Androgen Deficiency in Aging Men: A Case Study

At the age of 52, Richard experienced many changes in his health, including alterations in his mood, energy levels and libido. An evaluation of Richard’s hormone levels revealed low testosterone, dihydrotestosterone (DHT), zinc and vitamin D levels. Dr. Aidun recommended a trial of sublingual testosterone replacement therapy coupled with zinc and vitamin D supplements. Richard and his wife both noticed improvements in his energy and mood after three months of treatment.


When Richard turned 52, he began experiencing a number of changes in his energy levels, mood and libido. He had been married for 20 years and had no history of problems with intimacy, but was now unable to maintain an erection. Over the course of six months he was plagued by additional symptoms, including depression, lack of motivation and fatigue. Richard and his wife reported his mood changes as shocking, considering Richard generally has a positive temperament and Type A personality.

During this time, Richard also began putting on weight around the stomach. These changes developed gradually over the course of one year, but the changes in his attitude and sexual function were considered drastic.

Pre-Treatment Health Evaluation

Richard’s hormonal evaluation included the complete analysis of free testosterone, total testosterone and estradiol, as well as dihydrotestosterone (DHT) and the binding sex hormone globulin. Dr. Aidun also completed an evaluation of Richard’s thyroid profile and lipid panel and tested for nutrient deficiencies of zinc and vitamin D. A complete blood count (CBC) was also performed, as well as a prostate specific antigen test, or PSA.

While Richard’s symptoms suggested problems with hormone imbalance, evaluating testosterone levels alone would not provide a complete analysis of his health. Prior to proceeding with anti-aging treatment like testosterone replacement therapy, Dr. Aidun checked for contraindications like sleep apnea, prostate cancer or enlargement or a high red blood cell count.

The results of Richard’s evaluation were as follows:

Richard’s hormonal levels were all within the normal range, though his total testosterone, DHT and zinc levels were all close to the minimal levels recommended for optimal health. Recommended testosterone levels fall between 250 and 1100 ng/dl, with anything below 330 ng/dl medically regarded as low. The optimal range for a man of Richard’s age is 650 ng/dl, but Richard’s testosterone levels were close to half of that level, at 380 ng/dl. He was also deficient of vitamin D.

Richard’s estradiol and globulin levels, as well as his thyroid profile, lipid panel and complete blood count all returned normal. There was no indication of comorbidities, and prostate health was optimal.

Initial Treatment

Richard’s low total testosterone levels made him a candidate for a trial of testosterone replacement therapy. Richard opted for sublingual treatment with testosterone over injections, as the sublingual form of treatment requires fewer office visits during treatment.

Richard’s testosterone replacement therapy program included:

  • Sublingual testosterone replacement therapy: Richard took half of a testosterone lozenge twice daily.
  • Zinc: Taken in supplement form daily.
  • Vitamin D: Taken in supplement form daily.

Zinc assists in the conversion of testosterone to DHT, and prevents the conversion of testosterone to estrogen, so is ruled as an important supplement during anti-aging treatment.

Post-Treatment Follow Up

After two months of testosterone replacement therapy Richard reported a significant improvement in mood and sexual function. He felt overall positive about the treatment, though his health was not yet returned to an optimal state. Both Richard and his wife felt they noticed improvements in his overall demeanor.

A complete evaluation of blood samples was conducted after three months of testosterone replacement therapy. At this time Richard felt an even greater improvement in sexual function and mood than he did one month prior.

At this point Richard’s hormonal levels improved across the board:

  • Total testosterone levels improved more than two-fold, increasing from 380 ng/dl to 876 ng/dl.
  • Estradiol levels increased from 35 pg/ml at the onset of treatment to 48 pg/ml, which is just above the normal range. Estradiol levels typically fluctuate during treatment, as testosterone can convert into Estradiol and cause the levels to rise. Estradiol levels returned to 30 ng/dl at the four month treatment evaluation.
  • Vitamin D levels increased from 24 ng/ml to 56 ng/ml to be at a normal, though not optimal level.

Post-Follow Up Treatment Plan

After three months, Richard’s blood work demonstrated a high conversion of testosterone to estradiol and a rapid increase in DHT levels. Decreasing the testosterone dosage addressed both of these concerns.

Although Richard experienced an overall improvement in his health and mood, his health was not yet considered optimal. He was recommended to continue testosterone replacement therapy for nine months.


After six months, Richard had enough energy to begin exercising again and felt an increase in his stamina and overall energy levels. He also noticed faster recovery time after exercise. After one year, all hormonal levels and blood work samples were at optimal levels.


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