How hormone Deficiency is treated:
LOW SIGNAL – An area of the brain fails to produce enough of its signal (called LH) that stimulates testosterone production in the testicular tissue. (Examples: repeat concussions, pituitary disorders, aging)
TESTICULAR FAILURE – The brain makes plenty of signal, but testicles fail to respond appropriately and produce insufficient testosterone. (Examples: aging, testicular injury, a history of certain infections, genetic conditions)
MIXED – Common scenario where the problem involves both the brain and the testicle. Includes instances where total testosterone is normal, but free testosterone is low. (Examples: aging, obesity, mineral deficiencies, exposure to endocrine disrupting chemicals, steroid abuse)
TESTOSTERONE REPLACEMENT – Most popular & reliable method of treatment. Research has shown TRT to be a safe and effective method of maintaining T levels in the high-normal range.
MEDICATION – Some specific types of low testosterone will respond to oral medication (something many clinics will never tell you). Based on your lab results and health profile, your specialist will discuss whether this treatment is right for you.
TREAT OTHER CAUSES OF LOW T – In some cases, certain medications or particular medical conditions may be responsible for your low T. A thorough review of your medical history and lab results will clarify if these are potential issues that can be corrected and if your natural testosterone production can be restored.
Follow-up lab work is the most important part of a successful TRT program. We recommend performing new blood work every 4-5 weeks until the dosage has been “dialed-in”.
We perform the most comprehensive blood analysis to be sure you get the correct dosage for your unique biochemistry. This also allows us to minimize the side effects of treatment as well as keep any risks to an absolute minimum.
Regardless of what some clinics promise, it takes time for some symptoms to improve. There is no way around it. Your body is adjusting to new hormone levels, and certain tissues are regaining function. This simply doesn’t happen over night.
For example, energy levels and sleep typically improve quickly after TRT has begun however, libido and sexual function can take 3-6 months to improve.
This is why it is critical to work with an experienced and trained clinician. They will know which symptoms require patience, and which need attention.
Our in-depth blood analysis allows us to track biomarkers of common health problems such as cardiovascular disease, insulin resistance, and chronic inflammation. This allows us to be sure that your overall health is improving during therapy. We go beyond the industry standard and provide our patients a higher level of care.
Frequently Asked Questions:
What kinds of testosterone replacement therapy do you offer?
While there are multiple methods of testosterone delivery but, the research has shown that 2 methods are superior:
- Topical Cream – This method involves applying the cream to the skin. The newer compounded creams provide excellent delivery of testosterone, compared to the older gels which had questionable absorption. The cream provides a more steady testosterone level, and avoids the typical peaks and valleys, that occur with injections. Cream is also bioidentical to the testosterone our bodies produce. Many experts believe bioidentical hormones have more health benefits than the synthetic forms.
- Testosterone Injection – Injections are the most popular method of testosterone delivery. There are decades of research behind T injections and it has been shown to be safe and effective. Men typically inject once or twice per week, which is somewhat more convenient than the cream. However, this method does not provide as steady of a testosterone level compared to creams. There will be higher peaks and lower valleys. Some men notice a difference in how they feel when testosterone levels are at their lowest. This method also typically has more side effects (acne, mood changes, and erythrocytosis)
Can you tell me more about the medication that might stimulate my own testosterone production?
A medication called Clomid or clomiphene has been used to stimulate men’s own testosterone production for many years. While this doesn’t work for every man, it does work for certain men with a particular type of low testosterone.
While Clomid worked for many men, there were some very common side effects with the medication. This is because Clomid actually contains 2 medication. One of the medications acts like estrogen in a man’s body. This caused some pretty severe side effects like: erectile dysfunction, loss of libido, moodiness, depression and weight gain.
A few years ago some scientists had the idea to “purify” Clomid and remove the portion of the medication that acts like estrogen. What was left is a medication called enclomiphene. Studies have shown that enclomiphene can be very effective in raising natural testosterone production without the side effects seen with Clomid. In fact enclomiphene works for the majority of men who have testosterone deficiency.
Your clinician will order blood tests to help determine whether you are a candidate to try this medication. While there is no guarantee that the medication will work, in our experience most men respond well to the medication. Enclomiphene also preserves your fertility unlike testosterone therapy, which will compromise your ability to have children.
How often will I need blood work?
The blood work requirements will depend on whether you are a new patient or you have been on therapy for some time:
New Patients – We recommend those new to testosterone have blood work every 4-5 weeks, until the clinician feels your levels are appropriate and stable. During this time the clinician is keeping track of how your body is responding to testosterone, and is watching for any side effects of treatment. After the proper dose is found, we typically will do blood work every 3 months for the first year. This is necessary because TRT will change your biochemistry over time, and further adjustments may be needed.
Experienced Patients – Anyone who has been on testosterone therapy for a year or longer is considered experienced. They typically require little to no dosage adjustments at this stage. However, certain biomarkers of health need to be monitored regularly (such as PSA and blood cell concentration). We recommend doing blood work every 4-6 months for these individuals. We decide on the frequency of blood work on a case-by-case basis. Some men will need more frequent follow up, while others will need less. The cost of blood work is included in your treatment.
Do you use estrogen blockers with your patients?
The answer is sometimes and here is why.
Estrogen blockers, also known as aromatase inhibitors are a controversial subject in hormone therapy. It was once thought that estrogen needed to be controlled during TRT. High estrogen levels were thought to contribute to moodiness, weight gain, gynecomastia (male breast enlargement) and even heart disease. In addition, higher estrogen levels were thought cause fluid retention. The body builder crowd feared they would lose muscle definition if estrogen got too high. All of this lead to the idea that estrogen was an enemy and needed to be controlled. An overuse of aromatase inhibitors followed. Unfortunately, this “bro science” thinking continues today, despite new studies that have proven these ideas to be completely false.
Here is what we understand now. Estrogen is a very important hormone in a man’s body. The benefits of estrogen for men are numerous. These include: increased bone density, improved cholesterol levels, decreased risk of heart disease, improved libido, better mental clarity, and enhanced skin metabolism.
If estrogen is limited too aggressively, then men will lose out on these health benefits. Limiting estrogen can even be potentially harmful. There may be certain circumstances where aromatase inhibitors are needed, but these cases are fairly rare. This is why blood work is so important during hormone therapy. The thing to realize is that each patient is unique. If you have a friend that takes an aromatase inhibitor, it does not necessarily mean that is best for you.
We will guide during the process and we will make sure you are using testosterone therapy in a safe and healthy way.
Can I do my shots at home?
Yes, self injection is easy and simple. We believe that self injection is an essential skill that our patients should master. Testosterone administration should easily fit in with your busy schedule. We will provide in-person training on the proper injection technique and we are always available for any questions or problems that come up. We can even perform the first few injections for you until you feel comfortable doing it yourself.
What if I do not want to do self injections?
If the self-injection technique is not right for you, then we recommend our patients use topical testosterone cream. Our specially compounded testosterone cream is designed to be easily absorbed through the skin and allows for a very steady testosterone level. The newer creams have been shown to be very effective.
The topical creams also have the advantage of fewer side effects, and are less likely to cause a skin reaction.
Do you offer pellets?
No. Maintaining and improving your overall health is our number one priority. We feel that pellets are a suboptimal method of testosterone replacement. They have been shown to be problematic in many different ways. For example pellets require the clinician to guess the proper dosage. Since we all process testosterone in unique ways, the dosage typically misses the mark. If too many pellet are implanted, there is no way to reduce the dose (for 3-4 months)! If too few are implanted, a second procedure has to be done to implant more.
In addition, as your testosterone therapy progresses over months, your body’s needs typically change. Pellets do not allow us to fine tune your dose to compensate for changing biochemistry.
Lastly, there can be pain or reactions related to the pellet implantation site. There are even case reports of the pellets working themselves through the skin and falling out. Pellets have been proven to be too troublesome to suggest them for our patients.