanders SW, Middleton RG, Stephenson RA, Hoover DR, Rajaram L, Mazer NA (1997) Prostate size in hypogonadal men treated with a nonscrotal permeation-enhanced testosterone transdermal system. Urology 49:191-196 Meuser W, Nieschlag E (1977) Sex hormones and vocal register in adult men. Dtsch Med Wschr 102:261-264

Mooradian AD, Morley JE, Korenman SG (1987) Biological actions of androgens. Endocr Rev 8:1-28

Morales A, Johnston B, Heaton JPW, Lundie M (1997) Testosterone supplementation forhypo-gonadal impotence: assessment of biochemical measures and therapeutic outcomes. J Urol 157:849-854

Morales A, Lunenfeld B (2002) Investigation, treatment and monitoring of late-onset hypogonadism in males. Official recommendations of ISSAM. Aging Male 5:74-86 Morgentaler A, Carl MD, Bruning MD, De Wolf WC (1996) Occult prostate cancer in men with low serum testosterone levels. JAMA 276:1904-1906 National Institute on Ageing Advisory Panel (2001) Report of National Institute on Ageing Advisory Panel on Testosterone Replacement in Men. J Clin Endocrinol Metab 86:4611-4614 Navarro MA, Villabona CM, Blanco A, Gomez JM, Bonnin RM, Soler J (1994) Salivary excretory pattern of testosterone in substitutive therapy with testosterone enanthate. Fertil Steril 61: 125-128

Nieschlag E (1998) If testosterone, which testosterone? Which androgen regimen should be used for supplementation in older men? Formulation, dosing and monitoring issues. (1998) In: Bhasin S, Bagatell CJ, Bremmer WJ, Plymate SR, Tenover JL, Korenman SG, Nieschlag E (eds) Therapeutic perspective - Issues in testosterone replacement in older men. J Clin Endocrinol Metab 83:3443-3445

Nieschlag E, Behre HM (eds) (2000) Andrology: Male reproductive health and dysfunction.

Springer, 2nd edition, Heidelberg, New York Nieschlag E, Cuppers HJ, Wiegelmann W, Wickings EJ (1976) Bioavailability and LH suppressing effect of different testosterone preparations in normal and hypogonadal men. Horm Res 7:138 Nieschlag E, Kramer U, Nieschlag S (2003) Androgens shorten the longevity of women: sopranos last longer. Exp Clin Endocr Diab 111:230-231 Nieschlag E, Nieschlag S, Behre HM (1993) Life expectancy and testosterone. Nature 366:215 Nomura A, Heilbrunn LK, Stemmermann GN, Judd HL (1988) Prediagnostic serum hormones and the risk ofprostate cancer. Cancer Res 48:3515-3517 Ozata M, Yildirimkaya M, Bulur M, Yilmaz K, Bolu E, Corakci A et al. (1996) Effects of gonadotropin and testosterone treatments on lipoprotein (a), high density lipoprotein particles and other lipoprotein levels in male hypogonadism. J Clin Endocrinol Metab 81:3372-3378 Pedersen MF, Moller S, Krabbe S, Bennett P (1986) Fundamental voice frequency measured by electroglottography during continuous speech. A new exact secondary sex characteristic in boys in puberty. Int J Ped Otohinol 11:21-27

Pusch HH (1989) Oral treatment of oligozoospermia with testosterone-undecanoate: results of a double-blind-placebo-controlled trial. Andrologia 21:76-82 Rebuffe-Scrive M, Marin P, Bjorntorp P (1991) Short communication: effect of testosterone on abdominal adipose tissue in men. Int J Obes 15:791-795 Rolf C, von Eckardstein S, Koken U, Nieschlag E (2002) Testosterone substitution of hypogonadal men prevents the age-dependent increases in body mass index, body fat and leptin seen in healthy ageing men: results of a cross-sectional study. Eur J Endocrinol 146:505-511 Rosenfeld RG, Northcraft GB, Hintz RL (1982) A prospective, randomized study of testosterone treatment of constitutional delay of growth and development in male adolescents. Pediatrics 69:681-687

Rowley MJ, Heller CG (1972) The testosterone rebound phenomenon in the treatment of male infertility. Fertil Steril 23:498-504 Ruch W, Jenny P (1989) Priapism following testosterone administration for delayed male puberty. Am J Med 86:256

Schulte-Beerbuhl M, Nieschlag E (1980) Comparison of testosterone dihydrotestosterone, luteinizing hormone, and follicle-stimulating hormone in serum after injection of testosterone enanthate or testosterone cypionate. Fertil Steril 33:201-203 Schurmeyer T, Wickings EJ, Freischem CW, Nieschlag E (1983) Saliva and serum testosterone following oral testosterone undecanoate administration in normal and hypogonadal men. Acta endocrinol 102:456-462 Shabsigh R (1997) The effects of testosterone on the cavernous tissue and erectile function. World J Urol 15:21-26

Sih R, Morley JE, Kaiser FE, Perry HM, Patrick P, Ross C (1997) Testosterone replacement in older hypogonadal men: a 12-month randomized controlled trial. J Clin Endocrinol Metab 82:1661-1667

Skakkebaek NE, Bancroft J, Davidson DW, Warner P (1981) Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double blind controlled study. Clin Endocrinol 14:49-61

Snyder PJ, Lawrence DA (1980) Treatment of male hypogonadism with testosterone enanthate.

J Clin Endocrinol Metab 51:1335 Sokol RZ, Palacios A, Campfield LA, Saul C, Swerdloff RS (1982) Comparison of the kinetics of injectable testosterone in eugonadal and hypogonadal men. Fertil Steril 37:425-430 Sorva R, Kuusi T, Taskinen MR, Perheentupa J, Nikkila EA (1988). Testosterone substitution increases the activity of lipoprotein lipase and hepatic lipase in hypogonadal males. Atherosclerosis 69:191-197

TchernofA, LabrieF, Belanger A, Despres JP (1996) Obesity and metabolic complications: contribution of dehydroepiandrosterone and other steroid hormones. J Endocrinol 150 Suppl:155-164

Thomas JA, Keenan EJ (1994) Effects of estrogens on the prostate. J Androl 15:97-99 Tschop M, Behre HM, Nieschlag E, Dressendorfer RA, Strasburger CJ (1998) A time-resolved fluorescence immunoassay for the measurement of testosterone in saliva: monitoring of testosterone replacement therapy with testosterone buciclate. Clin Chem Lab Med 36:223-230

Vermeulen A, Verdonck G (1992) Representativeness of a single point plasma testosterone level for the long term hormonal milieu in men. J Clin Endocrinol Metab 74:939-942 von Eckardstein S, Nieschlag E (2002) Treatment of male hypogonadism with testosterone undecanoate injections at extended intervals of 12 weeks: a phase II study. J Androl 23:419-425 Wang C, Alexander G, Berman N, Salehian B, Davidson T, McDonald V, Steiner B, Hull H, Callegari C, Swerdloff R (1996) Testosterone replacement therapy improves mood in hypogonadal men - a clinical research center study. J Clin Endocrinol Metab 81:3578-3583 Wang L, Shi DC, Lu SY, Fang RY (1991) The therapeutic effect of domestically produced testosterone undecanoate in Klinefelter syndrome. New Drugs Mark 8:28-32 Whitworth JA, Scoggins BA, Andrews J, Williamson PM, Brown MA (1992) Haemodynamic and metabolic effects of short term administration of synthetic sex steroids in humans. Clin Exp Hypertens 14:905-922

Wittert GA, Chapman IM, Haren MT, Mackintosh S, Coates P, Morley JE (2003) Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status. J Gerontol A Biol Sci Med Sci 58:618-625 WHO (World Health Organization) Nieschlag E, Wang C, Handelsman DJ, Swerdloff RS, Wu F,

Einer-Jensen N, Waites G (1992) Guidelines for the use of androgens. WHO, Geneva WHO (World Health Organization) Task Force on the Diagnosis and Treatment of Infertility (1989) Mesterolone and idiopathic male infertility: a double-blind study. Int J Androl 12:254264

Wu FCW, Farley TMM, Peregoudov A, Waites GMH, World Health Organisation Task Force on Methodsforthe Regulation of Male Fertility (1996) Effects of testosterone enanthate in normal men: experience from a multicenter contraceptive efficacy study. Fertil Steril 65:626-636 Young NR, Baker HWG, Liu G, Seeman E (1993) Body composition and muscle strength in healthy men receiving testosterone enanthate for contraception. J Clin Endocrinol Metab 77:1028-1032

Zelissen PMJ, Stricker BHC (1988) Severe priapism as a complication of testosterone substitution therapy. Am J Med 85:273 Zgliczynksi S, Ossowski M, Slowinska-Srzednicka J, Brzezinska A, Zgliczynski W, Soszynksi P (1996) Effects of testosterone replacement therapy on lipids and lipoproteins in hypogonadal and elderly men. Atherosclerosis 121:35-43 Zitzmann M, Nieschlag E (2001) Testosterone levels in healthy men and their relation to behavioural and physical characteristics: facts and constructs. Eur J Endocrinol 144:183-197 Zitzmann M, Junker R, Kamischke A, Nieschlag E (2002a) Contraceptive steroids influence the hemostatic activation state in healthy men. J Androl 23:503-511 Zitzmann M, Rolf C, Brune M, Vieth V, Nieschlag E (2002b) Monitoring bone density in hypogonadal men by quantitative phalangeal ultrasound. Bone 31:422-429 Zitzmann M, Depenbusch M, Gromoll J, Nieschlag E (2003) Prostate volume and growth in testosterone-substituted hypogonadal men are dependent on the CAG repeat polymorphism of the androgen receptor gene: a longitudinal pharmacogenetic study. J Clin Endocrinol Metab 88:2049-2054

Natural Weight Loss

Natural Weight Loss

I already know two things about you. You are an intelligent person who has a weighty problem. I know that you are intelligent because you are seeking help to solve your problem and that is always the second step to solving a problem. The first one is acknowledging that there is, in fact, a problem that needs to be solved.

Get My Free Ebook

Post a comment