Understanding Testosterone
Testosterone therapy has been at the center of controversy for many years now. The medical community is continuously so slow to change and there are many scientists and physicians who do weigh in on the pros and cons. However, administered appropriately, the course of treatment, has shown to be very effective at treating the symptoms of hypogonadism or male menopause (andropause) in otherwise healthy individuals.
We can explore the benefits of testosterone therapy, but we also must understand that the majority of men will have sufficient testosterone throughout life and will not show significant symptoms. However, there are individuals who still are in the lower “normal” ranges and have persistent symptoms. Western medicine ignores these individuals until they are doing so poorly that “something” must finally be done.
For example, up until a few years ago, a lab (specifically, LabCorp) showed a [Normal Total Testosterone] range was between LabCorpRange. Coincidently, as more insurance companies were attempting to disqualify patients from receiving TRT (and saving those insurers from spending money on those patients), the ranges of “normal” dropped significantly overnight! Thankfully, clinicians of competent men’s health offices provide care based on patient symptoms along with lab studies. A patient is more than a Number! We will discuss which individuals are best suited for TRT, and what treatment options are available through Optimal Men’s Center.
Testosterone Levels by Age
WHAT IS TESTOSTERONE TREATMENT?
Testosterone therapy, also known as TRT, is a catch-all term for hormone therapy consisting of injections or other supporting sources of testosterone. TRT is a medical procedure used to help relieve symptoms in patients with a level of T-serum that is near or below average.
Doctors may recommend TRT to strengthen, and even reverse, the symptoms associated with hypogonadism such as decreased libido, low strength, irritability, elevated fat deposits as well as muscle tone loss, and fragile bones, to name only a few. Thankfully, TRT can help with much more.
It may also be prescribed as a treatment for andropause, a hormone imbalance occurring in middle-aged men (sometimes referred to as “male menopause”).
TRT is not just a testosterone supplement. It can also trigger the gonads to produce more T naturally in the future if given at the correct dosage. This is just another explanation of why not to overtreat a patient.
UNDERSTANDING HORMONES
It is helpful to understand the science of hormones and how they work in our bodies. When it comes to hormones in both men and women, there’s a lot that can go wrong (but thankfully, they can go right too!). Your body is made up of some very complex systems, not the least of which is your endocrine (aka hormonal) system. The hypothalamus and pituitary glands are like finely tuned command centers in your brain. These two areas of your brain manage other organs like your pancreas, adrenal glands, thyroid, gonads, liver, and others. The goal is to do it as flawlessly as possible.
The Science of Hormones
The hormonal system relies on a complex feedback loop, known as the hormonal axes. This feedback loop allows the interaction of hormones between the brain and other glands in the body. The three most significant axes are ones that involve your hypothalamus, your pituitary, and the axes including, adrenals (HPA), gonads (HPG), and thyroid (HPT).
There are others such as melatonin, etc., but the ones above are some of the most significant. This hormonal system is intertwined with another system called the neuronal system and is known as the neuroendocrine system.
This neuroendocrine system feedback loop controls your reactions to stress, bodily functions like digestion, blood pressure, blood sugar, your immune system, and even moods and sexual desire which all begin in the brain. Keeping your body’s hormonal balance keeps this neuroendocrine system, and everything it controls, operating at peak efficiency.
Testosterone
Both men and women have this hormone. But in the male, there is 7 to 10 times more circulating in the body. This results in male characteristics much more different than a female such as increased bone mass, how fat is distributed throughout the body, as well as increased muscle mass, strength as well as higher production of red blood cells. Of course, men also produce sperm. Testosterone works in unison with other hormones, to feed your energy levels, calibrate your moods, and trigger your desire for, and your ability to have, sex. Low t levels (take the quiz) can disrupt these processes and spoil your quality of life. Over the years, our clinicians are seeing patients who are overly fatigued, depressed, physically weak, and overweight. These are very common symptoms of Low Testosterone.
A decrease in the T count will occur at any time, not just during mid-life or old age. Stress, acute illness, poor nutrition, and a host of other conditions can bring about male hormone imbalances. Testosterone therapy is the jumpstart men can take advantage of making significant lifestyle changes which will restore their vitality, quality of life, and health.
DHEA
DHEA is an important adrenal hormone that balances the effect of the Cortisol stress hormone and is important as an anabolic hormone for the immune system.
Produced through the adrenal gland. DHEA supports the body because other hormones, including testosterone and estrogen, are produced.
DHEA also begins to decline as we age, which in turn affects the capacity of your body to generate Testosterone.
Most patients with low DHEA levels will have low Testosterone levels, too.
Some therapists think DHEA is a necessary component of the overall hormone balance. Medical research does not support that assertion.
Nevertheless, Dr. Berman insists on closely monitoring DHEA levels in his patients to ensure that all hormones involved in the endocrine system are optimally balanced, especially testosterone, which drives so many important functions.
Cortisol
Cortisol is a catabolic hormone, which means it contributes to the processes of breakdown, such as muscle tissue breakdown during exercise.
Testosterone is an antioxidant which helps to improve muscle mass. When these two hormones of the opposite effect are out of balance, trouble can arise.
Cortisol is what the body uses to turn protein into sugar to provide energy for stress response during battle or flight. Too much cortisol however suppresses our immune system and causes inflammation.
In a fight or flight scenario, this not only causes us a disservice but it can also cause serious health concerns.
Estradiol
Another important process that takes place in the endocrine system is turning of Testosterone into estrogen. Both men and women’s bodies convert Testosterone to estrogen, but in different amounts, with men’s bodies converting about 10% of their Testosterone to estrogen when they are in good health.
There is an enzyme of aromatase, which controls the balance between testosterone and estrogen with care. As men age, the activity of the aromatase enzyme increases, converting more testosterone into estrogen. That means t levels can get even more depleted.
Thyroid
Studies show a link between thyroid function and levels of testosterone, both of which are required to control the same processes effectively within the body. Thyroid hormones rely on testosterone to do protein synthesis work, a very complex process that takes place in order to build proteins at a cellular level. This promotes muscle mass build-up and can control fat metabolism.
Testosterone at a low level can impact muscle growth and unnecessary weight gain. Testosterone therapy may be an effective treatment, but the thyroid must first be determined and works as it should. If not, hormone replacement therapy may help, but only under a licensed, experienced physician like Dr. Berman ‘s supervision.
Melatonin
The pineal gland is responsible for producing melatonin hormones. Sleep and awakeness are controlled by the levels of melatonin. We all have an inner clock which is called the circadian rhythm. This clock tells us when it’s time to sleep, wake up and it regulates our body as it prepares for cooler seasons, including our blood pressure and temperature.
Work suggests it can also play a part in inhibiting the growth of cancer cells. This hormone is, as you might expect, largely released at night. Because hormones play such an important role in regulating sleep patterns, low levels, particularly low levels of melatonin, are critical for analyzing your overall health profile of the hormones.
So, who is a good candidate for testosterone treatment?
For men over the age of 30, TRT can be a beneficial treatment. Research has shown people start noticing declines in testosterone levels around 30 years of age.
Some people don’t notice the gradual reduction in hormone production but others may start to feel the negative side effects that facilitate low T.
TRT is not approved for people who have prostate cancer or had a heart attack in the last 3-6 months. It should be used with caution in patients with a known coagulation disorder, those with specific heart problems such as atrial fibrillation or recently hospitalized with congestive heart failure.
We have numerous incredible stories, we helped get patients off the transplant list with congestive heart failure to giving a double lung transplant patient a new optimal life.
A full physical assessment must be performed by the doctors at Optimal Men’s Center before hormone therapy is considered to ensure that each patient is well enough for TRT.
So, what kind of testosterone treatments do you offer?
Testosterone may be given in a variety of ways, but which method is best suited to an individual will depend from one person to another. Take a look below at the most common methods of delivering testosterone in men along with the pros and cons of each.
Injections
Intramuscular vs Subcutaneous
One of the most common and cost-effective methods of injecting testosterone into the body is by injections.
The injection process uses an oil-based solution (typically cottonseed oil or grapeseed) combined with testosterone. The testosterone is released more predictably into the bloodstream through an injection.
For years, the thought was that the only acceptable way to administer an injection was by an intramuscular (IM or into the muscle) route. A subcutaneous injection (SC or the area right under the skin) is also an appropriate alternative.
However, this is still debated to this day. Because muscle tissue has a greater blood supply (when compared to SC), the testosterone would be absorbed faster. Of course, that might make sense, but absorption that is too fast may result in undesired side effects for some individuals.
Our thoughts are that what is more important is consistency for the patient. Patients that self-administering will find it easier to inject via SC. The debate continues.
We do know that Injections are the best method for all patients but those who are on a blood thinner may notice more bruising and may need an alternate administration method.
The quantity and frequency of testosterone injections are adjusted by the doctor from time to time during the therapy according to the response to the treatment.
This is why it is crucial to have consistent follow-up because dosing usually changes throughout therapy. Every patient needs a customized testosterone replacement regimen.
The BIG takeaway here is that almost everyone will do better with injections. We have been involved with the care for tens of thousands of patient visits during Testosterone therapy and very few patients will do better on other forms of administration.
Pellets
Another process medical practitioners use to administer testosterone is by implanting pellets of testosterone under the skin.
Pellets of testosterone, like Testopel, measure 3 mm by 9 mm and contain crystalline testosterone.
These testosterone pellets are inserted under the skin, usually close to the hip / outer buttock region, using an instrument called a trocar.
They take up to three-6 months to release testosterone gradually into the body. Testosterone implantation is a simple process which normally takes no more than 10-15 minutes.
Since pellets take some time to release testosterone in the body, having the right dose of testosterone is absolutely essential. The problem is that everyone breaks down testosterone differently.
We have seen patients who were given only a small dose via the pellet and have testosterone levels 2-3 times higher than what is recommended.
It then causes all sorts of side effects and the simple procedure of implantation now becomes a more complex technique for removal.
In addition, there are risks with this procedure such as infection, extrusion (it pushes it way out through the skin) a hematoma (a collection of blood that usually breaks down over several months), or a seroma (a collection of fluid that is usually large).
The problem with a seroma is sometimes they become an abscess and other times develop into a calcified, hard knot. Patients that have had this complication can have residual pain and many times can never get a testosterone injection on that side of the buttock/hip.
It is always advisable to first begin your testosterone therapy in the form of injections because there are many more risks with pellets. Creams or gels are also an alternative.
Creams or Gels
Testosterone administration can also be achieved using clear, odorless, and fast-drying creams or gels that make it into your skin after application, which slowly helps regulate the levels of testosterone in your body. Testosterone creams provide an easy and clear way to increase low levels of testosterone in the body, as they simply need to be placed across your stomach region, back, or shoulders. You must allow the skin area to dry properly after you have applied the testosterone cream, and even cover it with your clothes to prevent any direct contact with any external item, including human touch. Because after the testosterone cream is administered for around 5-6 hours, you will need to avoid taking a bath or swimming, because it will stop the cream from generating any good effects for your skin. All Testosterone creams and gels provide a much easier treatment to boost your testosterone levels, as they save you from the injection or implantation of some external product. Moreover, this non-invasive testosterone therapy often provides a convenient option for people who adopt busy lifestyles and are unable to find time for any other treatment process.
A drawback to therapy is that creams or gels are inconsistent with their absorption. This varies drastically from one person to another. This can cause undesired side effects. The biggest drawback, and it is a huge one, is exposure to others. If you expose a woman or child you can cause irreparable harm. The testosterone amount of exposure could be 20 times higher than their own natural production. If you do not wash your hands sufficiently after application of the cream, the area that the cream was applied to sweats and some of the medication soaks into your clothes, or you touch something after application (and prior to hand washing) that another person could potentially touch, are all possibilities. It can cause masculinization such as acne, hair growth, deepening of the voice, breast shrinkage, loss of menstruation, and then there are even worse things like a child who has not gone through puberty could have even more serious side effects. Even though we do prescribe them for a few patients, they can be useful. There are times when we have because there were no other options such as for soldiers who are in combat action and unable to administer injections, those patients who do not have children, are a partner in a homosexual relationship, or are unmarried.
I mean, really. What kind of results can I even expect?
First off, testosterone helps with recovery and if you are sleeping better, you will then, directly and indirectly, benefit almost every other organ system in the body. Men report higher energy levels, not only heightened libido but overall better sexual function. There is also an enhanced mood, better concentration, and more.
Testosterone Therapy has been shown to have cosmetic incentives as well. Men that have difficulty growing a full beard or even a patchy beard usually have lower testosterone, so increasing this can lead to the promotion of hair growth. Of course, everyone understands the increase in muscle tone. But, many people are unaware (including most of the medical community) that numerous studies have shown the weight lost by men receiving TRT is almost exclusively fat. If you throw in more weight-training or other strength exercises with the TRT, the weight loss can be even more significant versus diet and exercise alone. But, your doctor keeps telling you to exercise and you will lose weight…
Most men think hip and spine fractures only happen to women. In reality, low testosterone, coupled with lower body weight, results in many men having a fracture in one of those areas. In fact, if they have a non-traumatic fracture in their spine, the orthopedic surgeon who repairs it, as well as the patient’s PCP STILL never checks the T level. Negligence or ignorance?
Bone mineral density is improved in all men on testosterone but even more important for those over 60. In addition, if a man has osteoporosis, they are in “andropause” and that puts them at higher risk for Alzheimer’s Disease, Prostate Cancer, Cardiovascular Disease Risk increases, and most likely, having problems with an erection.
What do I do next?
The clinicians at Optimal Men’s Center are some of Arizona’s leading experts on Testosterone therapy and are committed to helping men reclaim their health. Our company is passionate about the treatment and maintenance of hormonal imbalances.
We believe in treating the root of the problem rather than merely administering hormone therapy every few weeks.
Wellness is much more than just receiving a medication.
Our health care professionals will work with you to develop a unique lifestyle plan that will fit your nutritional, physical, and mental needs. We can help you to become your best self, to become Optimal.
When you believe the side effects of a hormone deficiency are felt, please arrange a consultation to get you back on track to feeling your optimum.
Once men begin their journey with TRT they will wonder why they waited so long to get their drive back!
