Nelson Vergel
Founder, ExcelMale.com
"If your testosterone is below about 425 ng/dl and your dr. is not treating you, then you need to read this book. The risks dramatically increase at about this level for arteriosclerosis, erectile dysfunction, diabetes, insulin resistance, venous leakage and so on. This book summarizes the latest studies and the author is Lee Myer, creator of the popular men's site, Peak Testosterone."
The following information is an excerpt from the book "Low Testosterone by the Numbers" by Lee Myer. I highly recommend it since the author really did his homework by reading most important papers on TRT to counter a lot of the misconceptions out there. I particularly like it since he did a better job than me when it comes to explaining the different health issues related to low T and what "low T" means in different studies. He also went through the trouble of providing references to each one of his statements (I know how much work that is!).
Reading this book before you read mine would be a great thing for anyone to who has not read either one of them. You can get it at
http://www.peaktestosterone.com/Low_Testosterone_By_The_Numbers.aspx
MORNING ERECTIONS
One of the most important things for the health of your penis actually occurs while you’re sleeping: morning erections. Most experts believe that morning erections are critical for oxygenation of the internal penile tissues. Not too surprisingly, low testosterone has been linked with decreased morning erections and this may be yet another reason that it leads to penile atrophy. As an example, one study looked at men with a wide variety of testosterone levels. They found that men with low testosterone had an assortment of erectile problems, including decreased morning erections, and estimated that the threshold for morning erections was about 200 ng/dl (6.8 nmol/l). [40]
The good news? A number of studies have shown that nocturnal erections are increased and improved after testosterone replacement. [41] However, it is important to note that recovery from lack of morning erections can take time. One study found that morning (and spontaneous) erections improved steadily over the course of 12 months. [42] This is likely because the body must literally rebuild tissues and receptors within the penis.
VENOUS LEAKAGE
We mentioned above that a huge block of men with erectile dysfunction, around a third, are unresponsive to Viagra, Cialis and Levitra. The primary reason for this appears to be an ugly condition called venous leakage. Venous leakage refers to the anti-erection physical state where blood leaks out of the penis as fast as it flows
in, leading to limp or non-existent erections. The rapid loss of an existing erection can also be a sign of venous leakage. “Easy come, easy go” as they say...
NOTE: There can be other reasons for and contributors to these kinds of erectile issues, including damage to the pudendal nerve from back injury or biking, pelvic surgery, hypertension, diabetes and other medical conditions. [63] [64]
What is one of the primary causes of venous leakage? You guessed it - low testosterone. Researchers have found in the last decade that the internals of the penis literally atrophy in the absence of a testosterone-rich environment. Nerves within the penis wither. Collagen is lost. Connective tissue is hardened. [49]
Of course, this is potentially bad news for your sex life. The reason is that the structures that are supposed to pinch off the veins that allow blood out of the penis don’t do their pinching. This allows as much of an outflow as an inflow into the penis and means that even with all the blood flow-boosting nitric oxide in the world, an erection cannot occur. One reader described this situation by writing, “While I can achieve erections strong enough to gain entry with Cialis, I still do not have strong erections for longer than 10 seconds without stimulation and only a couple seconds if standing.” A leaking boat can’t float…
So what is the magic number at which internal penile damage begins to occur and venous leakage begins to rear its ugly head? In one study, researchers looked at men with venous leakage, all of whom had testosterone < 300 ng/dl (10.2 nmol/l). [50] Obviously, 300 ng/dl and less can be a problem area for many guys.
However, could we say, then, that 300 ng/dl is the threshold? Actually, for some men it is probably higher than that as indicated by one study where all participants had venous leakage and some men had testosterone up to 400 ng/dl. [51] In other words, it depends on the individual, but it is possible that some men will begin to experience damage to the penis at 400 ng/dl (13.6 nmol/l) with still others at 300 ng/dl or even 250.
Is there a solution? Several studies to date have shown that by restoring testosterone to more normal levels, a partial reversal is possible. Of course, just how much of a reversal can be achieved likely depends on many factors, including the number of hypogonadal years as well as various lifestyle factors. The good news is that a study of Russian, low T men with erectile dysfunction and venous leakage showed good results from testosterone therapy. In this study, almost all of these men were unresponsive to PDE5 Inhibitors such as Cialis, Levitra and Viagra and all of them had testosterone below 300 ng/dl (10.2 nmol/l). [52] In spite of their seemingly dire circumstances, about a third of the men were cured through just testosterone therapy alone. Another third were cured through a combination of testosterone and PDE5 Inhibitors. The means that a solid majority of the men were significantly healed of their venous leakage and achieved a substantial reversal with the help of HRT.
The following information is an excerpt from the book "Low Testosterone by the Numbers" by Lee Myer. I highly recommend it since the author really did his homework by reading most important papers on TRT to counter a lot of the misconceptions out there. I particularly like it since he did a better job than me when it comes to explaining the different health issues related to low T and what "low T" means in different studies. He also went through the trouble of providing references to each one of his statements (I know how much work that is!).
Reading this book before you read mine would be a great thing for anyone to who has not read either one of them. You can get it at
http://www.peaktestosterone.com/Low_Testosterone_By_The_Numbers.aspx
MORNING ERECTIONS
One of the most important things for the health of your penis actually occurs while you’re sleeping: morning erections. Most experts believe that morning erections are critical for oxygenation of the internal penile tissues. Not too surprisingly, low testosterone has been linked with decreased morning erections and this may be yet another reason that it leads to penile atrophy. As an example, one study looked at men with a wide variety of testosterone levels. They found that men with low testosterone had an assortment of erectile problems, including decreased morning erections, and estimated that the threshold for morning erections was about 200 ng/dl (6.8 nmol/l). [40]
The good news? A number of studies have shown that nocturnal erections are increased and improved after testosterone replacement. [41] However, it is important to note that recovery from lack of morning erections can take time. One study found that morning (and spontaneous) erections improved steadily over the course of 12 months. [42] This is likely because the body must literally rebuild tissues and receptors within the penis.
VENOUS LEAKAGE
We mentioned above that a huge block of men with erectile dysfunction, around a third, are unresponsive to Viagra, Cialis and Levitra. The primary reason for this appears to be an ugly condition called venous leakage. Venous leakage refers to the anti-erection physical state where blood leaks out of the penis as fast as it flows
in, leading to limp or non-existent erections. The rapid loss of an existing erection can also be a sign of venous leakage. “Easy come, easy go” as they say...
NOTE: There can be other reasons for and contributors to these kinds of erectile issues, including damage to the pudendal nerve from back injury or biking, pelvic surgery, hypertension, diabetes and other medical conditions. [63] [64]
What is one of the primary causes of venous leakage? You guessed it - low testosterone. Researchers have found in the last decade that the internals of the penis literally atrophy in the absence of a testosterone-rich environment. Nerves within the penis wither. Collagen is lost. Connective tissue is hardened. [49]
Of course, this is potentially bad news for your sex life. The reason is that the structures that are supposed to pinch off the veins that allow blood out of the penis don’t do their pinching. This allows as much of an outflow as an inflow into the penis and means that even with all the blood flow-boosting nitric oxide in the world, an erection cannot occur. One reader described this situation by writing, “While I can achieve erections strong enough to gain entry with Cialis, I still do not have strong erections for longer than 10 seconds without stimulation and only a couple seconds if standing.” A leaking boat can’t float…
So what is the magic number at which internal penile damage begins to occur and venous leakage begins to rear its ugly head? In one study, researchers looked at men with venous leakage, all of whom had testosterone < 300 ng/dl (10.2 nmol/l). [50] Obviously, 300 ng/dl and less can be a problem area for many guys.
However, could we say, then, that 300 ng/dl is the threshold? Actually, for some men it is probably higher than that as indicated by one study where all participants had venous leakage and some men had testosterone up to 400 ng/dl. [51] In other words, it depends on the individual, but it is possible that some men will begin to experience damage to the penis at 400 ng/dl (13.6 nmol/l) with still others at 300 ng/dl or even 250.
Is there a solution? Several studies to date have shown that by restoring testosterone to more normal levels, a partial reversal is possible. Of course, just how much of a reversal can be achieved likely depends on many factors, including the number of hypogonadal years as well as various lifestyle factors. The good news is that a study of Russian, low T men with erectile dysfunction and venous leakage showed good results from testosterone therapy. In this study, almost all of these men were unresponsive to PDE5 Inhibitors such as Cialis, Levitra and Viagra and all of them had testosterone below 300 ng/dl (10.2 nmol/l). [52] In spite of their seemingly dire circumstances, about a third of the men were cured through just testosterone therapy alone. Another third were cured through a combination of testosterone and PDE5 Inhibitors. The means that a solid majority of the men were significantly healed of their venous leakage and achieved a substantial reversal with the help of HRT.
