TESTOSTERONE THERAPY

FAQ

EVERYTHING YOU EVER WANTED TO KNOW ABOUT TESTOSTERONE
Testosterone is a hormone found in all mammals and is primarily produced in the testicles in men. Hormones stimulate regulate and control nearly every biological process. Both genders make testosterone in specialized structure called glands. Hormones are involved in nearly every biological function including sexual reproduction, metabolism, immune function and growth.
  • Lack of interest in sex (low libido)
  • Decreased endurance
  • Erectile dysfunction
  • Fatigue
  • Anxiety
  • Depression
  • Weakness
  • 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).

Our grandfathers had a higher level of T due to multiple environmental and lifestyle factors. In his time, there was less obesity, more physical activity and different level of stress. He also had a diet that consisted of less processed food, no soy added to his diet, no exposure to herbicides, pesticides, biphenols plastics. He did not typically abuse substances such as alcohol, marijuana, caffeine and opiates. The average age of our patients is 41 years old. This is largely due to our environment and lifestyle, as well as the inevitable process of aging. We understand that the world is full of temptation and stimulation. At Fountain of You MD we are not interested in passing judgement. We ask our patients to fully disclose their lifestyle choices so the we can facilitate behavioral changes. It is an essential part of designing a customized approach to improve the quality of life.

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.

Improvements will generally begin to be seen after 3 months of continuous therapy (6 treatments) but results can vary as does the time frame.
Your Testosterone level will return to pre-therapy levels. If for whatever reason you decide to stop therapy, our physicians will be glad to “ease you down” with an affordable 6 week regimen of “Novel TRT therapy” to avoid “crashing” at no additional charge. The patient may receive a prescription with no expense other than the pharmacy charge.
Testosterone replacement therapy (TRT) has been used for decades and studied just as long. To date no controlled clinical study has shown any adverse health risks associated with the therapy although those with pre-existing conditions such as blood clots or coronary disease would be advised to discuss TRT with their primary physician and/or cardiologist before proceeding. Men with higher levels of Testosterone live longer with less heart disease compared to men with lower levels of Testosterone and have a better quality of life. Fortunately Testosterone replacement therapy (TRT) has been vindicated by many recent studies. Many physicians still believe that increased T will “fuel” prostate cancer. In fact recent studies now show that Low T is more of an issue in the possible cause of prostate cancer. We continue to take a cautious approach and monitor your PSA every 6 months in all of our patients. If the PSA rises we will appropriately refer you to your primary care physician or a urologist and provide you with copies of your blood work. We are glad to work closely with your PCP and will always defer to his judgement.

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%).

Although we are primarily hormone replacement specialists, we are generalists and do offer a concierge medical service. If we discover, through our exams or lab tests, that you have other health issues, we will gladly refer you back to your personal physician or suggest a primary physician for treatment. You may decide to enroll in our concierge medical practice for an additional monthly fee.
No. We do not send out bills of any kind. Payment is required at the time of service in the form of cash, check or credit/debit cards or you may prepay with a substantial discount. We also accept Health savings account payments. We are also glad to provide you with a list of charges and payments that you may submit to to your insurance company. Many of our patients have received reimbursements from their insurance companies for services rendered.
We believe that TRT should be made as affordable as possible. We have contracted and negotiated with labs, pharmaceutical manufacturers, and medical suppliers to make TRT as affordable as possible. We are frugal with our advertising dollars and pass the savings on to our patients. Our best advertisement is word of mouth and referrals from satisfied customers. We offer a self referral program to all our patients. We also utilize social media and often receive referrals from specialists and primary care doctors who defer to our expertise. We do not believe that “if you have to ask how much, you can’t afford it”. Our pricing is transparent. At Fountain of You MD, we want to offer the best possible therapy to all individuals regardless of income level.We are always striving to reduce overhead and the long term costs for our patients.
At Fountain of You MD clinics we have vast experience in the art of managing hormonal deficiencies. We have managed tens of thousands of patients and the majority of our staff are patients at our clinic are our patients as well. Nothing makes you a better caregiver than having the same condition yourself. We are very proud of our staff and their caring bedside manner. Unlike other clinics that manage TRT, we use one of the largest labs in the nation. Our lab studies are independently run and the lab we use employs conservative methodology to calculate your true deficiency. There is unfortunately no standardization for testosterone values and methodology. The results can vary dramatically. Some clinics take a blood sample at your visit and run your sample at the office while you wait. The most often used machines in TRT clinics use a different methodology. The result is a Testosterone value that can be 400-500 points lower than our lab. It is not a statistically incorrect value, but typically the value is 30-40% lower than the hospital lab or independent lab value. We do not employ these methods and do not believe they are accurate or reflect your true level.
Since B12 supports the energy pathways in the body to ward off depression, anxiety, and fatigue, we find it is a valuable additive.
A growing number of men have attempted to raise their testosterone through external testosterone supplementation, Includes natural supplements, and or synthetic supplements (anabolic steroids). However, use of these supplements can have damaging and irreversible effects on the body in the long term, such as a reduction in sperm count (even zero counts!), excess fluid retention, enlargement of the prostate and an increase in red blood cells. Most boosters do not really boost production, but are designed to free up your existing Testosterone. The quality and purity of many of these products is highly questionable. Protect your sexual health. If you observe changes in your sexual response or experience any difficulty being intimate with your partner, talk to a qualified doctor at the earliest. If low testosterone or growth hormone deficiency is to blame, our physicians will discuss suitable treatment options and guide you in making an informed choice. Do not resort to testosterone supplementation on your own, as this may do you more harm than good in the long run.
We recognize that your time is valuable. We respect and value your time and our business practices demonstrate our dedication. We are glad to educate you on proper sterile technique,storage, drawing technique, and proper injection methodology. The following videos provide educational information on how to self administer TRT at home. We do require you to attend all required follow up visits and facilitate your compliance with dosing and required monitoring blood work.
Testosterone is a controlled substance and requires periodic face to face encounters. It is illegal to prescribe or administer TRT via telemedicine.