The Effects of Testosterone on Libido

Sexual stimulation and erection begin in the brain when neuronal testosterone-receptor sites are prompted to ignite a cascade of biochemical events that involve testosterone-receptor sites in the nerves, blood vessels, and muscles. Free testosterone promotes sexual desire and then facilitates performance, sensation, and the ultimate degree of fulfillment.

Without adequate levels of free testosterone, the quality of a man's sex life is impacted and the genitals atrophy. When free testosterone is restored, positive changes in structure and function of the sex organs can be expected. (It should be noted that sexual dysfunction can be caused by other factors unrelated to hormone balance such as arteriosclerotic blockage of the penile arteries.)

The genital/pelvic region is packed with testosterone receptors that are ultra-sensitive to free testosterone-induced sexual stimulation. Clinical studies using testosterone injections, creams, or patches have often failed to provide a long-lasting libido enhancing effect in aging men. (98) We now know why. The testosterone can be converted to estrogen. The estrogen is then taken up by testosterone receptor sites in cells throughout the body. When an estrogen molecule occupies a testosterone receptor site on a cell membrane, this blocks the ability of serum testosterone to induce a healthy hormonal signal. It does not matter how much serum free testosterone is available if excess estrogen is competing for the same cellular receptor sites.

Estrogen can also increase the production of sex hormone-binding globulin (SHBG), which binds the active free testosterone into a non-active "bound testosterone". Bound testosterone is not able to be picked up by testosterone receptors on cell membranes. For testosterone to produce long-lasting libido enhancing effects, it must be kept in the "free" form (not bound to SHBG) in the bloodstream. It is also necessary to suppress excess estrogen as this hormone can compete for testosterone receptor sites in the sex-centers of the brain and the genitals.

Restoring youthful hormone balance can have a significant impact on male sexuality.

Anabolic Steroids and Infertility

Anabolic Steroids are synthetic substances similar to the male sex hormone testosterone. If used consistently from a young age they can be detrimental to the users health because they upset the body's hormonal balance.

Anabolic Steroids are known to have a variety of harmful side effects, are out of bounds for athletes and users are required to only take them under prescription of a medical doctor. Yet many people take them for the short term benefits they provide - for athletes to improve performance or to enhance physical appearance.

These drugs are often sold on the black market and because their short term benefits are so attractive users tend to ignore the dangerous and possible long term side effects. Users do not consider the effects these substances may have on their fertility health.
   

 Medical Benefits

Steroids aren't only used for bulking up but can be prescribed for legitimate medical reasons. Your medical practioner is well aware of the side effects and will prescribe a dosage with this in mind to cater for your particular situation.


 Some of the medical uses are:

    Men with too little testosterone - Whether it's due to an accident or a disease; such as testicular cancer, some men have to have their testicles removed.Their bodies will no longer be able to produce testosterone. They will be given prescribed oral anabolic steroids to replace the testosterone.

    People with chronic illnesses, such as cancer or even AIDS can use anabolic steroids to stimulate their appetite and help build muscle.
    Pituitary problems -  Steroids can help adolescent males with pituitary problems. When the pituitary gland malfunctions, the brain signals to the testes may not function correctly and the testes therefore does not produce testosterone. Boys suffering from this condition can be prescribed steroids at the appropriate age, as per his doctor. This treatment will allow them to develop secondary sexual characteristics, such as a deepening of the voice, growth spurts and pubic and facial hair.

Anabolic Steroids and fertility

There are a number of side effects users will experience when taking these substances. Some are short term and others may have long term side effects. Unfortunately any side effects will in most cases also effect the male fertility health. Some of these side effects can include:

Short term effects

    Puffiness and swelling in the face and neck due to increased water retention.
    Development of breast tissue in males.
    Increased risk of injury to muscles and joints.
    Increase in muscle mass.
    Heightened aggression, sleeping disorders, anxiety and irritability.
    Stunted growth if taken during adolescent growth spurts due to skeletal maturation and accelerated puberty changes.
    

Long term effects

    Growth of breasts due to the high level of testosterone some of which the body converts to oestrogen.
    Increased erectile dysfunction and shrinking testicles.
    Heart and liver disease - some steroids are toxic to the liver.
    Kidney disease due to the increase in toxins to be broken down.
    Aggressive behaviour and depression.
    Jaundice from high levels of steroids - affects liver function.
    Increased blood pressure.
    Prostate enlargement.


Anabolic Steroids and male infertility are often linked due to the effects on the body as mentioned here.  Any increased toxins in the body have the potential to affect the sperm being produced.

A semen analysis will give a good indication of the health of the sperm if a male has used steroids previously and is now having difficulty with infertility. A low sperm count will also be detected by going for a semen analysis.

Fortunately medical technology and advancement in procedures such as sperm washing as well as ICSI - Intra-Cytoplasmic Sperm Injection could assist men whose fertility may have been affected by the usage of Steroids.

Your doctor will be able to advise you on using an Assisted Reproductive Technology (ART) procedure in the event of being diagnosed with infertility due to this usage.

HMG: The Miracle Fertility Med?

When we administer certain hormones into our bodies, various cells and organs have the ability to sense this. Your body 'sees' this increase in testosterone or similar molecules and as a result it can sense that it is in a higher concentration than what would be normal in the blood. As a result, it will shut down its own testosterone production. There are various mechanisms involved in this, but an important one is the cessation in production of luteinizing hormone (LH) and follicle stimulating hormone (FSH), produced by the pituitary gland. These hormones are required for the testes to be stimulated to produce testosterone but also play a role in sperm production.

From a blood-testosterone aspect this all seems okay to us, sure we have shut down natural testosterone production, but we still have testosterone in us; right? Well, one of the big problems with regards to fertility is that the testes do not work like that. The Leydig cells in the testes produce testosterone when stimulated by LH. Testosterone is released from these cells which are in close proximity to the Sertoli cells. When Sertoli cells see a high concentration of testosterone, they are stimulated to produce and mature sperm by the process of spermatogenesis. A high blood concentration of testosterone will not do this job. Thus administering anabolic androgenic steroids (AAS) will shut down natural testosterone production which will in turn slow down (and eventually near turn off) the proper formation and maturation of sperm. Thus infertility is a serious issue with use of anabolic steroids.

Classically, HCG has been seen to rectify this problem in males. HCG is an LH analogue – it 'looks' like LH to the body and so it can stimulate the Leydig cells to produce testosterone and in turn, hopefully, restore fertility. In some cases this will occur, and many people have had success from HCG therapy relating to infertility. However, the response is not robust and certainly with longer shut-down periods, many often find the use of HCG (even in combination with other post cycle therapy (PCT) medicines such as clomifene (aka clomid) and tamoxifen (aka nolvadex), etc) to not be effective at restoring fertility.

Furthermore, what HCG lacks is to produce the important effects that FSH inflicts upon fertility. FSH, despite its name, is important in male fertility in two main pathways. The first thing it does is to enhance the action of LH, by increasing the amount of protein that will 'see' testosterone in the Sertoli cells. The more easily these cells can see testosterone, the more likely spermatogenesis will occur. Secondly, FSH enhances the maturation of sperm by effects on their primary division. These are two important aspects of the role of FSH in the male testes that HCG is not optimal in promoting.

HMG, or its full name Human Menopausal Gonadotropin, bears similarities to HCG in that while HCG is similar to human LH, HMG contains actual LH. Additionally (and crucially) though, HMG also contains purified FSH. The combination of these two hormones perform the effects described above: induction of natural testosterone production by Leydig cells, and subsequent formation and maturation of sperm cells. The result is improved and potentially recovered fertility for the male concerned.

Does HMG really work?
So often we hear about various different drugs and the science for them is sound, but real world evidence is lacking. There are a few studies performed on HMG over the last 25 years, and I would like to draw your attention to two of these studies, pointing out a few key details. The first goes back to 1985 by Ley & Leonard and is an important study as it looks at males who had previously encountered anabolic steroids treatment (treatment for low hormone levels including mainly testosterone). This study is available online and I encourage you to read it in more detail than the brief summary I will provide here.

They looked at 13 hypogonadotropic men all of who had undetectable levels of LH/FSH, lower than normal levels of testosterone and azoospermia, thus were unable to currently conceive. Obviously with the low hormonal levels there were issues with libido as well. Furthermore, there were instances where upon testis biopsies, Leydig cells were completely absent. Despite this, all 13 men responded to treatment with HCG with increasing testosterone levels. However, upon addition of HMG treatment, most men saw a further increase in testosterone, sometimes very large. HCG was able to increase sperm counts in most men slightly; however, only upon addition of HMG were sperm counts above 'normal' fertility levels (i.e. 20 million per ml) observed. The study indicates that the addition of HMG therapy surpasses any level that HCG treatment could achieve alone. Admittedly this is a particular subset of men who have medical conditions and abnormal hormone issues, but the results are interesting nonetheless.

The second is more recent by Buchter et al in 1998. This is even more interesting from the point of view that it looks at three times the number of cases as the previous study and in a different manner. Again, this study can be found online and I encourage you to read it. The most interesting result you could take away from this study is that in the group of men treated who suffered from hypopituitarism, all 21 treated with HCG/HMG achieved spermatogenesis and a large proportion (81%) was able to successfully achieve pregnancies. The discussion of this article is most interesting as it raises the points from its own study and the literature that many in the field believe that to achieve spermatogenesis and pregnancy in a gonadotropin-compromised individual requires combinational therapy of HCG and HMG. The important point to note is that HCG is not sufficient alone in many cases.

Given the fact that other studies point to HMG increasing endogenous testosterone further than HCG can, as those who have relatively 'normal' pituitaries but have compromised their function due to AAS use, it would be wise to consider the use of HMG. This would not only be for purposes of fertility, but to induce natural testosterone levels back to normal values when they have been suppressed. Treatment in this latest study was the use of HCG twice per week at 1000-2500IU per dose (Mon-Fri) and HMG three times per week at 75-150IU (Mon-Wed-Fri). Thus for bodybuilders seeking to regain fertility, spermatogenesis and restore natural testosterone levels but wishing to keep costs down, a weekly dose of the lower ends should be employed for at least one month.

A schedule would involve:
Monday: 1000-1500IU HCG + 75IU HMG
Wednesday: 75IU HMG
Friday: 1000-1500IU HCG + 75IU HMG

Depending on the amount of suppression this cycle may need to be lengthened for a further period.