Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) provides a replenishing supply of testosterone to men and women whose bodies no longer produce enough for their needs. Low testosterone (Low T, hypogonadism), can produce mild or potentially debilitating symptoms that tend to worsen with time. In this review, we look at the many facts, treatment concerns, benefits, and questions surrounding TRT.

Testosterone replacement is complex therapy due to the nature of how hormones influence one another. It is not merely a matter of increasing testosterone levels, as that can boost other hormones, such as dihydrotestosterone (DHT) and estradiol (estrogen) that can create additional problems if they get too high.

Androgen hormones such as testosterone play many roles in the body, including maintaining bone and muscle strength, brain functions, libido, metabolism, and balancing emotional stability. That is why ensuring hormone balance, through the use of bioidentical testosterone replacement therapy is crucial for men and women dealing with the symptoms of Low T.

Testosterone Basics

It is always best to start any search for information at the beginning, in this case, examining the basics of what testosterone is and how it impacts the body. Testosterone is more than just the primary male sex hormone. By binding with androgen receptor cells throughout the brain and body, testosterone supports functions such as:

• Stimulating red blood cell production
• Regulating the processing of lipids, carbohydrates, and proteins
• Increasing and maintaining muscle mass and strength
• Slowing bone turnover
• Enhancing brain functions, including learning, focus, and memory
• Maintaining emotional well-being and reducing stress, depression, and anxiety
• Supporting a healthy libido
• Promoting sperm cell maturation
• Improving female ovarian follicle sensitivity
• Protecting against insulin resistance

These are some of the reasons why men and women turn to testosterone replacement therapy when their bodies no longer provide enough testosterone for their daily needs.

Physiology of Testosterone Production in Adults

The physiology of testosterone begins with cholesterol. The same substance that doctors warn about is what the body needs to make the steroid hormones. Through a series of enzymatic and hormone conversions, cholesterol eventually becomes testosterone using one of the two pathways below:

The regulation of testosterone production in males and females is as follows:

The regulation of testosterone production in males and females is as follows:

In Males

The hypothalamus measures how much testosterone is in the bloodstream. If testosterone levels are low, the hypothalamus sends gonadotropin-releasing hormone (GnRH) to the pituitary gland to stimulate the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to the testes. Once there, LH tells the Leydig cells to produce testosterone. FSH stimulates the development and maturation of sperm cells. Most of the testosterone produced in the male body comes from the testes, with a small amount coming from the adrenal glands.

In Females

The process is similar in women, except for LH and FSH going to the ovaries to carry out their functions. Only about 25% of a woman’s testosterone comes from her ovaries. Another 25% comes from the adrenal glands, with the remaining 50% coming from peripheral tissues.

Facts And Warnings About Testosterone Replacement Therapy (TRT)

Testosterone replacement therapy is a well-researched treatment, but there are still some things to know:

It Is Legal But…

You must have a verified deficiency to receive a prescription for legal testosterone therapy. That is the only way to purchase testosterone legally in the US. Buying testosterone without a prescription is both illegal and dangerous.

It Is Safe But…

Testosterone therapy is only safe to use as prescribed by an endocrinologist in a dosage determined appropriate for one’s personal use. Administering too much testosterone and raising T levels too high can result in potentially dangerous side effects.

It Works But…

Testosterone replacement therapy reviews show how well it works for men and women with Low T. However, getting the right dosage is crucial to a positive outcome. Some people need other medications along with testosterone to block estrogen conversion and promote natural testosterone production.

TRT Can Be Dangerous If:

• It is purchased from unregulated sources without a prescription
• The treatment is not prescribed and supervised by an experienced hormone specialist
• A person has contraindicated conditions such as:
• Cancer
• Uncontrolled heart failure
• Hematocrit over 48%
• Elevated PSA level above 4 ng/mL
• Cerebrovascular incident or myocardial infarction within the past six months

Who Can Be Prescribed Testosterone Replacement Therapy?

Both men and women can receive testosterone replacement therapy if they are diagnosed with low testosterone levels. Doctors who specialize in hormone treatment, such as endocrinologists, are the best ones to contact when one suspects testosterone deficiency is the cause of symptoms.

The prescribing of testosterone therapy requires the following:

• Medical consultation
• Blood test
• Physical exam
• Health history questionnaire completion
• Follow-up consultation

During the consultations with a hormone specialist, adults learn what to expect during the diagnostic process as well as setting realistic goals for the treatment.

Problems That Can Be Cured with TRT If Prescribed By a Doctor

The first thing we want to point out is that testosterone replacement therapy is not a cure. It will not increase testosterone production, only testosterone levels. While it can reduce and even reverse many of the symptoms of low testosterone, it should never be referred to as a cure. TRT is a way of bringing the body back into proper hormonal balance.

• Here Are 3 Things That Testosterone Can Do

1. Help improve metabolism to aid in weight loss and increase energy
2. Strengthen muscles and bones, providing better muscle definition and tone
3. Stimulate libido

• Here Are 3 Things That Testosterone Cannot Do

1. Stop aging
2. Improve male fertility
3. Cure other illnesses and conditions – although it can help reduce risks and symptoms

Types and Effectiveness of Modern Testosterone Replacement Treatment

Testosterone replacement therapy for men comes in many options, including:

• Testosterone cypionate and enanthate injections – long considered the best testosterone replacement therapy for men. T injections provide superior absorption into the bloodstream and excellent results – at the lowest cost.
• Transdermal testosterone patches and gel – provide more balanced testosterone levels, although the absorption rate is unknown at first. Costs are significantly higher as are cross-contamination risks to others.
• Transbuccal tablets – adhere to the gums and offer good absorption, although they are costly and can cause oral irritation and bitter taste.
• Implantable pellets – surgically implanted beneath the skin to provide long-lasting effectiveness. The pellets are expensive and can work their way out of the body, reducing the benefits.

Most Frequent Fears and Concerns About TRT

These questions address some of the most commonly stated fears and concerns about testosterone replacement therapy:

Does TRT Cause Sleep Apnea?

Some people experience a short-term worsening of their sleep apnea symptoms until they begin to lose weight. TRT does not cause sleep apnea.

Dangerous To Stop?

It is not dangerous to stop testosterone therapy under doctor supervision. Your physician will guide you on how to get off TRT while improving natural testosterone production.

Does TRT Lead To Erythrocytosis?

TRT can increase the risk of erythrocytosis (increased red blood mass), especially if the dosage of testosterone is too high.

Is It Possible To Get Polycythemia After Testosterone replacement?

People who do not undergo proper medical monitoring could see their red blood cell count get too high if they increase testosterone levels too much.

Can Testosterone Therapy Cause Depression?

Testosterone therapy typically reduces the symptoms of depression that accompany low testosterone.

Is TRT Dangerous If You Have Epilepsy?

Low testosterone is often linked to epilepsy. Closely-monitored testosterone therapy has been shown effective and safe at improving Low T symptoms.

Does TRT Affect Cholesterol?

Although there are some contradictory reviews, TRT has been shown to help normalize cholesterol levels.

Does TRT Provoke Diabetes?

No, the concern is more that low testosterone often contributes to type 2 diabetes.

How Does TRT Effect Fertility?

TRT can lower male sperm count as it bypasses the testes. Other treatments are necessary if fertility is an issue. Testosterone can help improve female fertility by improving ovarian follicle sensitivity.

Individual Nuances Of Testosterone Replacement Therapy

We are often asked, what is the most effective form of TRT by men and women dealing with low testosterone levels. For men, we typically recommend testosterone cypionate injections. The most effective option for women is pharmacy-compounded testosterone cream.

The answers below address some of the other most frequently asked questions about testosterone replacement therapy:

How Long Does Testosterone Replacement Therapy Last?

TRT use can be indefinite based on individual needs and preferences. Assessment typically occurs every six months.

What Is the Average Dose for Testosterone Replacement Therapy?

Testosterone dosages depend on the type of treatment prescribed and how much is needed by the individual. TRT is a customized protocol.

What Happens When Testosterone Therapy Doesn’t Work?

The doctor will look at the dosage and form of treatment to see if changes should be made.

Does Testosterone Replacement Therapy Increase Sperm Count?

No, TRT can decrease sperm count because it bypasses the testes. Other medications such as HCG and clomid can increase natural testosterone production and subsequent sperm cell maturation.

Expectations And Reviews Of Our Patients On Testosterone Replacement Therapy

Possible Cost Of Testosterone Replacement Therapy

The cost of testosterone replacement therapy depends on the type and dosage of the medication. “Is testosterone replacement therapy expensive?” Most people pay under $200 per month for treatment – some considerably less. Please contact our clinic for a free consultation to learn more about testosterone replacement therapy.