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Embarking on the path of Testosterone Replacement Therapy (TRT) often evokes a blend of enthusiasm and concern among men. The allure of renewed vigor, heightened sexual desire, and robust muscle growth is enticing. However, there are a lot of less well-known aspects that your healthcare provider might not immediately disclose. For instance, were you aware that TRT could affect your fertility or exacerbate your sleep apnea? While TRT heralds a new dawn for many, it doesn’t offer a universal remedy. In light of this, we have meticulously curated a comprehensive list of 18 pivotal aspects that might elude your doctor's attention but are indispensable for you to grasp. Venture further to unearth the profundities of TRT. Low Blood Levels of Testosterone and Associated Risks: < 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome Reference: Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192. PubMed < 400 ng/dl (15.3 nmol/l) - Venous leakage (internal penile damage) risk Reference: Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed < 350 ng/dl (11.9 nmol/l) – All-cause death risk and anemia risk Reference: Khaw, K. T., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luben, R., ... & Day, N. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 116(23), 2694-2701. PubMed < 300 ng/dL (10.2 nmol/L) - Lowered libido, weight gain & Diabetes risk increased Reference: Traish, A. M., Saad, F., & Guay, A. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction Journal of Andrology, 30(1), 10-22. PubMed < 300 ng/dL (10.2 nmol/L): Quartile risk of fractures (osteoporosis), memory-related issues and depression risk increases Reference: Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E.,... & Cummings, S. (2006). Testosterone and estradiol are common among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed < 250 ng/dl (8.5 nmol/l): Arterial plaque (arteriosclerosis) & sleep quality affected Reference: Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men Atherosclerosis, 233(1), 278-283. PubMed < 235 ng/dl (8.0 nmol/l) hardening of arteries (dialysis patients) Reference: Carrero, J. J., Qureshi, A. R., Parini, P., Arver, S., Lindholm, B., Bárány, P., ... & Stenvinkel, P. (2009). Low serum testosterone increases mortality risk among male dialysis patients. Journal of the American Society of Nephrology, 20(3), 613-620. PubMed < 200 ng/dl (6.8 nmol/l) morning erections decrease Reference: O'Connor, D. B., Lee, D. M., Corona, G., Forti, G., Tajar, A., O'Neill, T. W., ... & EMAS Study Group. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1577-E1587. PubMed < 150 ng/dl (5.1 nmol/l) - Increased inflammation (TNF-alpha) Reference: Malkin, C. J., Pugh, P. J., Jones, R. D., Kapoor, D., Channer, K. S., & Jones, T. H. (2004). The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 89(7), 3313-3318. PubMed The Unspoken Implications of TRT Your doctor might overlook mentioning certain ramifications when you commence Testosterone Replacement Therapy (TRT): Fertility and TRT Sperm Count Drop: TRT lowers the levels of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), two hormones that help make sperm. If preserving fertility is a priority, discuss with your healthcare provider incorporating Clomiphene or hCG into your TRT regimen. Hematological Effects Blood Viscosity Increase: TRT can escalate your blood's hematocrit level, thereby increasing its viscosity. Although some practitioners may advise halting TRT, this side effect can be managed adeptly through blood donations or therapeutic phlebotomy. Beware; frequent blood donations might deplete iron levels and induce fatigue. Impact on Natural Testosterone Production Suppression of Endogenous Testosterone: TRT suppresses your body’s natural testosterone synthesis, which may rebound anywhere between a few weeks and six months post-cessation. The Multifaceted Benefits and Varied Efficacy of TRT Muscle Mass, Fat Reduction, and Sexual Health Sex Drive and Physique Enhancement: TRT predominantly augments libido, muscle mass, and fat metabolism in men. However, its effectiveness varies, and meticulous dosage and frequency adjustments along with side effect management are imperative. It’s not a panacea. Administration Techniques Methods of Injection: Contrary to what most people think, testosterone can be injected superficially (IM) or deeply (subcutaneously) into the muscle using a 1/2-inch, 27-29-gauge insulin syringe. Topical Testosterone Efficacy of Gels and Creams: Testosterone gels and creams are efficacious but often under-dosed by physicians. More concentrated compounded products or dosage adjustments based on blood levels can rectify this. Dosage Frequency Optimized Injection Schedules: Shifting from biweekly 200mg injections to weekly 100mg or twice-weekly 50mg dosages can often yield better results. Addressing Concerns and Optimizing TRT Outcomes Sleep Apnea and TRT Sleep Apnea Dynamics: TRT could exacerbate central sleep apnea but might alleviate obstructive sleep apnea over time as weight loss occurs. Erectile Function Erectile Function and Libido: TRT enhances erectile function and libido in a majority of men. Some may benefit from adjunctive low-dose daily Cialis, which also harbors cardiovascular advantages. Self-Monitoring and Telemedicine Monitoring Blood Tests: Companies like DiscountedLabs.com enable self-monitoring of blood tests without a doctor visit. Moreover, telemedicine facilitates access to testosterone doctors nationwide, albeit mostly without insurance coverage. Debunking Misconceptions and Enhancing TRT Knowledge Prostate Health and Cardiovascular Effects Prostate Cancer and Heart Attacks: Contemporary evidence refutes the notion that TRT triggers prostate cancer or heart attacks, though vigilant monitoring is crucial for optimal cardiovascular outcomes. Community Support and Knowledge Sharing Leveraging Online Communities: Engage with seasoned TRT users on platforms like the ExcelMale forum or Testosterone Replacement Discussion Facebook group to broaden your understanding. Comprehensive Testing Holistic Blood Analysis: Ensure your doctor conducts a thorough blood analysis encompassing total and free testosterone, DHT, thyroid function, and prolactin (especially for those with extremely low T levels) to rule out pituitary adenomas. Insurance, Professional Expertise, and Addressing Common Hurdles Insurance and TRT Insurance Coverage: Insurance coverage for TRT products is often restrictive, but utilizing a compounding pharmacy can be a viable alternative. Expertise in TRT Management Urologists Leading the Charge: The burgeoning expertise of urologists in TRT management is notable, with extensive TRT-centric discussions now a staple at urology conferences. Identifying and Addressing Co-morbidities Co-morbid Conditions: Men with co-existing health issues may encounter challenges in reaping TRT benefits, warranting a thorough cardiovascular assessment for those experiencing water retention and hypertension. Estradiol Management Misconceptions About Estradiol: People often get the wrong idea about this hormone, which plays a big part in libido, bone health, and brain function, because it is not given enough attention when it comes to management. Emerging evidence suggests aromatase inhibition might be unnecessary in TRT management. Armed with this extensive knowledge, you’re now better positioned to make informed decisions on your TRT journey. Remember, individualized consultation with healthcare professionals is indispensable for optimizing your TRT experience.    

Testosterone replacement therapy is an important treatment option for men with low testosterone and symptomatic hypogonadism. Various formulations of exogenous (supplemental) testosterone replacement therapy exist, including oral, buccal, intramuscular, transdermal, subdermal, and nasal preparations. However, exogenous testosterone replacement therapy is a double-edged sword, posing risks to fertility due to negative feedback mechanisms on the hypothalamic-pituitary-gonadal (HPG) axis, which is the primary regulator of testosterone production and sperm production in men.  Testosterone replacement therapy (TRT) is one of the most effective ways to combat low testosterone levels, but you must understand the risks associated with the treatment. As with any hormone replacement therapy, there are a few downsides to receiving regular testosterone injections. But do these risks outweigh the benefits? That’s a decision you’ll have to make for yourself!   Testosterone replacement therapy- Target Blood Test Limits: To minimize TRT side effects, different medical guideline groups have created lab test value ranges and maximum acceptable targets . These values have been collected from three TRT guidelines and clinical practices around the United States: Hematocrit (percent of red blood cells in plasma) under 53 PSA (Prostatic specific antigen) under 3 (4 is max since doctors will not prescribe TRT at this number) Estradiol (sensitive) between 20-50 pg/mL. However, if you have high testosterone, estradiol will be "high" per Quest or Labcorp since 0.4% of total testosterone aromatizes to estradiol. Blood pressure under 135/85 Estimated Glomerular (eGFR) (kidney function) over 60 Liver enzymes not elevated over 20 percent of top value of reference range Total Testosterone over 450 ng/dL Free Testosterone equal or above 2 percent of total If donating blood to bring hematocrit down, ferritin should never under 30 ng/mL or micrograms/liter (this could lead to fatigue) Free T3 (if hypothyroid and on treatment) in the upper quartile of range. (depending on range it can be 3.7- 4.2 pg/mL) HDL over 40 mg/dL (higher TRT doses can lead to decreased HDL cholesterol) You can order these lab tests here: TRT Male Hormone/Wellness Follow-Up Panel PSA Lipid Panel Thyroid Panel    

Table of Contents Timing for Female Hormone Testing Female Hormone Testing Through Menstrual Cycle Women's Hormone Blood Testing Mistakes The Best Time for Female Hormone Blood Testing Female Hormone Testing Data Reference Timing for Female Hormone Testing   Throughout our life, male or female, many of us reach a point where things may not feel quite right. Our energy levels may be low; our desire for sexual activity is not what it used to be if it exists at all. We may be experiencing unexplained weight gain or muscle loss, not to mention issues with fertility. It is for these reasons; many men and women will seek out treatment options. Such options sought out by both sexes have increasingly been hormone treatment plans, which almost always begin with blood testing. This process is relatively more straightforward for most men, but female hormone testing is slightly more complicated. Timing for the female hormone blood panels is an essential factor that must be taken into consideration.   Female Hormone Testing Through Menstrual Cycle   When determining hormone levels within the body, a premenopausal woman requires blood tests that are timed for the most accurate results. You will find some labs, and physicians will offer saliva-based tests, which may not provide accurate results, but blood testing will often be the way to go for a fuller measure of various markers in the body.   While the various tests are essential, blood testing itself must be coupled with appropriate timing. For example, for the adult male, generally, the best time to have blood drawn for testing is the first thing in the morning on an empty stomach. Some women may follow a similar approach, but for the female, this is far from optimal. Hormone testing for premenopausal women, our focus here today, is best timed around the woman’s cycle. Fasting may be necessary as it is with men, but the female hormone blood test's timing needs further consideration.   Women's Hormone Blood Testing Mistakes   Failure to time a blood test around a woman’s cycle may render inaccurate hormone lab test results.  One may find their hormone levels similar to a postmenopausal female even if still well within the premenopausal stage of life if the timing is off. For a healthy adult female with regular menstrual cycles, estrogen and progesterone blood test levels will be extremely low at the beginning of the follicular phase of one’s cycle. These hormones will often mimic that of a menopausal female despite functioning ovaries. Any testing done during this period of a woman’s cycle is useless. Although both men and women experience fluctuations in hormone levels throughout the day, week, and even months, more significant changes usually exist within a woman’s monthly cycle.     The Best Time for Female Hormone Blood Testing   As menstrual cycle timing is crucial related to female hormone blood testing, most premenopausal women will find labs to be at their most accurate state at days 19-21 of their monthly cycle. This period is when they are at their peak production of progesterone. As alluded to before, progesterone will be lower during other points of the cycle to even seemingly nonexistent during the follicular stage.     As many women supplement with progesterone, often for fertility purposes, one might ask how this would impact their choice in timing? If a woman is supplementing with medical progesterone, as it is usually only taken during the luteal phase of her cycle, which is when progesterone is sometimes only taken for fertility purposes; it is important to have blood work done at this point to view accurate results. As is with the woman who is not taking progesterone, we are merely attempting to test our hormone levels when progesterone is at its peak.   It is important to note that some doctors prescribe testosterone for hormonal imbalances in women.  However, suppose a low dose of progesterone does not accompany this exogenous testosterone. In that case, the testosterone treatment may negate the benefits of HRT since a therapeutic-created form of estrogen dominance will affect the quality of life. The introduction of a low dose of progesterone will help normalize the whole hormone gambit within the woman’s body, thereby producing measurable results that can help her reach optimal health should treatments need adjustment.   If you still have a menstrual cycle, the time of the month for estradiol and progesterone test is essential. Wrong timing will often render your lab result useless because, at certain times of the month, healthy women with normal and suboptimal hormone profile will have similar numbers to menopausal/peri-menopausal women.  During the early follicular phase, estrogen and progesterone are naturally very low and in the menopausal range, even if you are a healthy 28-year-old with fully functioning ovaries and fertility. So, testing on the wrong days does not give you any useful data on your ovarian function. For women with 28-day cycles that ovulate on day 14, the best day to evaluate progesterone blood test levels is at its highest, seven days after ovulation.   Female Hormone Testing Data   A study published in 2006 reviewed the issue of timing of premenopausal hormone blood testing.  It was a three-year study that included regular blood testing of 113 premenopausal women. The study performed estrogen and progesterone blood tests in both the luteal phase and the women’s cycles' follicular phase.   Data from the study showed that the differences between tests performed at the luteal and follicular phases were significant. Levels of free estradiol were the only marker of relative statistical insignificance. Estrogens and androgens, among other items, were statistically opposed between the two periods of testing, reinforcing the need for women to plan their hormone blood testing accordingly with their monthly cycle. While many women do not track their cycle, if blood testing is necessary and you are attempting to get to the bottom of an issue, tracking it is essential to make sense of female hormones' lab test results.   If you find hormone testing is something you would like to do, a great place to start is with Discounted Labs’ Women’s Hormone Tests     References   Stacey A. Missmer, Donna Spiegelman, Elizabeth R. Bertone-Johnson, Robert L. Barbieri, Michael N. Pollak and Susan E. Hankinson. “Reproducibility of Plasma Steroid Hormones, Prolactin, and Insulin-like Growth Factor Levels among Premenopausal Women over a 2- to 3-Year Period.” Cancer Epidemiol Biomarkers Prev. 2006 May;15(5):972-8. Prior JC (2020). "Women's reproductive system as balanced estradiol and progesterone actions—A revolutionary, paradigm-shifting concept in women's health". Drug Discovery Today: Disease Models. 32, Part B: 31–40.     

How to Safely Use PCT After TRT: Stopping Testosterone Replacement Therapy Table of Contents What is Post Cycle Therapy PCT? Why Do Men Stop TRT? Common reasons a man may need to discontinue TRT include: Normalizing Natural Testosterone After Stopping TRT PCT Treatments to Jump Start Natural Testosterone and Sperm Production How to Know if Your PCT Worked? Buy Discounted Lab's Post-PCT Panel  References: There is a common phrase most men will hear when they consider testosterone replacement therapy (TRT); it may be something they hear from friends or often what they read online: “TRT is for life.” There is an element of truth to this statement: when a man has low testosterone, in order to treat it and maintain healthy or optimal levels, he will always need TRT to achieve it. However, saying “it's for life” remains a somewhat inaccurate statement, and this is where we enter into the realm of what is commonly referred to as Post Cycle Therapy or PCT. TRT and anabolic androgenic steroids (AAS) can lead to dysfunction in HPTA (Hypothalamic-Pituitary-Testicular Axis). Supplemental testosterone can inhibit the release of the body's own testosterone production through negative feedback inhibition on LH levels. This feedback inhibition also results in the suppression of FSH levels, leading to the suppression of sperm production (spermatogenesis). During recent years a large surge in testosterone prescriptions and TRT clinics has unfortunately led to many men who have been misdiagnosed with low testosterone yet placed on TRT when it may not have been needed in the first place. If you are one of these men and you are considering discontinuing testosterone treatments, some protocols can help restore your hormone axis. You do not want to stop testosterone "cold turkey," which will lead to unnecessary symptoms that could last for many months. Understanding TRT and Its Impact on the Body Testosterone Replacement Therapy (TRT) can be a game-changer for men with low testosterone levels, but it’s crucial to understand how it impacts the body. TRT involves introducing exogenous testosterone into the body, which can disrupt the natural hormone production process. To grasp the full picture, we need to explore the Hypothalamic-Pituitary-Testicular Axis (HPTA) and how TRT affects it. The Hypothalamic-Pituitary-Testicular Axis and TRT The Hypothalamic-Pituitary-Testicular Axis (HPTA) is a sophisticated system that regulates testosterone production. It starts with the hypothalamus, which produces Gonadotropin-Releasing Hormone (GnRH). This hormone signals the pituitary gland to release Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). LH and FSH then stimulate the testes to produce testosterone. When you undergo Testosterone Replacement Therapy (TRT), this delicate balance can be disrupted. The introduction of exogenous testosterone can suppress the body’s natural production of LH and FSH, leading to a decrease in the body’s ability to produce testosterone on its own. Impact of TRT on Natural Testosterone Production The impact of TRT on natural testosterone production can be significant. When exogenous testosterone is introduced, it can lead to a suppression of LH and FSH, which are crucial for natural testosterone production. This suppression can result in various symptoms, such as low libido, fatigue, and decreased muscle mass. Over time, prolonged use of TRT can lead to hypogonadism, a condition where the testes are unable to produce sufficient testosterone. This is why understanding the effects of TRT on natural hormone production is essential for anyone considering or currently undergoing TRT. What is Post Cycle Therapy PCT? PCT is a treatment plan after discontinuing anabolic androgenic steroids (AAS). It is a phrase most commonly associated with what we might call “recreational steroid users” (RSU), such as bodybuilders: people who do not need steroid hormones like testosterone for medical reasons but use them for muscular competition advantage. In such cases, the individual will supplement with AAS for a set period of time, known as a steroid cycle, and then discontinue use. As his use of AAS shut down his natural testosterone production, just as it does with TRT, he will often implement a PCT plan for natural production to restart. Such plans will include Selective Estrogen Receptor Modulators (SERMs) or other items, such as the peptide HCG. The goal for the RSU, as eluded to prior, is to regain his natural production of testosterone as quickly and efficiently as possible. There is no guarantee this will work. There is no guarantee he will reach his previous levels before AAS use, although perhaps levels that accurate enough. Then we have the TRT patient; such an individual had low testosterone levels before he began administering exogenous testosterone. The use of testosterone, just as it did with the RSU, will stop his natural production. This is a factor that bothers many men, but let us keep in mind a very significant one: you already had low levels, your body was not able to produce enough, to begin with, and was not going to be able to, or you wouldn’t be on TRT. Nonetheless, there are reasons some men may find they need to discontinue use, and when that occurs, a PCT plan may be in order. Such a plan will not address his primary issue, low testosterone, but the goal here is to get at least some natural production back online. Why Do Men Stop Testosterone Replacement Therapy? Common reasons a man may need to discontinue TRT include: Need for Fertility TRT Cost TRT Side Effects or Health Issues Of the three potential reasons to stop TRT, fertility is the overwhelming reason for most men. Along with suppressing natural testosterone production, TRT can also have a negative impact on sperm production. There was a time in history not that long ago when it was thought exogenous testosterone would be touted as a male contraceptive. This idea died out when many men using testosterone found they were still able to impregnate a female. While many men on testosterone were found to be severely lacking in this department, it wasn’t enough or significant enough to market the hormone as an actual contraceptive. The other common reasons for discontinuing TRT are cost and side effects. These are the least common reasons in comparison to fertility needs or desires, but both are still possible. We all go through points in life where money can get a little tight; loss of a job, unexpected expenses – whatever the reason, if you find you need to stop, considering a PCT plan with your physician will make the transition easier. You’re still going to have low testosterone levels in the end – remember, you already had them, or you wouldn’t have started TRT in the first place – but you’ll hopefully be in a better position than you would be without, and in time, when your situation improves, you’ll be able to jump back on your TRT plan. The same may hold true for the individual who has side effect issues. This will be the least common reason for discontinuation of TRT but certainly within the realm of possibility. You could be one of the rare individuals who cannot control his hematocrit even with regular therapeutic phlebotomy. You could be someone that has other health concerns and, for whatever reason, need to discontinue use until you figure out what’s going on with your body. Hormonal imbalances, such as elevated estrogen levels, can also occur when stopping TRT, leading to conditions like gynecomastia. As was with the individual who was experiencing income issues, a PCT plan may be in order. Preparing for TRT Discontinuation Deciding to discontinue TRT is a significant step and should be approached with caution. One of the most critical aspects of stopping TRT safely is to do so under the guidance of a medical professional. Abruptly stopping TRT can lead to severe withdrawal symptoms and a dramatic drop in testosterone levels, which can be detrimental to your health. Gradual Tapering Under Medical Supervision When it comes to discontinuing TRT, gradual tapering is the safest approach. This process involves slowly reducing the dosage and frequency of testosterone administration to allow the body to adjust and begin producing testosterone naturally again. A healthcare provider can create a personalized tapering schedule based on factors such as the dosage and duration of your TRT use. This might involve reducing the amount of testosterone you inject or apply through gels over a set period. Regular check-ups with your healthcare provider are crucial during this time to monitor your progress and make any necessary adjustments to your tapering plan. This careful and monitored approach helps minimize withdrawal symptoms and supports the body’s natural transition back to producing testosterone on its own. By understanding the impact of TRT on your body and following a medically supervised tapering plan, you can safely discontinue TRT and support your body’s return to natural testosterone production. Normalizing Natural Testosterone After Stopping TRT For most men, studies have shown that for men who stop TRT, natural testosterone production can normalize within three months or longer, and spermiogenesis in well over a year. This is certainly not optimal when conception is the goal, which leads to the possible need for a PCT protocol. Post cycle therapy (PCT) is crucial in maintaining and recovering natural testosterone levels after using performance-enhancing drugs, as it helps enhance the body's own testosterone production. PCT Treatments to Restore Hormonal Balance and Jump Start Natural Testosterone and Sperm Production The use of the SERMs has been shown to increase testosterone levels to baseline in as little as 2-4 weeks. Studies have also shown spermiogenesis to improve significantly within 3-6 months. Clomid as we can easily see, greatly improves the time frames of recovery of these two important factors related to conceiving (testosterone and semen). PCT is crucial to restore hormonal balance, helping individuals recover from the use of anabolic steroids by promoting natural testosterone production and mitigating adverse effects caused by hormonal imbalances. HCG is another item commonly used in PCT for fertility purposes. HCG PCT has the ability to stimulate both testosterone production and spermiogenesis. It is not uncommon for fertility specialists to try both Clomid and HCG and, in some cases, in conjunction with one another. Unfortunately, there is much controversy among many fertility specialists regarding how much HCG should be administered for this purpose. While many physicians will prescribe SERMs in the range of 25-50mg per day to every other day, commonly prescribed HCG doses can run anywhere from 1000iu per day to 2500iu or even larger doses split into every other day schedules. Other common drugs used in this treatment, but to a lesser extent, include the SERM Tamoxifen Citrate, best known by its most notable trade name, Nolvadex. Treatments usually requires 4 weeks. Unfortunately, for some men, a PCT plan that includes some or all of these medications will not work. A HCG PCT plan is most likely to work in a TRT patient who is receiving treatment due to secondary hypogonadism. If a PCT plan has not worked – testosterone levels and sperm count have not increased – it is likely that the individual has primary hypogonadism, and as a result, will be best served (quality of life) by remaining on TRT. It’s imperative to note: this individual had primary hypogonadism prior to beginning TRT, he did not obtain it because of TRT. How to Know if Your PCT Worked? After going through PCT, physicians tend to check your testosterone blood levels and upstream hormones like LH and FSH to determine if your hormone axis has been restored. Discounted Labs has created a Post PCT Lab Test Panel that makes it easy for men to know if their PCT has successfully worked. This lab test panel is designed to measure the health and recovery of the Hypothalamic-Pituitary-Testicular Axis (HPTA) after attempting to normalize it spontaneously or with the use of Post Cycle Therapy (PCT) (with the use of clomiphene, hCG, and other treatments) It is suggested that this panel be done no sooner than 4 weeks after PCT cessation and in a fasting state (morning time). Lab tests included in the post-PCTest Panel: Ultra Sensitive Estradiol Test by Liquid Chromatography/Mass Spectrometry (LC/MS assay used to measure estradiol in men more accurately estradiol in men) Total and Free Testosterone LC/MS- No upper limit Luteinizing Hormone (LH) (responsible for activating Leydig testicular cells to produce your own testosterone). This hormone is shut down by testosterone replacement or AAS. Follicle Stimulating Hormone (FSH) (Responsible for activating Sertoli testicular cells to produce sperm). This hormone is shut down by testosterone replacement or AAS. CBC - Complete Blood Count (Includes hematocrit- red blood cell volume) CMP - Comprehensive Metabolic Panel (Includes liver and kidney function, glucose and electrolytes) For any man, simply discontinuing the use of testosterone can be difficult, to put it mildly. Your testosterone levels will completely bottom out when going the cold-turkey route, and this often. This severe sexual dysfunction, decreased energy, and even depression, to name a few of the consequences. Your levels may go up enough to at least function, to a degree, but it's going to take an enormous amount of time, as previously discussed. Cutting this time down significantly, and giving your body a boost in testosterone during the therapy process, is the only means of discontinuation that makes any sense, meaning some form of a PCT plan is a sensible approach. Buy Discounted Lab's Post-PCT Panel  References: Diagnosis and Management of Anabolic Androgenic Steroid Use Testosterone Use in the Male Infertility Population: Prescribing Patterns and Effects on Semen and Hormonal Parameters How to Stop TRT Safely

When it comes to TRT blood pressure, understanding the various factors that can impact this crucial health metric is essential for men who use testosterone. In this blog post, we'll talk about the link between testosterone replacement therapy (TRT) and high blood pressure, as well as some of the possible side effects and problems that may come up during treatment. We'll talk about the dangers of TRT-induced high blood pressure and emphasize how crucial regular monitoring is. Additionally, we'll examine water retention and edema in men on TRT, shedding light on their causes and management strategies. Furthermore, our investigation into testosterone's impact on kidney functioning will provide valuable insights into how hormone therapy affects renal function. We'll also debunk common misconceptions surrounding estrogen conversion's role in extracellular water (ECW) increases while exploring alternative explanations for changes in fluid balance during TRT. Lastly, we'll address lifestyle factors influencing water retention during hormone therapy, such as sodium intake, alcohol consumption's effects on fluid balance, and the significance of regular exercise throughout treatment. By gaining a deeper understanding of these issues related to TRT, blood pressure management becomes an achievable goal for those undergoing hormone therapy. Table of Contents: High Blood Pressure and TRT Risks Associated with High Blood Pressure Caused by TRT Importance of Regular Blood Pressure Monitoring Water Retention and Edema in Men on TRT Causes Behind Edema-Related Swelling in Men on TRT Strategies for Managing Water Retention The Importance of Cardiovascular Workup Testosterone's Impact on Kidney Functioning The Role Played by Kidneys in Regulating Body Fluids How Testosterone Affects Renal Function Taking Control of Blood Pressure During TRT Estrogen Conversion Not Responsible for ECW Increase Debunking Misconceptions about Estrogen's Role in ECW Increase Investigating Alternative Explanations for Changes in Fluid Balance Moving Forward: The Importance of Ongoing Research Lifestyle Factors Influencing Water Retention During TRT The Role of Sodium Intake in Water Retention Effects of Alcohol Consumption on Fluid Balance Importance of Regular Exercise During Hormone Therapy FAQs in Relation to Trt Blood Pressure Does TRT therapy raise blood pressure? Does testosterone play a role in blood pressure? Can testosterone cypionate cause high blood pressure? Does low testosterone shots cause high blood pressure? Conclusion High Blood Pressure and TRT Several studies have determined that having low testosterone may increase the incidence of high blood pressure in men. TRT can improve blood pressure control in hypogonadal men. However, in some other men, testosterone replacement therapy (TRT) can increase blood pressure during the initial weeks of treatment. Monitoring your blood pressure is crucial to regaining control over it while on TRT. In this section, we will discuss the dangers of TRT-related high blood pressure and emphasize the significance of regular blood pressure monitoring. Risks Associated with High Blood Pressure Heart Attacks: Elevated blood pressure puts extra strain on your heart muscles, which may eventually lead to heart attacks. When arteries become narrow due to plaque buildup or a clot forms in one of these vessels supplying oxygen-rich blood to your heart muscle cells, it could cause permanent damage. Strokes: High blood pressure can also cause strokes, which occur when there's an interruption in the flow of oxygenated blood supply towards specific regions within our brains, leading them to not be able to function properly anymore, resulting in either death, tissue loss, or, depending upon severity, the location of the affected area(s). Kidney Damage: Prolonged hypertension may result in chronic kidney disease (CKD) due to the increased workload placed on these organs, which filter waste products out of the bloodstream efficiently enough for elimination via the urine production process, eventually leading to renal failure if left untreated over time. Erectile Dysfunction: High blood pressure can cause erectile dysfunction by damaging the lining of your blood vessels and limiting the flow of blood to your penis. This makes it difficult for men to achieve or maintain an erection during sexual activity. Brain Shrinkage: Studies have shown that high blood pressure may contribute to a reduction in brain volume, also known as brain shrinkage. This condition has been linked with cognitive decline and an increased risk of dementia later in life. Importance of Regular Blood Pressure Monitoring To mitigate these risks while undergoing TRT, it is essential to monitor your blood pressure regularly if it is increasing. Here are some reasons why regular monitoring is crucial: Detecting Early Warning Signs: Frequent measurements help identify any fluctuations in your BP levels before they escalate into more severe health issues such as heart attacks or strokes, allowing you to take preventive measures early on. Maintaining an Optimal Treatment Plan: By keeping track of how well current medications work in controlling hypertension symptoms (if applicable), doctors are able to adjust dosages accordingly to ensure the best possible outcome for patients' overall wellbeing throughout the duration of therapy sessions undertaken using testosterone replacement products/services available in today's medical industry standards, practices, guidelines, and recommendations set forth by medical groups. Lifestyle Adjustments: Tracking changes allows individuals to pinpoint specific factors contributing to their elevated pressure - whether it be dietary habits, stress levels, or lack of exercise regimen adherence, among others; thus enabling them to make necessary adjustments in order to improve their overall health status while still receiving the benefits associated with TRT treatments being administered under the supervision of healthcare professional team members involved in the case management process. In conclusion, understanding the risks of high blood pressure caused by testosterone replacement therapy and monitoring your BP regularly is essential for maintaining optimal health during treatment. By making lifestyle adjustments and working closely with your healthcare provider, you can effectively manage hypertension while reaping the benefits of TRT.   Key Takeaway:  In some men with metabolic syndrome, older age, and other factors, testosterone replacement therapy (TRT) can increase blood pressure, which poses long term risks such as heart attacks, strokes, kidney damage, erectile dysfunction, and brain shrinkage. Monitoring and treating your blood pressure is crucial to regain control over it while on TRT, and making lifestyle adjustments with the help of healthcare providers can effectively manage hypertension while reaping the benefits of TRT. Water Retention and Edema in Men on TRT One potential side effect of testosterone therapy is edema, particularly dependent edema, which is more common in older men [10]. Edema refers to water retention, and dependent indicates water retention towards the ground, such as when sock imprints are visible around the ankles after removing them. Testosterone-induced water retention can cause swelling in the extremities, particularly in the legs and feet, leading to discomfort and potential complications if left untreated. A study looking at various doses of testosterone enanthate in older men revealed nearly half experienced leg edema in the groups provided with supraphysiologic testosterone (300 and 600 milligrams per week of testosterone enanthate). A comprehensive cardiovascular workup may help identify any underlying issues contributing to this condition, while maintaining a low-sodium diet and drinking plenty of water can alleviate symptoms. In this section, we will discuss the causes behind edema-related swelling in men on TRT and strategies for managing water retention. Causes Behind Edema-Related Swelling in Men on TRT The primary cause of edema-related swelling during TRT is an increase in extracellular fluid volume resulting from testosterone's impact on sodium reabsorption in the kidneys. Testosterone stimulates sodium and water retention through an autocrine or paracrine mechanism that affects sodium metabolism, leading to elevated blood pressure levels experienced by some men undergoing hormone therapy. Men with pre-existing metabolic syndrome, obesity, baseline high blood pressure, and kidney dysfunction can be more susceptible than others to having this problem. Additionally, certain lifestyle factors, such as high sodium intake, alcohol consumption, and a lack of exercise, can exacerbate these symptoms. Strategies for Managing Water Retention To minimize the impact of TRT-induced edema and improve overall health outcomes, it is essential to adopt effective management strategies targeting both hormonal imbalances caused by treatment itself as well as lifestyle factors that contribute to fluid accumulation within the body: Maintain a Low-Sodium Diet: Reducing your daily salt intake helps prevent excessive fluid buildup around cells, which could lead to hypertension. Aim for less than 2300 mg per day, according to CDC guidelines. Stay Hydrated: Drinking adequate amounts of water helps flush out excess sodium and promotes healthy kidney function. Aim for at least eight 8-ounce glasses per day, or consult your healthcare provider for personalized recommendations based on individual needs. Incorporate Regular Exercise: Engaging in regular physical activity not only aids weight management but also improves circulation and reduces fluid retention. Choose activities that you enjoy, such as walking, swimming, or cycling, to maintain consistency. Minimize Alcohol Consumption: Alcohol can dehydrate the body and increase water retention by disrupting hormonal balance. Limiting alcohol intake will help minimize edema-related swelling during TRT. Monitor Blood Pressure Regularly: Keeping track of your blood pressure levels is crucial to ensuring they remain within a healthy range while undergoing hormone therapy. Invest in a reliable home blood pressure monitor and take readings daily until control is regained. Besides these strategies, it's essential to communicate with your healthcare provider about any concerns related to edema or other side effects experienced during TRT. They may recommend adjustments in dosage or additional medications such as diuretics (water pills), which aid in reducing fluid buildup within the body, if necessary. Physicians may also recommend lowering the TRT dose or switching from testosterone injections to gels to attain lower testosterone blood level peaks. The Importance of Cardiovascular Workup If you are experiencing persistent edema-related swelling despite implementing the above strategies, it might be time for a comprehensive cardiovascular workup conducted by a qualified medical professional specializing in men's health issues like testosterone deficiency (hypogonadism). A qualified medical professional specializing in men's health issues such as testosterone deficiency (hypogonadism) can perform a comprehensive cardiovascular workup to assess any underlying heart or vascular issues that may be contributing to fluid retention. In conclusion, managing water retention during TRT is crucial for maintaining optimal health outcomes while undergoing hormone therapy. By adopting effective strategies targeting both hormonal imbalances caused by treatment itself as well as lifestyle factors that contribute to fluid accumulation within the body, men on TRT can minimize edema-related swelling and improve their overall quality of life.   Key Takeaway:  Due to the effect of testosterone on kidney function, men receiving testosterone replacement therapy (TRT) may experience swelling associated with edema. To manage this side effect, men should maintain a low-sodium diet, stay hydrated, exercise regularly, minimize alcohol consumption, and monitor their blood pressure levels. If these strategies do not work, it is important to seek a comprehensive cardiovascular workup from a qualified medical professional specializing in men's health issues like hypogonadism. Testosterone's Impact on Kidney Functioning Increased extracellular water retention, which is a result of testosterone's impact on kidney function, may be the cause of elevated blood pressure levels in men undergoing TRT. One possible explanation for this phenomenon is the direct impact of testosterone on the way kidneys manage sodium in the body. In this section, we will explore the role played by kidneys in regulating body fluids and how testosterone affects renal function. The Role Played by Kidneys in Regulating Body Fluids Kidneys play a crucial role in maintaining overall health by filtering waste products from the bloodstream and excreting them as urine. Additionally, these vital organs are responsible for balancing electrolytes such as sodium and potassium while also controlling fluid balance within the body. This process involves adjusting both water intake through thirst signals and water output via urine production based on factors like hydration status, blood pressure levels, and hormone regulation. A key component of kidney function is its ability to regulate extracellular fluid volume (ECFV), which includes both interstitial fluid surrounding cells and plasma within blood vessels. ECFV directly impacts blood pressure since it determines the amount of circulating blood volume that needs to be pumped throughout the body by the heart. How Testosterone Affects Renal Function The primary effect of testosterone on the kidneys is the stimulation of sodium reabsorption. This means that the kidney cells are instructed to retain more sodium, which can lead to an increase in blood pressure. This is one of the reasons why testosterone replacement therapy is not recommended for men with hypertension unless blood pressure is managed first. Research has shown that testosterone could act directly on the kidneys through an autocrine or paracrine mechanism, stimulating sodium reabsorption along with increased water retention. This effect leads to a higher extracellular fluid volume, resulting in elevated blood pressure levels experienced by some men undergoing hormone therapy. Autocrine mechanism: Testosterone may act directly on the kidney cells that produce it, leading to an increase in sodium and water reabsorption. This process can contribute to elevated blood pressure levels by increasing extracellular fluid volume. Paracrine mechanism: Testosterone could also influence neighboring kidney cells through paracrine signaling, which involves the release of chemical messengers that travel short distances to affect nearby cells. In this case, testosterone might stimulate adjacent renal tubule cells responsible for regulating sodium and water balance within the body. In addition to these direct effects on kidney function, testosterone has been shown to impact other hormones involved in fluid regulation, such as aldosterone and vasopressin. For example, studies have found that men with low testosterone levels exhibit reduced aldosterone secretion, a hormone responsible for promoting sodium retention and potassium excretion by the kidneys. Consequently, when TRT is administered and testosterone levels rise again, there could be an associated increase in aldosterone production, resulting in greater sodium retention along with increased extracellular fluid volume. Taking Control of Blood Pressure During TRT If you are experiencing high blood pressure while undergoing TRT due to increased extracellular water retention caused by changes in renal function, hormonal imbalances related to treatment itself, or lifestyle factors like diet and exercise habits (as discussed earlier), it's essential to take proactive steps towards managing your condition effectively: Maintain regular check-ups with your healthcare provider. Your doctor will monitor your progress during TRT closely so they can adjust dosage if necessary or recommend additional interventions such as medication adjustments or lifestyle modifications aimed at reducing blood pressure levels. Monitor your blood pressure at home: Invest in a reliable home blood pressure monitor and take readings twice daily to keep track of any fluctuations that may occur during treatment. Maintain a healthy lifestyle: incorporate regular exercise, good hydration, a balanced diet low in sodium, limit alcohol consumption, and manage stress levels to help minimize the impact of TRT on blood pressure and overall health. In conclusion, understanding how testosterone impacts kidney function can provide valuable insights into managing high blood pressure during hormone therapy. By taking proactive steps towards maintaining optimal renal health while undergoing TRT, men can experience the benefits of this treatment without compromising their cardiovascular well-being.   Key Takeaway:  Testosterone replacement therapy (TRT) can lead to an increase in extracellular water retention, which contributes to elevated blood pressure levels. Testosterone impacts kidney function by stimulating sodium reabsorption and increasing water retention, resulting in a higher extracellular fluid volume that causes high blood pressure. To manage this condition effectively, it's essential to maintain regular check-ups with your healthcare provider, monitor your blood pressure at home, and maintain a healthy lifestyle. Estrogen Conversion May Not Be Responsible for Water Retention It was once believed that the increase in extracellular water (ECW) experienced by men undergoing testosterone replacement therapy (TRT) could be attributed to the conversion of testosterone into estrogen within peripheral tissues. However, recent research has debunked this hypothesis, indicating that other mechanisms must be at play when it comes to understanding how hormone treatments impact fluid balance within the body. In this section, we will explore why estrogen is not responsible for increased ECW and discuss alternative explanations for changes in fluid balance during TRT. Debunking Misconceptions about Estrogen's Role in ECW Increase The idea that estrogen might be responsible for increased ECW stemmed from its known effects on sodium and water retention. Indeed, studies have shown that elevated levels of estrogen can lead to an increase in total body water due to enhanced renal reabsorption of sodium and subsequent water retention. This led some researchers to speculate whether a similar mechanism might explain the observed rise in extracellular fluid volume among men receiving TRT. However, more recent investigations have demonstrated no significant correlation between circulating estradiol levels (the primary form of estrogen) and changes in extracellular fluid volume following testosterone administration. These findings imply that the aromatization, or conversion, of testosterone into estradiol cannot solely account for any increase in ECW experienced by men on TRT. Investigating Alternative Explanations for Changes in Fluid Balance In light of these discoveries, scientists are now considering other potential mechanisms that might account for the increase in ECW observed among men undergoing hormone therapy. One such possibility is that testosterone itself may directly affect kidney function, as discussed earlier in this article. Due to its modulation of secretion and action, testosterone levels may have an impact on vasopressin, a hormone that regulates the body's water balance.  Recent studies suggest that testosterone can also modulate vasopressin secretion. Vasopressin is a hormone that regulates water balance and blood pressure in the body. It is released from the pituitary gland and acts on the kidneys to regulate the amount of water excreted in urine. Research shows that testosterone can regulate the production and release of vasopressin in the hypothalamus, a region of the brain that plays a key role in regulating hormone secretion. Testosterone can enhance vasopressin secretion, which in turn can increase water reabsorption in the kidneys and reduce urine output. Therefore, testosterone can have an impact on the body's fluid balance, which can have implications for overall health and well-being. More research is needed to fully understand the complex relationship between testosterone and vasopressin secretion. A third hypothesis involves aldosterone, another hormone involved in maintaining proper electrolyte balance and blood pressure regulation.Testosterone has been found to stimulate aldosterone production, which could theoretically contribute to changes in ECW by promoting sodium retention and subsequent water reabsorption at the level of renal tubules. Another factor that may increase blood pressure is the effect of TRT on increasing red blood cells and hematocrit to high levels in some men.  High hematocrit can increase blood viscosity and blood pressure. In addition to these hormonal factors, it's important not to overlook lifestyle influences when examining changes in fluid balance during TRT. As mentioned previously, high-sodium diets, alcohol consumption, and a lack of exercise can all exacerbate water retention issues among men receiving hormone treatments. Moving Forward: The Importance of Ongoing Research While we now know that estrogen conversion is not responsible for increased ECW during TRT, there remains much work to be done when it comes to understanding how various factors influence fluid balance among individuals undergoing this form of therapy. Continued research into hormonal pathways - as well as individual differences related to both genetics and lifestyle choices - will help paint a clearer picture regarding how to best manage side effects like edema-related swelling while optimizing the overall benefits of TRT for men who need it. For now, it's essential that patients and healthcare providers alike remain vigilant when monitoring fluid balance during hormone therapy. By staying informed about the latest research findings and being proactive in addressing any potential issues related to water retention, men on TRT can minimize their risk of experiencing complications while maximizing the positive impact of treatment on their health and well-being.   Key Takeaway:  Recent research has debunked the hypothesis that estrogen is responsible for increased extracellular water (ECW) in men undergoing testosterone replacement therapy (TRT). Alternative explanations include direct effects of testosterone on kidney function, modulation of vasopressin secretion and action, and stimulation of aldosterone production. It's important to monitor fluid balance during hormone therapy and consider lifestyle influences such as high-sodium diets, alcohol consumption, and a lack of exercise. Lifestyle Factors Influencing Water Retention During TRT Men receiving testosterone replacement therapy (TRT) may experience increased water retention when consuming high-sodium foods, drinking alcohol, or skipping gym sessions for more than three days. Adjusting these lifestyle factors can help minimize the impact of TRT on blood pressure and fluid balance. The Role of Sodium Intake in Water Retention A diet high in sodium can cause your body to retain more water, leading to an increase in extracellular fluid volume. This is particularly true for men undergoing testosterone replacement therapy, as their bodies are already prone to retaining excess fluids due to the hormonal changes taking place. To combat this issue, it's essential that you monitor your daily sodium intake while on TRT. Limit processed foods: Processed and packaged foods often contain large amounts of hidden sodium. Opt for fresh fruits, vegetables, lean meats, and whole grains instead. Cook at home: Preparing meals at home allows you greater control over the amount of salt used in your dishes. Experiment with herbs and spices to add flavor without relying on salt. Read food labels: Pay attention to the nutritional information provided on food packaging so you're aware of how much sodium each product contains. Avoid dining out frequently: Restaurant meals tend to be higher in sodium compared to homemade options; limit eating out whenever possible. Effects of Alcohol Consumption on Fluid Balance In addition to increasing overall caloric intake and potentially contributing to weight gain, alcohol consumption can also have a negative impact on fluid balance in men undergoing TRT. Alcohol acts as a diuretic, causing your body to lose fluids and electrolytes through increased urine production. This loss of fluids can lead to dehydration, which may exacerbate blood pressure issues and water retention problems associated with testosterone therapy. To minimize the effects of alcohol on fluid balance during TRT: Limit alcohol intake: Aim for moderate drinking habits by consuming no more than two alcoholic beverages per day for men. Stay hydrated: Drink plenty of water throughout the day and especially when consuming alcohol to counteract its dehydrating effects. Avoid binge drinking: Consuming large amounts of alcohol in a short period increases the risk of dehydration and worsens blood pressure and water retention problems related to TRT. Importance of Regular Exercise During Hormone Therapy Maintaining an active lifestyle is crucial for overall health and well-being while undergoing hormone therapy. Regular exercise not only helps control weight gain but also plays a vital role in managing blood pressure levels and promoting healthy circulation. Additionally, physical activity has been shown to help reduce edema-related swelling caused by excess extracellular fluid buildup - one common side effect experienced by many men receiving testosterone treatment. Incorporate these tips into your fitness routine while on TRT: Create a consistent schedule: Aim for at least three days per week dedicated to cardiovascular exercises such as brisk walking, jogging, or swimming; consistency is key when it comes to maintaining optimal blood pressure levels during hormone therapy treatments like TRT. Incorporate strength training: Building muscle mass can help improve arterial stiffness and reduce the risk of cardiovascular disease and heart attacks. Monitor progress: Keep track of your progress and adjust your exercise routine as needed to ensure you're getting the most out of your workouts.   Key Takeaway:  Men undergoing testosterone replacement therapy (TRT) may experience increased water retention due to hormonal changes, which can impact blood pressure. To minimize the effects of TRT on fluid balance, it's important to monitor sodium intake, limit alcohol consumption, and maintain a regular exercise routine that includes both cardiovascular exercises and strength training. FAQs in Relation to TRT and Blood Pressure Does TRT therapy raise blood pressure? TRT therapy can potentially raise blood pressure in some individuals, especially if they have pre-existing hypertension or other cardiovascular risk factors. However, the effect varies from person to person and depends on individual health conditions and lifestyle factors. Regular monitoring of blood pressure is essential during TRT. Does testosterone play a role in blood pressure? Testosterone does play a role in regulating blood pressure by influencing vascular function, kidney function, and body fluid balance. However, its impact on an individual's blood pressure may vary depending on various factors such as age, overall health status,the presence of pre-existing metabolic syndrome or cardiovascular issues, hormone levels, and lifestyle choices. Can testosterone cypionate cause high blood pressure? Testosterone cypionate is a form of injectable testosterone used for TRT. It has the potential to cause high blood pressure in some men due to increased water retention or changes in renal function associated with higher testosterone levels. Monitoring your BP regularly while using this medication is important. Does low testosterone shots cause high blood pressure? Low-testosterone shots are typically administered as part of TRT when treating hypogonadism (low T). These injections can sometimes lead to elevated BP due to increased water retention or altered kidney functions; however, it doesn't happen universally among all patients undergoing treatment. Maintaining healthy habits like exercising regularly and reducing sodium intake will help mitigate the risks associated with elevated blood pressure. Conclusion Therefore, it is essential to monitor blood pressure regularly in order to avoid potential cardiovascular complications associated with TRT. Regular monitoring of blood pressure is crucial to preventing cardiovascular disease and other related health issues. While TRT can have a positive impact on muscle mass and metabolic syndrome, it's important to manage any side effects that may arise. If you're interested in learning more about the role of the pituitary and thyroid in the diagnosis and treatment of TRT blood pressure, check out this informative article from  Testosterone Wisdom. Take control of your health today by educating yourself on the benefits and risks associated with TRT blood pressure management!        

The Best Illustrated Testosterone Book Now Available on Amazon Nelson Vergel, a well-known author of men’s health and hormone books, has published his fourth testosterone book, Beyond Testosterone. Nelson Vergel holds a chemical engineering degree and an MBA. After an HIV diagnosis over 33 years ago, he explored therapies to reverse wasting syndrome to save his life and those of his peers, leading him to co-author “Built to Survive: The Clinical Use of Anabolic Steroids for HIV+ Men and Women”,” a book that became the leading wasting treatment guide in the HIV field. He has been a member of several NIH and pharmaceutical advisory groups and FDA review panels. Nelson also founded the Body Positive Wellness Clinic and Program for Wellness Restoration in Houston, providing health education and services to HIV+ people. To expand help to the general population, he wrote “Testosterone: A Man’s Guide” and created ExcelMale.com and DiscountedLabs.com to provide men’s health education and access to affordable blood testing. His latest project aims to improve access to testosterone and hormone replacement treatments around the world by providing the largest physician directory in the world. About the Book: Beyond Testosterone This 427-page illustrated book covers all aspects of testosterone replacement therapy, including the basics of testosterone, testosterone in women, and how to increase testosterone levels naturally. It also covers the diagnosis of low testosterone and the different treatment options available by prescription in the United States and around the world. Moreover, "Beyond Testosterone" goes in-depth on the benefits of testosterone replacement therapy, side-effect management, and the effects of testosterone on the prostate and cardiovascular system. The book also reviews the uses of human chorionic gonadotropin (HCG) and discusses whether estradiol is an enemy or a friend of men. It covers the use of anastrozole and how to prevent and treat gynecomastia, acne, hair loss, water retention, high blood pressure, erectile dysfunction, and low libido. It also explores the clinical use of FDA-approved anabolic steroids for different conditions, like wasting and other diseases. Furthermore, "Beyond Testosterone" provides information on fertility and HPTA recovery after anabolic steroid use or after stopping testosterone treatment. It also covers growth hormone-releasing hormones, DHEA supplementation, thyroid dysfunction diagnosis and treatment, and maintaining good mental health. Additionally, it provides tips on nutrition for muscle gain and fat loss, exercise, and how to monitor TRT lab tests. Lastly, the book includes a section on slack testosterone in Spanish, interviews with different experts, and resources. This book is an excellent resource for men who are considering testosterone replacement therapy or are already on TRT. It is a comprehensive guide that provides information on all aspects of TRT, from diagnosis to treatment to recovery. With "Beyond Testosterone," men can have a better understanding of their options and make informed decisions about their health.    Beyond Testosterone: Book Contents Introduction How to Use This Book Testosterone 101 Testosterone in Women How to Increase Testosterone Naturally Benefits of Testosterone Replacement Diagnosis of Hypogonadism (Low Testosterone) Testosterone Treatment Options Testosterone Side Effect Management Testosterone and the Prostate Testosterone and the Cardiovascular System Human Chorionic Gonadotropin (HCG) Estradiol: The Other Male Hormone Gynecomastia: Not a Simple Diagnosis Dihydrotestosterone: Should We Be Concerned About This Testosterone Metabolite? TRT-Related Acne and Hair Loss TRT-Related Water Retention and High Blood Pressure Erectile Dysfunction/Low Libido Clinical Use of FDA-Approved Anabolic Steroids Fertility and HPTA Recovery Growth Hormone-Releasing Products Thyroid Dysfunction: Diagnosis and Management Mental Health Nutritional Considerations Exercise Considerations Nelson's Tips for TRT Patients How to Monitor TRT Lab Tests La Testosterona: Información en Español Expert Interviews TRT Resources "Beyond Testosterone" is more than a medical guide; it's a tribute to the collective wisdom of the ExcelMale.com community, capturing the essence of community-driven health discussion. Each topic is enhanced with QR codes for updated information and practical tips, making it a dynamic tool for anyone seeking to understand the broader implications of testosterone in health. This book is indispensable for patients exploring testosterone therapy and clinicians aiming to enhance their therapeutic practices. It promises to empower readers with knowledge and inspire them to take charge of their health. Click here to buy: Beyond Testosterone by Nelson Vergel Click here to buy: US: Buy Now Canada: Buy Now UK: Buy Now Australia: Buy Now Spain: Buy Now Germany: Buy Now ALSO AVAILABLE ON THESE DEVICES FIRE TABLETS Fire HD 8 (8th Generation) Fire 7 (9th Generation) Fire HD 10 (9th Generation) Fire HD 8 (10th Generation) Fire HD 10 (11th Generation) Fire HD 10 Plus Fire 7 (12th Generation) Fire HD 8 (12th Generation) Fire HD 8 Plus   FREE KINDLE READING APPS Kindle for Android Phones Kindle for Android Tablets Kindle for iPhone Kindle for iPad Kindle for Mac Kindle for PC Kindle for Web

Measuring Testosterone in Women Introduction to Testosterone Testosterone is a hormone found in both men and women. It is important for many body functions. Measuring testosterone levels in women can be hard because their levels are lower than men's and can change throughout their menstrual cycle. How Menstrual Cycle Affects Testosterone Testosterone levels in women change during the menstrual cycle. The highest levels are usually around ovulation. Studies show that both total testosterone (TT) and free testosterone (FT) peak during the middle of the cycle. However, testosterone levels vary during the rest of the cycle. Some studies find higher levels in the follicular phase, while others find higher levels in the luteal phase. Many studies show no significant change throughout the cycle. These differences can be due to study methods, participant differences, and testing techniques. Despite these variations, the mid-cycle peak is a common finding. Normal Testosterone Ranges in Women Normal testosterone levels in women depend on their age and menstrual cycle phase. Using advanced methods like liquid chromatography-tandem mass spectrometry (LC-MS/MS), researchers have found the following ranges for healthy women aged 18–49: Total testosterone: 15-46 ng/dL Free testosterone: 1.2-6.4 pg/mL Bioavailable testosterone: 1.12–7.62 ng/dL During the menstrual cycle, total testosterone rises from about 15.6 ng/dL in the early luteal phase to a peak of 43.6 ng/dL at mid-cycle. Free testosterone rises from 9.00 pg/mL to 15.6 pg/mL. Testosterone levels also decline with age, with lower levels after menopause compared to reproductive years. Establishing exact reference ranges is challenging due to assay differences, menstrual cycle changes, and factors like body mass index. Testosterone Peaks During Ovulation Testosterone levels in women show a small peak around ovulation, usually at the middle of the cycle. The increase in luteinizing hormone (LH) before ovulation is what causes this peak. The increase varies between individuals, but studies using sensitive methods like LC-MS/MS consistently detect this mid-cycle peak. The day-to-day variability in testosterone levels is often greater than the ovulatory peak itself, making it hard to see in some cases. Measuring Testosterone: Mass Spectrometry vs. Immunoassays Two common methods for measuring testosterone are mass spectrometry and immunoassays. Immunoassays, like ELISA, are high-throughput, low-cost, and easy to use but can lack specificity. Mass spectrometry, such as LC-MS/MS, provides higher sensitivity and specificity and can measure multiple analytes simultaneously. However, it has higher costs and requires more expertise. Importance of Mass Spectrometry Sensitivity Mass spectrometry is crucial for accurately measuring low testosterone levels in women. Traditional immunoassays often lack the precision needed. Mass spectrometry methods like LC-MS/MS offer superior sensitivity, enabling better assessment of androgen status in women and diagnosing testosterone imbalances. This helps establish appropriate reference ranges and guide clinical decisions. Luteal Phase Hormonal Shifts After ovulation, the luteal phase begins and lasts until the next menstrual period. Progesterone levels rise significantly due to the corpus luteum. Estrogen levels also increase during the mid-luteal phase before declining. If pregnancy does not occur, both progesterone and estrogen levels drop sharply, leading to menstruation. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels decrease during the luteal phase. Follicular Phase Testosterone Trends During the follicular phase, starting from the first day of menstruation to ovulation, testosterone levels tend to be lower compared to other phases. However, they gradually increase as the phase progresses, peaking before ovulation. Women with longer follicular phases often have higher testosterone levels, while shorter phases are associated with lower levels. Testosterone Decline After Menopause Testosterone levels decline with age, reaching lower levels after menopause. This decrease can lead to symptoms like reduced bone density, lower energy, and depression. Some doctors prescribe testosterone therapy to alleviate menopausal symptoms, although there is no FDA-approved testosterone product for women. Sleep Patterns and Hormone Levels Sleep and hormone levels are closely linked. Circadian rhythms have an impact on melatonin, which regulates sleep. Hormonal changes during the menstrual cycle can affect sleep. Progesterone, which peaks during the luteal phase, can cause drowsiness, while its drop before menstruation can lead to sleep disturbances. Poor sleep can disrupt hormone production, leading to health issues like metabolic problems and increased appetite. Optimal Hormone Testing Timing in Women The best time to measure hormones depends on the specific hormone and the purpose of testing. For fertility assessment, FSH and estradiol are tested on day 3 of the cycle. Estradiol and progesterone are measured around days 19–22 to check for luteal phase defects. LH levels peak around ovulation, while progesterone rises after ovulation. Perimenopausal hormone patterns are erratic, making single-day measurements less reliable. Menstrual Cycle Hormone Imbalance Symptoms Hormonal imbalances can cause irregular periods, heavy bleeding, and missed periods. Skin issues like acne, digestive problems, mood swings, and sleep disturbances are common. Other symptoms include low libido, vaginal dryness, infertility, weight changes, and hair growth or loss. Persistent or severe symptoms may indicate an underlying endocrine disorder that needs further evaluation. How Women Can Buy Their Own Testosterone Test Without a Doctor Visit on DiscountedLabs.com Women who want to check their testosterone levels can easily do so without needing a doctor's visit. DiscountedLabs.com offers an affordable and convenient way to order blood tests online. Here’s how you can get your testosterone test: Visit the Website: Go to DiscountedLabs.com. Find the Testosterone Test: Use the search bar or navigate through the hormone testing section to find the testosterone test. Choose Your Test: Select the specific testosterone test you need. You can choose between total testosterone, free testosterone, or a comprehensive hormone panel. Add to Cart: Once you’ve selected your test, add it to your cart and proceed to checkout. Create an Account: If you’re a new user, you’ll need to create an account. Returning customers can simply log in. Enter Your Information: Fill in your personal details and complete the payment process. Get Your Lab Order: After your purchase, you will receive a lab order via email. This order allows you to get your blood drawn at a local lab. Visit a Lab: Take your lab order to a nearby partner lab. You can find a lab near you on the DiscountedLabs website. Get Your Results: After your blood draw, you’ll receive your test results online within a few days. You can review your results and share them with your healthcare provider if needed. By using DiscountedLabs.com, you can take control of your health and get the information you need without the hassle of scheduling a doctor's appointment.   Sources: Testosterone reference ranges in normally cycling healthy premenopausal women PEAK TOTAL AND FREE TESTOSTERONE IN WOMEN OF REPRODUCTIVE AGE ARE HIGHER THAN PREVIOUSLY REPORTED What Are “Normal” Testosterone Levels for Women?

The hypothalamus in the male body secretes GnRH pulsatilely to stimulate the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. LH gets to the testes through the bloodstream and binds to an LH receptor. This starts a chain of biochemical reactions that change LDL cholesterol into testosterone. The bloodstream carries the secreted testosterone from the testes to target tissues, where it produces its biological effects. Testosterone Production, Action, and Clinical Manifestations of Testosterone Deficiency in the Male Body Testosterone Production in the Male Body The pituitary gland releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in response to the hypothalamus' pulsatile secretion of GnRH. LH gets to the testes through the bloodstream and binds to an LH receptor. This starts a chain of biochemical reactions that turn LDL cholesterol into testosterone. The bloodstream carries the secreted testosterone from the testes to target tissues, where it produces its biological effects. Hypogonadism: Testosterone Deficiency Hypogonadism is the inability of the testes to produce physiological levels of testosterone. Primary hypogonadism refers to hypogonadism resulting from abnormalities in the testes, while secondary hypogonadism refers to a defect in the hypothalamic-pituitary axis.   Dual or mixed forms can also occur. If an insufficient amount of testosterone reaches the target tissues, manifestations of testosterone deficiency may appear in the liver, muscle, and adipose tissue. Mechanism of Testosterone Action Effects on Liver and Muscle Testosterone binds directly to the androgen receptor in the liver. In the liver, testosterone enhances protein synthesis. While in muscle, testosterone enhances muscle mass. Given its role in muscle, men with reduced levels of testosterone may complain of muscle weakness, lethargy, or decreased energy. Conversion to Estradiol: Effects on Brain and Bone In other tissues, testosterone must first undergo conversion before becoming biologically active. Estradiol binds to the estrogen receptor following the aromatization of testosterone in the brain and bone. Testosterone enhances bone development by promoting bone accretion. Men with reduced testosterone levels may develop osteoporosis. Testosterone acts in the brain to stabilize mood, enhance libido, and may even have a positive effect on cognition. As a result, men with testosterone deficiency can experience mood changes, a lack of motivation, and reduced libido. Conversion to Dihydrotestosterone: Effects on Skin, Hair, and Sexual Organs 5-alpha-reductase changes testosterone into dihydrotestosterone (DHT) so that it can bind to androgen receptors on hair, skin, and the prostate. Testosterone supports the growth of facial, body, axillary, and pubic hair in the adult. However, in some genetically susceptible men, testosterone may also inhibit hair growth in some areas of the scalp, leading to baldness. In the sexual organs, testosterone contributes to penile growth, spermatogenesis, and prostate growth and function. Profound hypogonadism interferes with the vascular function of the penis (corpora) and may lead to erectile dysfunction and a decrease in orgasm quality. Other Effects of Testosterone Other effects of testosterone include promotion of erythropoiesis and regulation of immune function. Clinical Manifestations of Testosterone Deficiency Men with testosterone deficiency may experience: Muscle weakness, lethargy, or decreased energy Mood changes, lack of motivation, and reduced libido Osteoporosis Erectile dysfunction and decreased orgasm quality Anemia due to decreased erythropoiesis Altered immune function Summary In summary, testosterone production plays a key role in many body tissues, and testosterone deficiency can result in a myriad of clinical manifestations. Buy a cheap testosterone test online  

Testosterone Injection: Subcutaneous vs. Intramuscular—Where to Inject Regardless of which TRT product you’ve been prescribed, a common question is where to inject testosterone. For decades, most men have used IM testosterone injections, primarily into the glutes, quads, or deltoids, using a 1 to 1.5-inch syringe. During the past five years, many men have also begun injecting testosterone subcutaneously (SubQ), a shallow injection into the fat layer on the abdominal or other areas—just under the skin but before reaching muscle. Many TRT patients find SubQ injections less bothersome than IM injections, as they require a smaller needle in both length and gauge. SubQ injections are also associated with less irritation for some men with IM injections. While some men may find IM injections to leave a minor soreness at the injected site, SubQ injections cause no noticeable pain or irritation. Understanding Testosterone Replacement Therapy Testosterone Replacement Therapy (TRT) is a medical treatment designed to help individuals with low testosterone levels, also known as hypogonadism. TRT aims to restore normal testosterone levels, alleviating symptoms such as low libido, fatigue, and decreased muscle mass. This form of hormone therapy can significantly improve the quality of life for those experiencing sexual dysfunction and other related issues. TRT can be administered through various methods, including intramuscular injections, subcutaneous injections, and topical gels. In this article, we will focus on testosterone injections, specifically intramuscular and subcutaneous injections, to provide a comprehensive understanding of these methods. Testosterone Injection Methods: Effects on Total Testosterone, Estradiol (E2), and PSA Testosterone Cypionate and Testosterone Enanthate are the two most commonly used forms of testosterone in men to treat hypogonadism (low testosterone). Both forms carry the same testosterone hormone; the ester is the only difference, which alters the hormone’s time release so that testosterone blood levels can remain up for a few days. These two testosterone compounds are identical in a testosterone replacement therapy (TRT) setting. Both forms are commonly used in hormone replacement therapy to treat hypogonadism in men. Where and How to Inject Testosterone? Regardless of which TRT product you’ve been prescribed, a common question is where to inject testosterone. For decades, most men have injected their testosterone intramuscularly (IM), primarily into the glutes, quads, or deltoids, using a 1- to 1.5-inch syringe. During the past five years, many men have also begun injecting testosterone subcutaneously (SubQ), a shallow injection into the fat layer on the abdominal or other areas—just under the skin but before reaching muscle. Many TRT patients find SubQ injections less bothersome than IM injections, as they require a smaller needle in both length and gauge. SubQ injections are also associated with less irritation for some men with IM injections. While some men may find IM injections to leave a minor soreness at the injected site, SubQ injections cause no noticeable pain or irritation. Many patients find it beneficial to inject weekly to maintain stable testosterone levels. Administering Testosterone Injections Safely Administering testosterone injections safely requires proper technique and precautions to ensure effectiveness and minimize risks. Before injecting, ensure the injection site is clean and free of any debris. Use a sterile needle and syringe, and follow the recommended dosage and injection frequency as prescribed by your healthcare provider. For intramuscular injections, use a longer needle (1 to 1.5 inches) and insert it at a 90-degree angle into the muscle, typically in the glutes, quads, or deltoids. For subcutaneous injections, use a shorter needle (0.5 to 1 inch) and insert it at a 45-degree angle into the fatty tissue, commonly in the abdominal area. Always dispose of used needles and syringes properly to prevent injury and contamination. By following these steps, you can administer testosterone injections safely and effectively. Choosing the Right Injection Site Choosing the right injection site is crucial for safe and effective testosterone injections. For intramuscular injections, common sites include the buttocks, thigh, and upper arm. These areas have larger muscle masses, which are ideal for proper absorption of the hormone. For subcutaneous injections, common sites include the abdomen, thigh, and buttock. When selecting an injection site, consider the following factors: Fat layer: Subcutaneous injections require a sufficient fat layer to ensure proper absorption. Muscle mass: Intramuscular injections require a larger muscle mass to ensure proper absorption. Nerve proximity: Avoid injecting near nerves to minimize the risk of nerve damage. Scarring: Rotate injection sites to minimize scarring and promote even absorption. By carefully choosing the injection site and rotating locations, you can enhance the effectiveness of your testosterone injections and reduce potential complications. What is the Best Way to Inject Testosterone? While subcutaneous testosterone injections are by far the most uncomplicated and most comfortable, the more critical question for any TRT patient is how effective this method is and how it affects the potential adverse side effects of TRT. Weekly injections are often recommended to maintain stable hormone levels and reduce side effects. A recent study from the Department of Urology at the University of California (UC) has provided us with such answers. The UC study attempted to answer four questions as they relate to IM vs. SubQ testosterone injections: Comparisons in: Total Testosterone Hematocrit (HCT) Estradiol (E2) Prostate-Specific Antigen (PSA) Two hundred thirty-two men took part in the UC study. Baseline levels were recorded for all men in the four measurement areas and then again at 6-12 weeks post-treatment. The results showed that men who underwent SubQ injections of testosterone resulted in a 14% greater increase in total testosterone levels than the testosterone level of IM patients. SubQ patients also had 41% lower hematocrit post-therapy than IM patients and 26.5% lower E2 levels. For both groups of men, there were no elevated levels of PSA. Additional Studies Comparing IM versus SubQ TRT While the UC study provides valuable data on four specific lab test values of concern and is one of the most recent studies on the topic of subcutaneous versus intramuscular testosterone injections, it is not the only information we have available. An additional Journal of Clinical Endocrinology study found that normal serum testosterone levels were maintained through SubQ injections. Most patients preferred the injection method due to less injection site pain. Similar results were found in a study headed by Dr. Al-Futais in a Canadian study that ran for one year in 2002. Similar results for subcutaneous testosterone injections have also been found in female-to-male (FTM) transgender people-based testosterone studies. The Journal of Clinical Endocrinology and Metabolism reported that FTM patients administering SubQ testosterone were found to easily reach stable and normal testosterone levels along with suitable E2 levels. The study concluded that SubQ testosterone injections are both safe and effective. These findings are particularly relevant for those undergoing gender-affirming hormone therapy, as they highlight the effectiveness and patient preference for SubQ injections. Although far less in-depth than we previously mentioned, a final study of note was published in the Journal of the Endocrine Society. Similar results to the reviews mentioned above were found, along with no significant changes between IM and SubQ patients relating to dihydrotestosterone (DHT). Interestingly, unlike the UC study, this study also measured no notable difference in E2 levels between the two categories. However, it must be noted that this particular study only included a single injection of testosterone undecanoate at 1000 mg. How to Inject Testosterone Using Subcutaneous Injections? If subcutaneous testosterone injections are right for you, you will merely need a small insulin syringe to administer the hormone. A 0.5-inch-long, 25-27 gauge needle in a 1 ml syringe will typically suffice. They also do not require aspiration, commonly used in old IM injection techniques. Unlike IM testosterone injections, SubQ injections do not require aspiration and use a smaller needle. Regardless, the aforementioned insulin needles and syringes are your best choice for comfort and ease of use. Due to the small needle size, you may find it slightly more difficult to draw the testosterone into the insulin syringe. But most men on TRT use 50-100 mg twice per week, which amounts to 0.25 to 0.5 ml of a 200 mg/ml testosterone cypionate or enanthate formulation commonly used in the United States. Those small volumes load up in just 1-2 minutes. Many TRT clinics prescribe protocols to patients to inject their testosterone subcutaneously once or twice weekly. This protocol effectively maintains stable testosterone levels with small, more frequent doses than the old dose of 200 mg once every two weeks. Two injections that split the weekly dose twice per week will suffice for most patients, such as a Monday and Thursday protocol. Is There Any Difference Between Testosterone Cypionate and Testosterone Enanthate? As mentioned early on, testosterone cypionate and testosterone enanthate are the two most commonly prescribed and lowest-cost testosterone esters worldwide. All four studies cited in our discussion were performed using Testosterone Enanthate, excluding the one using Undecanoate. However, using Testosterone Cypionate would have yielded similar, if not identical, results. Both versions of the testosterone hormone are just that, testosterone. Molecularly, there is no difference. It is merely the ester attached, and the carrier oil it may be mixed in is the only difference. Further, as the enanthate and cypionate esters have very similar time-release structures, total serum levels should be relatively the same with either compound, even if injected subcutaneously. Conclusion In conclusion, testosterone replacement therapy is a medical treatment designed to help individuals with low testosterone levels. Administering testosterone injections safely requires proper technique and precautions. Choosing the right injection site is crucial for safe and effective testosterone injections. By understanding the differences between intramuscular and subcutaneous injections, individuals can make informed decisions about their treatment options. Always consult with a healthcare professional before starting testosterone replacement therapy to ensure the best approach for your specific needs. References How to Inject Testosterone Intramuscularly, Shallow IM, or Subcutaneously? Comparison of Outcomes for Hypogonadal Men Treated with Intramuscular Testosterone Cypionate versus Subcutaneous Testosterone Enanthate SIU Academy. Choi E. 10/10/20; 309864; BSP-06.01 Subcutaneous Injection of Testosterone Is an Effective and Preferred Alternative to Intramuscular Injection: Demonstration in Female-to-Male Transgender Patients  The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 7, 1 July 2017, Pages 2349–2355 Pharmacokinetics and Acceptability of Subcutaneous Injection of Testosterone Undecanoate J Endocr Soc. 2019 Aug 1; 3(8): 1531–1540.