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COVID-19 has demonstrated that men tend to get it more than women. This has suggested to researchers that perhaps testosterone is to blame for more severe disease, which has led to the formulation of several theories. The cytokine theory proposes that a low testosterone level leads to an increase in inflammatory immune system proteins called cytokines which may facilitate a cytokine storm in men with COVID-19.  Conversely, the testosterone-driven COVID-19 theory suggests that testosterone may promote infection by the severe acute respiratory syndrome. An increase in venous thromboembolism has also been associated with COVID-19, particularly in patients who are more severely affected.  Furthermore, previous studies have found that even though patients diagnosed with cancer have an increased risk of contracting COVID-19, men on androgen deprivation therapy for prostate cancer had a lower risk of developing an infection. TRT and COVID-19 Risks Testosterone replacement therapy (TRT) is associated with secondary polycythemia (increased red blood cell production), but it is unclear whether this leads to an increase in thromboembolic events. However, some authors have suggested that men should be taken off TRT during this pandemic. A study was performed to determine the impact of TRT on the clinical outcomes of COVID-19 in men at the School of Medicine of Wayne State University in Detroit, Michigan and published on the Journal of Sexual Medicine in October, 2020. A total of 3,697 men diagnosed with COVID-19 were identified of which 38 were on TRT. 6 men in the TRT group and 13 men in the control group had incomplete data and were excluded resulting in inclusion of 32 men in the TRT and 63 men in the control groups. Among men on TRT, 32 were diagnosed with hypogonadism (2 hypergonadotropic, 7 hypogonadotropic, and 23 mixed). 23 men received intramuscular testosterone cypionate injections while 9 were on transdermal testosterone gel. TRT-COVID-19 Study Results Patients on TRT had higher rates of hypertension (65.6% vs 55.5%), cardiovascular disease (37.5% vs 30.1%), diabetes mellitus (40.6% vs 30.1%), and immunosuppression (25% vs 14.2%) and a lower rate of chronic obstructive pulmonary disease than controls (12.5% vs 25.4%), none of which were statistically significant.  When focusing on endpoints, patients on TRT had similar rates of hospitalization (62.5% vs 63.4%), thromboembolic events (12.5% vs 12.7%), and death (9.3% vs 12.7%) as their counterparts not on TRT. Patients on TRT had lower rates of ICU admission (12.5% vs 25.4%) and mechanical ventilator utilization (9.3% vs 19.0%) than patients not on TRT, but none were statistically significant. TRT was not an independent predictor of any of the examined endpoints on multivariable analysis. Testosterone Level and COVID-19 Once an infection occurs, testosterone may serve a protective role by decreasing the risk of a cytokine storm. A recent report observed lower levels of testosterone in men who were admitted to the ICU with SARS-CoV-2 infections. It is unknown whether these men had a low testosterone level at baseline or if they developed a low testosterone level in response to the infection. There is evidence to suggest that most men admitted to acute care units have a transient suppression of testosterone to a level below the normal range. A decreased testosterone level is associated with an increase in proinflammatory markers.  Testosterone may facilitate cell infection with the SARS-CoV-2 but also be protective of worse clinical outcomes during active infections. A study measuring testosterone levels of men at baseline and at various times during COVID-19 may help further delineate this relationship. In conclusion, this study failed to demonstrate a statistically significant difference in COVID-19 outcomes among men treated with TRT and those not on TRT. Future studies are needed to help further guide clinicians on the optimal management of hypogonadism with TRT in the era of COVID-19.   Reference: J Sex Med. 2020 Oct 9  

The internet is full of information on various subjects, but you probably already know that you have to carefully select your health information source. For example, if you're looking for information about men’s health and testosterone replacement therapy, Excelmale.com is probably your safest bet. Table of Contents Join a Growing TRT Forum of Almost 40,000 Members Topics Covered Include TRT, HCG, Erectile Dysfunction, Nutrition, and More Take Advice from Fitness and Nutrition Experts, Dietitians, Medical Doctors, and More Get Educated Through Men’s Health Videos, Articles, Podcasts, Scientific Papers, and More There Is a Dedicated HRT Section for Women Too Best of All - It's Free to Register! A lot of myths and disinformation usually surrounds these subjects. You might end up confused if you're trying to learn about TRT from the wrong places. On the other hand, if you go to the Excelmale.com forum, you can access scientifically proven data and experts' opinions. Created in 2013 by health author and men’s health advocate Nelson Vergel,  ExcelMale.com has become one of the most respected and largest testosterone forums globally. Keep reading to find out what makes Excelmale.com so unique and why you should visit it if you want to learn more about TRT and men's health. Join a Growing TRT Forum of Almost 40,000 Members You might be happy to find out that Excelmale.com is a testosterone replacement forum with a community of almost 40,000 members. This platform is reviewed daily by knowledgeable individuals to moderate it to prevent spamming or abuse carefully. All these people joined Excelmale.com to learn more about male health, fitness, and nutrition. They are real persons with life stories just like yours. You can find so much information on testosterone and other hormonal replacement therapies from people of all ages and different parts of the world. If you're worried about your personal information, then you should relax. This website is monitored continuously and secured with state-of-the-art protection systems. Your information will not be shared, and the moderators carefully check every message to prevent spamming, so you won't be a victim of cyberbullying. Topics Covered Include TRT, HCG, Erectile Dysfunction, Nutrition, and More The broad range of topics covered at Excelmale.com will amaze you. Not only that, this is the best TRT forum you can find on the internet, but you will also learn about the right testosterone TRT test, HCG use to prevent testicular atrophy, TRT side effects, thyroid treatments, PCT, Trimix injections, supplements, exercise, nutrition, and more. The experts who routinely post on Excelmale.com consult scientific papers and journals to give you the most recent and unbiased information out there. You will find out how to interpret some of your bloodwork results, how to optimize your gains, and how to naturally increase testosterone levels. Best of all, the information is conveyed in layman's terms. You will be able to understand the concepts without requiring a medical degree. Nelson Vergel routinely posts the latest information on TRT and other relevant subjects, so you should come back to this TRT forum more often. Take Advice from Fitness and Nutrition Experts, Dietitians, Medical Doctors, and More Most of the members on the Excelmale.com testosterone forums are regular TRT patients or people who are interested in testosterone replacement therapy and anything related to it. However, there is also a plethora of experts regularly posting on this testosterone replacement forum. For example, you might be able to receive advice from experts who work in compounding pharmacies. A compounding pharmacy can create drugs specifically for your needs, helping you get the right dosage at a reduced price. Other experts in nutrition and fitness also post information on how to live a healthier life. Even if you're not thinking of starting TRT soon, the Excelmale.com forum offers a multitude of valuable pieces of advice that can improve your health, so it's worth a visit. Best of all, TRT patients are invited to share some of their results so that others can learn from them. If you're currently under TRT and have a question, you're welcome to post it on the Excelmale.com TRT forum. You can get expert answers from doctors as well as regular solutions from TRT patients just like you. Get Educated Through Men’s Health Videos, Articles, Podcasts, Scientific Papers, and More Some people like to get informed through reading, and others like to watch a video. Many other people also like to listen to podcasts while doing housework. No matter your preferred learning method, you are covered if you visit the Excelmale.com TRT forum. That's because this forum spreads information through multiple channels, including short and long-form articles, eBooks, scientific papers, videos, podcasts, and more. You can watch and read for free, and some of the eBooks provided on Excelmale.com are also free to download. Apart from that, you can also find a transcription of videos for those who prefer to read instead of watching a clip. As the TRT industry is developing, more and more information becomes available to the general public. The Excelmale.com forum is the place where you can find this information and use it to your advantage. There Is a Dedicated HRT Section for Women Too Hormonal replacement therapy (HRT) is increasingly popular in the United States, Canada, and other countries. Although Excelmale.com is mostly a testosterone therapy forum for men, there is a special HRT women section dedicated to female health information. Here you can find more about the latest advancements in hormonal replacement therapy, diagnosis, side effects management, and more. The founders of Excelmale.com don't want women to feel neglected, and they have created this section on the same website. Experts in nutrition, fitness, and endocrinology routinely post articles and videos about hormonal therapies for women. This information could help you if you want to mitigate the effects of menopause or improve the hormonal balance in your body. Best of All - It's Free to Register! You might be happy to find out that it's free to register on Excelmale.com. You have access to all the information presented above with just a few clicks. Even better, you will also receive a free eBook upon registration. This eBook reveals the secrets of how to optimize your testosterone levels! Whether you're an active TRT patient, you're thinking of starting testosterone replacement therapy or want to improve your health, the Excelmale.com forums provide the best place to start. Make sure that you register on ExcelMale.com to join to join the best TRT community online and get weekly updates on the latest news and science on men’s health and productivity.   IMPORTANT: ExcelMale.com is not associated with the site Male Excel. ExcelMale.com was created several years before that site and it is also a trademarked brand.  

  Thanks to the advancements in medicine and laboratory equipment, it's now possible to use various human samples to obtain precise information about a patient's health. Moreover, various testing methods and techniques are highly accurate, helping doctors come up with the right diagnosis for each patient. For example, blood, urine, and saliva hormone testing are commonly used as samples to detect diseases, vitamin deficiencies, hormone levels, and so on. Doctors might also use a small tissue sample to detect cancer in certain patients (biopsy), but this is a subject for another article. Now we'll focus on the difference between saliva and blood hormone testing. Keep reading to find out more about it and which one is more suitable for certain types of health tests. Table of Contents Saliva Hormone Testing Advantages of Saliva Testing Disadvantages of Saliva Testing Blood Testing Advantages of Blood Testing Disadvantages of Blood Testing A Word About LC-MS Testing Conclusion Saliva Hormone Testing Believe it or not, human saliva contains a lot of hormones and substances that can help doctors come up with an accurate diagnosis. Saliva testing usually involves putting a swab into the mouth of the patient and letting it there until it becomes saturated. It's also possible to draw a saliva sample using specially designed tubes. The patient orders the plastic tubes as a sample kit for home collection and spits into the tubes at various moments of the day. This is usually done for cortisol measurement. Advantages of Saliva Testing One of the biggest advantages of saliva testing consists of its convenience. It's easier for patients to offer a saliva sample than to hold up an arm for blood drawing. Saliva testing is most preferred by people who are afraid of needles. At the same time, a lot of information about your hormones and general health can be taken from saliva. For example, saliva testing is used for cortisol (the stress hormone) produced by your adrenal glands, estriol, and several other hormones. Another advantage of saliva testing is that it can be done at home using special collection kits as mentioned above. Patients can also monitor certain hormones such as cortisol better because they can offer a saliva sample at various moments of the day. This helps doctors create a chart with the highs and lows of a specific hormone or substance. Disadvantages of Saliva Testing No testing method is perfect and saliva testing is not an exception to this rule. Although you can get a lot of information from a saliva sample, the levels of hormones present in this sample are comparatively lower than the level of hormones present in a blood sample. As a result, saliva testing might be highly inaccurate for testing certain hormones including testosterone and estrogen. Blood testing using the LC/MS assay technique described below for these hormones is recommended for men and women who want to keep track of their sex hormones. Additionally, various lifestyle factors can affect the results of saliva testing. For example, your diet and even how aggressively you brushed your teeth can alter the hormone levels in your saliva. This will render an inaccurate diagnosis for various hormone tests. Blood Testing Blood testing is also known as serum testing and it's one of the most popular and efficient testing methods out there. It's a tried and tested method used for decades to assess the health and wellbeing of a patient. Advantages of Blood Testing Multiple hormones including testosterone and estrogen can be tested using a blood sample. Patients typically draw blood at a nearby clinic and they receive the results after a few business days or even quicker. Blood testing is highly accurate and it works for nearly all types of tests out there. It can be used to accurately measure PSA levels in men as well as monitoring hormones in people undergoing hormonal therapy. Disadvantages of Blood Testing However, blood testing also has minor disadvantages. For example, this testing method provides a single snapshot of your hormones and/or general health. You cannot draw blood multiple types a day and have it measured in a lab. Blood samples are drawn several times per year at most. That's why blood testing might be done in a combination with other testing methods such as saliva and urine testing for certain hormones or substances such as estriol. This helps doctors come up with a more accurate diagnosis because they have a larger data pool from which to interpret the results. A Word About LC-MS Testing When it comes to analyzing a blood sample, a lot of improvements have been made in the last decades. Some of the most advanced testing methods involve liquid chromatography-mass spectrometry testing and this technique provides highly accurate results. LC-MS testing is often done to measure the total level of testosterone in your body. It can also be used for sex hormones such as estrogen, progesterone, and others. Without getting into too many technical details, this method uses highly advanced laboratory equipment to analyze ionized molecules of a particular sample or specimen. Unlike regular immunoassay-based tests used in saliva and common hormone blood test, LC/MS technology does not suffer from potential interactions from inflammatory markers like C-Reactive Protein (CRP) and supplements like biotin and others.  Laboratories usually design their own LC-MS assays which are complex chemical reactions that allow medical instruments to detect specific information in the blood sample. LC-MS is increasingly popular these days because it's highly flexible and very accurate. When you order a direct-to-consumer blood test such as a total testosterone test, your blood sample is usually analyzed using LC-MS testing in a laboratory. Given the complexity of this procedure, now you probably understand why blood testing is more accurate than saliva testing for most hormonal tests. Conclusion As you can see, all testing methods have their pros and cons. That's why it's important to select the correct testing options for certain hormones and substances. As mentioned earlier, saliva hormone testing is best used for cortisol measurement. You can order your 4-tube saliva testing kit from Discountedlabs.com at an affordable price. For most other hormone tests, blood testing is likely the most accurate and popular choice. You can test the levels of multiple hormones in your blood using individual tests or complex test panels. Check out this broad range of hormone tests on Discountedlabs.com. Most of these tests use LC-MS testing to deliver highly accurate results.  

It has been estimated that approximately 1 in 4 adults have low total testosterone levels, especially those over 40. Testosterone is the primary male sex hormone responsible for numerous body functions and processes. People with normal testosterone levels feel more confident, have more energy, increased libido and sex drive, and are more stable from an emotional point of view. On the other hand, low testosterone can cause mood swings, low libido, irritability, loss of muscle mass, lack of confidence, and poor mental clarity. One of the best ways to treat low testosterone symptoms is using testosterone replacement therapy (TRT). This is a tried and tested method of administering testosterone to patients using injections, creams, gels, patches, etc. However, many men with low testosterone levels are reluctant to go the TRT route. They usually try their luck with testosterone-boosting supplements, which claim to improve libido, and mood, increase energy levels and enhance the quality of life. But do these supplements work? Does science support their claims? This article is going to provide an answer to these questions, so keep reading. You’ll learn more about testosterone-boosting supplements, how they work, and whether they’re worth your money. Table of Contents Studies Done on 50 Testosterone Supplements Show Interesting Results Some of the claims by testosterone boosting supplements include: A Review of PubMed Literature on These 50 Testosterone Boosting Supplements Taking A Closer Look at the Claims Made by Testosterone Boosting Supplements Conclusions How Can You Test Your Testosterone Levels? References Studies Done on 50 Testosterone Supplements Show Interesting Results A study performed at the University of Southern California in Los Angeles reveals exciting details about testosterone supplementation. After a simple Google search, the researchers discovered 50 different testosterone-boosting supplements which make various claims and contain different types of ingredients. This study focused on literature published on PubMed regarding these supplements. It’s not a study involving actual people, control groups, etc. The purpose of the study was to determine if testosterone-boosting supplements’ claims are backed up by the academic literature. It has been discovered that nearly 50% of American adults take some form of supplement, including testosterone-boosting supplements. The reason why such supplements are taken is to help increase endogenous testosterone levels. In other words, American adults take supplements to help to boost their natural testosterone levels and reap all the benefits associated with it. Some of these supplements also contain popular herbs and plant extracts that claim to have anti-aging properties. Although testosterone-boosting supplements are popular, there’s little to no evidence to support their claims. These supplements are also loosely regulated by the FDA and other health organizations. For example, the FDA stated that supplements are not intended to treat or cure a disease, and they should not make claims such as “reduce pain” or “Improve libido.” With that being said, testosterone-boosting supplements are filled with such claims in an attempt to attract a broader audience. Some of the claims by testosterone boosting supplements include: 1.  Boost free testosterone 2.  Feel stronger 3.  Enhance sex drive and libido 4.  Increase muscle mass 5.  Help to burn fat more quickly The study has compiled a broad list of claims made by testosterone-boosting supplements on the market. A Review of PubMed Literature on These 50 Testosterone Boosting Supplements The 50 testosterone-boosting supplements found in this study have been closely evaluated. The researchers have discovered up to 109 different ingredients in their composition and analyzed them extensively. These ingredients have been analyzed and compared against the FDA’s Recommended Daily Allowance (RDA) levels. At the same time, the ingredients have also been compared with the upper tolerable intake level (UL). This standard reveals how much of a particular substance or ingredient is safe for the human body. Each testosterone-boosting supplement contained an average of about 8-9 ingredients. Some of the most popular substances were zinc, vitamin B6, magnesium, boron, Maca Extract, and others. The PubMed literature contained no studies for approximately 67 of these ingredients out of the 109 studied. For the other ingredients, PubMed showed at least one or more studies analyzing their effect on testosterone levels and whether or not they had anti-aging properties. 27 of these ingredients showed that they could increase testosterone levels when supplementing regularly. Approximately 11 ingredients were decreasing testosterone levels. Twenty ingredients didn't do anything to improve testosterone levels and did not affect the human body. For the other 15 ingredients, there was no data on PubMed showing their effects on testosterone levels. Interestingly, some of the testosterone-boosting supplements analyzed contained zinc and vitamin B3 above the standard UL. This is not a good thing because over-supplementation with zinc can cause different types of health complications, such as an increase in bad cholesterol levels. Similarly, too much zinc in the body can interfere with the proper absorption and utilization of iron and copper, so patients must be careful when taking too much zinc. Taking A Closer Look at the Claims Made by Testosterone Boosting Supplements The 50 testosterone-boosting supplements analyzed revealed interesting claims which usually sound “too good to be true”. Most of these supplements mentioned that they could “boost free T levels” and “increase lean muscle mass.” However, as mentioned earlier, just 27 out of those 109 ingredients found in supplements might show an increase in testosterone levels. Some of them can decrease T levels, while most have no effect. From these facts, we can deduce that many of the claims made by manufacturers of testosterone-boosting supplements are invalid. Testosterone-boosting supplements usually attract men because they believe these products can magically improve their health and make them feel better. On the contrary, all reputable scientists and experts say there's no substitute for a healthy lifestyle consisting of regular exercise and a proper diet rich in vegetables and fruits. Therefore, when you see a testosterone-boosting supplement making claims such as “make you feel stronger” or “give you more energy,” you should take these statements with a gram of salt. Conclusions Although the study looked at the published academic literature without patient involvement, studies on the ingredients in testosterone-boosting supplements reveal that roughly 25% of them might have beneficial properties. Therefore, low testosterone levels shouldn’t be treated with testosterone-boosting supplementation. TRT is a safer and more efficient approach in this case. The patient should speak with his doctor and find out if he’s a good candidate for testosterone replacement therapy. How Can You Test Your Testosterone Levels? On top of that, people shouldn’t just take testosterone-boosting supplements because they think they have low T levels. If you do feel the classic symptoms of low T, such as excessive fatigue, poor performance at the gym, and decreased sex drive, then you should test your testosterone levels. The best way you can do that is by using a direct-to-consumer lab which can be ordered from DiscountedLabs.com. The total and free testosterone test based on liquid chromatography is ideal for most people, but if you want a more comprehensive test, you can check out this comprehensive total, free and biovailable testosterone test  ============== References 1. Hypothalamic-pituitary-testicular axis disruptions in older men  2. Treatment of symptomatic androgen deficiency  3. Consumer usage and reasons for using dietary supplements   

Free Testosterone (FT) is the active form of testosterone (T) that can enter the cell. The main binding of Testosterone is to SHBG and albumin. There are different ways to determine FT. Some use free androgen index method, which is done by a calculation formula. Recently the LC/MS-MS (liquid chromatography / mass spectroscopy) has become the most widely and easy-to-use method. Free T is usually 2 percent or greater of total T.  Values under 2 percent are associated with higher SHBG or albumin. As shown in the figure above, about 2 percent of the testosterone in the body is active. This “free testosterone” is not attached to binding proteins that would prevent it from interacting with its receptor.About 40 percent of the body's testosterone is attached to albumin. This is a protein that can release the hormone as the need for it arises in the body. Free testosterone and testosterone attached to albumin are referred to as “bioavailable testosterone.”In a healthy young male, about 60 percent of his testosterone is attached to sex hormone-binding globulin (SHBG). Hormones bound to SHBG can't be used by the body and lose their anabolic effect. As males grow older or if an illness is present, SHBG sweeps up more and more testosterone, lowering free testosterone and its benefits.Total testosterone is the sum of bioavailable testosterone and testosterone bound to SHBG. Measuring the total testosterone in the blood may not provide the whole picture and let you know how much “active” or usable testosterone you have. Types of Testosterone Blood Tests- How to Choose the Best One?   A new study indicates that measuring free testosterone and total testosterone may provide a more accurate picture than measuring total testosterone levels alone when diagnosing a deficiency of this male hormone. There is concern that, under current clinical guidelines, some men are misdiagnosed with testosterone deficiency and receive inappropriate therapy. In contrast, others who should get treatment don't receive it, D.r Leen Antonio (University of Leuven, Belgium) explained when presenting her research here at the European Congress of Endocrinology (ECE) 2015. "I think it would be preferable to use free testosterone rather than total testosterone to measure deficiency, especially in men with borderline total testosterone levels. Our results suggest that free testosterone is more informative than total testosterone," she told attendees. Currently, total-testosterone levels are used to measure testosterone deficiency or hypogonadism. However, she explained that only free testosterone, unbound by sex-hormone–binding globulin (SHBG), can enter and activate androgen receptors in cells, resulting in testosterone-mediated effects. Source  

Table of Contents What is a PSA Test? Elevated Prostate Specific Antigen The Significance of Free PSA What if the Test Shows an Elevated PSA level? Getting Tested The PSA Controversy The Prostate-specific antigen or PSA test is a blood test that can be used as a measurement of prostate health.  According to a March 2009 European study published in the New England Journal of Medicine (1), the PSA test is not only a valid screening test for prostate cancer but could also significantly reduces mortality from this disease in middle-aged men.    What is a PSA Test? The PSA test was initially approved by the US Food and Drug Administration (FDA) in 1986 to track the progression of prostate cancer in individuals who have been previously diagnosed with the disease. In 1994, the use of the PSA test, together with a digital rectal exam (DRE) was approved by the FDA to test asymptomatic men for prostate cancer. Men who experience prostate symptoms will usually undergo a PSA test (with a DRE) to help a urologist determine what’s causing the problem.   Elevated Prostate Specific Antigen Prostate-specific antigen (PSA) is a protein secreted by healthy, as well as cancerous cells in the prostate gland. A PSA test is commonly used to measure the level of this protein in someone’s blood. This test is conducted by taking a blood sample and sending it to a laboratory for analysis. PSA test results are typically recorded as nanograms of PSA per milliliter (ng/mL) of blood. In men with prostate cancer, the blood level of PSA is frequently elevated. Although research does indicate that having an elevated PSA level does not always mean that a man has prostate cancer (2). PSA levels may also become elevated because of benign enlargement of the prostate gland as well as prostatitis (inflammation of the prostate) due to infection. It’s crucial to emphasize that a PSA test is not a specific prostate cancer test, but it’s a critical first step in checking for the possible presence of prostate cancer. There are other factors that could cause your PSA levels to increase (3):   Advancing age; PSA levels tend to rise with age. Inflammation of the prostate gland, from either infection or some other undetermined cause. Benign prostatic hyperplasia (BPH); also called an enlarged prostate.  A larger prostate has more cells secreting PSA, increasing the odds for an elevated PSA level. Prostate cells could be inflamed by a urinary tract infection, causing PSA levels to go up. Ejaculation can cause a mild elevation in the PSA score, but levels return to normal after only a few days. The recommendation is that men abstain from sex for at least 48 hours before PSA testing Anything that might cause trauma to the prostate like; bike riding, catheter insertion into the bladder, prostate biopsy, or cystoscopy can temporarily increase PSA levels.   GET A PSA TEST HERE   Conversely, some medicines (Proscar, Avodart, Propecia) (4) could lower your PSA.  If you’re taking any of these medications, you should advise your doctor.  A PSA level of less than 4.0 ng/mL is considered to be normal, but changes of more than 2.0 ng/mL over a year may indicate that prostate cancer is present (5).   The Significance of Free PSA PSA circulates through the body in two ways; bound to other proteins or by itself. Unbound PSA is called free PSA. A free-PSA test will measure the percentage of unbound PSA while a PSA test is used to measure the total of free and bound PSA in the blood (6). The free PSA is a defective variant of normal PSA that can no longer bind to other proteins and so circulates in the blood in the free form. Although the reason why is poorly understood - patients with cancer may have lower free PSA levels than those with a benign prostate condition (6).   GET A FREE PSA/TOTAL PSA RATIO TEST   What if the Test Shows an Elevated PSA level? If someone who isn’t experiencing the symptoms of prostate cancer decides to take a PSA test and discovers that he has an elevated PSA level the urologist could advise him to take another PSA test to confirm the original result. When results show that the PSA level is still elevated, the doctor could then recommend that he continue to be tested and digitally examined at regular intervals to detect changes (if any) over time (6). When the PSA level continues to rise or if a lump is detected during a digital examination, additional tests could be prescribed to discover possible causes (7). These tests can include:   Urine test to check for a urinary tract infection Transrectal ultrasound X-rays  Cystoscopy   If the doctor suspects prostate cancer is present, then a prostate biopsy may be recommended. This procedure is used to collect multiple samples of prostate tissue by inserting hollow needles into the prostate gland and then withdrawing them. Frequently, the needles will be inserted through the wall of the rectum in a procedure called a transrectal biopsy. A pathologist then studies the collected prostate tissue with a microscope. An ultrasound may also be used to view the prostate during the biopsy, although ultrasound alone can’t be used to make a prostate cancer diagnosis.   Getting Tested The accepted recommendation is that once a man reaches 40 years of age, he should begin having his prostate checked to establish a baseline for future monitoring. With a baseline set, the doctor can act quickly if PSA level changes indicate a potential problem (8). Unfortunately, many men underestimate the importance of setting a PSA baseline from a younger age. Establishing your baseline PSA level means that if there is even a small change in PSA levels - your doctor can quickly begin the necessary procedures to find out what may be causing the change and commence proper treatment if it’s indicated, possibly saving your life (9).   The PSA Controversy The PSA test is not a cancer test. The test is only used to determine the level of PSA in a man’s blood. A high PSA score may indicate the presence of prostate cancer – but there are many factors that can cause PSA levels to be elevated, from infection to resent ejaculation. Another problem is that the PSA test also cannot distinguish between elevated PSA as a result of benign cancer that will pose no threat in the course of a normal lifetime or from the presence of an aggressive tumor that poses a much more immediate threat (10). Regardless, current research still indicates that PSA is a valid and proven marker that can be used together with other variables for determining the chance that aggressive prostate cancer is present (10).   References   1) SchröderFH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality in a randomized European study, N Engl J Med, 2009, vol. 360 13(pg. 1320-1328).   2) O'Shaughnessy M, Konety B, Warlick C. Prostate cancer screening: issues and controversies.MinnesotaMedicine, August 2010.   3) Mayo Clinic Staff. PSA Test. (N.D.). https://www.mayoclinic.org/tests-procedures/psa-test/details/risks/cmc-20200313   4) Pannek J, Marks LS, Pearson JD, Rittenhouse HG, Chan DW, Shery ED, Gormley GJ, Subong EN, Kelley CA, Stoner E, Partin AW. Influence of finasteride on free and total serum prostate-specific antigen levels in men with benign prostatic hyperplasia. The Journal of Urology. 1998.   5) Carter, H. Ballentine et al. “Detection of Life-Threatening Prostate Cancer with Prostate-Specific Antigen Velocity During a Window of Curability.” Journal of the National Cancer Institute 98.21 (2006): 1521–1527. PMC. Web. 24 Nov. 2017.   6) Mione R1, Barioli P, Barichello M, Zattoni F, Prayer-Galetti T, Plebani M, Aimo G, Terrone C, Manferrari F, Madeddu G, Caberlotto L, Fandella A, Pianon C, Vianello L, Gion M. Prostate cancer probability after total PSA and percent free PSA determination. Int J Biol Markers. 1998 Apr-Jun;13(2):77-86.   7) Wilt, Timothy J et al. “Prostate Cancer: Epidemiology and Screening.” Reviews in Urology 5. Suppl 6 (2003): S3–S9. Print.   8) Larsen, Signe Benzon et al. “Baseline PSA Measurements and Subsequent Prostate Cancer Risk in the Danish Diet, Cancer and Health Cohort.” European journal of cancer (Oxford, England: 1990) 49.14 (2013): 3041–3048. PMC. Web. 24 Nov. 2017.   9) Weight, Christopher J. et al. “Men (Aged 40–49 Years) With a Single Baseline Prostate-Specific Antigen Below 1.0 ng/mL Have a Very Low Long-Term Risk of Prostate Cancer: Results from a Prospectively Screened Population Cohort.” Urology 82.6 (2013): 1211–1217. PMC. Web. 24 Nov. 2017.   10) H Ballentine Carter. Differentiation of lethal and nonlethal prostate cancer: PSA and PSA isoforms and kinetics. Asian Journal of Andrology. 2012 May; 14(3): 355–360.

Thanks to advancements in medicine and technology, nowadays it's possible to test the levels of almost any type of substance, hormone or nutrient in the body using a single blood sample. This, type of test can determine the likelihood of developing heart disease in the future. This is the case for cardiac C-reactive protein as well. But what exactly is cCRP or cardiac C-reactive protein? And how is it measured? This article provides answers to all these questions, so keep reading to find out more. Table of Contents What is C-Reactive Protein? What is Cardiac C-Reactive Protein? How is the cCRP Test Performed? What Are the Normal Levels Of cCRP In the Blood? Order Your CRP Test Today What is C-Reactive Protein? C-reactive protein is a type of substance produced by your liver. This protein is produced in response to inflammation in the body. When high levels of inflammation are detected, the liver makes more C-reactive protein to counter its effects. The more inflammation in the human body, the more C-reactive protein is produced. Doctors call this substance a biomarker. By measuring this biomarker, you can tell whether a person has a very inflamed body or whether inflammation can be triggered by a different type of disease or as a result of -intense physical exercises. What is Cardiac C-Reactive Protein? It's important to note that C-reactive protein shows inflammation in the body but doesn't tell where. You need a more sensitive and accurate test for that. This is where cardiac C-reactive protein comes into play. It's also known high-sensitivity C-reactive protein and biomarker for heart disease. Cardiac C-reactive protein is uindicateserson's predisposition to cardiovascular disease. Other tests are performed in c a CRP test to determine if a person is at high risk for heart disease. If the levels of the cCRPCRP are high, you might develop cardiovascular disease in  How is the cCRPCRPt Performed? Before taking the CCRP test, a general health assessment is usually performed. For example, your doctor might take your blood pressure, measure your cholesterol level, and ask you t your lifestyle choices and habits. Based on this assessment, your doctor might order a cCRPCRPt to determine the levels of high-sensitivity C-reactive protein in your blood. Generally speaking, the cardiac C-reactive protein test is recommended for people with up to a 10% chance of developing a heart attack in the next ten years. If you're healthy, this test might not mean anything to you. However, you can still order your test online from DiscountedLabs and measure the levels of cCRPCRPyour blood on your own. Once you have the test, you must need a blood sample for analysis. This sample is tested in a certified lab, and the results are mailed back to you in a few business days. Based on the results, you might be required to make lifestyle changes to prevent cardiovascular disease in the future. What Are Normal Levels Of cCRPCRPthe Blood? The levels of cCRPCRPthe blood are important because they can accurately predict cardiovascular disease in most individuals. Here are some basic values for your reference: Levels lower than 1mg /L indicate a low risk of cardiovascular disease Levels between 1mg/L and 3mg/L indicate a moderate risk of cardiovascular disease Levels higher than 3mg/L indicate a higher risk of cardiovascular disease Your doctor will help you interpret your results. As mentioned earlier, you shouldn't panic if your levels are higher than 3mg/L because it should also r your risk of heart disease in the future by making appropriate lifestyle changes. Quitting smoking is one of the best positive changes you can make, maker example. This involves eliminating most junk food you are eating, processed sugar, and refined carbs. You might also want to exercise more often and clean your diet. These lifestyle changes are done gradually to help you keep your blood pressure in check, improve your cholesterol levels, and reduce inflammation in the body. Multiple heart attacks can be fatal in some cases, so this test is crucial for these individuals. At the same time, this test is user helpful to people who have already had a heart attack. The results will indicate if the person in question is at risk of having another heart attack in the upcoming years. Order Your CRP Test Today Fortunately, you don't need a doctor's appointment to get your test. Make sure you talk with your doctor for more details, especially if the results worry you. You can order it from DiscountedLabs at an affordable price and compare your results with the reference values mentioned above. Order it from DiscountedLabs at an affordable price and compare your results with the above reference values. Make sure you talk with your doctor for more details, especially if the results worry you. Also, do not hesitate to check out the basic C-reactive protein test to learn more about its purpose, what it represents, and how it can help you in the future.      

According to the National Institute of Health, gynecomastia can affect more than 50% of adolescent boys during puberty. At the same time, gynecomastia can also affect up to 65% of men between 27 and 92 years, depending on their lifestyle, habits, drug intake, and other factors. But what is gynecomastia and why so many men get it? Is it dangerous? And what can you do to treat it effectively and safely? Keep reading this article to find out everything you need to know about gynecomastia, its types, causes, and treatment options. Table of Contents What is Gynecomastia? What Kinds of Gynecomastia Are There? Physiological Gynecomastia Neonatal Gynecomastia Pubertal Gynecomastia Aging Gynecomastia What Hormone Inbalances Can Cause Gynecomastia? Pharmacological Gynecomastia Caused by Medications How to Treat Gynecomastia Gynecomastia FAQ What is Gynecomastia? In simplest terms, gynecomastia is commonly known as “man boobs.” It’s a health issue characterized by an increase of the breast tissue in adolescent boys as well as adult males. Although this type of condition doesn’t usually pose serious health risks, it can have profound psychological consequences. Men simply don’t like having breasts which look like those of women. The prevalence of gynecomastia in seniors over 50 years of age is approximately 70%. In rare cases, untreated gynecomastia can lead to different types of diseases, including breast cancer, so that’s why it’s essential to accurately diagnose and treat them. Gynecomastia can also be referred to as male breast enlargement, and it splits into three main categories - physiological, pathological, and pharmacological. Let’s take a closer look at each one.   What Kinds of Gynecomastia Are There? Physiological Gynecomastia This type of gynecomastia is usually caused by an imbalance in the testosterone and estrogen ratio in the body. As you probably know, these two are the essential sex hormones, and they need to be present in specific quantities in the bloodstream in both males and females. For example, men have 40 times more testosterone than females, but they also have small amounts of estrogen. This estrogen helps with libido, bone density, and other critical bodily functions. Women have higher quantities of estrogen, but small amounts of testosterone for libido, muscle mass, mood, etc. Men who have relatively more estrogen than necessary to balance testosterone tend to develop gynecomastia. This can be caused by various factors. Neonatal Gynecomastia It usually happens at birth when the ratio of estrogen to testosterone is imbalanced. It should resolve itself after a few weeks. Parents must seek a doctor's help if the gynecomastia persists after one year. Pubertal Gynecomastia This type of gynecomastia usually happens among teenagers who reach puberty. The balance of estrogen to testosterone goes out of whack, and the breasts of adolescent boys grow more than usual. The issue should get resolved automatically in less than two years. If it doesn’t more investigations are required to determine the cause of this type of gynecomastia. Aging Gynecomastia Adult males who get old will also experience mild gynecomastia, which is caused by advanced age. This process happens as a result of an increase in aromatase activity. In other words, the brain, fat tissue, liver and testicles convert a larger portion of testosterone into estrogen. The resulting higher estrogen to testosterone ratio causes aging gynecomastia.   What Hormone Inbalances Can Cause Gynecomastia?   This type of gynecomastia is usually caused by an increase in estrogen hormones, a decrease in androgen hormones or a combination of both. Here are a few hormone inbalances that can cause gynecomastia: 1. Androgen deficiency Gynecomastia can be caused by a testosterone deficiency in males of all ages. When testosterone levels drop, estrogens become more prevalent and might dictate a breast enlargement in men. In such cases, gynecomastia acts as a symptom of testosterone deficiency and it helps individuals become aware of this health issue. Testosterone deficiency is usually associated with a higher aromatization rate (which converts more testosterone to estrogen) and a decrease in the production of luteinizing hormone (LH). The Klinefelter Syndrome is usually associated with hypogonadism in those patients. Unfortunately, this health issue can increase the likelihood of developing breast cancer; that’s why it’s crucial to test the testosterone levels as soon as possible if gynecomastia is observed in patients. Breast enlargement caused by androgen deficiency can be treated with testosterone replacement therapy (TRT). In these cases, testosterone is administered in an exogenous manner by using injections, creams, pills, gels, etc. 2. Hyperprolactinemia Hyperprolactinemia is a health condition in which a male has higher levels of the hormone prolactin in his bloodstream. Prolactin is a hormone present in all mammals which allows them to produce milk. Hyperprolactinemia might be caused by a type of growth on the pituitary gland, a condition known as a prolactinoma. This growth triggers an increase in the production of prolactin, which causes hyperprolactinemia. Certain medications can cause increased prolactin. One side effect of this condition is gynecomastia. 3. Estrogen Excess Different types of estrogens cause an increase in breast development in both males and females. However, males tend to have a much smaller amount of estrogen in their bodies, so the breast enlargement stops after a while. In some cases, an excessive amount of estrogen can be produced, which leads to gynecomastia. Tumors tend to cause excess estrogen production, which in turn leads to gynecomastia. The administration of exogenous estrogens can also trigger gynecomastia in males of all ages. Patients who develop tumors also experience other symptoms such as Cushing's syndrome, weight loss, and an accumulation of fat in the abdominal area. In some cases, gynecomastia can also be a symptom of more severe disease such as testicular cancer. People who have gynecomastia should also receive a thorough investigation of the testicles to see if more serious health issues are present. 4. Thyroid Problems The thyroid gland is a vital contributor to the healthy development of a male. Conditions such as hypothyroidism or hyperthyroidism can lead to abnormal secretion of testosterone, decreasing the levels of this hormone in the bloodstream. As a result, estrogens become more prevalent, and they cause gynecomastia in most patients. If patients are assessed, and their gynecomastia is caused by thyroid issues, receiving thyroid treatment is the most appropriate solution. After the thyroid hormonal balance is restored, gynecomastia usually goes away on its own. 5. Obesity People who are obese usually have gynecomastia as well. This happens because the aromatization of testosterone into estrogen occurs in the adipose tissue. As a result, having more fat around the body allows more testosterone to be converted into estrogen, which results in breast enlargement. 6. Growth Hormone Excess Another cause of gynecomastia might be represented by an excessive amount of growth hormone and IGF-1 in the bloodstream. These hormones are responsible for growing muscle mass and bones. Studies show a correlation between gynecomastia in pubertal boys and a high amount of growth hormone and IGF-1 in the blood. Men using growth hormone or growth hormone releasing hormones should be aware of this issue. 7. Other Causes Gynecomastia might also be caused by different other health conditions. For example, chronic liver disease can significantly decrease testosterone production, which leads to breast enlargement and gynecomastia. Resuming a healthy diet after a long period of starvation can also cause gynecomastia. That's because, during periods of food scarcity, the production of testosterone is reduced. Testicular damage might also trigger enlargement of breasts in men.   Pharmacological Gynecomastia Caused by Medications   It has been discovered as a result of numerous studies that gynecomastia can also be caused by various drugs. For example, some medications can reduce testosterone production; others might cause an increase in estrogen hormones or disrupt the sensitivity of androgen receptors. Opioids can also cause gynecomastia. 1. Performance-Enhancing Drugs (PEDs) in Athletes It is a well-known fact that various performance-enhancing drugs are taken by athletes and non-athletes to increase their sports performance. Anabolic-androgenic steroids (AAS) are usually used to increase muscle mass, reduce recovery time, and improve sports performance. One side effect of abusing such drugs is the development of gynecomastia since most anabolic steroids shut down the body’s own testosterone production, which increases the estrogen to testosterone ratio. Abusing PEDs cause breast enlargement in men because it increases the aromatization process. This converts more testosterone into estrogen and gynecomastia appears as a result.  After a prolonged period of abuse, other health complications can arise, such as erectile dysfunction and infertility. 2. Getting Exogenous Estrogen The estrogen hormone can be absorbed into the bloodstream in various ways and usually accidentally. For example, animals who are treated with estrogen-rich food or drugs are eaten by men who absorb some of these hormones. Similarly, some creams which are used to treat baldness can cause an increase in estrogen production, which leads to gynecomastia. Similarly, soy-based products tend to contain estrogens (known as phytoestrogens), which can get into the bloodstream. Lavender and tea tree oil also contain phytoestrogens and are commonly found in food and cosmetics. 3. Using Recreational Drugs Different types of drugs, such as marijuana can also cause gynecomastia if abused. The experts are not yet aware of why this process happens, but there is a health condition known as marijuana-induced gynecomastia. It is believed that this drug can reduce the production of testicular testosterone, which leads to hypogonadism and gynecomastia.   How to Treat Gynecomastia As you probably have figured it out, there's no one-size-fits-all treatment for gynecomastia in men. This condition can be a problem by itself, or it can be a symptom of a more severe health issue which needs to be investigated immediately. As a general rule of thumb, gynecomastia can be caused by an increased aromatization of testosterone to estrogen, increased IGF-1, decrease thyroid function with or without a decrease in testosterone production. These two conditions can be triggered by drug abuse, organ damage, genetics, or other factors. Once the first physical symptoms are observed, the patient needs to visit his healthcare provider immediately to do more investigations. Gynecomastia is characterized by an increase of the hard to the touch breast tissue, especially under the nipple area. Therefore, it shouldn’t be confused with fat mass. The doctor can perform various investigations such as doing a blood test for testosterone and/or for estrogen levels. Depending on these results, the doctor might recommend other tests to discover why the testosterone to estrogen ratios are unbalanced. If testosterone blood levels are low, doctors prescribe testosterone replacement therapy.  If estrogen is high while testosterone is normal, doctors usually prescribe tamoxifen.  However, certain more advanced gynecomastia cases require surgery to extract breast gland tissue. In some cases, gynecomastia is caused by other underlying issues. For example, if it's caused by thyroid problems, the thyroid gland must be treated with appropriate medication. If gynecomastia is caused by liver damage, addressing the liver might help to fix gynecomastia for good. Those who are obese should consider losing weight to alleviate their gynecomastia symptoms. Entering a weight loss program and eating healthier foods can facilitate the process of losing weight.   Gynecomastia FAQ Here are a few answers to some of the questions you might have about gynecomastia. 1. Is Gynecomastia Painful? Some patients might experience mild pain in their chest area as well as tenderness, especially when gynecomastia gets into an advanced state. However, the pain is not sharp or intense, and it usually goes away once proper treatment for gynecomastia is administered. 2. Does the Breast Tissue Subside Once Gynecomastia Is Treated? One of the main concerns of patients with gynecomastia is whether the breast tissue will continue to "hang" after the condition is treated. Unfortunately, the tissue will not subside on its own in most cases, but there are solutions to this problem. Once the underlying cause of gynecomastia is treated, patients can perform small surgeries to remove the excess breast tissue and achieve a more "manly" chest. 3. Does Scarring Occur After Removing the Breast Tissue? Luckily, the scarring is minimal around the nipple area and almost invisible. Patients can go to the beach and not worry that someone will see that they had gynecomastia surgery because the scarring is virtually non-existent. 4. Are There Any Other Drugs or Substances Which Cause Gynecomastia? Certain drugs or substances might cause gynecomastia such as marijuana, steroids, or other performance-enhancing drugs. However, men might develop breast tissue enlargement as a result of consuming high amounts of alcohol too. Alcohol can damage the liver, which in turn decreases the production of testosterone. At the same time, certain drugs such as spironolactone, ketoconazole, and others can also trigger the development of gynecomastia. Cimetidine, which is a drug used to treat ulcer, is also associated with this type of health issue. Conclusions Treating gynecomastia can be done with relative ease these days, as long as you are aware of its existence. For a complete and thorough test which helps you diagnose this condition quickly, check out the Gynecomastia Test Panel. This lab test panel provided by Discounted Labs can be done using a blood sample, and you get the results in just a few business days. The results can help your doctor decide what therapies are best for you to eliminate your gynecomastia.   Reference: Sansone A, et al. Gynecomastia and hormones. Endocrine. DOI 10.1007/s12020-016-0975-9

Testosterone Replacement Therapy (TRT) has changed the lives of many men around the world.  Like any therapy, it can have great benefits if properly managed but negative side effects if not monitored.  This article will briefly and simply review the different TRT tests that most physicians use to monitor your progress while minimizing potential side effects.   Table of Contents How to Know if You Need TRT Follow Up Lab Tests After Starting TRT Avoiding or Lowering High Hematocrit on TRT Avoiding Low Ferritin and Iron Monitoring the PSA Test on Testosterone Monitoring Estradiol Test on Testosterone Avoiding High Blood Pressure and Water Retention on TRT Monitoring Kidney Function Avoiding High Liver Enzymes Monitoring Thyroid Tests Maintaining Good HDL Levels on TRT Prolactin in Men with Low Testosterone: The Forgotten Hormone Where to Buy Your Own TRT Tests: How to Know if You Need TRT The first thing doctors actually measure before you get on testosterone replacement is your total and free testosterone blood levels to find out if you have low testosterone. They will also ask you a few questions to see if you have low testosterone or hypogonadal symptoms. They include low sex drive, erectile dysfunction, fatigue, low mood, and issues with cognitive capacity and function. So, testosterone replacement therapy includes anything to increase testosterone levels with either injections or creams, gels, pellets, oral, nasal, and other TRT options. Follow Up Lab Tests After Starting TRT Once you get on testosterone replacement, your doctor will have you come back either at week six or eight to run another blood test to see if your dosage needs to be adjusted and/or you may require other medications to monitor or to modulate or change levels like estradiol, hematocrit, etc. The first one obviously is testosterone total and free. You come back at week six or eight, and your total testosterone is not over 500 nanograms per deciliter, your doctor will probably choose to increase your dosage or your frequency of injections in the case of injections. Free testosterone is usually around 2% of total or higher. If you have lower than 2%, your doctor will probably focus on any issues related to high sex hormone binding globulin (SHBG), which is a protein that binds to testosterone and does not free it up for action. Avoiding or Lowering High Hematocrit on TRT Hematocrit is the proportion of red blood cells in the blood. Testosterone tends to increase red blood cells.  Some men don't have that issue, but most men at least have a two to a three-point increase in hematocrit after starting TRT. Hematocrit increases a lot more in men on TRT who have sleep apnea and in smokers since these two can cause oxygen starvation.  High hematocrit can increase the viscosity of the blood and may cause cardiovascular issues. So, the magic number to go for is a hematocrit of 53 or below. When you're getting close to 53, you have to basically donate blood or go for what we call a therapeutic phlebotomy to bring down the red blood cell amount in the blood. And that's very important because as hematocrit goes up, your blood becomes more and more viscous, and your cardiovascular system gets compromised.  It's also very important not to let it go too high because above 52, most blood centers would not accept you as a donor, so you would have to require a special prescription for a therapeutic phlebotomy from your doctor for the blood centers to take your blood and dispose of it later. Keep in mind that donating more frequently than every three months may decrease your ferritin and iron stores considerably, which can cause fatigue and other issues. Here are some hematocrit lab panels, or you can buy them as part of the CBC panel. Avoiding Low Ferritin and Iron When your hematocrit is over 53, and you donate blood frequently than every three months, you can deplete your iron stores which makes you tired, depressed, and with no libido. Blood donations should not be happening that frequently because you'll lose iron. Some doctors will test your iron and your ferritin, and if you have low levels, they will put you on an iron supplement. Discounted Labs sells a blood donation panel that is designed to inform you if you can safely donate blood. Monitoring the PSA Test on Testosterone High PSA, prostate-specific antigen, is the only contraindication for testosterone replacement therapy if it is 4 or above. Obviously, physicians get very concerned that a man with higher PSA may have prostatic cancer, although it could be caused by an infection of your prostate (prostatitis) that could be easily treatable with an antibiotic. So, all high PSA tests do not mean you have cancer, but it could mean that you could have a treatable prostatic infection.  Your doctor may prescribe antibiotics and retest your PSA after your antibiotic cycle is finished.  He or she may need to refer you to a urologist if your high PSA test does not come down.  But if you do have a PSA of four or higher, you are not going to be allowed to use testosterone replacement unless your doctor can actually prove that it's an infection that will eventually be treated so that your PSA can come down. Monitoring Estradiol Test on Testosterone Estradiol (E2) is a very important hormone for men. We need it because estradiol is actually linked to bone health, cognitive functioning, cardiovascular health, even sex drive, and decreased fat mass. Having very low estradiol of under 20 pg/mL is actually not good for you since it can decrease bone density and cause other issues. Having very high estradiol in relation to your testosterone blood level may also have some consequences.  Several studies have different opinions and conclusions on what high estradiol means. About 0.3 to 0.4% of testosterone gets converted into estradiol by the aromatase enzyme. So obviously, the body increases the amount of estradiol as your testosterone goes up. There's nothing wrong with that. Estradiol balances testosterone to keep a better lipid (cholesterol) profile and to keep healthy sperm counts, just to name a few benefits. But what level of estradiol in men is too high? For example, if you have a testosterone level after you start TRT of 700 nanograms per deciliter, obviously, your estradiol is going to be higher than when before you started TRT. Is that cause for concern? Most men on testosterone replacement therapy do not need to take medications to lower estradiol. Estrogen blocker medications like anastrozole (Arimidex) are being overprescribed by many TRT clinics.  Men with a history of gynecomastia or breast enlargement may have issues with gynecomastia again if your estradiol's over 50 pg/ml, but in most studies where men with gynecomastia were followed, a lot of those men had low testosterone while they had high estradiol. A large study in adolescent boys showed that most of the ones with gynecomastia also had high IGF-1.  Some studies have shown that the ratio of testosterone to estradiol is really the important factor to monitor, with ratios over 12 being needed for healthy sperm production in men. But the management of estradiol in men is a very controversial topic as there is not a lot of agreement in the field.  Some doctors insist on keeping an E2 level of 20 to 40 picograms per milliliter no matter how high testosterone levels reach. We have learned in the past three years that the old immunoassay-based estradiol test tends to overestimate estradiol in men. Two studies have shown that the real estradiol value is better tested with a liquid chromatography-mass spectrometry sensitive estradiol assay. So, make sure that if your doctor is going to check your estradiol, you're using the right LC/MS E2 test. Discounted Labs offers several lab panels that contain sensitive estradiol.  Another concern of high estradiol is that some men feel that water retention is an issue, although that has not been proven by any studies. Most men with TRT-related water retention assume that their estradiol is high but fail to get it tested. Avoiding High Blood Pressure and Water Retention on TRT Some men on testosterone replacement therapy tend to have increased blood pressure related to water retention. There are some central nervous system effects that increase blood pressure and heart rate. These men can gain considerable weight during the first weeks of TRT.  Most lose most of that weight after a few weeks of therapy.  Some studies have shown that testosterone may decrease sodium excretion by the kidneys, which makes the body retain water to keep that sodium diluted. Ways to improve blood pressure are to lose weight, take a blood pressure medication, exercise, and decrease excessive sodium intake. Many men assume that their estradiol is high when they experience water retention. That assumption has not proven to be correct. Monitoring Kidney Function The estimated glomerular filtration rate, or eGFR, is a way to measure your kidney function. It's part of what we call a CMP blood test panel, and we are aiming at an eGFR over 60. Anything below that is indicative of a slowdown in the way your kidneys are filtrating toxins from your body. TRT does not really cause a decrease in eGFR. However, a lot of men taking creatine, exercising heavily, or eating very high protein intake tend to probably have artificial increases in creatine that decrease eGFR. You can Google eGFR formula and see how that's calculated. Avoiding High Liver Enzymes Current testosterone replacement therapy options have not been shown to increase liver enzymes; only the old oral forms of TRT used to cause that problem. However, doctors obviously follow it up. A very important distinction to make is that men that are exercising heavily with weights at the gym may artificially  increase in AST and ALT that has nothing to do with toxicity to the liver. Monitoring Thyroid Tests TSH, thyroid stimulating hormone, is also something else that most doctors follow up, although some actually do not. Low thyroid function (hypothyroidism or high TSH) may have the same symptoms as low testosterone. TRT medical guidelines groups around the world recommend different schedules for monitoring men on TRT, and a few of them agree with each other. Rarely do any guidelines mention thyroid function monitoring in men on TRT. TSH levels above 2.5 may indicate that you have hypothyroidism. If you have high TSH, doctors usually tend to use a comprehensive thyroid panel that includes free T3 and free T4, along with antibodies, to see if you have an autoimmune disease like Hashimoto's that may be inducing hypothyroidism. Maintaining Good HDL Levels on TRT High-density lipoprotein or HDL is another one of the variables most affected by testosterone replacement, especially at higher doses. When I say higher doses, anybody using 200 milligrams of testosterone replacement per week — cypionate or enanthate — tend to have a lowering of HDL. Low HDL has been shown to cause cardiovascular issues, so your doctor will always follow your lipids. Testosterone replacement has not really been shown to increase LDL, and there are some studies that show that TRT improves triglyceride blood levels because testosterone tends to improve the way the body metabolizes carbohydrates. There's very little we can do to increase HDL besides aerobic exercise, losing weight, decreasing TRT dose, and taking a supplement. Niacin supplementation is one of the ways to increase HDL, but some people get flushing of the skin and face. Last but not least, the use of anastrozole, an estradiol blocker, can also decrease HDL since estradiol is known to protect HDL levels. Prolactin in Men with Low Testosterone: The Forgotten Hormone Prolactin is not a hormone that is usually measured at TRT baseline or even at follow-up unless you have severe erectile dysfunction, even with good levels of testosterone. Men that have low testosterone at baseline, and I mean low testosterone, very low — under 150 nanograms per deciliter — are probably the best candidates to get a prolactin test. It is a hormone that women and men produce – obviously, women that are lactating produce it at higher concentrations in their bodies because it helps lactation. It also has some other benefits; otherwise, men would not have it. Prolactin has some immune-enhancing benefits and some cardiovascular benefits that are starting to show up in studies. So, prolactin is not an evil hormone, but it can, at higher concentrations, cause erectile dysfunction. The reason for high prolactin could be a benign tumor called pituitary adenoma (diagnosed by MRI), which can be producing a lot of pituitary output for prolactin, and that could actually impair your testosterone replacement therapy benefits. So, it's a hormone that is hardly looked at unless you are a man that has very low testosterone blood levels at baseline or do not respond well (unresponsive erectile dysfunction) after eight weeks or ten weeks of testosterone replacement therapy and/or you are having high prolactin symptoms, like lactation. That's actually a very rare symptom that actually occurs in men with pituitary adenomas. Where to Buy Your Own TRT Tests: DiscountedLabs.com provides very low-cost blood testing in most US states. You don't need to see a doctor because the company has in-house physicians that provide a prescription. After ordering your lab test online, you receive an email with the lab request form that you take to the closest lab near you. Once you go to a lab and get your blood drawn, you receive an email with your results within five to seven business days, depending on the blood test. For more information, visit DiscountedLabs.com   Visit ExcelMale.com to download Nelson's latest book: Beyond Testosterone   Click here for TRT Resources