We certainly need the effects of testosterone all over our body and not just to the testes. Levels of total testosterone and free testosterone need to be monitored as well as Estradiol levels, and if possible levels of dihydrotestosterone (DHT). This potent form of testosterone can cause central scalp baldness and can lead to benign prostatic hypertrophy (BPH).

Two enzymes of 5-alpha reductase cause the conversion of testosterone to DHT, one in the skin causing sebum (skin oil) production and changing hair growth. The other 5-alpha reductase in the prostate will increase the productjon of DHT to allow increased fibrous and muscular size of the prostate - sometimes out of control - blocking the flow of urine because of benign prostatic hypertrophy (BPH). In our practice we liberally use saw palmetto (Serenoa repens), a herbal extract from berries to inhibit 5-alpha reductase that may also suppress estrogen.

We reserve the use of finasteride (Proscar and Propecia) for the major suppression of DHT when the levels are much too high or when BPH or baldness are major issues to be tackled.

Before anyone is even considered for testosterone replacement, a thorough digital rectal exam is done, and serum PSA (blood test for prostate specific antigen) is a must to detect prostate cancer.

Patients with snoring and sleep apnea are cautioned that testosterone replacement worsens this condition and discussion with your doctor is imperative.

The third book of the Doctors' Secrets trilogy, "What Men Want: Testosterone - Sharing the Secrets of Men's Health" is an in-depth study targeting men's health issues.