By Abraham Morgentaler, MD

Reviewed by Anti-Aging Psychologist Dr. Michael Brickey

Age brings declining testosterone levels. Low testosterone levels are associated with arteriosclerosis, diabetes, osteoporosis, erectile dysfunction, increased fat, and decreased libido, energy, and muscle mass. While common in men over 50, it is estimated that only 5% of American men with low testosterone levels get treatment for it.

Urologist Dr. Abraham Morgentaler is a Clinical Associate Professor at Harvard and Director of Men’s Health Boston, a practice focusing on men’s health issues. His ©2008 book is very readable and comprehensive. He explains how to recognize low testosterone levels, the blood tests, and the treatment options. It is a perfect book to read before seeing a doctor about testosterone so you know what to ask. The book also includes fascinating detective work that dispelled the myths about testosterone therapy causing prostate cancer.

Most testosterone is bound and not available. Some testosterone is converted to estradiol (an estrogen hormone), and a small fraction of testosterone is free. Increasing testosterone also results in more testosterone being converted to estradiol. Dr. Morgentaler believes the most important test result is not the testosterone level but the free (unbound) testosterone level. He dismisses estradiol levels as of little concern unless extreme and causing symptoms. An editorial in the May 2010 issue of Life Extension strongly disagrees. It cites studies indicating that even slightly elevated estrogen levels in men greatly increase the risk of coronary artery disease and the risk of stroke.

My own anti-aging physician, who has a holistic orientation, places a lot of emphasis on the ratio of free testosterone to estradiol. He also favors human chorionic gonadotropin injections as they get the testes to produce more testosterone while other modalities (e.g., creams, patches, pellets) add testosterone but result in a lower testosterone production from the testes. This is an issue if you are concerned about using a more natural, holistic approach, and/or if you want to keep sperm count optimal for having children.

With the exception of the concerns noted, this is an excellent and very helpful book. You can stream or download my (free) 50-minute podcast interview with Dr. Morgentaler at http://agelesslifestyles.com/2010/03/testosterone-supplementation-what-it-can-and-cannot-do/ list $16.95 Amazon $11.53