Page 4 - Testosterone Side Effect Management

What are the common symptoms of gynecomastia? Common symptoms of gynecomastia include breast swelling and tenderness, nipple discharge, and breast enlargement. It is important to note that gynecomastia may occur on one or both sides of the chest and can affect males of all ages, from infants to older adults. What is Gynecomastia and How to Diagnose it   Gynecomastia is a benign enlargement of the male breast resulting from a growth of the glandular tissue of the breast, known as male breast tissue. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. At least 30% of males, including older men, will be affected during their life. Since it causes anxiety, psychosocial discomfort, and fear of breast cancer, early diagnostic evaluation of male breast tissue enlargement is important, and patients usually seek medical attention. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging, and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. Men who start experiencing this problem complain of pain and tenderness around the nipple area. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both, which can lead to a decrease in the level of testosterone compared with the level of estrogen. As men get older, they produce less testosterone. Older men also tend to have more body fat, and this can cause more oestrogen to be produced. These changes in hormone levels can lead to excess breast tissue growth. Androgens include testosterone and DHT. High estradiol in the presence of low testosterone and DHT, growth hormone (IGF-1 is a metabolite), and a genetic predisposition to gynecomastia can increase the size of breast tissue in men. Additionally, the lowered testosterone can cause the breast glands to enlarge and the weight gain means fatty tissue accumulates under the breast, leaving the man with a larger quantity of glandular tissue and more fat in the breast. As fat cells are estrogenic, this additional fat can further disrupt the balance between testosterone and estrogen. Gynecomastia Causes Physiological gynecomastia, also known as physiologic gynecomastia, is common in pubertal boys and appears to be associated with increased hormone levels of insulin-like growth factor-1 (IGF-1) and pubertal growth, but not with a shift in the balance between estrogen and testosterone, a new study suggests. Study authors noted that IGF-1 together with estrogen is essential for the growth of breast tissue, and it appears that the effect of growth hormone on breast growth is mediated through IGF-1. "The stimulatory effect of IGF-1 on breast formation was synergized by estradiol, which was also elevated in boys with physiologic gynecomastia in our study. However, serum testosterone was similarly elevated, leaving the estradiol/testosterone ratio unaltered." Prolactin, another anterior pituitary hormone integral to breast development, is not only secreted by the pituitary gland but may also be produced by normal mammary tissue epithelial cells and breast tumors (14, 15). Testosterone converts into estradiol, DHT, and other metabolites. Men with higher amounts of the enzyme aromatase usually have this problem even at lower doses of testosterone. The growth of this glandular tissue is also influenced by a higher fat percentage, older age, excessive alcohol intake, and the use of certain medications. Gynecomastia rarely occurs in men using testosterone replacement since testosterone to estradiol ratios are improved. Estrogen levels that are too high or are out of balance with testosterone levels can cause liver disease and gynecomastia. In several studies on testosterone replacement, only a very small percentage of people receiving testosterone experience growth of breast tissue. In one HIV-specific study conducted by Dr. Judith Rabkin in New York, she reported that out of 150 men enrolled in the study, two men experienced this adverse reaction. Dihydrotestosterone (DHT) is a natural metabolite of testosterone that has antiestrogen activity and cannot be converted into estradiol at the tissue level. Systemic or locally administered DHT has been successfully prescribed for the treatment of patients with idiopathic and estrogen-induced gynecomastia. Gynecomastia is also seen in men with androgen resistance with low testosterone production and DHT, where unfettered estrogen can stimulate subsequent breast development. However, in men with normal androgen receptor activity, estradiol is unable to stimulate breast development. This is thought to be due to an imbalance between the inhibitory and stimulatory effect of these hormones. Gynecomastia may be caused by abnormal hormone changes, any condition that leads to an increase in the ratio of estrogens/androgens such as liver disease, kidney failure, thyroid disease, and some non-breast tumors. Certain health conditions, like hypogonadism, can either cause or be linked with gynecomastia. Click: Buy gynecomastia blood test panel   Gynecomastia Symptoms Gynecomastia is a condition that causes the breast tissue in males to swell and become larger than usual. The primary symptom of gynecomastia is noticeable breast enlargement in men, which can be unilateral or bilateral. Other symptoms include tenderness or pain around the nipple area, swelling or lumps in the breast tissue, and changes in breast shape or texture. In some cases, one of the gynecomastia symptoms may also be the discharge from the nipples. If you experience any of these symptoms, it's essential to consult with a doctor to determine the underlying cause and explore treatment options. Medications and Products That Can Cause Gynecomastia Some medications have been reported in the medical literature to cause gynecomastia due to decreases in testosterone, increases in estradiol, or both. These include: · Antiandrogens.  · HIV medications.  · Anti-anxiety medications. · Tricyclic antidepressants.  · Glucocorticoid steroids. · Antibiotics. · Ulcer medication such as cimetidine . · Cancer treatment (chemotherapy). · Heart medications such as digitalis and calcium channel blockers. · Anabolic steroids · Soy and flaxseed · Exposure to pesticides and byproducts of plastic processing has also been linked to increased estrogen and decreased sperm count in men. If the cases of gynecomastia are drug-induced, gynecomastia symptoms like decreased tenderness and softening of the glandular tissue will usually be apparent within one month after discontinuation of the drug. However, if the cases of gynecomastia have been present for more than one year, it is unlikely to regress substantially, either spontaneously or with medical therapy, because of the presence of fibrosis. In such circumstances, surgical subcutaneous mastectomy, ultrasound-assisted liposuction, and suction-assisted lipectomy, including gynecomastia surgery options like liposuction, are the best options for cosmetic improvement, as described in several case series. If symptoms persist after two years or past 17 years of age, further evaluation is indicated. During the rapid, proliferative phase, manifested clinically as breast pain and tenderness, medical therapy may be attempted. Most studies of drugs -- including testosterone (in patients without hypogonadism), have been uncontrolled and thus difficult to interpret because gynecomastia may resolve spontaneously. The few randomized, double-blind, placebo-controlled trials generally have been limited by small samples and do not disclose the potential side effects. Gynecomastia Treatments: Although not approved for the treatment of gynecomastia, the selective estrogen-receptor modulator tamoxifen, administered orally at a dose of 20 mg daily for up to 3 months, has been shown to be effective in randomized and nonrandomized trials, resulting in partial regression of gynecomastia symptoms in approximately 80% of patients and complete regression in about 60%. Patients in whom tamoxifen is effective usually experience a decrease in pain and tenderness within one month. In a retrospective analysis of a series of patients with idiopathic gynecomastia, 78% of patients treated with tamoxifen had complete resolution of gynecomastia, as compared with only 40% of patients receiving danazol. In case series describing the use of tamoxifen for this condition in more than 225 patients, adverse events were uncommon but can include body aches, low sex drive, and fatigue. In a double-blind study of 282 men randomized to receive 20 mg of tamoxifen once per day with bicalutamide or bicalutamide alone found that after six months, gynecomastia and breast pain were significantly reduced in men who received tamoxifen (88 versus 96 percent in the control group). The aromatase inhibitor anastrozole was not shown to be more effective than placebo in a randomized, double-blind, placebo-controlled trial in boys with pubertal gynecomastia. Although in an uncontrolled study of 10 patients with pubertal gynecomastia, the selective estrogen-receptor modulator raloxifene was shown to result in more than a 50% decrease in the size of the gynecomastia in the majority of the boys, there are insufficient data to recommend its use at this time. Lowering the testosterone dose had not proven helpful for the two patients in Dr. Rabkin's study. The use of antiestrogens, such as tamoxifen 10 mg twice daily, with lower doses of testosterone have been effective. Some physicians prescribe low dose aromatase inhibitors for men with early-onset gynecomastia. Gynecomastia can become permanent if the condition lasts very long although it may reduce in size when the androgen use is discontinued. In rare cases, surgical correction may be necessary in severe cases. For men who experience enlarged breast size, doctors usually check estradiol levels to determine whether too much testosterone is being converted into estrogen. However, physicians usually forget that other hormone metabolites like DHT and IGF-1 may be involved in the development of gynecomastia, so they do not include these tests in the diagnostics panel. In order to properly diagnose gynecomastia, your healthcare provider will take your past health and medicine history and give you a physical exam. A blood test may also be recommended to check hormone levels. In some cases, a biopsy may be performed to examine the breast tissue for cancer cells, especially if there are any breast abnormalities detected during a mammogram. Warning: Bringing estrogen down to very low levels could cause health problems in men in the long run. Hair/skin quality and health, brain function, bone density, lipids, sexual function, and other important factors may be greatly influenced by estrogen. More information about estradiol and gynecomastia. Bibliography: Braunstein, G. D., M.D. (2007). Gynecomastia. The New England Journal of Medicine, 357(12), 1229-123712 Schulster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl 2016;18:435-4034

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

Introduction Testosterone Replacement Therapy (TRT) is a commonly administered treatment for men grappling with hypogonadism or low testosterone levels. TRT has been shown to help ease the symptoms of low testosterone, but it also has a noticeable side effect: it raises hematocrit levels, which can cause a medical condition called erythrocytosis or polycythemia. Elevated hematocrit levels cause the blood to thicken, bringing about potential cardiovascular risks like strokes, heart attacks, and clotting events. This comprehensive guide seeks to elucidate various strategies to manage high hematocrit levels induced by TRT, fostering a well-rounded understanding for both patients and healthcare providers. Table of Contents Introduction Understanding Hematocrit and Its Normal Ranges Factors Contributing to High Hematocrit Levels in TRT When to Act on Rising Hematocrit Levels Testosterone Treatment and Blood Cell Production Managing High Hematocrit Levels Monitoring Adjusting TRT Dosage Lifestyle Modifications Sleep Apnea Management Medication and Supplements Comparative Effects of Different Testosterone Therapy Forms Therapeutic Phlebotomy Treating High Red Blood Cell Counts with Phlebotomy No Set Guidelines for Phlebotomy in Testosterone Therapy Yet Phlebotomy: A Temporary Solution? Conclusion References Footnotes Understanding Hematocrit and Its Normal Ranges Hematocrit gauges the volume of red blood cells in the blood, expressed as a percentage, illustrating the proportion of blood comprised of red blood cells. Normal hematocrit levels for men range from 41% to 50%, and for women, they range from 36% to 48%. Factors Contributing to High Hematocrit Levels in TRT Testosterone Replacement Therapy can trigger erythrocytosis, where an overproduction of red blood cells occurs. It is known that testosterone lowers hepcidin levels. Hepcidin is a hormone that is made in the liver and is closely connected to iron absorption pathways. This lowers hepcidin levels leads to erythrocytosis and raises hemoglobin and hematocrit levels. When to Act on Rising Hematocrit Levels If you're using testosterone therapy (TT) and your hematocrit—the percentage of red blood cells in your blood—reaches 54% or more, experts from the European Association of Urology (EAU) and the American Urological Association (AUA) recommend taking action. The EAU advises checking for other possible causes that might be increasing your hematocrit, which could include factors mentioned in their risk section [8]. Testosterone Treatment and Blood Cell Production Typically, the body produces more red blood cells in the first six months of testosterone treatment before this process levels off. If you stop TT, your hematocrit and hemoglobin (the protein in red blood cells that carries oxygen) usually return to normal within 3 to 12 months. Adjusting your TT dose or how it's administered might help prevent high red blood cell counts by mimicking the body's natural hormone levels more closely. Managing High Hematocrit Levels Monitoring Regular monitoring of hemoglobin and hematocrit levels is pivotal for patients undergoing TRT. It is recommended to get baseline hematocrit values before starting treatment and then to do regular measurements at 3, 6, and 12 months after starting treatment. Adjusting TRT Dosage In instances where hematocrit levels soar beyond 54%, healthcare providers might consider decreasing the TRT dosage or temporarily halting the therapy until hematocrit levels normalize. Additionally, switching to subcutaneous injections could also be contemplated as a strategy to modulate hematocrit levels. Lifestyle Modifications Adopting certain lifestyle alterations can significantly impact hematocrit levels. Hydration: Ensuring ample fluid intake to maintain high blood volume. Exercise: Engaging in regular physical activity to reduce blood thickness. Smoking Cessation: Avoiding smoking can decrease hematocrit levels Sleep Apnea Management TRT has the potential to make sleep apnea, a condition marked by intermittent breathing interruptions while sleeping, worse. Continuous Positive Airway Pressure (CPAP) devices or other medically approved treatments that help people with sleep apnea can also help people with high hematocrit levels improve their health. Medication and Supplements Medications like Losartan and supplements like Naringin have shown promise in helping manage high hematocrit levels. However, it's crucial to consult with a healthcare provider before embarking on any new medication or supplement regimen. Comparative Effects of Different Testosterone Therapy Forms While all forms of testosterone therapy, such as gels, pills, patches, and injections, are linked to increased hematocrit levels, injectable forms were once thought to have the most significant impact. Recent studies have shown that although injections like testosterone enanthate can significantly raise hematocrit compared to patches, usually no form of therapy increases hematocrit by more than 4.3%. This suggests that careful patient selection and monitoring could mitigate the risk of excessive red blood cell production. The risk does not seem to correlate with the duration of testosterone therapy but is more pronounced during the initial phase due to the abrupt hormonal shift. Typically, hemoglobin and hematocrit levels rise within the first six months of therapy and tend to normalize within a year of discontinuation. However, dosage is a critical factor, and selecting an appropriate dose requires considering individual patient factors. Therapeutic Phlebotomy Therapeutic Phlebotomy (TP) is a widely adopted procedure to manage testosterone-induced polycythemia, involving the removal of a pint of blood to diminish hematocrit levels. The frequency of  blood donations should not exceed once every 12 weeks to prevent iron loss due to frequent donations, contingent on individual responses to TRT. Treating High Red Blood Cell Counts with Phlebotomy Phlebotomy—the process of drawing blood—is a common treatment for polycythemia vera (PV) and high hematocrit caused by testosterone therapy, a condition with too many red blood cells, and there's no reason it can't be used for people with high red blood cell counts from TT [13]. A study by Marchioli and colleagues found that keeping hematocrit levels below 45% significantly reduced blood clots and other serious issues compared to allowing levels to be between 45 and 50%. While phlebotomy has been helpful in PV, its effectiveness for TT-related high red blood cell counts needs more high-quality research. An observational study by Hazegh et al. showed that men on testosterone who donated blood saw their average hemoglobin levels decrease over a year. The frequency of their donations varied widely, indicating that blood donation could be a useful strategy. There are No Set Guidelines for Plebotomy in Testosterone Therapy Yet Currently, there are no specific guidelines on how often or how much blood should be drawn if you're on TT and experiencing high red blood cell counts. Phlebotomy: A Temporary Solution? While phlebotomy can lower hematocrit levels, it may not be a permanent fix. Chin-Yee et al. evaluated patients who donated blood and found that many had high hematocrit levels even after donating. This suggests that while phlebotomy can help, it might not completely control red blood cell counts related to TT. In summary, phlebotomy can safely reduce hematocrit levels temporarily, but it should be used alongside other methods, like adjusting TT doses, to manage red blood cell counts effectively. More research is needed to define the role of phlebotomy in managing TT-related high red blood cell counts. Conclusion The meticulous management of high hematocrit levels in patients on TRT is pivotal to averting potential cardiovascular risks. A multifaceted approach can be used to effectively manage hematocrit levels. This includes monitoring, changing TRT dosages, making changes to the patient's lifestyle, managing sleep apnea, therapeutic phlebotomy, and medication or supplementation. It's incumbent upon healthcare providers and patients to collaborate and ascertain the most conducive management strategy, ensuring the efficacy of TRT while safeguarding the patient's health. References Footnotes Excel Male TRT Forum. (n.d.). How to Manage High Hematocrit Caused by Testosterone Replacement Therapy. Retrieved from Excel Male TRT Forum ↩ ↩2 Discounted Labs. (n.d.). High Hematocrit Caused by TRT: How to Lower and Manage it. Retrieved from Discounted Labs ↩ ↩2 ↩3 PubMed Central (PMC). (n.d.). Testosterone use causing erythrocytosis. Retrieved from PMC ↩ PubMed. (n.d.). Management of Erythrocytosis in Men Receiving Testosterone Therapy. Retrieved from PubMed ↩ Iron Mountain Men's Health. (n.d.). How to Lower Hematocrit While on TRT. Retrieved from Iron Mountain Men's Health ↩ American Journal of Clinical Pathology, Oxford Academic. (n.d.). Therapeutic Phlebotomy for Testosterone-Induced Polycythemia. Retrieved from Oxford Academic ↩ American Journal of Clinical Pathology, Oxford Academic. (n.d.). Therapeutic Phlebotomy for Testosterone-Induced Polycythemia. Retrieved from Oxford Academic ↩

Although testosterone frequently overshadows estradiol, a hormone more commonly associated with women, estradiol plays a significant role in men's health. Derived from testosterone through a process known as aromatization, estradiol contributes to various physiological aspects in men. Although it's crucial for maintaining bone density, its role in sexual health, body composition, and other health parameters is subject to ongoing discourse. Here, we delve into the dynamics of estradiol in men, its implications, and the importance of accurate measurement. Understanding Estradiol in Men The hormone estradiol, although present in smaller quantities in men compared to women, is produced through the aromatization of testosterone in liver, fat, and other cells. This conversion is nature’s design, hinting at a purpose behind it. Besides promoting bone health, estradiol’s influence on men's libido, body composition, and other factors is a hot topic among researchers. Excessive levels of estradiol, especially alongside low testosterone levels, could lead to conditions like gynecomastia (enlarged breasts in men). Hormonal Balance: The HPT Axis The Hypothalamic-Pituitary-Testicular (HPT) axis is a hormonal cascade that adjusts testosterone production based on the levels of testosterone and estradiol in the body. When either hormone level goes up too high, the HPT axis responds by decreasing the production of testosterone to keep hormone levels in balance. Aromatase Inhibitors: Boon or Bane? Aromatase inhibitors (AIs) stop the production of estradiol and are often given to people who are getting testosterone replacement therapy (TRT) to help them look younger and stay healthy. While higher estradiol levels could potentially cause gynecomastia and water retention, there's speculation, albeit without scientific backing, linking high estradiol levels to erectile dysfunction. The use of AIs is thought to mitigate these issues by lowering estradiol levels. However, the exact threshold of estradiol levels in men, beyond which it could be detrimental, remains undefined. Unveiling the Optimal Range Recent studies have started to shed light on estradiol's optimal range. For instance, levels below 20 pg/ml have been associated with increased bone loss, higher fat mass, and diminished sexual function in men. It is very important to get a correct reading of estradiol, and it is better to use a sensitive estradiol test (LC/MS assay) instead of the more common ECLIA-based test to avoid getting wrongly high estradiol readings from things like CRP (C-reactive protein). Estradiol’s Diverse Effects: A Closer Look 1. Bone Density: A study showed that estradiol levels below 11 pg/ml were linked to increased bone loss in men, emphasizing estradiol's role in bone health (Source). 2. Libido and Erectile Function: One groundbreaking study revealed that lower estradiol levels were correlated with increased body fat and a decrease in sexual desire and erectile function (Source). 3. Mortality Rate: A study highlighted that men with estradiol levels either below 21.80 pg/ml or above 30.11 pg/ml had a higher mortality rate, indicating a potential sweet spot for estradiol levels (Source). 4. Testosterone Therapy: In men undergoing TRT, elevated estradiol levels were associated with heightened libido, suggesting a nuanced interplay between testosterone and estradiol (Source). Conclusion The journey to demystify estradiol's role in men is ongoing. While its importance in bone health is well acknowledged, the hormone's broader impact on male physiology is gradually being unraveled. Accurate estradiol measurement and a deeper understanding of its optimal range could pave the way for enhanced men's health management, particularly for those undergoing testosterone replacement therapy.     Here is a more detailed discussion on estradiol in men: Click here   How to Get a sensitive estradiol test  

The prostate gland plays a pivotal role in men’s health, and its well-being is often a topic of great concern, especially when it comes to prostate cancer, a leading cause of death among men in the United States. This article delves into the intricacies of prostate health, detection methods for prostate cancer, and the debated connection between testosterone replacement therapy (TRT) and prostate cancer. Prostate Cancer Prevalence and Detection As men age, the occurrence of small, hidden prostatic lesions increases, which could potentially turn cancerous over time. The prevalence of these lesions is around 30% in American men aged over 45, and this figure soars to over 80% for those above 80 years of age. The transformation of these lesions into cancerous cells is often linked to genetic factors and lifestyle conditions, including diet. To detect prostate cancer, healthcare providers employ a variety of methods: Prostate-Specific Antigen (PSA) assays Digital Rectal Examination (DRE) Transrectal Ultrasound It's advisable for men, especially those above 40 or with a family history of prostate cancer, to undergo a DRE before commencing testosterone replacement therapy and every six months thereafter. While DRE may be uncomfortable, it's a small price to pay for ensuring good health. Any abnormal rectal exam findings, a PSA increase of more than 2 ng/mL, or a PSA level over 4 ng/mL usually necessitate further evaluation by a urologist, often involving an ultrasound and prostate biopsies. However, the PSA and DRE methods lack sensitivity and specificity. In some instances, benign prostatic hyperplasia (BPH), a non-cancerous inflammation, may falsely elevate PSA levels, while 25% of prostate cancer patients show normal PSA levels. As it turns out, needle biopsies can find hidden prostatic lesions in men whose PSA levels and ultrasound results are normal. Testosterone Replacement Therapy and Prostate Cancer: Unveiling the Connection The role of Testosterone Replacement Therapy (TRT) in PSA elevation or prostate cancer development has been a topic of considerable debate. Prostate cancer is initially androgen-dependent; thus, TRT is discouraged for men diagnosed with prostate cancer. However, a comprehensive analysis encompassing data from 18 studies revealed no significant link between blood levels of androgens and an increased risk for prostate cancer (Journal of the National Cancer Institute, 2008). Intriguingly, some emerging data suggest that high doses of testosterone may be beneficial in treating certain types of prostate cancer. A different study that looked at 149,354 men who were diagnosed with prostate cancer between 1991 and 2007 found that those who were treated with TRT did not have higher rates of death or use of Androgen Deprivation Therapy (ADT). The study, published in the Journal of Sexual Medicine (2014), concluded that TRT, post-prostate cancer diagnosis and treatment, doesn't exacerbate mortality rates or the necessity for ADT, even with prolonged TRT duration. Conclusion The dialogue surrounding prostate cancer, its detection, and the implicated role of TRT is complex. While the journey towards unambiguous understanding continues, regular screenings and open discussions with healthcare providers remain crucial for maintaining prostate health and making informed treatment decisions.   Reference: Kaplan, A. L., Lenis, A. T., Shah, A., Rajfer, J., & Hu, J. C. (2014). Testosterone Replacement Therapy in Men with Prostate Cancer: A Time-Varying Analysis. Journal of Sexual Medicine. For more insights on this topic, refer to: Does Testosterone Cause Prostate Cancer? Can Men Treated for Prostate Cancer Use TRT?

Starting Testosterone Replacement Therapy (TRT) is a significant decision that can have a profound impact on your health and well-being. While it offers numerous benefits, like enhanced mood, improved sexual performance, and increased muscle mass, there are also potential side effects and nuances that your healthcare provider might not fully explain. Below, we delve into critical aspects of TRT that every man should be aware of. But first, did you know that you can easily and affordably monitor your testosterone levels through DiscountedLabs.com? It's an excellent way to keep track of your health without the hassle of a doctor's visit. Table of Contents Impact on Sperm Count How TRT Affects Your Fertility Blood Viscosity and Hematocrit Managing Increased Red Blood Cells Shutdown of Natural Testosterone Production Recovery Post TRT Dose and Effectiveness TRT is Not a Magic Bullet Different Injection Methods Subcutaneous vs. Intramuscular Testosterone Gels and Creams Topical TRT: Right Dose, Right Results Optimal Injection Frequency The Shift Towards Frequent Dosing Sleep Apnea TRT and Sleep Quality Erectile Function and Libido The Added Benefits and Limitations Monitoring Your Blood Tests Taking Charge of Your Health Telemedicine for TRT Access to Expertise Prostate Cancer and Heart Attacks Debunking the Myths Community Support You're Not Alone Important Blood Tests Beyond Total Testosterone Insurance Limitations Navigating the System Consult a Urologist The Go-To Experts on TRT Comorbidities Risks and Workarounds The Estradiol Obsession Re-Thinking Estradiol Management Impact on Sperm Count How TRT Affects Your Fertility One aspect of TRT that is often overlooked is its effect on fertility. TRT reduces levels of LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone), which are crucial for sperm production. If you plan on having children, it's essential to discuss fertility preservation options with your healthcare provider. Treatments like clomiphene or the addition of hCG can be useful. Blood Viscosity and Hematocrit Managing Increased Red Blood Cells TRT may lead to an increase in hematocrit, or the amount of red blood cells in your blood, thereby making it thicker. While some doctors may suggest pausing TRT, this condition can be managed through blood donations or therapeutic phlebotomy. However, frequent blood donations can lead to iron depletion and fatigue. Learn more about managing high hematocrit here. Shutdown of Natural Testosterone Production Recovery Post TRT Once you're on TRT, your natural testosterone production will decline. Usually, your body can recover its testosterone levels within a few weeks to six months after stopping TRT, but it's essential to know that this therapy isn't a temporary commitment. Dose and Effectiveness TRT is Not a Magic Bullet Though TRT can dramatically improve quality of life by enhancing sex drive, muscle mass, and fat loss, the effectiveness varies from person to person. Factors like dose, frequency, and side effect management play a crucial role. Learn about the average time to see benefits. Different Injection Methods Subcutaneous vs. Intramuscular There's a common misconception that testosterone must be injected deep into the muscle. However, you can also use a 1/2 inch 27-29 gauge insulin syringe for subcutaneous injections. Read more about injection methods here. Testosterone Gels and Creams Topical TRT: Right Dose, Right Results Gels and creams offer a less invasive way to administer testosterone, but the effectiveness depends on the right dose and concentration. Doctors often miss this, so make sure you monitor your levels closely. Optimal Injection Frequency The Shift Towards Frequent Dosing Traditionally, doctors prescribed testosterone injections at 200 mg every two weeks. However, many are moving towards more frequent dosing schedules, like 100 mg per week or even 50 mg twice per week, using insulin syringes. Sleep Apnea TRT and Sleep Quality Be cautious if you have central sleep apnea, as TRT can worsen this condition. However, weight loss achieved through TRT may improve obstructive sleep apnea over time. Erectile Function and Libido The Added Benefits and Limitations While TRT generally improves libido, the results regarding erectile function are mixed. Some men also use low-dose Cialis for additional cardiovascular benefits. Read more about the benefits of Cialis. Monitoring Your Blood Tests Taking Charge of Your Health One of the great advantages of modern technology is that you can monitor your own blood tests via DiscountedLabs.com, without needing a doctor's appointment. Telemedicine for TRT Access to Expertise For those living in areas without easy access to a TRT specialist, telemedicine is a viable option. Just note that most telemedicine doctors don't accept insurance. Prostate Cancer and Heart Attacks Debunking the Myths Contrary to common belief, TRT has not been proven to cause prostate cancer or heart attacks. Proper monitoring of hematocrit, HDL, and blood pressure is crucial, however. Community Support You're Not Alone Don't underestimate the value of community support. Platforms like Excel Male Forum offer a wealth of shared experiences and advice from men who have been on TRT for years. Important Blood Tests Beyond Total Testosterone Many doctors only measure total testosterone and often neglect other important markers like free testosterone, DHT, and thyroid function. Ensure these are part of your monitoring plan. Insurance Limitations Navigating the System Most insurance companies have limitations on which TRT products they cover. You can bypass insurance restrictions by going through a compounding pharmacy. Consult a Urologist The Go-To Experts on TRT Urologists are becoming increasingly knowledgeable about TRT, making them an excellent resource for anyone considering this treatment. Comorbidities Risks and Workarounds Some men might not see the benefits of TRT due to other health issues, such as metabolic disorders that can lead to water retention and high blood pressure. A full work-up with a cardiologist is advisable for these men. The Estradiol Obsession Re-Thinking Estradiol Management Many men obsess about their estradiol levels and are often prescribed high doses of aromatase inhibitors, which may not be necessary. Learn more about the role of estradiol in men here. In conclusion, TRT is a multifaceted treatment that requires proper understanding and management. Keep yourself informed and consider using DiscountedLabs.com for your testosterone level monitoring. Take control of your health today!

Table of Contents What are Estradiol and Aromatase? When aromatase is unbalanced, estradiol becomes an issue Low estrogen levels in men, not testosterone increases risk of heart disease Androgen deprivation therapy can cause cognitive decline Does estradiol restore cognitive function during ADT? Should high estradiol levels be treated? What are Estradiol and Aromatase? Estradiol is a form of the female hormone estrogen. Although estradiol production is typically considered a female concern, men also need to maintain healthy levels of this hormone for optimal health. Since men lack ovaries (where most estradiol is produced in women), estradiol in men is created by a process that uses an enzyme called aromatase (1) in testicles, liver and fat cells. Aromatase converts a very small portion of testosterone levels into estradiol, and health problems can arise when aromatase levels are too high or too low (1). When aromatase is unbalanced, estradiol becomes an issue As men age, they can experience excess aromatase activity, raising estradiol levels and reducing testosterone to unhealthy levels. Low T levels will adversely impact quality of life by reducing libido, ability to maintain an erection, mood, and muscle mass, among other health factors (2). However, when the body produces too little aromatase, men can experience other, potentially serious health problems. Men with diminished aromatase levels will have an estradiol deficit, which can create problems similar to low-T; diminished sex drive, loss of bone mass, and increased body fat (3). Men on testosterone replacement therapy (TRT) taking higher doses of aromatase inhibitors can also experience estradiol deficit. Let’s look at recent studies finding that low estradiol can play a critical role in increasing the risk of cognitive decline and increase the odds of experiencing cardiovascular disease. Low estrogen levels in men, not testosterone increases risk of heart disease A study led by Elaine Yu, MD, MSc, addresses the suspicion held by many medical professionals that testosterone can promote cardiovascular disease in men, and that estradiol provides protection against it (4). The researchers sought to determine whether it was estradiol or testosterone that regulated men’s cardiovascular risk factors by comparing two groups whose hormone levels were changed using a combination of medications (4). They looked at 400 healthy men, between the ages of 20 and 50. Study participants were weighed, had fasting blood tests for markers of heart disease and diabetes, and also had a thigh scan using quantitative computed tomography (CT scan) to measure muscle fat content before and after the study (4). Yu’s team found that while higher levels of testosterone reduced these men’s levels of healthy (HDL) cholesterol, changes in estradiol levels had no effect at all on HDL(4). However, they also discovered that low estradiol levels did increase the markers for diabetes, like increased insulin resistance, increased fat in the muscles, and higher fasting blood sugar levels(4). Diabetes is a major risk factor for heart disease (5). Additionally, the study found that neither estradiol nor testosterone affected the levels of LDL (unhealthy) cholesterol. According to Yu, these findings indicate that in men, it’s higher testosterone levels combined with lower estradiol levels that can worsen cardiovascular risk factors, somewhat explaining differences in the incidence of heart disease between men and women. Some studies have shown that it is the ratio of testosterone to estradiol that is important, not just the level of each of those hormones. As testosterone increases with TRT, so does estradiol to balance the effects of testosterone on lipids, mood and insulin action. Androgen deprivation therapy can cause cognitive decline Androgen deprivation therapy (ADT) is an often used method to slow the growth of prostate cancer. It’s also used for men transitioning to women (6, 7). ADT is typically prescribed on an open-ended (no fixed period) basis to help treat advanced prostate cancer. An estimated 44 percent of men with prostate cancer will undergo ADT at some point as part of a strategy to slow tumor growth (6). ADT therapy is used specifically to block the male hormones, particularly testosterone, from stimulating prostate cancer cell growth. Research has confirmed that ADT can cause significant cognitive decline in women with breast cancer (8), but few studies have investigated cognitive impairment following ADT for men being treated for prostate cancer. Using formal tests, scientists recently compared the cognitive ability of 58 prostate cancer patients receiving androgen deprivation therapy to 84 prostate cancer patients who did not receive ADT, and 88 cancer-free men (9). They found that those treated with ADT were 70 percent more likely to develop cognitive impairment after six months, and over twice as likely to have significant cognitive impairment after one year(9).   Does estradiol restore cognitive function during ADT? A 2018 study published in Current Neuropharmacology has examined whether estradiol supplementation is an effective way to prevent this side effect (9). Researchers performed a literature search using PubMed and Google Scholar to identify studies on this topic and discover any evidence that estradiol supplementation has a cognitive benefit for men on ADT. They examined studies involving the effects of estradiol treatment on cognitive function in three androgen-deprived male populations; prostate cancer patients, male-to-female transsexuals, and castrated male animals (9). A review of the literature found that while some studies show that estradiol supplementation resulted in cognitive improvement (especially in spatial ability), They couldn’t determine (9): Whether estradiol will improve cognition after long-term ADT How early or delayed estradiol treatment post-castration will affect cognition If estradiol affects memory retention They conclude that for androgen-deprived males, there is some evidence that estradiol supplementation may improve both verbal and visual memory (9). However the variability between the reviewed studies resulted in significant inconsistencies, making further study necessary to determine what estradiol treatment protocol can best maximize cognitive improvement for men using ADT (9). Should high estradiol levels be treated? Men on testosterone replacement therapy can experience an increase in estradiol that can sometimes reach clinically elevated levels (10). A study published in the Journal of Sexual Medicine (11) looks at the phenomenon of increased estradiol levels in men undergoing TRT to discover whether high estradiol levels in this population should be treated. Researchers comprehensively reviewed the published literature on the role of estradiols in male sexual function and testosterone deficiency to answer this question. The study findings reveal that (11): Although estradiol have been used at pharmacologic doses to suppress serum testosterone, there is no evidence that naturally occurring elevations of estradiol will cause a reduction in testosterone levels Absent testosterone deficiency, study findings suggest that elevated estradiol levels don’t seem to be harmful. Once again, monitoring and treating the ratio of testosterone to estradiol may be more important than either hormone alone. Estradiol could help maintain some sexual function in castrated men Given the evidence uncovered by this review study, researchers report that, although further research is needed, the existing evidence doesn’t support the treatment of elevated estradiol for men on testosterone therapy (11). WATCH LECTURE ABOUT ESTRADIOL IN MEN    BUY YOUR SENSITIVE ESTRADIOL TEST   References 1) Stocco, Carlos. “Tissue Physiology and Pathology of Aromatase.” Steroids 77.1-2 (2012): 27–35. PMC. Web. 11 June 2018. 2) Araujo, Andre B., and Gary A. Wittert. “Endocrinology of the Aging Male.” Best practice & research. Clinical endocrinology & metabolism 25.2 (2011): 303–319. PMC. Web. 11 June 2018. 3) Bulun, Serdar E. “AROMATASE DEFICIENCY.” Fertility and sterility 101.2 (2014): 323–329. PMC. Web. 11 June 2018. 4) Men's heart disease risk linked to high testosterone and low estrogen. The Endocrine Society. 5) Zhang PY. Cardiovascular disease in diabetes. Eur Rev Med Pharmacol Sci. 2014;18(15):2205-14. 6) Perlmutter, Mark A, and Herbert Lepor. “Androgen Deprivation Therapy in the Treatment of Advanced Prostate Cancer.” Reviews in Urology 9.Suppl 1 (2007): S3–S8. Print. 7) Unger, Cécile A. “Hormone Therapy for Transgender Patients.” Translational Andrology and Urology 5.6 (2016): 877–884. PMC. Web. 11 June 2018. 8) Wu, Lisa M., and Ali Amidi. “Cognitive Impairment Following Hormone Therapy: Current Opinion of Research in Breast and Prostate Cancer Patients.” Current opinion in supportive and palliative care 11.1 (2017): 38–45. PMC. Web. 11 June 2018. 9) Wibowo E. Cognitive Impacts of Estrogen Treatment in Androgen-Deprived Males: What Needs to be Resolved. Curr Neuropharmacol. 2017;15(7):1043-1055. 10) 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. doi: 10.1177/1557988314539000. Epub 2014 Jun 13. 11) Ravi Kacker, Abdulmaged M. Traish, Abraham Morgentaler. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency. The Journal of Sexual Medicine. (2012): Volume 9, Issue 6, Pages 1681–1696

Acne is one of the most annoying skin problems people can develop throughout their lifetime. It basically consists of small lesions, pimples, irritation, redness, and other skin imperfections. Acne can spread over the forehead, neck, face, shoulders and chest area. Although it's commonly believed that teenagers get the most acne problems, this skin condition can be prevalent in people of all ages. Acne can also develop as a side effect of taking exogenous testosterone, so even if you're well into your forties or fifties, you might still get acne at some point in your life. Are you wondering if TRT and acne correlate with each other? There are a handful of possible side effects of TRT (testosterone replacement therapy). While most side effects of TRT are manageable, if not avoidable, some can be quite serious if the use of exogenous hormones is abused or if simple genetic factors are not correctly dealt with accordingly. Then there are those potential side effects of TRT that are far less serious, but ones we might place in the vanity category. One of these side effects of TRT is acne. Acne is something most grown men do not concern themselves with; after all, we all think of it as an irritation long since left behind in adolescence. However, for some men, the use of exogenous testosterone can cause this childhood enemy to rear its ugly head once again. Before we dive into this particular side effect of TRT, there is a significant genetic factor we would be remised if we left out. Those who are naturally predisposed to acne are at the most risk. Those who never had severe acne issues in their youth will unlikely experience an issue while on TRT. Sure, anyone can get a zit even in adulthood. You may find a few pop up here and there on TRT that you normally wouldn’t get. But as it pertains to a serious issue, the genetically predisposed are at the highest risk. Table of Contents Testosterone and Acne: The Process Acne or Folliculitis? How to Differentiate? Avoiding TRT Acne Through Hygiene How to Deal With TRT-related Acne TRT and Acne: Other Treatments What Causes Acne? And how to Prevent It? Latest FDA-Approved Acne Products: Sarecycline Altreno Onextron Differin Gel Aczone Gel Trifarotine Cream Picking the Best Acne Treatment References Testosterone and Acne: The Process Testosterone is a hormone that converts to an even more powerful hormone known as dihydrotestosterone (DHT). Many studies have shown DHT to be upwards of five times more powerful than the testosterone hormone. DHT is an extremely important hormone in the male body. It is imperative to our sexual health if for no other reason. DHT also causes the body to produce more oil, leading to oily skin and more oil soaking into your pores, resulting in acne. However, blocking DHT is not a good idea since it has many benefits for men. It’s a relatively simple process, but one that can be quite bothersome if not embarrassing. Your health has greatly improved through TRT; you’re now in better shape, leaner, and more muscular, and your sex drive is back to where it used to be, but your face looks like that of a 14-year-old boy. If this doesn’t sound desirable, that’s because it’s not. However, there’s also some very good news: acne related to TRT is more than manageable if not outright avoidable. Check the DHT test on DiscountedLabs.com. Acne or Folliculitis? How to Differentiate? Sometimes what we think is acne isn't. Some men on testosterone replacement therapy (TRT) develop red bumps on their skin when on the hormone. Some doctors have found out that it is folliculitis. You need to see a dermatologist who can accurately diagnose this problem, so do not assume it is just acne.  Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. Eosinophilic folliculitis is an itchy rash with an unknown cause that is most common among individuals with HIV, though it can occur in HIV-negative individuals where it is known by the eponym Ofuji disease.  EF consists of itchy red bumps (papules) centered on hair follicles and typically found on the upper body, sparing the abdomen and legs. The name eosinophilic folliculitis refers to the predominant immune cells associated with the disease (eosinophils) and the involvement of the hair follicles. Folliculitis can be treated with minocycline, UV light, retionic acid washes, and topical corticoid steroids. Avoiding TRT Acne Through Hygiene The best thing you can do to prevent TRT related acne is also the simplest: hygiene. Washing your hands and face multiple times a day will have a positive effect. You can choose not to, but you’re only hurting yourself. This is something you should be doing even if you’re not on TRT. Carry a small towel with you each day and keep your face dry, but let’s not stop there. Acne can also easily appear on our shoulders, back, and chest, so it will be important to keep our entire body clean, especially if we’re predisposed to acne. Any time you become sweaty, such as after a gym session, working outside, or any other activity that leaves you a little sweaty, take a shower and put on a clean shirt. If you can’t take a shower immediately, let’s at least put on a fresh, clean, dry shirt and shower as soon as we can. Along with simply being hygienic, there are some good soaps, anti-acne soaps you may want to consider. Any soap containing the ingredients Benzoyl Peroxide or Salicylic acid will be worth a try. Simply wash your troubled areas with this anti-acne soap, rinse and repeat each time you shower. How to Deal With TRT-related Acne Want to get rid of pimples or prevent your TRT treatment from causing an outbreak? Here are a few things you can try: - Use Accutane -- Accutane, or isotretinoin, is one of the most potent prescription treatments to cure acne. It's usually used to treat cystic acne, which is a much more serious form of acne that is likely to cause scarring. The treatment is effective in up to 85% of cases. Taking 40 mg of Accutane every day for a week can do wonders for your acne. However, be aware that the medication does come with side effects, and it may lower testosterone levels and have psychiatric side effects is some people. Consult your physician before mixing TRT and Accutane. - Use Sporanox -- Sporanox, or itrconazole, is another useful medication to try as a means of curing your acne. It is an anti-fungal drug that may be able to kill off the P. acne bacteria that is increasing your skin cell turnover rate, thereby increasing your risk of clogged pores. Once again, check with your doctor before mixing TRT and Sporanox. - Try Vitamin B5 -- Vitamin B5, or pantothenic acid, is needed by your body in order to produce CoEnzyme A (CoA). This enzyme helps to oxidize (burn) fatty acids, particularly in your skin. If you don't have enough of this CoA, your body won't be able to eliminate the fatty acids produced by an increase in DHT, so the skin oil will increase and lead to acne. By taking Vitamin B5, you give your body what it needs to keep the fatty acid production under control. - Try anti-acne soap -- There are a number of anti-acne soaps available at every pharmacy and supermarket in the country. These soaps are often made with Benzoyl Peroxide or Salicylic acid, two highly effective anti-acne treatments. Ideally, you should shower after a heavy workout, and use the soap to wash your face and any body parts where there is an acne breakout. Topix Benzoyl Peroxide is a body wash worth trying. - Try zinc -- Zinc is one of the most important minerals for a healthy body. It plays a vital role in many important internal functions, not the least of which is your body's immunity to disease. But how can it help to protect against acne? Zinc ensures that your bloodstream carries sufficient Vitamin A to your skin, and it helps to regulate the cellular apoptosis (death) of your skin cells. By ensuring that your skin cells die at a healthy rate, zinc essentially prevents the buildup of dead skin cells that soaks up skin oil to clog your pores. - Get out -- Your body NEEDS sunlight in order to produce Vitamin D, one of the vitamins that play a role in fatty acid oxidation. However, be warned: too much sunlight can dry out your skin, causing it to produce even more oil. No more than 30 minutes of sunlight per day is needed to encourage healthy Vitamin D production. If your acne is the result of the TRT, you may want to consider reducing the dose of testosterone. This can reduce the amount of DHT produced in your body, preventing acne. However, this is something you should discuss with your doctor. You can also discuss other useful treatments for dealing with the TRT-related acne. TRT and Acne: Other Treatments If your acne is severe due to TRT, there are several medications you may want to consider. These medications can have a positive effect, but they are not without their own potential risk. One of the most commonly used medications for the treatment of acne is Accutane. Accutane has a success rate of upwards of 85%. However, while it’s generally used for severe cases, such as cystic acne, some TRT users may find it to be the right course of action. The most common side effect many users concern themselves with is that the drug can lower testosterone levels. However, in your case, you’re already using exogenous testosterone. Your natural production is already subpar. This side effect of Accutane should not be an issue for you. There are other drugs, such as Sporanox, an anti-fungal medication that some may find helpful. A full lost of FDA approved medications for treating acne that may be worth consideration if this particular side effect of TRT manifest: Trifarotene Cream Aczone Gel Differin Gel Onextron Altreno Sarecycline (Seysara) Many natural remedies are available that many may find to be effective, not to mention simply healthier. Three of these remedies include B5, zinc and vitamin D. Some may find B5 useful due to its ability to produce Coenzyme A (CoA). This enzyme will help in the oxidization of fatty acids, primarily in the skin, burning the fatty acids that increase due to DHT. Then we have the overall fantastic mineral zinc. This mineral plays several important roles in the human body. For our purposes here, zinc helps carry vitamin A to the skin. This greatly aids in preventing the buildup of dead skin, which can clog our pores and lead to acne. Finally, vitamin D: vitamin D, while it’s not the only source of oxidizing fatty acids, it is one that plays an important role. A mere thirty-minutes of sunlight per day will give you all the vitamin D you need to meet the desired end.  If the use of the various vitamins and minerals discussed doesn’t do the trick, if you’ve found prescription medications to be lacking for your needs, you may need to consider an alternative. This alternative action may be as simple as lowering your testosterone dose. You may only need to lower the total amount per injection and not the weekly dose. For example, if you’re injecting a total of 200mg per week, consider splitting it into 100mg twice a week. If you’re already following such a protocol, you could split the total milligrams injected per week into three or even four smaller injections. If one is following a sub-Q protocol, although injections will be frequent, they will be far less bothersome than 3-4 Intra-muscular injections per week. If that still doesn’t do the trick or you’re simply not interested in multiple injections per week, lowering the total dose of testosterone so that there’s less testosterone to convert to DHT may be your only option. What Causes Acne? And how to Prevent It? Acne develops when subcutaneous sebaceous glands on the skin get blocked or filled with excessive amounts of sebum. Sebum is a waxy-like substance which protects the skin. When too much sebum is secreted, the sebaceous glands can get infected which leads to acne. Contrary to popular belief, acne isn't really caused by a poor diet consisting of fatty foods. Acne might develop as a result of reaching puberty or when a person is getting through a great deal of stress. Taking advantage of testosterone replacement therapy (TRT) can also trigger acne as a side effect. This might be caused by an excessive amount of estradiol present in the bloodstream. Preventing acne is also quite difficult, but you can manage it much better thanks to a few products recently approved by the FDA. These creams and gels are designed to reduce the effects of acne and prevent it from ruining your image and the aesthetics of your skin. Let's take a closer look at some of these products and see what are their benefits! They can be used by TRT patients to mitigate the effects of acne on their face, chest, and shoulders. Latest FDA-Approved Acne Products: As a rule of thumb, keep in mind that not everyone who goes through TRT gets acne as a side effect. A plethora of patients doesn't experience skin problems at all, ever. Others might get mild acne on their faces and shoulders which can go away on its own. In some rare cases, the acne might be more severe and that's when you need to take advantage of these FDA-approved creams and gels. Sarecycline Sarecycline is also known as Seysara and it's a product derived from tetracycline. It can be used to effectively treat acne in people aged 11-30 years. Sarecycline is available in tablet form with dosages of 60mg, 100mg or 150mg. The dosages are given depending on the weight of the patient. For example, if the patient weighs less than 54kg (119lbs) then the recommended dosage is 60mg. If the patient weighs between 85kg (187lbs) and 136kg (299lbs) then the recommended dosage is 150mg. Patients weighing more than 54kg but less than 85kg should take the 100mg tablet. Sarecycline is used to treat moderate to severe acne in patients of all ages. Its efficiency was based on studies performed on more than 2,000 patients. The research involved a double-blind, placebo-controlled trial over a period of 12 weeks. Most of the patients experienced improvements after just 3 weeks of treatment and their acne and other skin lesions were significantly healed. The recommended dosage is to take one tablet per day with or without food. The FDA approves the use of this product, but its safety hasn't yet been established after a period of 12 months, so more research trials need to be conducted in the future. Still, sarecycline is an ideal acne product if you want to get rid of acne caused by TRT. Altreno Another great acne product you can try is Altreno, also known as tretinoin 0.05%. This topical treatment can be used on patients who are 9 years of age or older. It consists of a lotion that is applied directly to the damaged skin. The active ingredient is absorbed very quickly by the skin and it can significantly reduce moderate to severe acne in patients. The FDA approved this treatment option based on studies performed on identical research centers. These were double-blind, vehicle-controlled studies involving more than 1,600 patients. These patients were treated with Altreno for a period of 12 weeks and more than 90% of them were satisfied with the results. The lotion managed to significantly reduce inflammatory lesions and prevent the spreading of the acne to other body parts. As side effects, these were rare and involved skin exfoliation, mild pain, skin dryness, and dizziness. However, approximately 1% of the patients reported these side effects, so Altreno can be considered a pretty safe acne product to use. On top of being efficient in fighting acne, this retinoid can also moisturize the skin and prevent other types of infections or skin scarring. Patients should apply a small dose of Altreno on the affected skin and experience the first positive results in just a few weeks. Onextron Onextron has been approved by the FDA in 2014 to be an efficient and safe treatment for acne. It's also known as clindamycin phosphate and benzoyl peroxide and it can be applied as a gel on the affected skin. This treatment is suitable for patients aged 12 or older and the gel should be applied once a day for best results. This revolutionary cream has been approved by the FDA as a result of multiple studies involving almost 500 patients. These were vehicle-controlled studies performed by experienced researchers. The results of the study were impressive as more than 50% of the patients experienced significant improvements in their skin lesions. The studies lasted for 12 weeks and most of the patients were happy with the results they got after using Onextron. Approximately 1% of these patients experienced side effects such as burning sensations, allergic reactions or rashes. Such side effects were minor and they went away after a couple of days. That's why Onextron can be successfully and safely used as an acne treatment by people over 12 years of age. Differin Gel Differing Gel 0.1% is also known as adapalene and it has been approved to be used as an acne treatment since 1996. This lotion contains powerful active ingredients which are quickly absorbed by the skin. Differin Gel can be applied on the neck, shoulders, face or other body parts which contain skin lesions and imperfections. It is safe to be used by people over 12 years of age, according to the FDA. This over-the-counter medicine has been approved as a result of multiple clinical studies and trials done on hundreds of people with severe acne. Most of the patients experienced marked improvements in their skin condition. Side effects were minor and only encountered by a fraction of the people who tested this lotion. Some of these side effects include rashes, minor burning sensations, and mild allergic reactions. With that being said, Differin Gel shouldn't be applied to damaged skin which suffered cuts or scratches. This OTC medicine can be applied daily and its efficiency lasts for at least 12 months. Aczone Gel This is another useful acne cream that can be used by people over 12 years of age. Aczone Gel 7.5% is a safe and efficient lotion that can be applied daily on the affected skin. It can be used to treat minor and severe acne as well as other skin lesions from face, neck, shoulders, and chest. The FDA approved this medicine as a result of numerous multi-center, double-blind studies. More than 4,300 patients participated in these studies and almost all of them had severe acne. Aczone Gel was applied daily for a period of 12 weeks and more than half of the patients involved reported a successful outcome. The gel was effective in treating skin lesions and reducing the spreading of acne. When it comes to side effects, these are minor and only experienced by a few patients. For example, some side effects include itching or dryness of the skin. However, patients must be careful not to combine other medications they might use such as benzoyl peroxide with Aczone Gel. These 2 products can provoke serious side effects including the yellowing of the skin and the reduction of blood flow in the lips and other body parts. Aczone Gel should be used as a standalone medication and not in conjunction with other drugs. Trifarotine Cream The US Food and Drug Administration (FDA) approved trifarotene cream 0.005% (Aklief, Galderma) on October 2019, the first new retinoid molecule to be approved in the United States in over 20 years for the once-daily topical treatment of acne vulgaris. Trifarotene is the only topical retinoid that selectively targets retinoic acid receptor (RAR) gamma, the most common RAR found in the skin. It's also the first topical treatment specifically studied and proven to treat both facial (forehead, cheeks, nose, and chin) and truncal (chest, shoulders, and back) acne. It is approved for patients aged 9 years or older. Picking the Best Acne Treatment As you can see, there are a lot of great acne treatments and products you can try to get rid of your skin imperfections. Some of them are available by prescription while others are over-the-counter medicine which can be taken as pills or applied as lotions. As a rule of thumb, make sure that you always speak with your doctor or healthcare provider before beginning treatment with any of these acne products. It's ideal to be monitored by a healthcare professional who can provide recommendations when it comes to dosages or potential side effects. if you're currently on testosterone replacement therapy (TRT) and experience minor or severe acne, these products might be helpful for you. Talk with your TRT doctor and ask him which one is more appropriate for you. More information on TRT related acne.   References Testosterone and Acne: What You Need to Know The Role of Zinc in the Treatment of Acne: A Review of the Literature

Estradiol in Men: What is the Most Accurate Blood Test? Table of Contents Estradiol in Men: What is the Most Accurate Blood Test? Comparisons of Immunoassay and Mass Spectrometry Measurements of Serum Estradiol Levels and Their Influence on Clinical Association Studies in Men Objective: Design and Setting: Main Outcome Measures: Results: Conclusions: BUY SENSITIVE ESTRADIOL TEST HERE  Recent studies show the importance of estradiol in men and how low estradiol can be detrimental for not only for bone but also for sex drive. Low estradiol has also been linked to fat gain. So, physicians should be careful about treating men who are obviously being over diagnosed with high estradiol due to the use of the wrong test. This study compares the old estradiol blood test assay (ECLIA) to the more accurate sensitive one (LC/MS/MS). The sensitive estradiol test is a method for measuring estradiol levels in men (and children) using a sensitive liquid chromatography-tandem mass spectrometry (LC/MS)-based assay[2]. It is considered more accurate for men because it provides better sensitivity and accuracy at lower estradiol concentrations, which are typically found in men, as opposed to higher concentrations found in adult females[1][2]. Immunoassay-based estradiol tests, on the other hand, perform best at higher concentrations of estradiol, making them more suitable for individuals with levels in the adult-female range[2]. The sensitive estradiol test, with its greater sensitivity at lower levels, is more appropriate for men who generally have lower levels of estradiol compared to adult females[3]. Comparisons of Immunoassay and Mass Spectrometry Measurements of Serum Estradiol Levels and Their Influence on Clinical Association Studies in Men  (Source: The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 6, 1 June 2013, Pages E1097–E110)   Immunoassay-based techniques, routinely used to measure serum estradiol (E2), are known to have reduced specificity, especially at lower concentrations, when compared with the gold standard technique of mass spectrometry (MS). Different measurement techniques may be responsible for the conflicting results of associations between serum E2 and clinical phenotypes in men. Objective: Our objective was to compare immunoassay and MS measurements of E2 levels in men and evaluate associations with clinical phenotypes. Design and Setting: Middle-aged and older male subjects participating in the population-based Osteoporotic Fractures in Men (MrOS) Sweden study (n = 2599), MrOS US (n = 688), and the European Male Aging Study (n = 2908) were included. Main Outcome Measures: Immunoassay and MS measurements of serum E2 were compared and related to bone mineral density (BMD; measured by dual energy x-ray absorptiometry) and ankle-brachial index. Results: Within each cohort, serum E2 levels obtained by immunoassay and MS correlated moderately (Spearman rank correlation coefficient rS 0.53–0.76). Serum C-reactive protein (CRP) levels associated significantly (albeit to a low extent, rS = 0.29) with immunoassay E2 but not with MS E2 levels. Similar associations of immunoassay E2 and MS E2 were seen with lumbar spine and total hip BMD, independent of serum CRP. However, immunoassay E2, but not MS E2, associated inversely with ankle-brachial index, and this correlation was lost after adjustment for CRP (C Reactive Protein- An Inflammatory marker). Conclusions: Our findings suggest interference in the immunoassay E2 analyses, possibly by CRP or a CRP-associated factor. Although associations with BMD remain unaffected, this might imply for a reevaluation of previous association studies between immunoassay E2 levels and inflammation-related outcomes. BUY SENSITIVE ESTRADIOL TEST HERE