Page 2 - Testosterone Side Effect Management

TRT Side Effects: How to Manage Them What are the Main Side Effects of Testosterone Replacement Therapy (TRT)? Acne/oily skin  Hair loss Increased sex drive Unresolved erectile dysfunction Insomnia Sleep Apnea Testicular atrophy Enhanced assertiveness or reactivity High blood pressure/water retention Gynecomastia (male breast development)   Understanding Testosterone Replacement Therapy (TRT) Testosterone replacement therapy (TRT) is a medical treatment designed to restore normal testosterone levels in men with hypogonadism, a condition where the testicles do not produce enough testosterone. This therapy aims to alleviate symptoms such as low libido, fatigue, and decreased muscle mass, which are commonly associated with low testosterone levels. TRT involves administering testosterone through various methods, including injections, gels, patches, and oral medications. By restoring testosterone levels, TRT helps improve overall quality of life for men suffering from androgen deficiency syndromes. What are the Main Side Effects of Testosterone Replacement Therapy (TRT)? Like all treatments, testosterone therapy is associated with a number of known risks, particularly for men with testosterone deficiency. These risks should be communicated to patients prior to initiation of treatment. A key item is impaired spermatogenesis (sperm production) due to suppression of gonadotropins (LH and FSH). Men considered candidates for TRT should be questioned as to their desire to induce a pregnancy. Since sperm production may be reduced to zero, exogenous T alone should be avoided until fertility is no longer a concern. Treatment with hCG injections or oral clomiphene citrate may be considered in these men, as they do not suppress spermatogenesis. There is some limited data on the use of testosterone plus hCG for improvement of sperm quality and quantity in men. Acne may occur in younger men. Edema can be occasionally observed in middle-aged or older men due to the fluid-retentive properties of testosterone. Erythrocytosis (increased red blood cell count that causes high hematocrit) is infrequently seen with topical and injectable TRT treatments but is routinely observed in men treated parenterally with short-acting injections or implanted pellets. Although there is no evidence to date that T-induced erythrocytosis is associated with adverse events, it seems reasonable to prevent the hematocrit from rising excessively. Men whose hematocrit rises above 54% (or hemoglobin greater than 18 g/dL) should be considered for dose reduction, temporary discontinuation of T therapy, blood donation, or therapeutic phlebotomy. Read this first since it is the most common testosterone side effect: High hematocrit Acne/oily skin  Caused by Dihydrotestosterone (DHT) effect on increased oil production · Accutane– a powerful prescription item - 40 mg/day for one week sometimes stops acne if started at the first sign or as directed by your doctor. Accutane is potentially highly liver toxic and can lower testosterone. Do not use unless as last resort.· Sporanox—Effective for some acne-like eruptions that are caused by fungi. Some doctors also prescribe antibiotics, like tetracycline, for acne with good results.. Minocycline. Shower with Nizoral shampoo. Anti-bacterial soaps: use a scrubbing brush and wash twice a day, especially after sweating during a workout.· UV light or sunlight with moderation.. Zinc/copper supplements or zinc soaps may help some men with acne.. Other options: How to treat and prevent acne Hair loss Caused by DHT effect on hair follicles · Nizoral shampoo—Available by prescription and over-the-counter as a lower-dose product.· Rogaine—Available over the counter· Propecia - Available by prescription. A few males experience decreased erections with finasteride. Do not use. Increased sex drive · A problem? Sex drive is part of quality of life. Testosterone therapy may somewhat improve sexual function in men with low testosterone levels. This is not necessarily a bad side effect. Enjoy it. Unresolved erectile dysfunction · ED Medications: Available by prescription; enables robust erections. If you have sinus congestion or headaches/backaches, take non-drowsy allergy medication and ibuprofen. ED drugs can be combined with alpha-blockers and/or nitric oxide precursor amino acids (arginine or citrulline).· Yohimbine (Yocon) - Available by prescription; increases sex organ sensitivity. Can increase heart rate and blood pressure· Muse—Available by prescription; a pellet is inserted into the urethra to produce an erection. Unpopular· Trimix – Available by prescription from compounding pharmacies. The best and cheapest formula for injection into the penis for lasting erections.· Caverject - Available by prescription. An injection into the penis that produces an erection that can last 1 to 2 hours. Be careful with injecting too much since it can produce dangerously long erections that need to be treated in emergency rooms! Follow instructions from your urologist.· Papaverine—an older injectable medication, less expensive than Caverject.· Wellbutrin—prescription at 300 to 450 mg/day; increases dopamine.· HCG—First dose is 2,000 IU, then 250-500 IU twice or three times a week. No protocol has been proven in controlled studies yet. When Testosterone Replacement Doesn't Lead to Better Erections Insomnia Usually, this is caused by dosages that are too high. Find the least amount that gives you a good result. · Sleeping medications—e.g., Ambien, Sonata, Lunesta, Restoril· Melatonin: 1 to 3 mg before bedtime. If you wake up groggy after 6 hours, your dose should be lower.· Avoid working out too close to bedtime.· Limit caffeine, especially after 3 pm.· You may want to try a sleep formula with tryptophan, melatonin, and magnesium. Nutrients do not work as well as drugs, but they can help some people.Article: How to protect your circadian rhythm Unresolved Fatigue · Have your doctor prescribe a sleep study if you snore and wake up tired even after 7 hours of sleep. Some people may have to wear a C-PAP machine to breathe at night. Visit Home - SleepApnea.org for more information. There are also oral devices for those people who fail CPAP. Fatigue—When Testosterone Is Not Enough Testicular atrophy · HCG– One 2,000-unit injection per week for 2 weeks, followed by maintenance of 350-500 IU twice a week. Decrease testosterone dosage accordingly after starting hCG to reach levels around 500-1200 ng/dL while keeping all other lab work monitored. Watch this video on hCG and men Enhanced assertiveness or reactivity · Make sure you are getting enough sleep.. Count until 10 and be aware of your interaction with others.· Decrease caffeine.· Meditation, mindfulness, yoga; breathe from your belly for a few minutes when overreacting.· The testosterone dosage may be too high.· Ask yourself: Do I need to always be right?. Vent extra energy at the gym, sex, and sharing with your buddies at www.excelmale.com High blood pressure/water retention · Caused by sodium retention in the kidneys. Try to limit salt consumption. Caution is required due to potential water retention issues in patients with chronic kidney disease. . Blood pressure medications - Elevated blood pressure may be transient or not. Try ACE or ARBs since they seem to have fewer sexual dysfunction-related effects. · Magnesium (600 mg/day); vitamin B6 (100 to 200 mg/day); may help reduce water retention. · Water - Drink extra water every day to help flush the kidneys. . Check your estradiol to make sure it is not over 45 pg/ml. Treat if high with a low dose of anastrozole. . Make sure you are doing cardio exercise at least 3 times a week for 30 min. Sweat and lower your salt intake since TRT increases sodium retention in some men. Gynecomastia (male breast development) Caused by high estradiol in the presence of low testosterone. This is rare in men on testosterone replacement. · Arimidex inhibits estrogen production. Available by prescription. 0.25 mg per week. There is no agreement on what the highest E2 level is for men on TRT with high testosterone. Ensure that your estradiol does not go too low (under 20 pg/ml) if you use anastrozole since it is needed for bone, skin, brain, lipids, libido, good lipids and hair health.· Nolvadex (tamoxifen)– Competes with estrogen for receptors. Available by prescription, 10 to 20 mg/day. Use of Nolvadex during a steroid cycle may reduce the net anabolic effect, as it decreases the production of GH and IGF-1. High IGF-1 may be implicated in gynecomastia.. Severe cases may require removal of the breast tissue by surgery.· DHT cream- Some people have obtained great results by rubbing a 10% DHT cream on their nipples. Not available in the US but some people order it online from Germany. Read about medications/foods to avoid if you have gynecomastia.. Those who do know to respond to the above check other reasons. Find out how long it takes testosterone replacement to potentially show benefits For affordable blood tests in most cities in the U.S. : DiscountedLabs.com More information on TRT lab tests. Monitoring and Testing During TRT Regular monitoring and testing are essential during TRT to ensure safe and effective treatment. This includes: Regular blood tests to check testosterone levels, PSA, hematocrit, and liver enzymes Baseline bone density testing (DEXA) and bi-yearly bone density tests Monitoring of prostate health through PSA levels and DREs Regular check-ups with a healthcare provider to discuss any concerns or side effects These tests help in tracking the effectiveness of the therapy and in identifying any potential issues early, ensuring that the treatment remains beneficial and safe. When to Seek Care It is essential to seek medical attention immediately if any of the following occur during TRT: Symptoms of a cardiovascular event, such as chest pain or shortness of breath Severe side effects, such as acne, hair loss, or mood changes Changes in prostate health, such as increased PSA levels or abnormal DRE results Concerns about testosterone levels or overall health By understanding the benefits and risks of TRT, monitoring prostate health, and seeking care when necessary, men with hypogonadism can safely and effectively manage their condition and improve their overall quality of life. Regular communication with healthcare providers and adherence to recommended monitoring protocols are key to successful testosterone replacement therapy. References: [i]   Metzger, DL, et al. Estrogen receptor blockade with tamoxifen diminishes growth hormone secretion in boys: evidence for a stimulatory role of endogenous estrogens during male adolescence. J Clin Endocrinol Metab (1994) 79(2):513-518. [ii] el-Sheikh, MM, et al. The effect of Permixon (saw palmetto) on androgen receptors. J Acta Obstet Gynecol Scand (1988) 67(5):397-399. [iii] Suzuki, K, et al. Endocrine environment of benign prostatic hyperplasia: prostate size and volume are correlated with serum estrogen concentration. Scand J Urol Nephrol (1995) 29:65-68. [iv] Gann, PH, et al. A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia. The Prostate (1995) 26:40-49.   Buy your own on DiscountedLabs.com

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

Table of Contents Symptoms Of Hypogonadism (Low Testosterone) And How To Diagnose Primary and secondary hypogonadism (Low Testosterone) The pituitary gland and problems associated with it Exploring Hyperprolactinemia (High Prolactin) and Its Implications in Low Testosterone Throwing a spotlight on the pituitary and its function Pituitary imaging in the diagnosis of low testosterone Learning about thyroid and its role in low testosterone Conclusions Testosterone replacement therapy is available in many forms and can be beneficial for men who have low testosterone levels. When the body doesn't produce enough testosterone (a condition also known as hypogonadism), men can experience different symptoms such as low sex drive, fatigue, bad mood, and irritability. The body might not produce enough testosterone because of different factors. For example, the pituitary and thyroid glands play an important role in the production of testosterone and if they are not healthy, young men might experience low testosterone levels. It is important to note here that the production of testosterone decreases as men age and this is normal to be so. However, approximately 0.1% of men aged 40-49 years and about 3-5% of men aged 60-79 develop androgen deficiency which can negatively influence their lifestyle. Those who have type 2 diabetes and are obese are at a higher risk of having low blood testosterone. Before taking advantage of testosterone replacement therapy, it is important to assess the health of other organs in the body which are directly related to the production of testosterone such as the pituitary and thyroid. The pituitary gland is a very small organ situated at the base of the skull, weighing just 0.018 oz. It is responsible for releasing the growth hormone as well with the production of testosterone. If a patient is suspected of having low testosterone levels, doctors usually recommend analyzing and treating the pituitary gland as well, before opting for testosterone replacement (TRT) therapy. Similarly, the thyroid is an endocrine gland situated in the neck. It is responsible for the production of numerous hormones which help the body's metabolic processes. It also plays a vital role in the production of testosterone.   Symptoms Of Hypogonadism (Low Testosterone) And How To Diagnose   This type of medical condition can have various symptoms and as mentioned earlier, people who are obese or have type 2 diabetes are more likely to develop hypogonadism. Other risk factors include chronic depression, cancer, a medicine which interferes with testosterone production, chronic illness, and others. People who abuse opiates and glucocorticoids are also at a higher risk of developing hypogonadism over time. Proper testosterone production is strictly correlated with a healthy lifestyle, which involves working out regularly and eating a balanced diet. Smoking and cardiovascular diseases can also put someone at risk of developing low blood testosterone. By improving the testosterone level through replacement therapy or by treating any existing pituitary or thyroid issue, the overall quality of life can be drastically increased. For example, men who have tried testosterone replacement therapy report better sexual satisfaction, better mood, more energy and a general sense of wellbeing. In very rare cases, the testosterone level can be low because of other factors, such as extremely hard physical training. Professional athletes, especially those who compete in combat sports, might have low testosterone levels as a result of fatigue, improper nutrition, lack of rest, etc. it is important to take a look at a patient’s physical condition and training regime to accurately diagnose androgen deficiency. A professional can use special tests to diagnose hypogonadism. It is important to let an experienced healthcare provider assess the testosterone levels to avoid confusion and medical complications. Proper laboratory diagnosis is done early in the morning when testosterone levels are at their peak. Testosterone production follows something called a diurnal rhythm, meaning that the production is higher in the morning and lower at the end of the day. Working night shifts or having poor quality sleep can drastically influence the result of the analysis, so patients should take this into consideration. Similarly, having an acute illness can also render false testosterone diagnosis. It is necessary to perform 2 or more testosterone evaluations to determine if a patient is suffering from hypogonadism or not, since approximately 33% of men have a positive result after one measurement. Evaluating testosterone levels is highly recommended for certain patients, regardless if they experience the hypogonadism symptoms or not. For example, patients with HIV or those who have type 2 diabetes mellitus, osteoporosis or chronic pulmonary disease are also at a higher risk of having low serum testosterone. Once the testosterone levels have been measured and it has been confirmed that the patient might benefit from testosterone replacement therapy, additional endocrinology tests should be performed to determine the nature of the hypogonadism – primary or secondary. Treating hypogonadism accurately is paramount, especially if the patient has certain fertility goals.   Primary and secondary hypogonadism (Low Testosterone)   As mentioned earlier, a low testosterone level in the bloodstream might result from 2 factors. The Leydig cells located in the testes are responsible for producing the majority of testosterone in men. This process takes place using the luteinizing hormone (LH) from the pituitary gland. The LH is also strictly linked to the GnRH which is produced by the hypothalamus. The GnRH is released in a pulsatile manner and a disruption in this process can lead to low testosterone levels over time. To sum it up, men can suffer from primary hypogonadism (the testosterone is not produced in the testes), from secondary hypogonadism (the production of LH or GnRH is disrupted in the pituitary or hypothalamus) or both. If a patient has primary hypogonadism, the LH and FSH levels will be elevated as these hormones are produced by the pituitary and hypothalamus but not properly converted into testosterone. Most specialists recommend karyotype analysis for further investigation. The causes of primary hypogonadism can be multiple and they include HIV, toxins gathered in the body, acquired anorchia, orchitis, and more. On the other hand, if the LH and FSH levels are low, then additional investigations must be done to determine the nature of the secondary hypogonadism. It basically means that the testes are perfectly capable of making testosterone, but they don’t have the primary resource (LH) to do so.   The pituitary gland and problems associated with it   Secondary hypogonadism is a more complicated medical issue and it involves looking at the characteristics of the pituitary gland. There are numerous factors which might cause secondary hypogonadism such as certain types of tumors, untreated sleep apnea, infiltrative diseases, use of certain drugs such as marijuana, opiates, and heroin, etc. Hyperprolactinemia can be a contributing factor in about 5% of secondary hypogonadism. This means that a prolactin adenoma can put pressure on the pituitary gland and cause damage. There are also different types of medications which can affect prolactin secretion, such as metoclopramide and others. In some cases, secondary hypogonadism can be caused by GnRH deficiency which happens as a result of damage to the hypothalamus. This part of the brain can become injured as a result of toxins accumulation, trauma, taking certain types of medication, as well as systemic disease. If a patient is suspected of having secondary hypogonadism, he will receive a full pituitary workup to determine prolactin levels and to see if its secretion is disrupted or not. It is paramount to differentiate between secondary hypogonadism originating in the pituitary and the one originating in the hypothalamus. Men who have fertility goals and want to have children in the near future need a different type of treatment than those who don’t have any fertility goals. There are rare instances when men suffer from a combination of primary and secondary hypogonadism. This might happen as a result of alcohol abuse, sickle cell disease, and more. There are several treatment options available in this case such as spermatogenesis and others.   Exploring Hyperprolactinemia (High Prolactin) and Its Implications in Low Testosterone   It has been discovered that men who suffer from hyperprolactinemia experience a wide variety of symptoms, such as decreased sperm mobility and low libido. These can lead to a low-quality sex life and fertility problems. Even in the presence of relatively normal testosterone levels, hyperprolactinemia can have a significant negative impact on sexual health, leading to erectile dysfunction in worst cases. By normalizing prolactin levels, scientists have discovered that testosterone levels improve and the overall quality of life is enhanced as well. Correct prolactin levels are directly associated with a healthy testosterone metabolism. Therefore, patients who have low serum testosterone should seek treatment for improving prolactin levels first before opting for testosterone replacement therapy. Once it has been discovered that the body responds well to hyperprolactinemia treatment, it might not be necessary to take advantage of testosterone replacement therapy.   Throwing a spotlight on the pituitary and its function   The pituitary gland plays a vital role in the production of testosterone and it should be properly assessed to determine if there are any additional hormonal imbalances present in the body. For example, for men with a testosterone level lower than 150 ng/dL, an evaluation of the anterior pituitary axes is highly recommended. This evaluation can discover other medical conditions, such as hypopituitarism, which might affect proper testosterone production. Testing the pituitary gland should be done early in the morning before 9 am. This is done by drawing blood to measure cortisol levels as well as ACTH. If the patient works night shifts, which might compromise the accuracy of the test, an ACTH stimulant is administered intramuscularly. This test can give insights into the hormonal balance of the patient. For example, if it is suspected that the patient has Cushing syndrome, the doctor might recommend a 1 mg dexamethasone suppression test. If acromegaly is suspected (growth hormone deficiency), then other tests are necessary to determine the exact levels of growth hormone. Such tests are required to determine the full biochemical makeup of the patient in relation to the pituitary gland and hypogonadism. If the results are positive for one or more of those tests, the patient will be redirected to endocrinology for additional measurements.   Pituitary imaging in the diagnosis of low testosterone   Magnetic resonance imaging (MRI) might be used to discover further details about the pituitary gland and this decision is based on multiple tests of the hormone levels. Pituitary imaging is done only when proper clinical management is required and it can be used to discover incidentalomas, which can be 6 mm in diameter or less. These are small bodies that might grow on the pituitary gland and put pressure on it which in turn disrupts the regular flow of hormones required for healthy testosterone production. These incidentalomas are usually found in approximately 20% of autopsies and can also be encountered in up to 10% of the population who is referred to pituitary imaging. The MRI testing of the pituitary should be done on men who have severe secondary hypogonadism (testosterone levels are below 150 ng/dL, persistent hyperprolactinemia, and others). Pituitary imaging isn’t necessary for cases of primary hypogonadism and it is only performed when absolutely necessary.   Learning about thyroid and its role in low testosterone   The thyroid is very important when it comes to testosterone production. In general terms, hypothyroidism has been associated with a decrease in total testosterone levels, while hyperthyroidism might lead to converting too much testosterone into estradiol, which results in impaired sexual function, gynecomastia (enlarged man’s breasts), and other medical conditions. In some cases, hypothyroidism can lead to hyperprolactinemia, but such occurrences are rare. When this happens, improving the thyroid function through certain treatments or medication can stabilize prolactin levels and this, in turn, will normalize testosterone production. Hypothyroidism is also frequently associated with erectile dysfunction. Similarly, hyperthyroidism can also be problematic, as it has been associated with ejaculatory dysfunction, as shown in a study done on over 750 men. More than 50 percent of those who had hyperthyroidism also showed symptoms of reduced sperm mobility and ejaculatory problems. However, when these men received treatment for hyperthyroidism, their fertility and testosterone production improved significantly, which means that testosterone replacement therapy isn't necessarily the go-to treatment for all men suffering from androgen deficiency.   Conclusions   As presented in this article, the human body is very complex, and there might be multiple causes for a low serum testosterone level in the bloodstream on males of all ages. It is important to determine whether the hypogonadism is primary or secondary, as well as perform numerous tests and hormone evaluations to determine the nature of the hypogonadism and to prescribe the correct treatment. In case the pituitary gland is the culprit, MRI tests might be required, though such instances are rare. Certain types of treatments are also recommended if the patient has fertility goals. If none of the other medications and treatments for hypogonadism are accurate, then testosterone replacement therapy might be considered for certain patients. By the way, monitoring serum testosterone, LH, FSH and prolactin is very easy these days thanks to tests that can be bought online at discounted prices. Visit www.discountedlabs.com for more details.

Testosterone Replacement Therapy (TRT) is a common treatment for men with low testosterone levels. While TRT can have numerous benefits, such as increased energy, libido, and muscle mass, it is important to monitor other hormone levels, specifically estradiol and dihydrotestosterone (DHT). While DHT is a metabolite of testosterone, estrogen is a form of estrogen that results from the aromatization of testosterone. Understanding the optimal levels of these hormones on TRT is crucial for achieving the desired effects while minimizing potential side effects. In this article, we will discuss a study conducted on young and older men using different doses of testosterone and its implications for predicting estradiol and DHT levels on TRT. Table of Contents The Study: Testosterone Injections and Estradiol/DHT Levels Results and Findings Estradiol Levels DHT Levels Predictive Model Interpreting the Findings Conclusion The Study: Testosterone Injections and Estradiol/DHT Levels The study in question was conducted by researchers at Boston University School of Medicine and published in the Journal of Clinical Endocrinology & Metabolism in 2010. The aim of the study was to investigate the effects of different doses of testosterone injections on estradiol and DHT levels in young and older men. The participants included 51 young men aged 19 to 35 and 50 older men aged 59 to 75. To conduct the study, the participants were administered a blocker to suppress their natural testosterone production. They were then given weekly injections of different doses of testosterone for a duration of five months. The researchers measured the participants' estradiol and DHT levels throughout the study to assess the impact of testosterone doses on these hormones.     Results and Findings The study revealed several interesting findings regarding estradiol and DHT levels in men on TRT. Here are some key points: Estradiol Levels The study found that estradiol levels increased with increasing doses of testosterone in both young and older men. However, the increase in estradiol was more significant in older men compared to younger men. This suggests that older men may have a higher propensity for aromatization, which is the conversion of testosterone into estradiol. It is important to note that the estradiol levels observed in the study were higher than the reference ranges provided by some laboratories, which are primarily derived from men not on TRT. DHT Levels DHT levels also increased with higher testosterone doses, but the difference between young and older men was not as pronounced as with estradiol. DHT is derived from testosterone through the action of the enzyme 5-alpha reductase. While DHT is often associated with androgenic side effects, such as male pattern baldness and prostate enlargement, its role in TRT is still not fully understood. Predictive Model To help predict estradiol and DHT levels based on testosterone dose, the researchers developed a mathematical model using the data from the study. The model provides equations to estimate estradiol and DHT levels based on total testosterone levels. These equations can be helpful for clinicians and individuals on TRT to better understand and predict their hormone levels. Interpreting the Findings The findings from this study have important implications for individuals on TRT. It is essential to recognize that estradiol levels on TRT may be higher than the reference ranges established for men not on TRT. This is because the reference ranges are typically derived from individuals with lower testosterone levels. It is crucial to consider the individual's specific situation and response to TRT when interpreting estradiol levels. Additionally, the study emphasizes the need for regular monitoring of hormone levels to ensure they are within a safe and optimal range. By measuring estradiol and DHT levels, healthcare providers can make informed decisions regarding dosage adjustments and potential interventions to manage any adverse effects. It is important to remember that individual responses to TRT can vary, and what may be considered an optimal hormone level for one person may not be the same for another. Factors such as age, overall health, and personal preferences should be taken into account when evaluating hormone levels and making treatment decisions. Conclusion Understanding the impact of testosterone replacement therapy on hormone levels, particularly estradiol and DHT, is crucial for optimizing the benefits and minimizing the risks associated with TRT. The study discussed in this article provides valuable insights into the effects of different testosterone doses on estradiol and DHT levels in men. It is essential for individuals on TRT to work closely with healthcare professionals who can monitor hormone levels regularly and guide them in making informed decisions about their treatment. The predictive model developed in the study can serve as a helpful tool in estimating estradiol and DHT levels based on testosterone dose, but individual variations should always be taken into account. By monitoring hormone levels and adjusting treatment accordingly, individuals on TRT can achieve the desired effects while minimizing potential side effects. Regular communication with healthcare providers is key to ensuring the effectiveness and safety of testosterone replacement therapy. Disclaimer: The information in this article is based on the findings of a specific study and should not replace personalized medical advice. Individuals on TRT should consult with qualified healthcare professionals to address their specific needs and concerns.    

Testosterone is more than just a sex hormone. It plays a crucial role in a range of physiological processes, including the development of muscle mass, bone density, and even the modulation of blood sugar levels. While high levels of testosterone can have their own set of complications, this article focuses on the often-underestimated risks associated with low testosterone levels. What is Low Testosterone? Low testosterone is a condition where the body does not produce sufficient amounts of the hormone. The threshold for low testosterone varies, but it is generally considered to be below 300 ng/dL (nanograms per deciliter) for adult men. The condition can lead to various health issues, ranging from metabolic syndrome to increased risk of death from all causes. Understanding the Causes of Low Testosterone:  Testosterone, the primary male sex hormone, plays a crucial role in maintaining a range of bodily functions, from muscle mass and fat distribution to bone density and red blood cell production. While it's common for testosterone levels to decline as men age, significantly low levels can lead to a host of health issues. But what causes low testosterone levels? The reasons are many and can range from genetic conditions to lifestyle choices. Let's break it down. Secondary Causes: Hypothalamic-Pituitary Dysfunction Idiopathic GnRH Deficiency, Kallman Syndrome, and More Sometimes, low testosterone can be due to issues with the pituitary gland or the hypothalamus, parts of the brain that signal the testicles to produce testosterone. Conditions such as Idiopathic GnRH deficiency and Kallman syndrome can disrupt these signals. These conditions are examples of hypogonadotropic hypogonadism (Bhasin et al., 2010). Inflammatory Causes Inflammation of the pituitary gland can also result in low testosterone. This inflammation can be due to a variety of factors, including autoimmune reactions and certain illnesses (Dandona & Rosenberg, 2010). Trauma and Tumors Blunt head trauma or postsurgical complications can affect the pituitary gland, leading to low testosterone. Tumors like pituitary adenomas or craniopharyngiomas can have similar effects (Wu et al., 2010). Vascular Insult Issues with the blood vessels that supply the pituitary, such as pituitary infarct/apoplexy or carotid aneurysm, can also be a culprit. Drug-Induced Causes Certain medications like anabolic steroids, opioids, and drugs that induce hyperprolactinemia can contribute to low testosterone. Always consult your doctor if you are on medication and experiencing symptoms of low testosterone (Bhasin et al., 2010). Systematic Illness and Autoimmune Causes Chronic illnesses such as anorexia nervosa, chronic renal failure, and liver failure can result in low testosterone. Autoimmune conditions that attack the pituitary gland (autoimmune hypophysis) can also be a factor (Dandona & Rosenberg, 2010). Primary Cause: Testicular Dysfunction Chromosomal and Genetic Factors Issues right at the level of the testicles can also be causes. Conditions like Klinefelter's syndrome, XX male gonadal dysgenesis, and defects in androgen biosynthesis are all chromosomal abnormalities that can lead to low testosterone (Wu et al., 2010). Infections and Surgeries Orchitis (inflammation of the testicles due to infections like mumps or HIV) and orchiectomy (surgical removal of the testicle) can directly affect testosterone production. Other Factors Chronic infections like tuberculosis, irradiation, testicular torsion, and certain medications can also be responsible. Lifestyle and Other Factors Factors like obesity, aging, malnutrition, and exposure to toxins such as heavy metals and alcohol can also influence testosterone levels (Dandona & Rosenberg, 2010). Low testosterone can result from a variety of causes, ranging from medical conditions and medications to lifestyle choices. If you're experiencing symptoms, it's crucial to consult a healthcare provider for a comprehensive diagnosis and treatment plan. Risks Associated with Different Levels of Low Testosterone < 450 ng/dl (15.3 nmol/l) - Risk of Metabolic Syndrome Metabolic syndrome is a cluster of conditions that include high blood pressure, elevated blood sugar levels, excess body fat, and abnormal cholesterol levels. Testosterone plays a significant role in regulating these physiological functions. Research by Dhindsa et al. has highlighted the increased risk of metabolic syndrome in men with testosterone levels below 450 ng/dl1. < 400 ng/dl (15.3 nmol/l) - Venous Leakage (Internal Penile Damage) Risk Venous leakage is a condition that can result in erectile dysfunction due to internal penile damage. According to a study by Yassin and Saad, men with testosterone levels below 400 ng/dl are at a higher risk of developing this condition2. < 350 ng/dl (11.9 nmol/l) – All-Cause Death Risk and Anemia Risk Khaw et al. conducted a study that showed men with testosterone levels below 350 ng/dl had an increased risk of death from all causes, as well as a higher risk of developing anemia3. < 300 ng/dL (10.2 nmol/L) - Lowered Libido, Weight Gain & Diabetes Risk Increased A low level of testosterone can also have a detrimental effect on sexual health, including a decrease in libido. Furthermore, it is associated with weight gain and an increased risk of developing diabetes. Traish et al. discussed these risks in their research4. < 300 ng/dL (10.2 nmol/L) - Quartile Risk of Fractures (Osteoporosis), Memory-Related Issues & Depression Risk Increases Testosterone is crucial for bone density. Low levels can increase the risk of fractures, memory-related issues, and even depression. A study by Orwoll et al. emphasized these risks5. < 250 ng/dl (8.5 nmol/l) - Arterial Plaque (Arteriosclerosis) & Sleep Quality Affected Vlachopoulos et al. found that men with testosterone levels below 250 ng/dl had a higher risk of developing arterial plaque, which can lead to arteriosclerosis. Additionally, these men experienced a reduction in sleep quality6. < 235 ng/dl (8.0 nmol/l) - Hardening of Arteries (Dialysis Patients) Carrero et al. identified that low testosterone levels can increase the mortality risk among male dialysis patients by promoting the hardening of arteries7. < 200 ng/dl (6.8 nmol/l) - Morning Erections Decrease A study by O'Connor et al. showed that men with testosterone levels below 200 ng/dl experienced a decrease in morning erections, which is often a sign of erectile dysfunction8. < 150 ng/dl (5.1 nmol/l) - Increased Inflammation (TNF-alpha) Malkin et al. found that extremely low levels of testosterone, under 150 ng/dl, were associated with increased inflammation markers like TNF-alpha9. Conclusion Low levels of testosterone are linked to a wide range of health issues. While testosterone replacement therapy is often recommended for men with low levels, understanding the risks associated with varying degrees of low testosterone is crucial for effective treatment and prevention. Always consult your healthcare provider for diagnosis and treatment.   Buy a Low Cost Total and Free Testosterone Test on DiscountedLabs.com: Testosterone test near me.   Low Testosterone: What Do Different Medical Guideline Groups Say? Understanding the guidelines for diagnosing and treating low testosterone is crucial for both healthcare providers and patients. Different medical organizations have released various guidelines over the years, making it essential to know how each defines low testosterone levels. This article aims to shed light on what various medical guideline groups have to say about low testosterone, focusing on cutoff values and expert opinions. Expert Opinion Before delving into specific guidelines, it's worth noting that expert opinion often plays a significant role in forming these guidelines. Medical professionals and researchers contribute to these guidelines based on clinical experience, existing studies, and ongoing research. Therefore, guidelines are not static but evolve over time, reflecting the current state of medical knowledge. Year of Release and Update Knowing when a particular guideline was released or updated is important as it indicates the currency and relevancy of the information. Here is a brief timeline:   ISSAM: 2005 Endocrine Society: 2006 ISSM: 2008 AUA: 2015 ICSM: 2015, updated in 2018  Cutoff Values of Testosterone for Laboratory Diagnosis One of the most critical aspects of diagnosing low testosterone is determining the cutoff values. Various organizations have different parameters. Here's a summary: Guideline Group Cutoff Values for Total T (TT) Cutoff Values for Free T Year ISSAM TT < 231 ng/dL (8 nmol/L) N/A 2005 Endocrine Society TT: 231-346 ng/dL (8-12 nmol/L) Free T < 52 pg/mL 2006 ISSM TT < 230 ng/dL (8 nmol/L) Free T < 52 pg/mL 2008 AUA TT: 230-350 ng/dL (8-12 nmol/L) Free T < 65 pg/mL 2015 ICSM TT < 300 ng/dL Free T < 5 ng/dL 2018 Definitions and Abbreviations: ISSAM: International Society for the Study of the Aging Male ISSM: International Society for Sexual Medicine ICSM: International Consultation for Sexual Medicine AUA: American Urological Association TT: Total Testosterone Free T: Free Testosterone SHBG: Sex Hormone-Binding Globulin Understanding the various guidelines for diagnosing low testosterone is crucial for appropriate treatment. It's evident that different medical organizations have varying cutoff values, and these may be subject to change as more research becomes available. Always consult your healthcare provider for the most current and personalized advice. By keeping updated on these guidelines, both physicians and patients can make more informed decisions regarding the diagnosis and treatment of low testosterone. Sources: International Society for the Study of the Aging Male (ISSAM), Guidelines, 2005. Endocrine Society, Clinical Guidelines, 2006. International Society for Sexual Medicine (ISSM), Guidelines, 2008. American Urological Association (AUA), Guidelines, 2015. International Consultation for Sexual Medicine (ICSM), Guidelines, 2015, updated in 2018.   Footnotes 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 ↩ Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed ↩ 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 ↩ 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 ↩ Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E., ... & Cummings, S. (2006). Testosterone and estradiol among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed ↩ Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men. Atherosclerosis, 233(1), 278-283. PubMed ↩ 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 ↩ 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 ↩ 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 ↩

Key Highlights Understand the importance of sensitive estradiol testing for hormone therapy and men's health. Learn about the benefits of choosing discounted labs for your estradiol sensitive test. Discover the differences between standard and sensitive estradiol tests, including the testing methodologies involved. Prepare effectively for your estradiol sensitive test by following specific guidelines. Get insights into interpreting and understanding your estradiol test results with the help of healthcare providers. Explore the convenience of ordering your estradiol sensitive test online and what to expect during the process. Introduction Estradiol is an important hormone for both men and women. It affects many parts of our health. It plays a significant role in maintaining bone health, cognitive functions, sex drive, and overall body composition in both genders. It is especially important to understand estradiol in men's health. There are many myths about estradiol in men. This makes it essential to have accurate testing. Choosing a sensitive estradiol test can give clear information about hormonal levels. This allows for quick action if needed. This blog looks at the benefits of discounted labs for these tests. It also helps you know how to order and prepare for a sensitive estradiol test. Understanding Estradiol and Its Importance for Men Estradiol plays an important role in men's health. As the hormone responsible for developing and regulating the male reproductive system, it affects many body functions, including bone strength, sex drive, and mood. Understanding estradiol is crucial because imbalances in levels can lead to issues such as weaker bones, changes in sex drive, and hormone imbalances. That's why it is important to regularly check estradiol levels through tests to identify any potential concerns that may require medical attention. The Role of Estradiol in Male Health Estradiol is very important for men’s health, even though it is mostly known as a hormone for women. In men, estradiol helps keep bones strong, manage sexual desire, and support heart health. It also plays a key role in mood, thinking, and making proteins. Moreover, estradiol helps control the production of testosterone. If the levels of estradiol are not right, it can cause health problems. This shows how important it is to know about and check this hormone in men's health. Common Misconceptions About Estradiol in Men Estradiol is important for men's health, not just a hormone for women. Men can also experience problems with estradiol levels, which can affect their well-being. One common myth is that all types of estrogen are bad for men. In fact, having the right amount is key for good health. Another myth is that high estradiol always causes harm. Both low and high levels can negatively impact men's health. Knowing the truth about these myths can help people make better choices for their health care. Why Opt for a Sensitive Estradiol Test? Find out important hormonal imbalances with a sensitive estradiol test. This test gives specific results that normal tests may overlook. It helps in making accurate health evaluations. Differences Between Standard and Sensitive Estradiol Tests Standard estradiol tests check a wide range of estradiol levels in the blood. This gives a general view of hormone levels. On the other hand, sensitive estradiol tests use advanced methods like liquid chromatography and mass spectrometry, also known as immunoassay estradiol test. These methods help find low levels of estradiol with more accuracy, making it a highly sensitive estradiol test. The LC-MS estradiol test is primarily suggested for situations with very low estrogen levels. The sensitive test is better for people who need careful hormonal analysis. While standard tests can work well in many cases, sensitive tests give more detailed information. This is especially true for those with mild hormone imbalances. Choosing the right test depends on how much detail you need about estradiol levels. Identifying Symptoms of Estradiol Imbalance Estradiol imbalances can show different symptoms. In men, low estradiol levels may cause a lower sex drive and tiredness. High estradiol levels can result in male feminization. Both men and women may have dry skin and hormonal changes. Due to changes in estradiol levels, which birth control pills can also affect, women may experience irregular menstrual cycles or fertility issues. It's important to notice these signs and get estradiol testing to fix any imbalances quickly. Symptoms are key indicators showing the need to check for possible estradiol imbalances. Stay aware of these signs to keep good health. The Benefits of Using Discounted Labs for Buying Your Estradiol Sensitive Test Online Discounted labs provide a cheap way to get your estradiol test without losing quality. They have lab locations all over the country, making it easy for you to access their services. By using discounted labs, you save money while getting accurate test results. This is a great option for people looking for affordable healthcare. These labs give you a wallet-friendly choice without lowering the dependability and accuracy of your test results. Using discounted labs can help you monitor your estradiol levels easily and conveniently. Affordability Without Compromising Quality Discounted labs provide lowest cost estradiol sensitive teststhat are still high quality. These affordable options help you take care of your health without spending too much money. When you choose discounted labs, you get reliable results while saving cash. Being affordable does not mean you lose accuracy or dependability. These labs follow strict quality rules to give you trustworthy results that you can rely on. Caring for your health should not cost a lot, and discounted labs make great testing cheap and easy to get. You can pick affordable options without losing quality in your healthcare experience. Nationwide Lab Locations for Your Convenience Find it easy to access lab locations for your sensitive estradiol test. You can place a simple order online and choose the testing laboratory near you. There is a large network of collection sites to make your testing process smooth and quick. You will enjoy the ease of getting your blood sample taken at a place that works best for you. This saves you time and effort. Whether you’re in a busy city or a small town, you can find the closest lab location for your estradiol test at our nationwide reference lab locations without any trouble. How to Order Your Estradiol Sensitive Test Online To get your Estradiol Sensitive Test online, go to Discounted Labs's Sensitive Estradiol product page. Find the test in the menu and add it to your shopping cart. Next, go to checkout and fill out the information needed. After you place your order, you will get a confirmation email with instructions on how to download your lab request. Then, relax while the lab processes your lab request and gets ready for your test. It’s easy to take control of your health with just a few clicks. Simple Steps to Secure Your Test To get started, go to our website and pick the "Estradiol Sensitive Test" from our list of lab tests. Add the test to your shopping cart. Then, go to the checkout. Fill in the needed details and choose the closest lab location that works for you. After you pay, you will get a lab order to take with you to the lab. Don't worry, the process is easy and helps check your estradiol levels accurately through secure and reliable repeat testing. What to Expect After Placing Your Order When you order the sensitive estradiol test online, you will get a quick confirmation email about your purchase. Usually, the test kit will be sent to your address fast. Once you get it, follow the instructions it comes with to collect your sample. Then, send the sample back as directed for testing. Your results will be processed quickly, and you will receive them safely by email within the set time. You can feel confident that your experience with the sensitive estradiol test is simple and easy. Preparing for Your Estradiol Sensitive Test Prepare well for your Estradiol Sensitive Test by following these simple steps. First, talk to your healthcare provider for any special instructions. It is important to schedule this test during the follicular phase of your menstrual cycle and avoid taking any medication that might alter your estradiol levels during this time, such as birth control pills. Also, let the lab know if you are taking any medication that might change your estradiol levels. Make sure to arrive at the collection site well-hydrated. This will make the blood draw easier. By knowing these steps, you will get correct and trustworthy results from your test. Understanding the luteal phase of your menstrual cycle is also important in interpreting your estradiol levels, as they will naturally fluctuate during this time. Understanding Your Test Results Estradiol test results give important information about the hormone levels in your body, especially for individuals with conditions such as liver disease. This sensitive test provides detailed facts for your healthcare provider. Knowing the levels of estradiol is key because they can show if there are hormone imbalances or other health problems. These levels can also affect things like bone health, sex drive, and your overall well-being. Understanding these results can be complex, so it's important to talk to your healthcare provider. They can help you make sense of your estradiol test results. Conclusion Regularly checking estradiol levels is important for men's health. You can choose a sensitive estradiol test online to learn more about your hormone balance. Discounted labs provide easy and affordable options while still offering good quality. You can easily order your test online and prepare by following simple steps. Knowing your test results is key to spotting any hormone imbalance. Take control of your health today to keep your hormone levels at their best for your overall well-being and energy.   References The role of estradiol in male reproductive function Estradiol in Men- Myths and Realities Role of Estradiol (Estrogen) in Men and Its Management

Historically, when we think of sex hormones in men and women, we identify testosterone as the core regulator of orderly male growth and sexual function. In a similar fashion, we identify estrogens as central to regulating sexual and reproductive function, along with a host of non-reproductive functions in women. 17ß-Estradiol or E2, the principal form of estrogen, is also produced in significant quantities in males. Research over the last two decades has demonstrated that estrogens can play a pivotal role in regulating male sex drive, erectile function, spermatogenesis, and can also be responsible for body fat distribution, bone density, and overall morbidity and mortality. High estradiol, however, is known to cause breast tissue growth (gynecomastia) and water retention in men with low testosterone. Because of this dynamic, regulation of the balance of testosterone and estradiol in men is paramount. Although there is evidence to suggest that lower levels of estradiol (10-20 pg/ml) can increase bone loss, the impact of high levels of estrogen on male reproductive function and other morbid conditions is complex, and it is difficult to discern upper values for the optimal range where deleterious effects begin to occur. The impact of both estrogen deficiency and excess remains controversial. We present here a background of estradiol in men along with studies that highlight the importance of estrogen in male physiology.   Video: Increased Estradiol Improved Sex Drive in Men   Estradiol in Men: Background As early as the 1930s, it was known that the male testis was responsive to estrogen and that exposure to high doses of estrogens causes developmental abnormalities. It was also speculated that the source of estrogen in males was the conversion from testosterone, which at the time was still considered the main “male hormone.” It wasn’t until the 1950s that conversion of testosterone to estrogen became well-documented. In the following decades, it became well-established that males produced significant quantities of estrogens and males of multiple species had quantifiable amounts of circulating estradiol that was synthesized in reproductive and non-reproductive tissues. In females, ovaries are the main source of circulating estrogens and regulate many facets of the female reproductive system. In males, it has been shown that the testes only produce approximately 20% of circulating estrogens, with the remainder being produced in tissues such as adipose, brain, bone, and skin, which convert testosterone to estrogens through the aromatase cytochrome P450. The diffuse pattern of estrogen production in men meant that there was no simple means to produce an estrogen-deficient state in the male comparable to an ovariectomized female. Thus, the role of estradiol and estrogen signaling in the normal male remained elusive due to a shortage of clear endpoints for estrogen action, as well as a lack of a good experimental model to approach the problem. One significant advancement in the field came in the 1970s when it was demonstrated that the testes were the major source of estrogens in men. Biochemical analysis on aromatization of androgens to estrogens and protein labeling studies for localization of estrogen receptors (ER) and the conversion enzyme aromatase in the testis were utilized to further characterize the system. New developments in the ‘80s and ‘90s led to the hypothesis that estrogen and its α-receptor were “essential” for normal fertility. Because of this, the interest in the implications of estrogen signaling in the male reproductive system increased toward the end of the century. Work over the last two decades in genetically modified mouse models, and the discovery of natural mutations in men helped to make major advances in the investigation of estrogen physiology in men. Studies further revealed that estrogens are critical for normal development and function of male reproductive and nonreproductive organs.   Sex Steroids and the Male Libido As mentioned earlier, testosterone has long been identified as the dominant sex hormone in men, and we now know that estradiol, previously thought to be only a female hormone, also plays a critical role in modulating libido, erectile function, and spermatogenesis. The extent of this role, however, is unclear and remains the subject of debate. There is an abundance of estrogen receptors, as well as aromatase in organs important to sexual function such as the brain, penis, and testis. Estradiol, therefore, can affect libido at multiple stages. Studies have indicated that decreased testosterone is associated with low libido in males. In these men, administration of exogenous estradiol can improve libido. It is known that higher testosterone levels in men can prompt higher estradiol levels through conversion of androgens like testosterone to estradiol. In male hypogonadism, a condition in which the body does not produce enough testosterone, testosterone replacement (or supplementation) therapy can improve quality of life. Testosterone therapy is prescribed for millions of men and the numbers are increasing yearly. Currently, testosterone therapy is more often used in patients with non-specific symptoms, such as sexual function and fatigue, when lab levels of testosterone fall below a certain criterion (2 standard deviations below the mean value for health young adults). Although the measure is helpful, it fails to address the physiological changes at certain testosterone levels or potential role of the associated decline in estrogens that may occur in androgen deficiency. Effect of Testosterone and Estradiol on Men's Libido: In an innovative study to address these concerns, one group recruited healthy males to determine the point at which undesirable changes begin to occur with testosterone deficiency, estrogen deficiency or both and whether these changes were androgen-dependent, estrogen-dependent or a combination of the two.(Finkelstein et al. 2013) 2 groups of males (20 to 50 years of age) with normal testosterone levels were given goserelin acetate (to suppress endogenous testosterone and estradiol) and randomly assigned them to receive varying amounts of 1% testosterone gel (0g, 1.25g, 2.5g, 5g, or 10g) for 16 weeks. One group also received an aromatase inhibitor to suppress the conversion of testosterone to estradiol. Over the 16-week period, changes in body fat percentage, lean mass, subcutaneous- and intraabdominal-fat areas, thigh-muscle area and strength, and sexual function were assessed. The findings of this study indicate that when estradiol production was intact, fat accumulation began with mild testosterone deficiency (about 300 to 350 ng per deciliter). Lean mass, thigh-muscle area, and muscle strength, however, were maintained until testosterone levels dropped below 200 ng per deciliter. Sexual desire and erectile function exhibited different patterns in response to changes in serum testosterone reduction. While changes in lean mass, thigh-muscle area, and leg-press strength were associated with variations in testosterone levels, changes in fat measures were associated with changes in estradiol levels. Also, both androgens and estrogens were responsible for the maintenance of libido and erectile function.   Low Estradiol and Fat Gain: Surprising Results This study provides important information regarding the interpretation of testosterone levels in young and middle-aged men. The authors indicate that the increases in intraabdominal fat with aromatase inhibition can foreshadow an increase in cardiovascular disease observed with long-term estrogen deficiency. Lastly, since lean mass, thigh-muscle area, and erectile function were reduced at a dose of testosterone that prompted a mean serum level of approximately 200 ng per deciliter (1.25g per day).   High Estrogen in Men: Studies In the past, there has been some concern with possible side effects of elevated estrogen levels (hyperestrogenism), such as fatigue, gynecomastia, diminished libido, and erectile dysfunction. A large retrospective study conducted at 35 Low T Centers sought to understand if there were predictive factors of patients who were more likely to develop high estradiol levels after testosterone replacement therapy. (Tan, Cook, and Reilly 2015) As part of the study, the researchers also incorporated the use of aromatase inhibitor (AI) such as anastrozole (Arimidex) and selective estrogen receptor modulators (SERM) such as tamoxifen (Nolvadex) to alleviate symptoms of hyperestrogenism. The trend in estradiol levels in the 4 age groups studied (<25, 25 to 44, 45 to 65, and >65 years) was analyzed. Estradiol was lowest in the <25 years age-group with a rise in the 2 middle age groups the gradually tapered in the oldest age group (>65 years). Much of the use of aromatase inhibitors was in the 2 middle age groups, resembling the prevalence of hyperestrogenism. Interestingly, it was determined that patients with lower estradiol (<42.6 pg/ml) had complaints of low libido. The authors also make note that despite the use of AI and SERM in 30% of the treatment population, side effects occurred in <1%. One additional study worth mentioning sought to determine the associations between serum testosterone, estradiol, and libido in men undergoing testosterone supplementation therapy for symptomatic hypogonadism (total testosterone <300 ng/dl and 3 or more symptoms on the Androgen Decline in Aging Male questionnaire [ADAM]). (Ramasamy et al. 2014) As part of the ADAM questionnaire, all men were asked to rate their libido on a 5-point scale. Men were categorized into low (<300 ng/dl) or high (>300 ng/dl) testosterone and low (0.5-5.0 ng/dl) and high (>5.0 ng/dl) estradiol. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), serum testosterone, and sex hormone-binding globulin (SHBG) were analyzed to evaluate factors predicting libido. Men with high serum testosterone and estradiol levels reported greater libido. In total, 60.4% of men with both high serum testosterone and estradiol levels reported a very good to excellent levels of libido on their questionnaire. When analyzing the combined data, only estradiol at serum levels >5 ng/dl was associated with a greater libido. The authors indicate several limitations of the study and despite the lack of proper controls, a small sample size, and absence of score comparison before and after initiation of therapy, the study emphasizes the importance of estradiol in men on testosterone. Another recent study showed that change in estradiol level was the best predictor not only of the change in bone mineral density (BMD) and sexual desire.    Conclusions: In a review of the clinical implications of estrogens for sexual function and testosterone replacement therapy, one group notes that estrogens may contribute to the persistence of sexually stimulated erectile function when serum testosterone is severely depressed. Naturally occurring elevations in estradiol do not appear to be harmful, and the incidence of symptoms of excess estrogens are rare. They also add that the use of aromatase inhibitors is not recommended for long-term use and recommend against the use of aromatase inhibitors in men that experience positive effects from testosterone therapy despite elevated estradiol concentrations. When used, an aromatase inhibitor should be titrated so that estradiol levels remain above 40 pmol/L to preserve bone health. It is important to mention that levels of circulating sex hormones are highly regulated via feedback loop of the hypothalamic-pituitary-gonadal (HPG) axis and on a tissue level with aromatase activity. As levels change, the body compensates. Caution should be taken when testosterone is used pharmacologically. It is difficult to compare the response from patient to patient because of many contributing factors and levels of testosterone alone may not give a clear picture of an individual’s disposition.   References Cooke PS, Nanjappa MK, Ko C, Prins GS, Hess RA. Estrogens in Male Physiology. Physiol Rev. 2017 Jul 1;97(3):995-1043. Finkelstein JS, Yu EW, Burnett-Bowie SA. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013 Dec 19;369(25):2457. Tan RS, Cook KR, Reilly WG. High estrogen in men after injectable testosterone therapy: the low T experience. Am J Mens Health. 2015 May;9(3):229-34. Ramasamy R, Scovell JM, Kovac JR, Lipshultz LI. Elevated serum estradiol is associated with higher libido in men on testosterone supplementation therapy. Eur Urol. 2014 Jun;65(6):1224-5. Vermeulen A, Kaufman JM, Goemaere S, van Pottelberg I. Estradiol in elderly men. Aging Male. 2002 Jun;5(2):98-102. Kacker R, Traish AM, Morgentaler A. Estrogens in men: clinical implications for sexual function and the treatment of testosterone deficiency. J Sex Med. 2012 Jun;9(6):1681-96. Hess RA. Estrogen in the adult male reproductive tract: a review. Reprod Biol Endocrinol. 2003. Rochira V, Granata AR, Madeo B, Zirilli L, Rossi G, Carani C. Estrogens in males: what have we learned in the last 10 years? Asian J Androl. 2005 Mar;7(1):3-20. Schulster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl. 2016 May-Jun;18(3):435-40. Blakemore J, Naftolin F. Aromatase: Contributions to Physiology and Disease in Women and Men. Physiology (Bethesda). 2016 Jul;31(4):258-69.

Testosterone replacement therapy (TRT) is a medical treatment used to address low testosterone levels in men. Before initiating TRT, doctors conduct blood tests to measure total and free testosterone levels and evaluate symptoms such as low sex drive, erectile dysfunction, fatigue, low mood, and cognitive issues. Once TRT is underway, regular monitoring through blood tests is essential to ensure optimal outcomes and minimize potential side effects. This article explores the importance of blood tests in monitoring TRT, highlighting key values to consider for maximizing benefits and preventing complications. Table of Contents Blood Tests for Initial Assessment and Treatment Selection  Methods of Testosterone Replacement Therapy Follow-Up Blood Tests and Dosage Adjustments Monitoring Testosterone Levels Importance of Free Testosterone and Sex Hormone-Binding Globulin (SHBG) Monitoring Hematocrit Levels PSA Levels and Prostate Health Balancing Estradiol Levels Monitoring Blood Pressure Kidney Function (eGFR) Assessment Monitoring Liver Enzymes Thyroid Function Assessment Checking Iron Levels Monitoring HDL Cholesterol Levels Assessing Prolactin Levels Affordable Blood Testing Services and Additional Resources Conclusion Blood Tests for Initial Assessment and Treatment Selection Before initiating TRT, doctors rely on blood tests to assess testosterone levels and evaluate symptoms. Measuring total and free testosterone levels provides crucial information about hormone deficiencies. Additionally, asking patients about their symptoms helps identify possible signs of low testosterone. Based on these findings, doctors can determine the appropriate treatment approach for each individual.  Methods of Testosterone Replacement Therapy TRT can be administered using various methods, including injections, creams, gels, pellets, and nasal gels. The choice of method depends on factors such as patient preference, convenience, and specific medical considerations. The doctor's expertise is crucial in selecting the most suitable TRT option to ensure optimal results. Follow-Up Blood Tests and Dosage Adjustments Once TRT has commenced, regular follow-up blood tests are conducted around weeks six or eight. These tests help evaluate the effectiveness of the treatment and determine if any adjustments to dosage or additional medications are necessary. For instance, estradiol modulation may be required to maintain hormonal balance. Monitoring hormone levels through blood tests enables doctors to fine-tune treatment plans and ensure that patients receive the most beneficial outcomes from TRT. Monitoring Testosterone Levels Monitoring testosterone levels is a critical aspect of TRT. The target total testosterone level for men on TRT is typically above 500 nanograms per deciliter. If the measured level falls below this threshold, adjustments to dosage or injection frequency may be necessary to achieve optimal hormone balance. Importance of Free Testosterone and Sex Hormone-Binding Globulin (SHBG) Besides total testosterone, free testosterone levels are also significant. Free testosterone represents the portion of testosterone that is readily available for biological activity. Ideally, free testosterone should be around 2% of the total testosterone or higher. Lower levels may indicate issues related to sex hormone-binding globulin (SHBG), a protein that binds to testosterone and reduces its availability for use. Monitoring free testosterone levels helps doctors identify and address any SHBG-related concerns to optimize TRT outcomes. Monitoring Hematocrit Levels Hematocrit levels, which measure the proportion of red blood cells in the blood, should be monitored during TRT. Testosterone replacement can increase red blood cell count in some individuals. Elevated hematocrit levels can lead to increased blood viscosity and potential cardiovascular issues. To mitigate these risks, the ideal hematocrit range during TRT is below 53. Regular monitoring of hematocrit levels allows doctors to identify any concerns and take appropriate measures to maintain cardiovascular health. PSA Levels and Prostate Health Prostate-specific antigen (PSA) levels play a crucial role in monitoring prostate health during TRT. Men with a PSA level of four or higher require careful evaluation, as it may indicate prostate-related concerns, including the possibility of prostate cancer. Further investigation and consultation with a urologist are usually recommended for individuals with high PSA levels. Monitoring PSA levels is vital to ensuring the safe and effective administration of TRT. Balancing Estradiol Levels Estradiol, a form of estrogen, plays a significant role in men's health and well-being. Balancing estradiol levels is essential to maximizing the benefits of TRT. Very low or high estradiol levels can have negative effects on mood, cognition, cardiovascular health, sex drive, and body composition. The optimal range for estradiol levels provided by lab companies in men typically falls between 20 and 40 picograms per milliliter. However, this range does not apply to men with high testosterone blood levels caused by TRT. Regular monitoring of estradiol levels allows doctors to ensure hormonal balance and adjust treatment if necessary. Monitoring Blood Pressure Blood pressure monitoring is essential during TRT, as some men may experience increases in blood pressure due to hormonal changes. Lifestyle modifications such as weight loss, regular exercise, and medication can help manage blood pressure levels effectively. Regular blood pressure monitoring allows doctors to identify any changes and implement appropriate interventions to maintain cardiovascular health. Kidney Function (eGFR) Assessment Assessing kidney function is an important aspect of monitoring TRT. Estimated glomerular filtration rate (eGFR) is a measure used to evaluate kidney function. Contrary to common misconceptions, TRT itself does not cause a decrease in eGFR. Regular assessments of kidney function help ensure the safety and effectiveness of TRT by identifying any potential renal complications. Monitoring Liver Enzymes Liver enzyme levels, such as aspartate transaminase (AST) and alanine transaminase (ALT), should be monitored during TRT. It is important to note that TRT has not been shown to increase liver enzymes. However, men who engage in heavy weightlifting exercises may experience artificial increases in AST and ALT levels, which are unrelated to TRT or liver toxicity. Proper interpretation of liver enzyme levels is crucial to avoid unnecessary concerns or interventions. Thyroid Function Assessment Thyroid function should be monitored during TRT to ensure overall hormonal balance. Thyroid-stimulating hormone (TSH) levels are typically measured to evaluate thyroid function. A TSH level below 2.5 is indicative of a healthy thyroid. Further tests, such as measuring free triiodothyronine (T3) and free thyroxine (T4), may be conducted to assess thyroid function more comprehensively. Monitoring thyroid function allows doctors to address any thyroid-related issues that may impact TRT outcomes. Checking Iron Levels Regular monitoring of iron levels is important, particularly for individuals who frequently donate blood. Frequent blood donations can deplete iron stores, leading to fatigue and other related symptoms. To maintain optimal iron levels, individuals undergoing TRT should ensure that donation frequency aligns with recommended guidelines. If iron levels are found to be low, supplementation may be necessary to mitigate fatigue and maintain overall well-being. Monitoring HDL Cholesterol Levels High-density lipoprotein (HDL) cholesterol levels can be affected by TRT, especially at higher doses. Higher doses of testosterone replacement therapy may lead to a decrease in HDL cholesterol, which is a concern for cardiovascular health. Regular monitoring of lipid levels, including HDL cholesterol, allows doctors to assess cardiovascular risk and consider interventions such as niacin supplementation to manage HDL levels effectively. Assessing Prolactin Levels Prolactin levels are typically checked in men with very low testosterone levels or those who do not respond well to TRT. Elevated prolactin levels may indicate underlying issues that could impact the effectiveness of TRT. While prolactin is commonly associated with lactation in women, men also produce this hormone, and imbalances can lead to complications such as erectile dysfunction. Monitoring prolactin levels helps doctors ensure optimal treatment response for individuals undergoing TRT. Affordable Blood Testing Services and Additional Resources Discountedlabs.com offers affordable blood testing services, including the necessary tests for monitoring TRT labs. The website provides various blood test options, and results are typically delivered within five to seven business days. Additionally, Excel mail.com offers further information and resources on blood tests and TRT, including a blog page and a resources including a free downloadable book titled "Beyond Testosterome." These resources can help individuals educate themselves, better understand their blood test results, and make informed decisions about their TRT journey. Conclusion Monitoring TRT through regular blood tests is crucial for maximizing the benefits and preventing potential side effects. Key values to consider during blood tests include total and free testosterone levels, hematocrit levels, PSA levels, estradiol levels, blood pressure, kidney function, liver enzymes, thyroid function, iron levels, HDL cholesterol levels, and prolactin levels. Affordable blood testing services like Discountedlabs.com and resources from Excel mail.com provide individuals undergoing TRT with accessible options for monitoring their hormone levels effectively. Regular communication with healthcare professionals is vital to tailor TRT treatment and ensure its safety and efficacy. By monitoring key values through blood tests, individuals can optimize the benefits of TRT and enhance their overall well-being.            

Nelson Vergel, author of Testosterone: A Man's Guide (Amazon.com) and founder of ExcelMale.com and DiscountedLabs.com, talks about what he thinks are the 10 most important things that all men on testosterone replacement therapy should know to maximize benefits and minimize side-effects. For questions for Nelson, please register on ExcelMale.com and post them on the forum page. For more detailed information about what blood test parameters are important to monitor while on testosterone replacement therapy, read: Testosterone Replacement Blood Test Targets and Their Management For blood tests to buy to monitor your testosterone replacement, check these lab test panels: Pre TRT Lab Test Panel TRT MALE Hormone/Wellness Follow Up Panel   Find out more about testosterone replacement therapy and what tests to perform   Video Transcript:   Hi everybody. Nelson Vergel with ExcelMale.com. Somebody gave me a really good idea on ExcelMale.com. It's a forum of over 14,000 members. We discuss everything related to testosterone replacement, nutrition, exercise, supplements, and other options like Trimix, hCG, and estradiol, et cetera. Somebody asked me, "Nelson, why don't you do a video of Nelson's Top 10 TRT Commandments?" And this is what I'm doing today. So, I'm going to include the different observations and suggestions I have after reading over 40,000 posts over the last three years on ExcelMale.com.   Testosterone is not a magic bullet.   The first one is testosterone is not a magic bullet, and I remind guys who have high expectations when they start testosterone replacement because they have low testosterone that things may improve in many ways, like improvements in sexual function and sex drive, energy, cognitive function, et cetera. But sometimes they may not improve as much as you expect because there are many factors involved, especially in sexual function, libido, and desire. I have another presentation or lecture that I did on the subject, so you can check it out on ExcelMale.com, or on the YouTube channel, also named ExcelMale.com. But there are over 12 factors involved in the sexual desire in men. Testosterone is one of them, obviously, so fixing the low testosterone issue tends to improve things in that department. However, if you're not sleeping well, if you have excessive weight, if you're drinking too much, if you have some illnesses like diabetes or cardiovascular disease, and if you're taking medications that may influence sex drive and erectile function like blood pressure medications, antidepressants, et cetera, you may not get all the benefits that one would expect from testosterone. So, check out that video, and I will get into more details on that subject.   Do not obsess about estradiol.   The second one is the second commandment: do not obsess about estradiol. Estradiol has become the hottest topic of discussion in men's health forums, and it's a topic that is filled with misconceptions and a lot of speculative information. We have data that shows that estradiol is a very important hormone in men. It is produced from the aromatization of testosterone into estradiol by aromatase enzyme in the liver and in fat cells. The body actually produces it for a good reason. There's a good reason why nature put estradiol downstream of testosterone. We need estradiol for bone health, cognitive health, sexual function, and drive, and even keeping good body composition and cardiovascular health.   A lot of men tend to freak out when they start testosterone and they think everything is related, all the side effects are related to high estradiol. Biggest problem I see is that very few men are actually testing their estradiol. Doctors are not monitoring estradiol levels, and if they are, they're using the wrong tests. They're using the immunoassay instead of the liquid chromatography/mass spectrometry assay. The former basically overestimates estradiol. Secondly, water retention and/or nipple sensitivity may have nothing to do with estradiol blood levels. So, men are jumping into starting treatment with an AI, when in fact their estradiol is under 40 picograms per milliliter, and they don't really need to be taking it.   Many crash their estradiol blood levels under 20 mg and they started losing sex drive and they start even getting fatter, because it's being studied in research that that's the case. So, do not obsess about estradiol. Estradiol is not an evil hormone. Estradiol is in our body for a reason. Do not over treat with anastrozole. I'm telling doctors, be very careful. They are giving people high doses, over 1mg a week of anastrozole to men. I'm also really concerned that many clinics out there, and I hope they're listening to me, are starting men on anastrozole at baseline when the fact is, they should have waited or they should way until follow up, after six or eight weeks follow up, and test the men's estradiol after they start testosterone replacement. And then, and only then, determine whether or not they have high estradiol over 40.   And as our testosterone blood levels increase, so does estradiol. Only 0.4% of testosterone becomes estradiol, so it's only logical that we should have higher estradiol when we have obviously higher testosterone levels because of injections or gels or creams or pellets. So that's my biggest concern out there. Estradiol is not an evil hormone and we need it. Do not obsess. Do not put all your ... do not blame it on all the side effects, especially if you're not testing the blood levels.   Monitor your hematocrit.   Your hematocrit. Monitor your hematocrit, is number three, very closely during the first six to eight months. Hematocrit is the proportion of the blood, the blood volume, that is made up of red blood cells. Testosterone replacement increases the production of red blood cells, which is a good thing if you have anemia. However, overproduction of red blood cells and an increase of hematocrit obviously, can increase the viscosity of the blood, and that can lead to cardiovascular risks and events. So, doctors pretty much monitor this parameter using a very cheap panel called the CBC, the cells and chemistry, cell count and chemistry profile. Very cheap. I think you can buy it on discountedlabs.com for $29, and that includes hematocrit. As your hematocrit starts climbing up closer to 52, it is time for you to go and donate blood at a blood center. What I'm seeing, I'm seeing a few problems there. I'm seeing men waiting too long so they get to 53, 54 in hematocrit and they get rejected for donations because the Red Cross and different blood centers have a limit of 53. So do not wait too long, otherwise you are not going to be able to donate blood for free.   If you do wait that long and your hematocrit is 53, 54, 55, whatever,. I've seen guys walking around with a 65, which is crazy. That's when doctors don't monitor that. Very upsetting. Anyway, if you get to those high levels, you're rejected by the nation and you will need an order from your doctor, like a prescription. Your doctor calls in any blood center and you may have to pay for the phlebotomy. It's called a therapeutic phlebotomy. You would probably have to pay. Many centers charge over $100. So, do not wait too long. Do not donate blood or do therapeutic phlebotomies more frequently than every three months, because that has been shown to decrease iron levels and ferritin, which may make you fatigued. So, if you are by any chance one of those unlucky men that really produces a lot of red blood cells, you may have your doctor check your iron or ferritin after you donate blood. If they are low, you can take an iron supplement for a few weeks until it's normalized.   The high hematocrit issue does not happen to everybody. Most men have a bump around three to four points higher. Most of the time, hematocrit stabilizes after 18 months. For instance, I've been using testosterone for over 34 years, and I've only donated blood once, and usually it's within the first six months that you know whether or not your hematocrit will be increasing. After six months, chances are... unless you increase the dose of testosterone, obviously, that you will stay pretty much stable there. So, it's not a long-term concern.   Inject testosterone using easier methods: subcutaneous or shallow IM.   Okay, the next commandment is exploring easier ways to inject, subcutaneously, shallowly, or IM, which is shallow intramuscular injections. The old way of injecting testosterone with a big old syringe of one and a half inches on your glutes or quads is pretty much gone. There is no need to suffer through painful injections with big needles anymore. We have good data that shows that subcutaneous injections under the skin with a very tiny, half-inch, 27-gauge, or even 29-gauge syringe are enough to get the body to absorb and get the blood levels up. So, there is no need to suffer. I inject in the shoulders at 90 degrees with a 27-gauge, one-inch... I'm sorry, half-inch syringe, and it's basically painless. Also, inject twice a week instead of injecting once a week. We are moving from the world where doctors were prescribing testosterone at 200 mg every two weeks to 100 to 150 mg, depending on the blood levels that you need, every week to 50 to 75 mg every two weeks. So, there are clinics that are prescribing it once a week, but there's nothing wrong with that. I really believe so. But many clinics are now splitting the dosage in two and also bringing in something called hCG, which I will talk about.   So, do not suffer. Do not dwell anymore with big needle syringes. You can inject under the skin. You can inject shallow, at half an inch, anywhere in the quads, delts, or even the glutes. And that will basically ensure that most of us adhere to a long-term therapy like testosterone replacement. As you all know, testosterone replacement is a long-term commitment—a lifetime commitment. Never cycle testosterone on and off.   The next commandment is obviously to never cycle testosterone replacement on and off. This is a lifetime commitment. If you stop testosterone replacement, your blood levels will crash. You will not produce testosterone for a while. People tend to email me to ask me how many weeks they're going to be in that situation. It is impossible to predict, impossible to predict. Some studies on bodybuilders have shown that it takes probably as long as you were on testosterone to get back to your baseline. Remember, all of us who started testosterone replacement had low testosterone at baseline. That's why we got into testosterone replacement. So even if your body tends to readjust after a few weeks and bring you back to what you used to be, you're probably going to have low testosterone. So, that's a discussion that I don't see doctors doing very well with patients that are about to start therapy. The fact that it is a commitment. No, you're not going to die if you stop testosterone. It is true that you're going to have a rough time with low libido, energy, and cognitive function for a few weeks, but things will move on and you'll basically go back to where you used to be before testosterone. Know your TRT blood tests.   The next one is knowing your blood tests and your schedule for blood testing. Yes, your doctor is supposed to remind you when you're supposed to get blood tests done, but it's not brain science; it's not rocket science. On ExcelMale.com, on discountedlabs.com, which is my company, my lab test company, you can get tests online anywhere in the United States, with exception to New York State, New Hampshire, and Massachusetts. Basically,  the northeastern states have passed legislation to limit options for consumers there, but in most states, you can go to discountedlabs.com, order your test there, pay by credit card or PayPal, and then we will email you the results after five to seven days when you give your blood at the lab or location closer to you.   You can check the scheduling for testosterone blood testing and monitoring on ExcelMale.com, also through one of my videos that I made on that subject, and also on the blog page of discountedlabs.com. But know, at least, that you have to have certain blood levels tested at baseline. The doctor will probably have you come in six to eight weeks later, just to see if a dosage is good enough for you. We'll ask you about all your symptoms to see if they're getting better. They may check not only hematocrit, estradiol, or other hormones but also see whether you need a readjustment or treatment with anastrozole, like I said before. So, it is also important to tell the doctor when you got your blood test done, your blood draw, because some guys forget that you should be getting your blood drawn right before your next injection. I'm talking about injections. Gels and creams are different because, since we're using the same dosage every day, it doesn't really matter when you get the blood drawn.   Do not change more than one variable at a time. The next one is do not change more than one variable at a time, and I do remind everybody on ExcelMale. We are all kind of our own guinea pigs. Everybody has to experiment on themselves. Every time we start something, we can change the dosage, the frequency, or other things, but we cannot change more than one variable if you want to measure the impact of that change on your quality of life. And that's one of the biggest problems I'm seeing. Some guys start changing things around and then they forget what worked and what didn't. I know it's a basic concept, but we all get very impatient, and that's another thing I'm seeing: the expectations are not well-described by doctors at baseline. So, we start changing things around without telling the doctor, and then obviously everybody's lost. You and the doctor are lost.   So, one variable at a time. It takes a while to do that. To be a good guinea pig with good experimentation, good dosage adjustment, et cetera, it takes a while. It takes like six months average to get to that point where you say, "Okay, I'm pretty much in the dosage I need to be, frequency I need to be, anastrozole dosage if I need, hCG," which I'll be speaking about hCG, et cetera, et cetera. So, don't be impatient. I know most of us who are getting onto testosterone replacement are a little desperate. We are not feeling that great; our relationships are hurting because of sexual dysfunction or things like that, and we need a quick fix. It is not a quick fix. It takes a while, but generally, you will have good results if you do it well   You can’t change what you don’t measure.   The next one is that you can't change what you can't measure. I remind people, even I forget how I felt last week. And when you're going to the doctor, you haven't seen the doctor in eight weeks or 12 weeks, and the doctor asks you how you have been feeling? You're pretty much are going to say how you've been feeling the past few days, since you remember that. So, I kept that in mind and we created an app, available on the Apple Store or on Google Play, called TRT Analyzer. That app basically sends you a text message or a message during the day to ask you how you felt, and there are different variables like fatigue, exercise intensity, libido, if you had a morning erection, et cetera. And then you can graph. Inside the app, there's a graphing option and you can actually email the graphs to your doctor, even print them, and bring them to your next office visit. That will show basically what happened in the last 12 weeks or eight weeks that you haven't seen the doctor.   So, doctors love it because it helps them. It helps them. They actually score with the graph on every single parameter. So TRT Analyzer. Download it for free. There's been over 600 downloads this month, so we're very happy. Another site that I created is called myhealthgraphs.com. Myhealthgraphs.com. We'll probably be changing it into an app too. But it's a website. It's not an app. It's a website where you can add your blood test results, whatever you're following: testosterone, estradiol, hematocrit, et cetera, and it will also plot values for your doctor to see too. Doctors are busy. Doctors need people who save them time. Doctors tend to treat patients that save them time better than those that do not save them time. Doctors are human beings. They are really busy with a lot of pressure, and we walk into a doctor's office expecting the doctor to remember everything we told them last time. Even though it's written, some of them don't even have time to read the notes that they made from last time.   So, be a good patient and monitor everything; chart everything. Bring your reports on how you feel to the doctor. Believe me, you're going to get treated better than those who do not. The same doctor can treat two different patients differently just based on that behavior. I wish I had data to show, but it's my speculation.   Protect your testicles.   The next commandment is protecting your testicles, fertility, and upstream hormones. Talk to your doctor about hCG, or human chorionic gonadotropin. I made a video also on hCG, so check it out also on ExcelMale.com or the ExcelMale YouTube channel. But the thing about testosterone replacement when we started was that our testicle Leydig cells shut down. They don't produce testosterone anymore and they also start decreasing their production of sperm and our fertility gets really impacted, especially if we are obviously looking forward to having another kid with your wife or your girlfriend. So, that's a concern. Many doctors wrongly make patients stop testosterone replacement when they want to have a kid, which is a horrible thing to do. Instead, we have now some data from Baylor College of Medicine, Lipshult’s team, that shows that using testosterone and hCG together can prevent not only the atrophy of the testicles, or the shrinkage of the testicles, but also improve fertility.   Lately, we have gotten some data on the fact that hCG can reactivate all the hormones that are upstream of testosterone that were shut down by testosterone replacement. Testosterone replacement is obviously a good thing to do, but it shuts down LH, FSH, pregnenolone, progesterone, and even DHEA in many cases. So, all those hormones upstream tend to be reactivated by the effect of hCG. I'm going to get into many details on that because I have a video in which, actually, I think I drew a diagram on a whiteboard so that you can understand more of what I am trying to say. Because a lot of doctors say, "No, I don't prescribe hCG. I think there's no use for that," and I think after you watch that video, you will be able to negotiate with your doctor about the use of hCG in a much more educated fashion.   Don’t stay behind on TRT advances.   The next commandment is: don't stay behind on advances. Actually, that's the last commandment—the 10th one. And this is an evolving field—testosterone replacement and men's health in general. We don't only talk about testosterone on ExcelMale.com. We talk about thyroid hormones, about DHEA, about pregnenolone and progesterone, about supplements, about exercise, about, you name it, diet, even some cognitive practices, et cetera. It's really amazing how many studies are coming through every week, and even for me, I read everything that I can every day. Even before going to bed, I print out a few papers. Even for me, it's hard to keep up, and I know that if I'm not staying current, I may be missing things that are coming through in the field and obviously will not be able to help others with my information. But don't stay behind on advances. Register on ExcelMale.com and learn more, because an educated patient pretty much gets a lot better care.   So, thank you so much for watching this video.  Subscribe to the ExcelMale YouTube channel and register on ExcelMale.com. Thank you.