In the United States, doctors prescribe the medication and provide guidelines on how to safely administer the therapy. Although it may have benefits for some people, the treatment is not without risk. It may also induce male secondary sex characteristics, such as facial hair. It may also promote the matching of a person’s gender identity and their body and allow them to experience gender congruence. Prenatal androgens apparently influence interests and engagement in gendered activities and have moderate effects on spatial abilities. Both testosterone and DHT bind to an androgen receptor; however, DHT has a stronger binding affinity than testosterone and may have more androgenic effect in certain tissues at lower levels. In addition to its role as a natural hormone, testosterone is used as a medication to treat hypogonadism and breast cancer. As the metabolism of testosterone in males is more pronounced, the daily production is about 20 times greater in men. In humans and most other vertebrates, testosterone is secreted primarily by the testicles of males and, to a lesser extent, the ovaries of females. This condition is very common — up to 15% of females of reproductive age have it. In female adults, high levels of testosterone may be a sign of polycystic ovary syndrome (PCOS). Keep testosterone enanthate injection (Xyosted®) in the container it came in, tightly closed, and out of reach of children. Call your doctor if you have any unusual problems while receiving this medication. Testosterone injection may cause other side effects. Testosterone may also causeprecocious puberty (early puberty) in children and teenagers. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. "Normal" ranges for testosterone also vary significantly based on your age and sex. Laboratories may have different reference ranges for normal testosterone levels. Low levels may indicate a delay in sexual development. A testosterone level that’s too low or high can cause health problems regardless of your sex. Levels of testosterone are naturally much higher in males. More specifically, the testicles in males and the ovaries in females make testosterone. Testosterone is used as a medication for the treatment of male hypogonadism, gender dysphoria, and certain types of breast cancer. Preliminary evidence suggests that low testosterone levels may be a risk factor for cognitive decline and possibly for dementia of the Alzheimer's type, a key argument in life extension medicine for the use of testosterone in anti-aging therapies. These include adult-type body odor, increased oiliness of skin and hair, acne, pubarche (appearance of pubic hair), axillary hair (armpit hair), growth spurt, accelerated bone maturation, and facial hair. The male brain is masculinized by the aromatization of testosterone into estradiol, which crosses the blood–brain barrier and enters the male brain, whereas female fetuses have α-fetoprotein, which binds the estrogen so that female brains are not affected. The second theory is similar and known as "evolutionary neuroandrogenic (ENA) theory of male aggression". It is therefore the challenge of competition among males that facilitates aggression and violence. Higher testosterone levels in men reduce the risk of becoming or staying unemployed. If a father's testosterone levels decrease in response to hearing their baby cry, it is an indication of empathizing with the baby. For instance, fluctuation in testosterone levels when a child is in distress has been found to be indicative of fathering styles. Fatherhood decreases testosterone levels in men, suggesting that the emotions and behaviour tied to paternal care decrease testosterone levels. Testosterone levels do not rely on physical presence of a partner; testosterone levels of men engaging in same-city and long-distance relationships are similar. You can inject testosterone in the left or right side of your stomach except your navel (belly button) and the area 2 inches around it. Do not use it if it is cloudy, contains visible particles, or if the expiration date on the package has passed. Always look at testosterone solution before you inject it. Be sure that you understand these instructions, and ask your healthcare provider if you have any questions. Do not use more or less of it or use it more often than prescribed by your doctor. Some effects are reversible once a person stops the treatment. When a person receives treatment for gender dysphoria, they may also begin to feel more like themselves and more comfortable in their own body. At age 16 years or younger, additional paperwork is necessary for people to access such therapy. Testosterone and other androgens have evolved to motivate men to pursue competition, even when doing so leads to risk. Studies conducted have found direct correlation between testosterone and dominance, especially among the most violent criminals in prison who had the highest testosterone. have been undertaken on the relationship between more general aggressive behavior, and feelings, and testosterone. Nearly all studies of juvenile delinquency and testosterone are not significant. Testosterone levels play a major role in risk-taking during financial decisions. Paternal care increases offspring survival due to increased access to higher quality food and reduced physical and immunological threats. This increases the reproductive fitness of the parents because their offspring are more likely to survive and reproduce.|High levels of testosterone in female infants may lead to enlargement of their clitoris that can look almost like a penis. Excess testosterone in male children can lead to precocious (early) puberty, which is when puberty begins before the age of nine. It’s unlikely — and difficult to tell — that a male adult has higher-than-normal levels of testosterone. The two charts below list the general normal ranges of testosterone based on age and sex. If any of these organs — your hypothalamus, pituitary gland or gonads — aren’t working normally, that can cause abnormal testosterone levels. For adult females, testosterone enhances libido.|There has been speculation that these changes in testosterone result in the temporary reduction of differences in behavior between the sexes. Testosterone may be a treatment for postmenopausal women as long as they are effectively estrogenized. There is a time lag effect when testosterone is administered, on genital arousal in women. This reaction engages penile reflexes (such as erection and ejaculation) that aid in sperm competition when more than one male is present in mating encounters, allowing for more production of successful sperm and a higher chance of reproduction. Therefore, these mammals may provide a model for studying clinical populations among humans with sexual arousal deficits such as hypoactive sexual desire disorder. Testosterone is included in the World Health Organization's list of essential medicines, which are the most important medications needed in a basic health system.|Studies have shown small or inconsistent correlations between testosterone levels and male orgasm experience, as well as sexual assertiveness in both sexes. 2020 guidelines from the American College of Physicians support the discussion of testosterone treatment in adult men with age-related low levels of testosterone who have sexual dysfunction. In humans, testosterone plays a key role in the development of male reproductive tissues such as testicles and prostate, as well as promoting secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair. Late-onset male hypogonadism happens when the decline in testosterone levels is linked to general aging and/or age-related conditions, particularly obesity and Type 2 diabetes. Classical male hypogonadism is when low testosterone levels are due to an underlying medical condition or damage to your testicles, pituitary gland or hypothalamus.|In the hepatic 17-ketosteroid pathway of testosterone metabolism, testosterone is converted in the liver by 5α-reductase and 5β-reductase into 5α-DHT and the inactive 5β-DHT, respectively. The conjugates of testosterone and its hepatic metabolites are released from the liver into circulation and excreted in the urine and bile. Androsterone and etiocholanolone are then glucuronidated and to a lesser extent sulfated similarly to testosterone. An additional 40% of testosterone is metabolized in equal proportions into the 17-ketosteroids androsterone and etiocholanolone via the combined actions of 5α- and 5β-reductases, 3α-hydroxysteroid dehydrogenase, and 17β-HSD, in that order. Approximately 50% of testosterone is metabolized via conjugation into testosterone glucuronide and to a lesser extent testosterone sulfate by glucuronosyltransferases and sulfotransferases, respectively. The plasma protein binding of testosterone is 98.0 to 98.5%, with 1.5 to 2.0% free or unbound. The amount of testosterone synthesized is regulated by the hypothalamic–pituitary–testicular axis (Figure 2).|A link has also been found between relaxation following sexual arousal and testosterone levels. Men who watch a sexually explicit movie have an average increase of 35% in testosterone, peaking at 60–90 minutes after the end of the film, but no increase is seen in men who watch sexually neutral films. In non-human primates, it may be that testosterone in puberty stimulates sexual arousal, which allows the primate to increasingly seek out sexual experiences with females and thus creates a sexual preference for females. The reflexive testosterone increases in male mice is related to the male's initial level of sexual arousal. When testosterone-deprived rats were given medium levels of testosterone, their sexual behaviours (copulation, partner preference, etc.) resumed, but not when given low amounts of the same hormone.|The age at which a person can access gender affirming hormone therapy varies across the world. Undergoing T therapy during adolescence (around the age of 16 years and older) may stop the development of female secondary sex characteristics, such as breasts. 3.1 In hypogonadal men who have started testosterone therapy, we recommend evaluating the patient after treatment initiation to assess whether the patient has responded to treatment, is suffering any adverse effects, and is complying with the treatment regimen.|Testosterone has been detected at variably higher and lower levels among men of various nations and from various backgrounds, explanations for the causes of this have been relatively diverse. Although commonly used as a reference range, some physicians have disputed the use of this range to determine hypogonadism. 5α-Reductase is highly expressed in the male reproductive organs (including the prostate gland, seminal vesicles, and epididymides), skin, hair follicles, and brain and aromatase is highly expressed in adipose tissue, bone, and the brain. Two of the immediate metabolites of testosterone, 5α-DHT and estradiol, are biologically important and can be formed both in the liver and in extrahepatic tissues. Certain cytochrome P450 enzymes such as CYP2C9 and CYP2C19 can also oxidize testosterone at the C17 position to form androstenedione. In addition to 6β- and 16β-hydroxytestosterone, 1β-, 2α/β-, 11β-, and 15β-hydroxytestosterone are also formed as minor metabolites.|The 6β-hydroxylation of testosterone is catalyzed mainly by CYP3A4 and to a lesser extent CYP3A5 and is responsible for 75 to 80% of cytochrome P450-mediated testosterone metabolism. In addition to conjugation and the 17-ketosteroid pathway, testosterone can also be hydroxylated and oxidized in the liver by cytochrome P450 enzymes, including CYP3A4, CYP3A5, CYP2C9, CYP2C19, and CYP2D6. A small portion of approximately 3% of testosterone is reversibly converted in the liver into androstenedione by 17β-HSD.}