EVERYTHING YOU EVER WANTED TO KNOW ABOUT TESTOSTERONE
- Lack of interest in sex (low libido)
- Decreased endurance
- Erectile dysfunction
- Weight gain
- Lack of self-esteem
- Lack of motivation
- Confused thinking
- Decreased erectile rigidity
- Decreased muscle mass
Yes. Testosterone acts directly on the penis by assisting in blood flow in the erectile chambers. Many older men can still get erections, but have trouble maintaining or achieving the rigidity they had in their 20’s. TRT is the best option available to restore full erectile ability. Although not always effective, the benefits are evident and effective in restoring better quality erections in the majority of men. Men often perceive that their sex drive has not diminished and yet they have low T. After therapy begins, they realize how much it affected their sex drive.
We consider the gold standard for serum (blood) testosterone testing to be bioavailable free testosterone and not total levels. no other test can match the accuracy. Total T is the total level of testosterone (both free and total) in your blood . Only 2% (or less) of the total testosterone in your blood is Free T. As we age we form more sex hormone binding globulin that effectively binds our testosterone, and makes it unavailable for use. Free T is the only testosterone that can enter the body’s cells and do the needed work that leads to symptomatic improvement. The other 98% of testosterone in your blood is bound, unavailable and unable to enter your body’s cells. Free T is the level that we follow and use to help manage the optimal dosage for symptom relief.
Using a comprehensive approach. We passionately believe that our patients can augment their TRT by making making lifestyle changes. We use the highest quality Testosterone in a time release form to ensure optimal results. We utilize intramuscular injections exclusively every 2 weeks. We do not believe in transdermal (through the skin) therapy. It is not well absorbed in many men, has many restrictions (can be inadvertently transferred to children and females), is very expensive (up to $600 per month) , and is difficult to control the dosage. Some studies gauge it as effective in as low as 15% of man. It is extremely easy to prescribe but also less safe and effective. It is absorbed by the lymphatic system where it can be converted to DHT, which promotes prostatic enlargement. It is also associated with “transdermal fatigue” (the longer you use it the less effective it becomes).
Testosterone and estrogen are structurally very closely related. It doesn’t take much modification to convert Testosterone to Estrogen. The enzyme that causes the conversion is called aromatase. It can be “revved up” by many things in our world today. When we are in young adulthood, our Testosterone is at its peak. As we age and our T inevitably falls, estrogen begins to dominate. The ratio of T to E is extremely important in effectively managing TRT. If we raise your testosterone and your estrogen level rises as well, it will blunt or block the effectiveness of your injections. Many men need additional therapy in the form of low cost “ aromatase inhibitors” or estrogen blockers. Approximately 1.3 of all patients have inherently high aromatase activity no matter what lifestyle changes they make. Many physicians do not recognize the importance of managing estrogen along with testosterone. Many clinics routinely start an estrogen blocker at the onset of therapy. We do not believe in starting our patients on any meds they might not need. If you are responding poorly to therapy, or have overt symptoms of Estradioll excess (i.e. emotionality, inability to lose weight, fluid retention, breast tenderness or nipple sensitivity), we will manage and/or test you accordingly.
The initial visit will include a physician consultation and examination. We attempt to make the process as educational and transparent as possible. We have provided educational material on our website to benefit all individuals. We ask that you study the available materials to get the most out of your visit and understand why and how we administer therapy. Your lab appointment is already completed and if you meet the screening requirements, you may begin immediately if the physician believes you would benefit from treatment.
Your test will be performed by a local lab. The test will supply the physician with a Testosterone reference level needed to calculate a safe and effective treatment program designed exclusively for you. TRT treatment may not begin until you have completed your lab appointment.
To maintain the optimum levels of Testosterone you will be required to return every two weeks (a quick 10 minute visit) for the administration of the required Testosterone replacement dosage. We’ll quickly, easily and safely adjust your Testosterone levels back to where they should be so that you can obtain optimal results.
Injections of Testosterone will last approximately 15-17 days and after that there will be a dramatic drop. The 14 day treatment schedule keeps that dramatic drop from occurring.
Pharmaceutical manufacturers and the FDA indicate a 14 day treatment protocol with the dose amount being the only variable. This is the prevailing standard of care. The vast majority of people have a limited scientific knowledge of what this truly means when it comes to drug in plasma half life and pharmacokinetics. Clearly the 7 day protocol makes no medical sense.
a) Increase in red blood cell count, also called secondary polycythemia. It can be a potential health problem if your hemoglobin and or hematocrit gets too high. We recommend TRT patients donate blood at least twice annually during therapy which to stay ahead of the problem. It is also a noble thing to do. The Red Cross loves our patients. We will monitor your initial red cell count with a quick and low cost hematocrit at the beginning of therapy then again at 12 weeks and every 6 to 12 months or as often as deemed necessary determine by your treating physician.
b) Decreased spermatogenesis and sperm count. This is common in men and may be partially counteracted by the addition of hCG therapy. , but normally reversible after stopping Testosterone
We recommend sperm storage in a sperm bank for those with any hesitation about future fertility.
c) Testicular Atrophy / Testicular Shrinkage. The pituitary gland is the master gland. It sense levels of various hormones and provides a feedback loop for regulation. For example, if your thyroid is low, the pituitary senses low thyroid hormone. It sends a signal directly to the thyroid to make more thyroid hormone.
When undergoing TRT the human body will see the increase in Testosterone from your injections as its own and slow or cease production in the testicles. Inevitably the testicles are going to shrink. Our state of the art therapy offers hCG as an option to combat testicular atrophy.
HCG is a naturally occurring hormone. If a woman obtains a urine pregnancy test at the drug store, she is measuring hCG. It doubles every day in pregnancy. It’s is a naturally occurring hormone that we have all had in our bodies. hCG mimics leutinizing hormone. It sends a signal to the testicles to make more T. It also boosts Leutinizing hormone, follicle stimulating hormone, progesterone, and natural or endogenous testosterone production. It also helps preserve spermatogenesis and increases ejaculatory volume. d) Sleep apnea: Testosterone does not cause sleep apnea, but can possibly make it worse if sleep apnea is untreated. On the other hand, many physicians believe that the benefits of weight loss more than counteract this tendency.
e) Mild fluid retention, Acne, oily skin, increased body hair, injection site pain and flushing have also been reported in a small minority of patients (<6%).