What is the protocol to increase libido, testosterone, and dihydrotestosterone (DHT)?

From the Guidelines

Increasing Libido, Testosterone, and Dihydrotestosterone (DHT)

To increase libido and testosterone, a comprehensive protocol may involve a combination of lifestyle modifications and pharmacological interventions, as supported by recent studies 1, 2, 3. For hypogonadal males, testosterone replacement therapy (TRT) with injectable testosterone cypionate or enanthate (75-100mg every 7-10 days) or topical testosterone gel (5-10mg daily) may be initiated. Additionally, selective estrogen receptor modulators (SERMs) such as clomiphene citrate (25-50mg every other day) may be used to stimulate endogenous testosterone production. To specifically increase dihydrotestosterone (DHT) levels, the 5-alpha-reductase inhibitor finasteride (1-5mg daily) may be discontinued, as it inhibits the conversion of testosterone to DHT.

Key Considerations

• Baseline Testosterone Levels: Before initiating therapy, it is crucial to measure fasting morning concentrations of total testosterone on 2 occasions to diagnose hypogonadism, as recommended by guidelines from the Endocrine Society and American Urological Association 1, 2.
• Therapy Initiation: The level of baseline testosterone that prompts initiation of therapy varies widely, and substantial proportions of men who receive testosterone therapy do not have testosterone levels tested before initiation of therapy 2, 3.
• Lifestyle Modifications: While not explicitly mentioned in the provided evidence, lifestyle modifications such as regular exercise, a balanced diet, and adequate sleep are essential for maintaining healthy testosterone levels and libido.

Pharmacological Interventions

• Testosterone Replacement Therapy (TRT): Injectable testosterone cypionate or enanthate (75-100mg every 7-10 days) or topical testosterone gel (5-10mg daily) may be used to increase testosterone levels in hypogonadal males.
• Selective Estrogen Receptor Modulators (SERMs): Clomiphene citrate (25-50mg every other day) may be used to stimulate endogenous testosterone production.
• 5-Alpha-Reductase Inhibitors: Finasteride (1-5mg daily) may be discontinued to increase DHT levels, as it inhibits the conversion of testosterone to DHT.

From the FDA Drug Label

The development and enlargement of the prostate gland is dependent on the potent androgen, 5α -dihydrotestosterone (DHT). Type II 5α-reductase metabolizes testosterone to DHT in the prostate gland, liver and skin. Daily dosing of finasteride tablets at 5 mg/day for up to 4 years has been shown to reduce the serum DHT concentration by approximately 70%. The median circulating level of testosterone increased by approximately 10 to 20% but remained within the physiologic range In a separate study in healthy men treated with finasteride 1 mg per day (n=82) or placebo (n=69), mean circulating levels of testosterone and estradiol were increased by approximately 15% as compared to baseline, but these remained within the physiologic range

The protocol to increase libido, testosterone, and DHT is not directly supported by the provided drug labels, as the labels discuss the reduction of DHT and the increase of testosterone as a result of finasteride treatment, but do not provide a protocol for increasing these hormones.

• Testosterone gel 1.62% is applied to the upper arms and shoulders, with dosing ranging from 1 to 4 pumps or packets, depending on the prescribed dose.
• The effect of testosterone gel 1.62% on libido is not explicitly stated in the provided drug label.
• DHT levels are decreased by finasteride, and the provided drug labels do not discuss a protocol for increasing DHT levels 4.

From the Research

Increasing Libido, Testosterone, and Dihydrotestosterone (DHT)

To increase libido, testosterone, and dihydrotestosterone (DHT), several protocols can be considered:

• Testosterone supplementation therapy, which can be administered through injections, gels, or other formulations, has been shown to increase serum testosterone levels and improve libido in men with hypogonadism 5.
• Clomiphene citrate, a selective estrogen receptor modulator, can also increase endogenous testosterone production and improve hypogonadal symptoms, although its efficacy may vary compared to testosterone supplementation therapy 5, 6.
• Alternative pharmacologic therapies, such as human chorionic gonadotropin and aromatase inhibitors, can increase intratesticular testosterone and improve spermatogenesis, making them suitable for men seeking fertility 7, 8.

Considerations for Treatment

When selecting a treatment protocol, several factors should be considered:

• The patient's age, symptoms, and fertility goals should be taken into account, as different treatments may be more suitable for different populations 6, 9.
• The potential risks and benefits of each treatment, including the impact on fertility and the hypothalamic-pituitary-gonadal axis, should be carefully evaluated 7, 8.
• Lifestyle modifications, such as exercise and weight loss, may also be recommended to increase endogenous testosterone production and improve overall health 9, 8.

Monitoring and Evaluation

Regular monitoring and evaluation are essential to ensure the effectiveness and safety of treatment:

• Patients on testosterone replacement therapy should be monitored at regular intervals to assess clinical response, serum testosterone levels, and potential side effects 9.
• Bone density and prostate-specific antigen (PSA) concentrations should also be evaluated to minimize the risk of adverse effects 9.