180 - AMA #28 [sneak peek]: All things testosterone and testosterone replacement therapy

Summary

In a recent episode of The Drive podcast, host Peter Etia and Bob delved into the topic of testosterone and testosterone replacement therapy in men. The aim of the episode was to provide a comprehensive overview of the subject, covering what testosterone is, how it works, the epidemiology of testosterone deficiency, the benefits and risks of replacement, and practical information on low testosterone levels and replacement.

Testosterone is a steroid hormone that is synthesized from cholesterol and exerts its effect by binding to an androgen receptor. It is transported in the blood by sex hormone binding globulin (SHBG) and albumin, and only the unbound portion is able to exert a biological influence. The hypothalamic-pituitary-gonadal axis regulates testosterone production, with gonadotropin releasing hormone from the hypothalamus triggering the release of luteinizing hormone and follicle-stimulating hormone from the anterior pituitary gland. These hormones stimulate testosterone production in the testes. Testosterone levels are regulated through a feedback loop, with low levels resulting in increased secretion of LH and FSH and high levels inhibiting their production.

The podcast hosts also discussed the risks and benefits of testosterone replacement therapy. Long-term exogenous testosterone supplementation can result in a permanent loss of the body's ability to produce testosterone. It is important to note that symptoms of low testosterone but with an inappropriately low LH and FSH are usually caused by sleep deprivation and hypercortisolemia. Therefore, it is important to rule out these underlying causes before undergoing testosterone replacement therapy.

Overall, the podcast provides a detailed and informative overview of testosterone and testosterone replacement therapy in men. It covers the science behind testosterone production, the risks and benefits of replacement therapy, and practical information on low testosterone levels and replacement. It is a must-listen for anyone interested in the topic.