Defy Medical

Abstract | Context: Although sex hormone binding globulin (SHBG) and testosterone (T) have been inversely associated with risk of diabetes, few studies have examined dihydrotestosterone (DHT), a more potent androgen than T, or older adults, whose glycemic pathophysiology differs from younger adults.

Objective: To determine the associations of SHBG, T, and DHT with insulin resistance and incident diabetes in older adult men. Design: In a prospective cohort study, we evaluated baseline levels of SHBG, T, and DHT using liquid chromatography–tandem mass spectrometry among 852 men in the Cardiovascular Health Study free of diabetes and cardiovascular disease in 1994.

Harumi Okuyama, Peter H Langsjoen, Tomohito Hamazaki, Yoichi Ogushi, Rokuro Hama, Tetsuyuki Kobayashi & Hajime Uchino Pages 189-199 | Published online: 06 Feb 2015 | Link To Article

In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q 10and ‘heme A’, and thereby ATP generation. Statins inhibit the synthesis of vitamin K 2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress. An impairment of selenoprotein biosynthesis may be a factor in congestive heart failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency. Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated.

A Low Dead space syringe is a type of syringe designed to limit the amount of dead space that exists between the syringe hub and needle and reduces the amount of “wasted” medication with each injection. Syringe dead space is the volume of residual fluid that remains within the syringe after the plunger is fully depressed during medication injection. The difference between “High Dead Space” or a standard syringe, and a “Low Dead Space” syringe is determined by the amount of fluid that remains within the needle and syringe itself. When a patient is injecting his/her prescribed medications multiple times per week, the amount of “waste” can add up significantly. More medication can be lost when a new needle is attached for injection purposes. Dead space in a standard syringe can be as high as 84 micro liters with each injection. This can also introduce the problem of inaccurate dosing, especially when prescribed smaller, more frequent injections of your prescribed medication.

Low Dead space syringe

With a typical wastage of 84uL (microliter = 0.084mL) per injection, a patient injecting 0.35ml of testosterone twice weekly should expect about 28 injections per 10mL of Testosterone Cypionate.

28 injections X 0.084mL wastage per injection = 2.35ml of wastage per 10mL vial.


28 injections X 0.002mL wastage LOW DEAD SPACE = 0.56mL of wastage per 10mL vial.
See picture above

To better assist our patients and provide the most accurate needle and syringe options for administering medications, Defy Medical is now offering a more precise, low dead space 1mL Luer Lock syringe. These syringes can be used for injecting testosterone, HCG and injectable vitamins/amino acids.

To place an order please contact our office at 813-445-7342 or email us at and we can ship the order directly from our clinic.

hypothyroidism, or an underactive thyroid

About 15 percent of the 10-12 million people in the U.S. with hypothyroidism, or an underactive thyroid, continue to feel sick despite following the standard of care recommended by the American Thyroid Association. Physicians routinely prescribe levothyroxine, a synthetic thyroid hormone, adjusting the dose until blood levels of thyroid-stimulating hormone (TSH) stabilize.

Despite normal TSH tests, these patients still have many nagging symptoms of hypothyroidism. "Patients complain of being depressed, slow and having a foggy mind," said Rush's Antonio C. Bianco, MD, PhD, an immediate past president of the American Thyroid Association that is professor of medicine at Rush and an expert on thyroid disorders "They have difficulty losing weight. They complain of feeling sluggish and have less energy. Yet we doctors keep telling them, 'I'm giving you the right amount of medication and your TSH is normal. You should feel fine.'"

By: Patricia Kime, September 23, 2016 (Photo Credit: Lance Cpl. Joshua Rudy/U.S. Marine Corps)/p>

The Defense Department is studying whether a boost of testosterone can keep military muscle and brains operating in top form during long periods of combat.

When troops are engaged in prolonged physical activity like war and contingency operations, they are unable to consume the calories needed to sustain high physical and mental function, according to medical researchers.

The calorie deficit -- sometimes as much as 50 percent to 60 percent below the needed amount -- can result in muscle loss, fatigue, cognitive decline and, in men, a drop in testosterone, leaving them vulnerable to injury, illness, wounds or death.

Thienel M, et al. Int J Obes. 2016;doi:10.1038/ijo.2016.149.
August 29, 2016

Among men with obesity, intranasal oxytocin administration led to reduced food intake following an overnight fast vs. men who received an intranasal placebo, according to recent study results.

We demonstrate that the acute intranasal administration of oxytocin inhibits reward-[driven] but also hunger-driven food intake in obese men and that this effect is not compensated for by changes in energy expenditure,” Matthias Thienel, a doctoral student at the Institute for Medical Psychology and Behavioural Neurobiology at the University of Tubingen, Germany, and colleagues wrote. “In normal-weight men, the oxytocin-induced reduction in calorie consumption was restricted to snacking, indicating that the inhibitory effect of oxytocin on food intake is generally larger in obese than normal-weight subjects.”

Compounding pharmacies must safeguard public health

By Shaun Noorian
September 9, 2016

Having a prescription filled is one of the routine things most of us do for our health. That simple activity is anything but routine for the millions of individuals who can’t tolerate medicines made for the masses. They may have an allergy to an ingredient, require a drug of a different strength than is commercially available, require an injectable medicine rather than one in pill form, or need a drug that is no longer manufactured by a pharmaceutical company.

That’s where compounding pharmacies come in. These companies customize medications, often mixing raw ingredients into preparations that can be taken orally, applied to the skin as a lotion or cream, placed under the tongue as a lozenge or, in the case of sterile compounding, injected into the body or placed in an intravenous line.

Abraham Morgentaler, MD (Chairman); Michael Zitzmann, MD (Cochairman);
Abdulmaged M. Traish, PhD (writing group);
Anthony W. Fox, MSc, MD (writing group); T. Hugh Jones, MD (writing group);
Mario Maggi, MD (writing group); Stefan Arver, MD; Antonio Aversa, MD;
Juliana C.N. Chan, MD; Adrian S. Dobs, MD; Geoffrey I. Hackett, MD;
Wayne J. Hellstrom, MD; Peter Lim, MD; Bruno Lunenfeld, MD;
George Mskhalaya, MD; Claude C. Schulman, MD; and Luiz O. Torres, MD


To address widespread concerns regarding the medical condition of testosterone (T) deficiency (TD) (male hypogonadism) and its treatment with T therapy, an international expert consensus conference was convened in Prague, Czech Republic, on October 1, 2015. Experts included a broad range of medical specialties including urology, endocrinology, diabetology, internal medicine, and basic science research. A representative from the European Medicines Agency participated in a nonvoting capacity. Nine resolutions were debated, with unanimous approval: (1) TD is a well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health, and quality of life; (2) symptoms and signs of TD occur as a result of low levels of T and may benefit from treatment regardless of whether there is an identified underlying etiology; (3) TD is a global public health concern; (4) T therapy for men with TD is effective, rational, and evidence based; (5) there is no T concentration threshold that reliably distinguishes those who will respond to treatment from those who will not; (6) there is no scientific basis for any age- specific recommendations against the use of T therapy in men; (7) the evidence does not support increased risks of cardiovascular events with T therapy; (8) the evidence does not support increased risk of prostate cancer with T therapy; and (9) the evidence supports a major research initiative to explore possible benefits of T therapy for cardiometabolic disease, including diabetes. These resolutions may be considered points of agreement by a broad range of experts based on the best available scientific evidence.

Read Full Article

Published July 13, 2016
US Pharmacist

Houston—Older men using “Low T” treatment will undoubtedly welcome this news from their pharmacist: Testosterone replacement therapy was found to increase their interest in sex and promote more sexual activity if they previously had low libido and low testosterone levels.

The study, touted as the largest placebo-controlled trial in older men conducted on the subject to date, was published recently in the Journal of Clinical Endocrinology & Metabolism.

The sexual function study is part of the National Institute of Health’s Testosterone Trials, a series of seven studies examining the effectiveness of hormone therapy in men who are 65 or older, have low testosterone levels, and are experiencing symptoms of testosterone deficiency.

Dr Justin Saya, M.D. – Case Study of HPTA Suppression for MTF Transgender Patient

Case Study: Observations of Testosterone/Estradiol Levels and HPTA Response in a MTF Transgender Patient Undergoing Hormonal Feminization Therapy

Dr Justin Saya, MD - Defy Medical
May 11, 2016

Case Study of HPTA Suppression for MTF Transg ender Patient

Case Presentation

Patient consent was obtained to use laboratory data and case details from patient, however care is taken to maintain patient privacy and limit any potentially identifying information.

Patient is a biological male presenting a t an age of 20 – 25 years old having been referred by his counselor for hormonal treatment to assist MTF transgender transformation. A thorough examination and consult was performed on patient including counseling, lab review, and all appropriate consents were reviewed and sign ed. Once appropriateness of treatment was determined, MTF transformative hormonal treatment was initiated in the form of estradiol cypionate twice weekly injections. For the purpose of simplicity and a focused discussion, dosages of e stradiol cypionate will not be included, but rather the resulting serum estradiol levels (via LC - MS/MS) from gradual estradiol cypionate dosage escalation.

By André Guay and Susan R. Davis

Excerpt from World Journal of Urology 2002. 20:106-110

It has become apparent that androgens play a significant role in women’s health. More than the expected level of androgens in a woman’s blood stream causes obvious symptoms of androgen excess; less readily apparent are the consequences of female androgen deficiency. The symptoms are subtle, affecting a woman’s sexual desire, satisfaction, and mood, and are commonly mistaken as signs of an underlying depression, prompting referral for counseling and psychotherapy, when hormone measurements would be more appropriate and more fruitful. Androgen deficiency in women is a topic that the medical community has been slow to address. This is partially attributed to the fact that the most common symptom is decreased libido, a very common nonspecific complaint that has long been associated with the psychological issues of stress and depression. One of the earliest reports showing an association between decreased sexual desire and decreased testosterone in women was published in 1959, but acceptance of this association has been slow. However, more evidence now shows that many women-pre-menopausal and post-menopausal-do suffer from androgen deficiency. Because the symptoms of such a deficiency resemble those of depression, misdiagnosis and lack of treatment are common. Improved awareness of the symptoms, diagnostic procedures, and appropriate available treatments are needed, to avoid misdiagnosis and unnecessary or inappropriate treatments.

By Susan Scutti - Apr 8, 2016

Testosterone Shots and Gel May Reduce Heart Attack Risk In Men With Coronary Artery Disease

Last year, the Food and Drug Administration required manufacturers of testosterone products to add new label information warning of a possible increased risk of heart attacks and strokes. A new study suggests this may be both unnecessary and unhealthy for some men. Testosterone therapy or T therapy helped men with preexisting coronary artery disease reduce their risks of strokes, heart attacks, and even death.

In fact, the men who did not receive testosterone as part of their treatment were 80 percent more likely to suffer an adverse event, such as a heart attack, than those taking T.

Northwestern Memorial HealthCare - Public Release: 17-Feb-2016

CHICAGO, IL - A new study published in the New England Journal of Medicine shows testosterone treatment for men over 65 years old not only improves sexual function but also slightly improves mood and physical ability. A team of researchers from 12 medical centers across the United States, including Northwestern Memorial Hospital, participated in the study.

"In recent years, talk about low testosterone and its treatments have become part of the public discussion," said Mark E. Molitch, MD, a Northwestern Medicine endocrinologist and one of the authors of the study. "Yet questions have always lingered about the treatment's effectiveness and safety. I believe the results of this large, nationwide study will provide doctors and patients answers and guidance they've been looking for."

Dr Justin Saya, M.D. – February 2016

Serum Beta hCG Concentrations Resulting from Single hCG Injection

Dr Justin Saya, M.D. - Defy Medical, LLC

Prior to delving into discussion, I wanted to take time to express a special thank you to Defy Medical management and staff for following through with the logistics of the following case study, the study participants for their willingness to volunteer, and also my colleagues, Jill Dillenburg, RN and Dr John Crisler, D.O. for their support of the case study.


The human endocrine system comprises a complex network of organs, glands, hormones, receptors, binding globulins, enzymes, and mRNA/DNA transcription cascades that result in a multitude of vital end-products and processes throughout the body. Furthermore, this network is, for the most part, self-regulating via intricate control processes involving both positive and negative feedback loops.

Have you been prescribed Propecia (aka finasteride) for Hair-Loss

Common side effects from taking Propecia includes:

  • Depression
  • Anxiety
  • Muscle weakness & loss
  • Erectile Dysfunction
  • Inability to orgasm
  • Bone loss
  • Fatigue

If you are experiencing any of these symptoms after taking Propecia the good news is you wont have to needlessly suffer as there is treatment available which can reverse the effects of finasteride.

Defy Medical offers interventional treatment designed to reverse these symptoms through hormone re-balancing and optimization while providing hair restoration at the same time using the latest evidence based treatment protocols. Contact us for a free consultation!

Cynthia Fox, Science Writer

Men’s Heart Disease Partly Due to Low Estrogen

One reason men have more heart disease than women is the very fact that they are men, reports Harvard University endocrinologist Evelyn Yu, M.D., MS.c. Both men’s higher testosterone levels and their lower estrogen levels, play a role.

Study of 83,000 veterans finds cardiovascular benefits to testosterone replacement

Veterans Affairs Research Communications

A Veterans Affairs database study of more than 83,000 patients found that men whose low testosterone was restored to normal through gels, patches, or injections had a lower risk of heart attack, stroke, or death from any cause, versus similar men who were not treated.

The study also found that men who were treated but did not attain normal levels did not see the same benefits as those whose levels did reach normal. The study was published online Aug. 6, 2015, in the European Heart Journal.

Eating foods rich in amino acids could be as good for your heart as stopping smoking or getting more exercise – according to new research from the University of East Anglia (UEA).

A new study published today reveals that people who eat high levels of certain amino acids found in meat and plant-based protein have lower blood pressure and arterial stiffness.

Public Release: 22-Jun-2015
Oregon State University

high-fat and a high-sugar diet

CORVALLIS, Ore. - A study at Oregon State University indicates that both a high-fat and a high-sugar diet, compared to a normal diet, cause changes in gut bacteria that appear related to a significant loss of "cognitive flexibility," or the power to adapt and adjust to changing situations.

This effect was most serious on the high-sugar diet, which also showed an impairment of early learning for both long-term and short-term memory.

The testosterone storm

The concept of the thyroid storm is well known in medicine. Today we are dealing with what might be called a “testosterone storm” surrounding the scientific and public health debate over the use of testosterone replacement therapy. Last year, after a September 2014 FDA Advisory Committee meeting, manufacturers were required to include a label addition about a “possible” increased risk of heart attacks and strokes in patients taking testosterone. A large-scale study to assess cardiovascular risk was also recommended. The uncertainty of whether or not testosterone supplementation increases cardiovascular risks is the primary driver of the conflict.

Florida State University

Testosterone needs estrogen's help to inhibit depression

In popular culture, the phrase “battle of the sexes” seems to pit the male hormone (testosterone) against the female (estrogen). Now a Florida State University College of Medicine researcher has documented a way in which the two hormones work together to protect low-testosterone males from the effects of anxiety and depression.

Specifically, the testosterone must first be converted into estrogen. That’s the latest discovery from the lab of biomedical sciences Professor Mohamed Kabbaj. With a six-year grant from the National Institute of Mental Health, he is investigating the ways in which anxiety affects the sexes differently.

By Sanjai Sinha, MD, FACP, Assistant Professor, Department of Medicine, Weill Cornell Medical College, New York, NY
Reviewed By Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY

Declining Testosterone in Older Men

Serum testosterone concentration peaks during adolescence and early adulthood. Males tend to have a 1% to 2% reduction per year in testosterone beginning in their 30s.1 A more precipitous decline may indicate a higher probability of mortality. Observational studies have associated low serum testosterone and late-onset hypogonadism with cardiovascular risk factors, diabetes, and hyperlipidemia.2-4 While these intermediary outcomes are clearly related to premature death, the effect of testosterone decline on longevity is less clear. Several studies have shown conflicting results.

Summary written by: J. Bruce

male population explores the relationship between your testosterone and erectile function

A recent study of a male population explores the relationship between your testosterone and erectile function. As suspected, higher levels of testosterone equals a better erection and improved sex drive. This study also helps to explain the different types of blood tests used to check testosterone, and why it is important for men and women to have more than just the total testosterone checked (also known as serum testosterone).

The study observed over 700 men from a specific population (population-based study) and established a correlation between a man’s testosterone level and his erectile function.

Topical minoxidil fortified with finasteride

Background:Finasteride acts by reducing dihydrotestosterone levels, thereby inhibiting miniaturization of hair follicles in patients with androgenetic alopecia (AGA). Oral finasteride is associated with side effects such as decreased libido, sexual dysfunction, and gynecomastia. Aim:The aim of the following study is to assess the efficacy of maintaining hair growth with 5% topical minoxidil fortified with 0.1% finasteride in patients with AGA after initial treatment with 5% topical minoxidil and oral finasteride for two years.

Morgentaler A, Conners WP. Testosterone therapy in men with prostate cancer: literature review, clinical experience, and recommendations. Asian J Androl [Epub ahead of print] [cited 2015 Feb 6]. Available from: DOI: 10.4103/1008-682X.148067

January 26, 2015 | by Neuro Science News
- See more at:

Female sex hormones have a strong effect on the psyche. This has been confirmed by numerous scientific studies and by phenomena such as the "baby blues," a bout of low mood following childbirth, or recurrent mood swings that occur prior to menstruation. However the male sex hormone testosterone also affects our mood and emotions, as well as our libido -- and in a positive way.


--John Crisler, DO

We have already learned a practical bit about the various hormones composing the metabolic “symphony” which constitutes our hormonal milieu. We know where these hormones are produced, largely what influences modulate their production, as well as the target tissues of their various and varied actions. But we still need to integrate this knowledge into a practical “recipe”, if you will, to enable the clinician to return to his/her practice, and immediately begin screening for, and successfully treating, male hypogonadism. In other words, how do we administer Testosterone Replacement Therapy (TRT) for men?


By Nelson Vergel, BsChE, MBA

Testosterone is the precursor hormone for estradiol. Estradiol is a hormone more abundant in women than men that is produced by the aromatization of testosterone in liver, fat and other cells. Nature created it for a reason. It has been shown to be responsible for healthy bone density but its role in men's sex drive, body composition and other variables is source of great debate. One thing is certain: High estradiol blood levels can cause growth of breast tissue in men

Testosterone Replacement Therapy and Polycythemia

By Nelson Vergel, B.S.Ch.E., M.B.A.

Polycythemia is an excessive production of red blood cells. With polycythemia the blood becomes very viscous or "sticky," making it harder for the heart to pump. High blood pressure, strokes and heart attacks can occur.

The association between testosterone replacement therapy and polycythemia has been reported for the past few years as this therapy has become more mainstream. In addition to increasing muscle and sex drive, testosterone can increase the body's production of red blood cells. This hematopoietic (blood-building) effect could be a good thing for those with mild anemia.

Defy Medical is offering a national patient assistance program to people with HIV who currently have limited access to medications meant to improve their quality of life.

December 1, 2014 -
Defy Medical is offering a national patient assistance program to people with HIV who currently have limited access to medications meant to improve their quality of life. According to the Center for Disease control over 50% of people living with HIV in the United States will be over 50 years of age by the year 2015. This aging population that has been exposed to a deadly virus and toxic medications in the past has a lot more comorbidities than HIV-negative people of the same age.

Most absorption of testosterone in testosterone gels happens during the first 4 hours. The 1.62 % Androgel package insert says this about showering after testosterone gel application and using moisturizers/sun block:

Effect of showering

In a randomized, 3-way (3 treatment periods without washout period) crossover study in 24 hypogonadal men, the effect of showering on testosterone exposure was assessed after once daily application of AndroGel 1.62% 81 mg to upper arms/shoulders for 7 days in each treatment period. On the 7th day of each treatment period, hypogonadal men took a shower with soap and water at either 2, 6, or 10 hours after drug application. The effect of showering at 2 or 6 hours post-dose on Day 7 resulted in 13% and 12% decreases in mean Cavg, respectively, compared to Day 6 when no shower was taken after drug application.

Showering at 10 hours after drug application had no effect on bioavailability. The amount of testosterone remaining in the outer layers of the skin at the application site on the 7th day was assessed using a tape stripping procedure and was reduced by at least 80% after showering 2-10 hours post-dose compared to on the 6th day when no shower was taken after drug application.

Defy Medical is dedicated to helping veterans access affordable therapies which focus on quality of life and longevity.

Defy Medical is dedicated to helping veterans access affordable therapies which focus on quality of life and longevity.

Many veterans have access to healthcare but are limited to specific treatments which may exclude quality of life medications. Veterans usually have to pay out of pocket for such medications or cannot get prescriptions they need due to limitations in their health care system. Some may not meet the qualifications needed to receive complete medical care and don’t know where to turn. The types of treatment increasingly sought by veterans who cannot obtain treatment through conventional pathways include; treatments to combat depression, low testosterone, sexual dysfunction, fatigue, and other life quality issues.

BMJ Open 2014;4:e005462 doi:10.1136/bmjopen-2014-005462
Reproductive medicine Research
Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men


Objective Study associations between three measures of alcohol consumption (recent, typical/habitual, binging), semen quality and serum reproductive hormones.

Im sure this study has been posted before, but for those that missed it here is a study showing the opposite of what is being touted in the media regarding testosterone and heart attacks. This study claims that maintaining T levels above 550ng actually reduced cardiac disease risk. Note that they tested estradiol levels, which was lacking in the inaccurate study recently published.

It is shocking that the recent study which claimed that testosterone causes heart attacks has found its reach within certain medical circles, then to the masses, considering the obvious flaws within the study itself. Not surprising are the attorney's looking to make a buck off anything they can spin to their benefit. They are using this flawed study to generate lawsuits against Big Pharma producers of testosterone medications. The problems within this study include: Lack of testing and monitoring estradiol conversion, which can happen in aging men and easy to manage with proper treatment. Lack of testing and monitoring Hematocrit/red blood cells which can become elevated in men given testosterone. This is also easily manageable and preventable when properly monitored.

Frederick LR, Cakir OO, Arora H, Helfand BT, McVary KT.

J Sex Med. 2014 Jul 24. doi: 10.1111/jsm.12647.

INTRODUCTION: Prior research conducted on treatment of erectile dysfunction (ED) has been derived from surveys involving relatively small populations of men. There are needs for large population-based studies in this area. Our study addresses that need.


The Journal of Urology

Volume 160, Issue 2, August 1998, Pages 389–393

For First Time, Researchers Analyze Levels of Testosterone and Estradiol to Predict Patients' Likelihood of Suffering Usually Fatal Condition, Take Another Step Toward Offering Preventive Treatments


Los Angeles - Sept. 2, 2014 – Measuring the levels of sex hormones in patients' blood may identify patients likely to suffer a sudden cardiac arrest, a heart rhythm disorder that is fatal in 95 percent of patients.

A new study, published online by the peer-reviewed journal Heart Rhythm, shows that lower levels of testosterone, the predominant male sex hormone, were found in men who had a sudden cardiac arrest. Higher levels of estradiol, the major female sex hormone, were strongly associated with greater chances of having a sudden cardiac arrest in both men and women.

"Because sudden cardiac arrest is usually fatal, we are constantly looking for ways to predict which patients are susceptible so we can concentrate on prevention," said Sumeet Chugh, MD, director of the Heart Rhythm Center in the Cedars-Sinai Heart Institute and the Pauline and Harold Price Chair in Cardiac Electrophysiology Research. "If we wait until someone has a sudden cardiac arrest, it is usually too late for treatment."

We have selected a few abstracts from studies done on the effects of low testosterone, and testosterone supplementation in women. Sometime referred to as “the hidden disease”, low testosterone in women has been overlooked mainly due to testosterone being viewed primarily as a “male hormone”. Women have testosterone too, although in smaller amounts than men, but this small amount is necessary for many important functions highlighted in the studies below. The potential side effects listed within many of these studies as a concern are acne and facial hair growth (hirsutism) but we know that this can be mitigated with proper dosing. If acne or facial hair growth occur, typically this means the testosterone is dosed too high. Proper dosing will not produce these effects.

DHEA: What do the studies show?

DHEA is a steroid prohormone produced by the adrenal glands and transformed in target tissue through intracrine mechanisms to androgens or estrogens. Plasma DHEA levels decline with age. By the age of 70–80 years, levels may be as low as 10%–20% of those encountered in young individuals.

The importance of DHEA in steroid hormone production increases with age. Indeed, in postmenopausal women, production of estrogens by the ovaries declines dramatically, making the adrenals the only source of steroid hormones through DHEA. In men, although T secretion by the testicles continues late into life, T levels progressively decline, and DHEA’s importance in steroid hormone production is also higher with increasing age. DHEA’s effect is mostly through its hormone end products.