Page 5 - Testosterone Side Effect Management

Table of Contents Testosterone Fractions in Men How SHBG Influences Free Testosterone What Factors Influence Your SHBG Levels? How Do You Know if Your SHBG Levels Are High? How to Lower SHBG and Automatically Increase Free Testosterone Levels? Raise Your Total Testosterone Level Lower Your Estradiol Levels DHEA Supplements Might Help What if My SHBG Levels Are Already Low? Now You Know More About SHBG and the Role It Plays in Your Body!   When people hear about testosterone, they immediately think about muscles, alpha males, confidence, and probably sports cars. This is the most important male sex hormone and one of the most important hormones in the human body. However, this hormone has several fractions. It is influenced by your lifestyle and it can influence how you think and how you feel. For example, too much sex hormone-binding globulin (SHBG) can decrease free testosterone which can lead to low libido and other symptoms.  That is why some men search for ways to decrease SHBG levels. If you are interested in testosterone fractions and how to naturally increase this sex hormone in your body then keep reading. You will find out more about the bioavailability of testosterone and why it plays a vital role in your health. You will also find out how to decrease SHBG levels. Testosterone Fractions in Men If you do a testosterone test, your doctor will mention your average levels. For example, the generally accepted healthy levels of testosterone for men are between 350 ng/dl and 1,100 ng/dl. If you have a total testosterone level under 350 ng/dL, you might be diagnosed with hypogonadism (testosterone deficiency). However, this is the total testosterone level in your bloodstream. This hormone is made up of several fractions and they are important too. For example, there are bound testosterone (bound) and free testosterone (non-bound) levels that circulate through your blood. Total testosterone is made up of these two types of testosterone. Free testosterone makes up for about 2% of your total testosterone levels. This is the one that goes to your muscles, brain, and influences other organs and tissues in your body. The bound testosterone usually attaches to two substances - albumin or SHBG. The amount of testosterone that is bound to albumin is about a third of your total testosterone. The amount of testosterone that is bound to SHBG is approximately two-thirds of your total testosterone. Albumin is a protein and it carries your testosterone through the bloodstream and releases it as it is needed. You often hear the term "bioavailable testosterone". This refers to the amount of testosterone that can be used by your body. Luckily, testosterone bound to albumin can detach if necessary and get used as free testosterone. The one bound to SHBG cannot do that. In this case, the bioavailable testosterone in your body is the sum of free testosterone and albumin-bound testosterone. How SHBG Influences Free Testosterone It's a well-known fact that the levels of albumin in your blood are generally stable. This protein doesn't have massive spikes in quantity for a male adult. On the other hand, SHBG levels can increase and decrease based on various factors. Most importantly, the levels of SHBG influence how much free testosterone you have in your blood. High levels of SHBG are usually associated with low levels of free testosterone. Less testosterone is available for muscles, the brain, and organs. The vice-versa is also true. Lower levels of SHBG are associated with higher levels of free testosterone. This can positively influence your mood and libido. What Factors Influence Your SHBG Levels? Multiple types of factors influence how much SHBG there is in your bloodstream. Aging is one of the most important factors.  As men age, their SHBG levels will naturally go up while the free testosterone levels will go down. However, you can do something about the other factors. For example, liver problems can increase SHBG levels in men of all ages. If you have a fatty liver due to chronic alcohol consumption or other reasons, chances are that your SHBG levels are also higher than normal. This is true for other liver problems such as cirrhosis or cancer. Thyroid problems can also increase SHBG levels. If your thyroid gland is less active or hyperactive, you might start to feel the symptoms of this health issue. Too much estradiol in your body is also responsible for increasing SHBG levels. Obesity and high triglyceride levels are commonly associated with an increase in SHBG levels in the blood. If you are overweight and your lipid profile is not very good, chances are that your overall testosterone levels might drop. Finally, inflammation is another factor that could increase SHBG levels and decrease free testosterone ones. Acute inflammation is good for the body to help you fight diseases. Chronic inflammation, on the other hand, can lead to life-threatening issues and raise your SHBG levels. How Do You Know if Your SHBG Levels Are High? A simple blood test provides the best opportunity to test your testosterone levels accurately. Medical technology got very advanced, and it's possible to find out exactly how much testosterone is flowing through your blood quickly and safely. However, remember that most tests will communicate your total testosterone levels. You should dig a little bit deeper and find out the exact SHBG and free testosterone levels. These are the ones that interest you the most in this case. If the percent of total testosterone that is free testosterone is below 2 percent, then you may have high SHBG. For example, the optimal SHBG levels in adult males are between 10 and 60 nmol/L. If you have more than that, chances are that your free testosterone levels are also smaller than normal. Ask your doctor for assistance if you cannot figure out the SHBG levels independently. Discounted Labs sells several tests, including the SHBG test as part of lab test panels.   How to Lower SHBG and Automatically Increase Free Testosterone Levels? Now that you have learned more about SHBG and how it can influence your body, the next obvious question is to find out a way to decrease SHBG levels. You cannot stop the aging process, but you can do something about the other factors that influence SHBG. Raise Your Total Testosterone Level This is the simplest and often the best method to reduce SHBG and increase free testosterone. If your testosterone levels are low, do something to increase them. For example, you can lose weight, start exercising more often and clean your diet of junk food and processed meals. This will automatically increase your total testosterone level. A fraction of this level is free testosterone, but it's a fraction of something larger than before, so you'll definitely experience its positive effects. Lower Your Estradiol Levels Another way you can reduce your SHBG levels is by lowering the number of estrogens in your body. Estrogens are the maprimaryemale sex hormones but are also needed by the male body. One of the most important estrogens is estradiol. Men have small amounts of estradiol too, but too much can lead to high SHBG levels and even gynecomastia if low testosterone is present. Lowering estrogen levels is possible for men of all ages. For example, you should avoid soy-based products as these have the tendency to increase your blood estrogen levels. At the same time, try to minimize alcohol consumption, exercise more, lose weight if you are overweight, and get plenty of sleep. DHEA Supplements Might Help DHEA or dehydroepiandrosterone, is one of the most abundant steroids in the human body. It's a weak estrogen and androgen hormone. It serves many purposes in the body and it can be sold as a supplement. Some studies show that small doses of DHEA administered to men might decrease SHBG levels. However, more research is needed as increasing the levels of DHEA in the body can have serious side effects in the long run. For example, high levels of DHEA are commonly associated with Parkinson's Disease. This complex neurodegenerative disease can lead to memory loss and poor brain function. If you decide to take DHEA supplements, make sure that you speak with your doctor first. Remember that these solutions might work for people with SHBG levels higher than normal. If your SHBG level is low, you should not worry about lowering it further. What if My SHBG Levels Are Already Low? In this case, your free testosterone levels are optimal and you don't have to do anything to increase them. However, more SHBG is needed too. This could signify an underlying health condition that must be explored further. For example, if you have low SHBG in your bloodstream, you might have a fatty liver or metabolic syndrome. This condition can be caused by excessive alcohol consumption or other factors. A liver problem is usually associated with insulin resistance too. Generally speaking, low SHBG levels are good predictors of diabetes in people of all ages. You must do a blood glucose and a A1c test to see how glucose is processed in your body. If you're pre-diabetic, you can still do something to increase insulin sensitivity and avoid this chronic condition. Now You Know More About SHBG and the Role It Plays in Your Body! Although deciphering the mysteries of testosterone and SHBG is not easy, major medical advancements are made each day. As you can see, too little SHBG is bad, but too much of it is not good either. Patients must aim for an optimal level of SHBG and monitor it closely using a SHBG blood test.    

Table of Contents The 6 Most Popular Discounted Lab Panels Online Why Using Direct-to-Consumer Labs? How Do Online Lab Tests Work? What Lab Tests Can You Choose? What Are the Most Popular Blood Tests Online? 1. Heavy Metal Test Symptoms of Heavy Metal Poisoning 2. Hormone and Wellness Panels for Men and Women 3. Comprehensive Fatigue Panel 4. Erectile Dysfunction ED Panel 5. Electrolyte Panel 6. Elite Male Blood Test Panel Get Your Blood Test Today! The 6 Most Popular Discounted Lab Panels Online   According to the World Health Organization, chronic diseases kill millions of people each year. Diabetes alone accounted for nearly 1.6 million deaths in 2015. Deaths caused by neurodegenerative diseases such as dementia doubled since 2000, and this number is expected to grow in the upcoming years. Although these are alarming facts, you might be happy to find out that numerous diseases and injuries, particularly chronic illnesses, can be prevented. To prevent a disease, you first need to be aware of it. To be aware of it, you need to do the right thing and get your health checked periodically. Discovering a predisposition to the disease earlier on gives you a massive advantage. You’ll be able to follow special treatments and minimize its risks or eliminate them. But how to get tested for various diseases which might affect you? Well, one of the simplest and most efficient ways is by using direct-to-consumer labs. These are usually discount labs you can purchase online at affordable prices and have your general health checked in a matter of days. Why Using Direct-to-Consumer Labs? Direct-to-consumer labs are discounted labs sold by various companies such as DiscountedLabs.com. Many people decide to buy their lab tests instead of working with their primary physicians because this route offers numerous advantages. For example: You can choose your preferred test from hundreds of labs available online You save money since you eliminate the middle man and buy "directly from the source” and not having to pay for a doctor’s visit copay. You get your results back in just a few business days.  Your information and results are confidential and secure You can draw blood or offer a urine sample in the nearest clinic from your house You have more control over your health More and more people are taking advantage of this opportunity to buy a cheap blood test and become more aware of their health, so why shouldn’t you? How Do Online Lab Tests Work? Getting a blood test online is not rocket science. The procedure has just a few steps: 1. Order your preferred test from DiscountedLabs.com 2. Get a form which allows you to go to the nearest lab or clinic to draw blood that you can download after your purchase. 3. Have your blood samples analyzed by a Quest Diagnostics laboratory in your state or the nearest state. 4. The results will be available for you to download in 5-7 business days from the day of your lab blood draw. 5. You can visit your doctor to help you interpret these results or compare them against reference values you find online As you can see, the process is simple, confidential and secure. You don’t even have to visit your doctor for a prescription since DiscountedLabs.com provides that for you. What Lab Tests Can You Choose? There are numerous things you can test in a human body using just a blood, urine or saliva sample. For example, some of the most popular tests include a complete blood count test which tells you how much hemoglobin there is in your blood, the number, and type of your blood cells, etc. You can also go for a pregnenolone test or a cheap testosterone test to determine your testosterone levels. Cheap blood tests are also available, and they can show information about your cholesterol levels, triglycerides, inflammation biomarkers and more. Buying a testosterone test online is increasingly popular especially if you’re a bodybuilder and you want to monitor your T levels or if you think you have testosterone deficiency. DiscountedLabs.com offers dozens of affordable tests for both men and women, so you have a lot of options at your disposal when it comes to taking care of your health. What Are the Most Popular Blood Tests Online? If you’re buying for the first time and you don’t know what to focus on, keep reading to find out a list of some of the most popular direct-to-consumer labs you can buy today. These tests can be obtained using a discounted labs coupon to help you save some money in the process. Here is a way to compare all discounted lab panels to see which one is best for you. 1. Heavy Metal Test The dangers of having heavy metals in your body are real. The heavy metals category includes mercury, arsenic, cadmium, lead and other types of toxic substances. These elements can stick to your bones and organs, causing serious health problems in the long run. The body can easily eliminate trace amounts of heavy metals regularly. However, if you get too high of a quantity of arsenic, for example, you're exposed to serious health risks. Lead is one of the most poisonous heavy metal out there. It can cause brain damage, depression, anxiety, and even panic attacks. Testing for heavy metals can be done using a single blood sample or a urine sample. The Heavy Metals Profile I is performed using a blood sample, and it determines the levels of arsenic, mercury, and lead in your body. There are two more tests sold by DiscountedLabs such as the heavy metal profile II and the urine test. These also come at affordable prices and allow you to discover the levels of cadmium, lead, and arsenic in your system. Symptoms of Heavy Metal Poisoning Having a high amount of toxic metals in your body puts you in a risky situation, so you need to see your doctor immediately if this happens. Moreover, you’ll be able to experience certain symptoms along the way, and you shouldn’t ignore them. These symptoms depend on the type of metal which caused the poisoning. For example, these symptoms are common among people: l Stomach pain l Diarrhea l Nausea l Dizziness l Tingling in your feet l Weakness and headaches l Vomiting Some of these symptoms are your body's desperate attempt to eliminate the accumulated heavy metals. Help your body by getting tested for heavy metals immediately and find out if you're at risk. 2. Hormone and Wellness Panels for Men and Women Any hormonal imbalance you might experience can drastically influence your health. For example, testosterone deficiency can lead to poor sex drive and even symptoms of anxiety and depression in men of all ages. Instead of looking for “testosterone testing near me” on Google, you can order a testosterone test online and have your hormonal levels checked quickly. In women, estrogen levels are the most important. One of the most popular estrogens is estradiol. This hormone directly influences mood, cognition, sex drive, libido, and other functions in women. It is also possible to check the estradiol levels for men and see if they are elevated. Very high estradiol levels in men might be caused by testosterone replacement therapy. This is a rare but known side effect of TRT, but it can be minimized with certain medications. Another common side effect of TRT has high hematocrit. If you’re wondering what high hematocrit mean then you should know that this is the percentage of red blood cells in the blood. An elevated hematocrit might cause various health problems in the long run. Donating blood can be the answer if you’re wondering how to lower hematocrit on TRT, donating blood can be the answer. However, you shouldn’t donate blood more often than one or two times per year because this can lower your ferritin levels which causes anemia. There are high hematocrit symptoms to which you should pay attention. For example, having high hematocrit levels can lead to: l Fatigue l Itching l Bone pain l Blurred vision l Excessive sweating As you can see, there are numerous important hormones you need to be mindful of such as testosterone, estrogen, estradiol, ferritin, etc. A complete hormone and wellness panel can make your life easier because it provides a complete overview of your health. DiscountedLabs.com sells a Complete Hormone & Wellness Panel for MEN and a Hormone & Wellness Panel for WOMEN, so pick the one suitable for you to learn more about your hormonal health. 3. Comprehensive Fatigue Panel If you feel tired after a long day at work, it’s normal to be so, especially if you also found some time to visit a local gym for half an hour. However, if you constantly feel tired, even in the morning when you wake up, then this is not normal. Diagnosing excessive fatigue is not that easy. There are numerous potential causes which need to be analyzed independently. For example, here are a few factors which might directly influence your energy levels and how tired you feel regularly: l Your thyroid function l Whether you have hyperglycemia or hypoglycemia l Your total and free testosterone levels l The amount of iron in your blood cells l The number of red blood cells in the blood l Any adrenal problems you might have One hormonal imbalance in these areas can make you feel excessively tired. Also, keep in mind that such health problems don’t get corrected on their own. You need to do a thorough health checkup and see what causes your tiredness. A comprehensive fatigue panel takes all these factors into account and analyzes multiple hormones and substances in your bloodstream. Based on the results, your doctor can make appropriate health recommendations. For example, people who have low energy levels as a result of insufficient iron in their bloodstream might need to take an iron supplement. Similarly, those who have low testosterone levels might benefit from TRT or various lifestyle changes to improve their total and free testosterone levels. 4. Erectile Dysfunction ED Panel Another commonly purchased panel is the ED blood test. Unfortunately, the prevalence of erectile dysfunction is quite high, especially among men who are 40 years old or older. However, this health condition can be treated in numerous ways. There are both invasive and non-invasive procedures as well as pills which can improve the symptoms of erectile dysfunction. Certain lifestyle changes can also improve one's erection. However, the most important thing is to know exactly what caused the ED and how to treat it efficiently. For example, having low testosterone levels can lead to erectile dysfunction in men of all ages. In this case, TRT might be the appropriate treatment method to improve libido. Similarly, high estradiol can also be linked to erectile problems. Estradiol is a female sex hormone. If there is too much (or even too little) estradiol in the bloodstream, the person in question will experience erectile dysfunction. ED can also be caused by thyroid problems. For example, the TSH, T3, and T4 are all thyroid hormones which directly influence the production of testosterone and sex drive in general. If these hormones are out of balance, one might not be in the mood for sex that often. Prolactin is another important hormone in the body. It is produced by the pituitary gland, and if it’s not secreted correctly, ED can appear in men. As you can see, there are numerous factors which influence sex drive. The Erectile Dysfunction Panel which can be bought from DiscountedLabs.com looks at all these hormones to determine which one is out of balance. All you need to do is to buy the panel online and go to your nearest lab for a blood sample. The results will be communicated to you in a few business days, and then you can begin looking for appropriate solutions to your ED problem. 5. Electrolyte Panel Electrolytes are important substances in the human body. The most popular ones are potassium and sodium. Other electrolytes include chloride and carbon dioxide. The job of electrolytes is to regulate important bodily functions such as maintaining correct blood pH, muscle and nerve function. When electrolytes go out of balance, various physical symptoms can appear. For example, too much sodium in the body makes the blood acidic. This can lead to chronic illnesses in the long run. At the same time, too much potassium can cause heart problems and other similar health conditions. The Electrolyte Panel which can be bought from DiscountedLabs.com looks at four different important electrolytes in the body such as carbon dioxide, chloride, potassium, and sodium. This is one of the most affordable blood tests online, and it requires only a small blood sample to run it. 6. Elite Male Blood Test Panel If you want to have a broader overview of your health, the Elite Male Blood Test Panel is highly recommended for you. This is one of the most comprehensive panels sold on DiscountedLabs and one of the most affordable in the United States. Using just a simple blood sample, you get to find out more information about multiple hormones, enzymes, and substances in your body such as testosterone, prolactin, thyroid hormones, IGF-1, PSA and more. This panel looks at more than ten different hormones in your bloodstream, helping you diagnose certain conditions or preventing more serious diseases. A lipid panel is also included in this package, revealing information about your good cholesterol, bad cholesterol, and triglyceride levels. Another important hormone checked by this panel is sensitive estradiol. This hormone is linked to sex drive, and if it is in high quantities, it can lead to gynecomastia which is also known as “male boobs.” The estradiol levels might increase as a result of testosterone replacement therapy. If you’re currently using TRT, you might want to get this panel to find out if you’re prone to develop gynecomastia in the future. The Elite Male Blood Test Panel also looks at your complete blood count. It analyzes your hematocrit, the number of red blood cells, the amount of hemoglobin in your bloodstream, etc. Knowing more information about red blood cells helps you determine if you’re predisposed to anemia. Similarly, having a high hematocrit can cause problems in the long run so that you can monitor this important parameter with the Elite Male Panel. Another important aspect checked by this panel is the metabolic function. More precisely, the test looks at the kidney and liver health. As you probably already know, your liver is one of the most important organs in the body. It is responsible for eliminating toxins and producing numerous hormones required for a healthy living. Once you know the state of your liver, you'll be able to make appropriate lifestyle changes to improve its function. The same story goes for your kidneys. For example, creatinine is a byproduct which needs to be excreted by the kidneys. If this process doesn't happen correctly, you can develop kidney problems in the future. The Elite Male Blood Panel helps you look at all these vital aspects and have a broader understanding of your health. Get Your Blood Test Today! As you can see, ordering direct-to-consumer labs is efficient, more affordable and saves time. You don’t have to search for “discounted labs tests near me” on Google anymore; the answer comes directly from DiscountedLabs.com.  

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

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

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

Here are Some Important Things That Your Doctor May Fail to Tell You Before You Start Testosterone Replacement Therapy (TRT):       1- TRT decreases your sperm count.     Some doctor prescribe Clomiphene alone or hCG with TRT to preserve your fertility     2- TRT may increase your blood viscosity due to increased hematocrit, the amount of red blood cells in the blood.     Some doctors may want to stop your TRT when this happens, but this side effect can be managed easily with blood donations or therapeutic phlebotomy.   Just be careful: frequent blood donations can deplete iron and cause fatigue.     3- TRT shuts down your own testosterone production.     It may take up to 6 months for your testosterone to return to baseline after you stop.     4- TRT works to improve your sex drive, muscle mass, and burn fat.     But it does not work for everyone and dose/frequency are important along with other factors like side effect management.   TRT is not a magic bullet.     5- Testosterone can be injected under the skin (Most doctors think you should inject deeply into muscle)     6- Testosterone gels and creams are effective but some doctors do not adjust the dose based on your blood level and symptoms.     7- Many doctors still prescribe testosterone injections at 200 mg every two weeks.     Many are moving towards recommending 100 mg/week or 50 mg twice per week with an insulin syringe.     8- TRT can worsen sleep apnea.     Apnea can improve with weight loss and can be treated with a CPAP machine.     9- TRT improves erectile function in some men but not all.     It improves libido in most men regardless of age, though.     10- You can monitor your own blood tests via companies that sell discounted labs without a doctor visit.     11- You can access a testosterone doctor via telemedicine if you don’t have one close by.     However, most of them do not take insurance.     12- TRT does not cause prostate cancer or heart attacks.     Cardiovascular outcomes depend on proper monitoring of hematocrit, HDL, and blood pressure.     13- Many men do not know that they ask questions to TRT-experienced men by visiting the ExcelMale forum.     14- In follow up visits, some doctors only measure blood levels of total testosterone but forget to include free testosterone, DHT (metabolite), and thyroid function tests.     15- Most insurance companies only pay for certain TRT products but not others.     And most refuse to pay if your testosterone is over 350 ng/dL.     16- You can buy affordable TRT options with a prescription at compounding pharmacies like Empower Pharmacy.     17- Urologists are quickly becoming the most knowledgeable doctors of TRT management.     18- Some men fail to achieve benefits from TRT. Comorbidities and other issues can be to blame.     GO TO: DiscountedLabs.com/Resources for   Free Testosterone Book Doctor's Referrals Forums & More

Table of Contents Does Testosterone Increase Risks of Heart Disease? What is the Effect of Testosterone Therapy in Older Men? What Can You Do to Prevent Heart Disease While on Testosterone Replacement Therapy? BUY A TESTOSTERONE BLOOD TEST PANEL Reference:  Does Testosterone Increase Risks of Heart Disease? There is widespread misinformation that testosterone supplementation increases the risk of heart disease. There is no evidence to support this belief in men younger than 65 years of age. Testosterone administration to middle-aged men is associated with decreased visceral fat, triglycerides, lower blood sugar concentrations, and increased insulin sensitivity. Several studies have shown that low total and free testosterone concentrations are linked to increased intra-abdominal fat mass, the risk of coronary artery disease, and type 2 diabetes mellitus. Testosterone has also been shown to increase coronary blood flow. Similarly, testosterone replacement retards the build-up of plaque in experimental models of atherosclerosis. In 1994, Phillips and colleagues studied 55 men with angina. They found a strong correlation between very low levels of testosterone and increased severity of coronary artery disease as measured by arteriograms, suggesting that testosterone may have a protective effect. This is consistent with the observation that the risk for atherosclerosis increases with age in men, while testosterone levels decrease. Two other smaller studies found that the administration of testosterone decreased risk factors for coronary artery disease. The prospective European investigation into cancer in Norfolk (EPIC- Norfolk) Prospective Population Study examined the prospective relationship between the body’s own (endogenous) testosterone concentrations and mortality due to all causes, cardiovascular disease, and cancer in a nested case-control study based on 11,606 men aged 40 to 79 years surveyed in 1993 to 1997 and followed up to 2003. Among those without prevalent cancer or cardiovascular disease, 825 men who subsequently died were compared with a control group of 1489 men still alive, matched for age and date of baseline visit. Lower endogenous testosterone (the body’s own) concentrations at baseline were linked to mortality due to all causes (825 deaths), cardiovascular disease (369 deaths), and cancer (304 deaths). So this study found that in men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes and that low testosterone may be a predictive marker for those at high risk of cardiovascular disease.   What is the Effect of Testosterone Therapy in Older Men? But there are some emerging contradicting data from a much smaller study that showed that older men who have higher endogenous testosterone (without taking testosterone) might have a higher incidence of heart disease. A large U.S. multicenter study showed that older men with higher testosterone levels are more likely to have a heart attack or other cardiovascular disease in the future. The results were presented at The Endocrine Society’s 92nd Annual Meeting in San Diego in June 2010. Study participants were age 65 or older and included 697 community-dwelling men who were participating in the National Institutes of Health-funded study, called the Osteoporotic Fractures in Men (MrOS). None of these men were receiving testosterone therapy, according to the study abstract. All subjects had blood tests to determine their testosterone levels. The investigators then divided the men into quartiles, or four groups, of testosterone range to observe trends in rates of coronary heart disease events. This type of heart disease results from plaque-clogged or narrowed coronary arteries, also called atherosclerosis. A coronary heart disease event included a heart attack; unstable angina, which is chest pain usually due to atherosclerosis and which doctors consider a prelude to a heart attack; or angioplasty or bypass surgery to clear blocked arteries. During an average follow-up of nearly four years, 100 men, or about 14 percent, had a coronary disease event, in particular, heart attacks. After the researchers adjusted for other potential contributing risk factors for heart disease, such as elevated cholesterol, they found that higher total testosterone level relates to an increased risk of coronary disease. Men whose total testosterone was in the highest quartile (greater than or equal to 495 nanograms per deciliter, or ng/dL) had more than twofold the risk of coronary disease compared with men in the lowest quartile (below 308 ng/dL). So, this is contradictory data that may be concerning, but does it say anything about the cardiovascular risks of supplementing testosterone to men with testosterone deficiency? A report published in the New England Journal of Medicine in June 2010 about a study researching the use of testosterone gel in older men showed that such study was stopped early due to a higher incidence of side effects in men treated with the gel. Participants in this trial called the Testosterone in Older Men with Mobility Limitations, or TOM, were non-institutionalized men aged 65 and older who had difficulty walking two blocks or climbing ten steps and whose serum testosterone was 100 to 350 ng/dl (very low levels). So, these were frail older men. The goal was to recruit 252 men, but only 209 subjects had been enrolled by the time the trial, which started in 2005, was stopped on December 2010. Testosterone use had the desired effect of improving the men’s muscle strength and mobility. But they also experienced a high rate of adverse effects — not just cardiovascular problems but respiratory and skin problems. Unfortunately, they did not report hematocrit, estradiol, and bioavailable testosterone. I dream of the day when a study will be done the right way to include all of those variables. Only then we can draw the right conclusions about who is more prone to side effects. Managing high hematocrit with blood donation/phlebotomy and high estradiol with anastrozole can probably eliminate some of the reported side effects in older men, but there is only one way to find out: To have proper studies using those management strategies. To date, no study listed in clinicaltrials.gov is following men who are taking testosterone and who have access to phlebotomy or estrogen blockers to manage the two main side effects that may affect cardiovascular health in older men: high hematocrit and estradiol. Previous studies have shown that in general, older men have more side effects when using testosterone (polycythemia, gynecomastia, high blood pressure, prostatic hyperplasia) and more comorbid conditions. High hematocrit and estradiol increase clotting and viscosity, so it is not surprising to me that older men who use testosterone would have more cardiovascular risks if monitored poorly by their physicians. It amazes me how many older men using TRT are walking around with hematocrit over 54 and estradiol levels above 100 pg/dl without being offered phlebotomy or estrogen blockers. This is one of the main reasons I felt compelled to write this book. Older men also require more testosterone to reach normal levels since they have more sex hormone binding globulin that attaches to testosterone and renders it useless. So, physicians should carefully monitor these patients if they decide to provide testosterone replacement. The age cut off when the risk-to-benefit ratio of testosterone changes is not known yet. There are several studies that are currently being performed to provide more answers. A U.S.-based study showed that testosterone therapy does not increase men's risk for heart attack. The study, conducted by researchers at the University of Texas Medical Branch at Galveston, examined 25,420 Medicare beneficiaries 66 years or older treated with testosterone for up to eight years. It appeared in the July 2, 2012 issue of the Annals of Pharmacotherapy. So, the jury is still out. But if no complicating factors like high cholesterol, blood pressure or strong family history of heart disease are present, many doctors opt for prescribing testosterone to older men who need it to have a better quality of life. And most doctors keep an eye on hematocrit but few on estradiol. Hopefully, this will change as more doctors wake up to the risks associated with poor monitoring and management of TRT. It is the excessively high doses of testosterone used by athletes and recreational bodybuilders that are linked to significant decreases in the plasma concentration of HDL (high-density lipoprotein - the good cholesterol) and increases in LDL (low-density lipoprotein – the bad cholesterol). Replacement doses of testosterone have been shown to have only a modest or no effect on plasma HDL in placebo-controlled trials. Testosterone supplementation has been shown to decrease triglycerides, a dissolved fat that can lead to cholesterol increases and metabolic syndrome. In spite of these studies, some physicians continue to think that testosterone replacement can dramatically increase cholesterol levels.   What Can You Do to Prevent Heart Disease While on Testosterone Replacement Therapy? Given the state of the modern diet, all of us should have our doctor check our fasting cholesterol and triglycerides (another lipid-linked with heart disease risk). If you think that you have low testosterone, you may already have a problem with your lipids. The recommendations of exercise and diet (low in sugars and animal fats) apply for everybody but are especially important for men who have high LDL and high triglycerides at the time of starting testosterone replacement. Testosterone therapy can be an important part of your health regimen but don’t start it thinking that it will cure high cholesterol. Sometimes high lipids are related to poor diet, sedentary lifestyle, medication side effects, and bad genes. Your treatment for high cholesterol and triglycerides can also include statin and fibrates drugs prescribed to you by your doctor. I would try to modify your diet and to exercise before you jump on taking these medications since they may have muscle related side effects and do not correct the root cause of the problem, which is a metabolic abnormality that could be addressed with good adherence to lifestyle modifications. The key word is “adherence,” which seems elusive is many people who rather take a pill than watch their diet and exercise. For more on diet and exercise, refer to the chapter “ Miscellaneous Health Tips to Support Healthy Testosterone.” NOTE: I think you’re getting why I’m telling you that you need doctor’s supervision when on testosterone. So far you’ve read about the potential impact on hemoglobin and hematocrit, blood pressure, and estradiol, all of which can negatively affect your cardiovascular health. Imagine the even greater risk of those using testosterone at higher than replacement doses that usually buy it from underground sources and do not have a doctor who monitors them. No wonder testosterone and anabolic steroids get such a bad reputation. I tell bodybuilders that do not have a doctor to follow them to at least decrease their risks by getting a bodybuilder panel on DiscountedLabs.com that do not require a prescription. There are many around the United States, and you can find them by visiting DiscountedLabs.com . Of course, this is not the best solution and in no way a replacement for the supervision of a doctor. Irresponsible bodybuilders do more self-inflicted damage when their mistakes fuel the hysteria surrounding hormones in the United States. This hysteria has made it difficult for many men who need TRT to get it. Over-the-counter “testosterone boosters” may present problems with lipids, so do not think that because you are buying something at a health food store, that makes that product safe. Let your doctor know if you are taking any of those. Most do not work and those that did where banned by the FDA and taken off the market.   BUY A TESTOSTERONE BLOOD TEST PANEL   Reference:  From the book “Testosterone: A Man’s Guide” by Nelson Vergel (available on Amazon.com)

Table of Contents What is aldosterone? The ALD test What is Renin? Hypertension and the renin test What is Adrenal Corticotropic Hormone (ACTH)? The ACTH test References A frequent cause of high blood pressure and water retention is when levels of certain hormones in the body are unbalanced or functioning poorly. The hormones that are frequently at fault are secreted by the kidneys and the pituitary or adrenal glands. They are called aldosterone, ACTH, and renin What is aldosterone? Aldosterone (ALD) is one of a group of connected hormones. They form the renin–angiotensin–aldosterone system (1); this system is activated when there is a decrease in blood flow to your kidneys following a drop in blood volume or blood pressure such as during heavy bleeding, or sodium levels fall below healthy levels (1). Aldosterone is a mineralocorticoid, which means that it adjusts the mineral levels in our cells, particularly sodium and potassium (2). It regulates both fluid levels and blood pressure in the body. Stress is a factor that can increase the release of aldosterone and cause sodium levels to rise. Regardless why, an increase in aldosterone results in edema (water retention) and high blood pressure (3). Someone experiencing high aldosterone levels may also experience (4): Low potassium levels (causing muscle cramps) Abnormally increased blood volume Unusually alkaline blood (because aldosterone promotes acid secretion) People experiencing high blood pressure and edema may be advised to check their aldosterone level with an aldosterone (ALD) test. When the level of this hormone is too high, it can cause damage to the cardiovascular system. If levels are too high, medicines can be prescribed that will lower aldosterone to healthy levels. The ALD test An ALD test is frequently used to diagnose both fluid and electrolyte disorders (5) that may be caused by: Diabetes Adrenal disease Heart problems Kidney failure An ALD test may help diagnose problems like (6): Over-secretion of aldosterone Underactive adrenal glands (adrenal insufficiency) Low blood pressure caused by standing up (orthostatic hypotension) Hard to control high blood pressure or high blood pressure that occurs at a young age What is Renin? Renin is also called angiotensinogenase; it’s an enzyme produced by the kidneys to control aldosterone production (7). It’s also essential in the renin–angiotensin aldosterone system (RAAS) which maintains your body’s fluid balance and blood pressure. This system regulates blood plasma volume, lymph and interstitial fluid (the fluid which surrounds the cells in the body) and controls constriction of the arteries and blood vessels (7). Three factors stimulate the secretion of renin (8): When a drop in arterial blood pressure is detected by pressure-sensitive receptors in the arteries When a drop in salt level is detected in the kidneys When activity is detected in the sympathetic nervous system activity Renin’s primary function is to increase blood pressure to maintain healthy blood flow to the kidneys. It’s secreted by specialized kidney cells that can detect changes in blood pressure through stretch receptors in the vascular walls (8). Renin starts a chain reaction that makes the hormone called angiotensin, which makes small blood vessels narrower and stimulates the adrenal glands to secrete aldosterone. Aldosterone signals the kidneys to hold on to fluid and salt. Both can increase blood pressure. When this process is out of balance, blood pressure can rise to dangerous levels. Hypertension and the renin test If you experience high blood pressure (hypertension), your doctor needs to find out the reason why to prescribe the correct treatment. A renin test is used to discover what’s happening in the body that may be causing it. The doctor might order this kind of test if high blood pressure starts when you’re young or medication hasn’t kept it under control. Because renin is involved in aldosterone metabolism, an ALD test may be conducted at the same time (9). Your test results will tell the doctor if your renin levels are high, low, or healthy. Either high or low levels could help explain why your blood pressure is too high. What the renin and ALD test results may mean (10, 11): Excess renin with normal aldosterone levels could mean that you’re salt-sensitive Low renin and excess aldosterone may indicate that your adrenal glands aren’t functioning properly If both renin and ALD are high, it may be a sign of kidney trouble Whatever the results are, they will help the doctor decide which drugs or treatments are best to get your blood pressure under control. What is Adrenal Corticotropic Hormone (ACTH)? Adrenocorticotropic hormone is a hormone secreted in the anterior (front) pituitary gland in your brain (12). The role of ACTH is to maintain appropriate levels of the stress hormone cortisol, which is released by the adrenal glands. Cortisol is our body’s natural alarm system. As our body’s primary stress hormone, it works with different parts of the brain to influence our fear, mood, and motivation (13). Cortisol is best known for fueling the body’s “fight-or-flight” response in a crisis. But, cortisol also has a critical role in a variety of things the body does, like (13): Controlling the sleeping and waking cycle Boosting energy levels to better handle stress (and restore normal levels afterward) Influences how the body uses carbs, proteins, and fats Reducing inflammation Regulating blood pressure Increasing blood sugar Symptoms of high cortisol can include; high blood pressure, obesity, high blood sugar levels, and edema. Low cortisol levels can cause weight loss, fatigue, low blood pressure, and muscle weakness (14). The ACTH test If you’re experiencing the symptoms of a cortisol imbalance, your doctor may order an ACTH test to measure the levels of both ACTH and cortisol in the blood (15). The ACTH test will help your doctor detect the diseases that are associated with too much or too little cortisol in the body (15). Your doctor might also perform a physical examination before making a firm diagnosis. If it’s determined that an ACTH secreting tumor (sometimes located on an adrenal gland) is the cause of your cortisol imbalance, then surgery may be indicated (16). You may also be prescribed a drug like cabergoline to normalize your cortisol levels (17).   GET THE ALDOSTERONE LAB TEST HERE   References 1) Manrique C, Lastra G, Gardner M, Sowers JR. The Renin Angiotensin Aldosterone System in Hypertension: Roles of Insulin Resistance and Oxidative Stress. The Medical clinics of North America. 2009;93(3):569-582. doi:10.1016/j.mcna.2009.02.014. 2) Aldosterone and Mineralocorticoid Receptors in the Cardiovascular System Funder, John W. Progress in Cardiovascular Diseases , Volume 52 , Issue 5 , 393 – 400 3) Yoo HD, Choi KS, Jung MH, et al. A Study of the Renin-Angiotensin System and the Blood Volume in the Nephrotic Syndrome. The Korean Journal of Internal Medicine. 1986;1(1):72-77. doi:10.3904/kjim.1986.1.1.72. 4) https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/adrenal-gland-disorders/hyperaldosteronism 5) Balcı AK, Koksal O, Kose A, et al. General characteristics of patients with electrolyte imbalance admitted to emergency department. World Journal of Emergency Medicine. 2013;4(2):113-116. doi:10.5847/wjem.j.issn.1920-8642.2013.02.005. 6) Sau-Cheung Tiu Cheung-Hei Choi Chi-Chung Shek Ying-Wai Ng Fredriech K. W. Chan Chiu-Ming Ng Alice P. S. Kong. The Journal of Clinical Endocrinology & Metabolism, Volume 90, Issue 1, 1 January 2005, Pages 72–78, https://doi.org/10.1210/jc.2004-1149 7) Hall JE. Control of blood pressure by the renin-angiotensin-aldosterone system. Clin Cardiol. 1991 Aug;14(8 Suppl 4):IV6-21; discussion IV51-5. 8) Persson PB. Renin: origin, secretion and synthesis. The Journal of Physiology. 2003;552(Pt 3):667-671. doi:10.1113/jphysiol.2003.049890. 9) Rayner BL, Opie LH, Davidson JS. The aldosterone/renin ratio as a screening test for primary aldosteronism. S Afr Med J. 2000 Apr;90(4):394-400. 10) https://www.uclahealth.org/endocrine-center/renin-test 11)https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=aldosterone_renin_blood 12) Lim CT, Khoo B. Normal Physiology of ACTH and GH Release in the Hypothalamus and Anterior Pituitary in Man. [Updated 2017 Oct 24]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279116/ 13) Fujiwara, Toshihiko et al. Role of cortisol in the metabolic response to stress hormone infusion in the conscious dog. Metabolism - Clinical and Experimental , Volume 45 , Issue 5 , 571 – 578 14) https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310 15) https://medlineplus.gov/ency/article/003696.htm 16) Chiara Dall'Asta Luigi Santambrogio Massimo Castellani Bruno Ambrosi. Difficulties in diagnosis and treatment of ectopic ACTH-producing tumors of the chest. European Journal of Cardio-Thoracic Surgery, Volume 21, Issue 1, 1 January 2002, Pages 149–151. 17) Ferriere A, Cortet C, et al. Cushing's disease: a large retrospective multicenter study. Eur J Endocrinol. 2017 Mar;176(3):305-314. doi: 10.1530/EJE-16-0662. Epub 2016 Dec 22.

Table of Contents High hematocrit: the main side effect of Testosterone Replacement Therapy (TRT) What are the symptoms of high hematocrit? What are factors that increase the risks of TRT polycythemia ? How to Lower Hematocrit? How to Manage Increased Hematocrit Caused by Testosterone Replacement Therapy High hematocrit: the main side effect of Testosterone Replacement Therapy (TRT) Testosterone replacement therapy (TRT) is one of the most effective ways to combat low testosterone levels, but it's vital that you understand the risks associated with the treatment. As with any form of hormone replacement therapy, there are a few downsides to receiving regular injections of testosterone. But do these risks outweigh the benefits? That's a decision you'll have to make for yourself! Note: Remember the purpose of TRT: to restore testosterone to NORMAL, healthy levels in the body. Ideally, testosterone levels should be normal after TRT. Even at normal levels, there is a risk of side effects. One of the primary risks of testosterone that is you need to be aware of is called polycythemia. This is a condition where your body produces too many red blood cells, also known as high hematocrit level. Hematocrit refers to the red blood cell content in your blood. If your hematocrit levels rise, your blood will become too thick or viscous. This can, in turn, make it more likely that you will develop strokes, heart attacks, and clotting events. Polycythemia is serious and potentially life-threatening if untreated.   What are the symptoms of high hematocrit? In recent years, there has been an increased association between TRT and polycythemia. With TRT becoming a more mainstream treatment, more people are experiencing the symptoms of polycythemia, which include: Weakness Fatigue Headache Itching redness of the skin bruising joint pain dizziness abdominal pain shortness of breath breathing difficulty when you lie down numbness, tingling, or burning in the hands, feet, arms or legs Turning very red or "flushing" after workout When polycythemia occurs, the blood becomes very thick. But instead of being able to carry MORE oxygen, the increase of red blood cells can be dangerous. The risk of clotting increases as a result of the red blood cell count increase. Note: While there is a risk of hematocrit increase, there is no proof that TRT increases the risk of clotting events. It's vital to be aware of the potential risk, so doctors need to be careful when prescribing TRT to men with high hematocrit levels, red blood cell disorders, and obstructive pulmonary disease. All of these things increase the risk of clotting events as a result of the hematocrit increase caused by TRT.   What are factors that increase the risks of TRT polycythemia ? There are a number of factors that can increase your risk of developing this problem. According to Dr. Michael Scally, polycythemia "occurs quite frequently in people who are on replacement testosterone." Age also plays a role in your polycythemia risk. Young men are far less likely to experience this problem than older men. The mode of delivery and the dose of testosterone affect the increase in your hematocrit levels. Men who receive formulations of pharmacokinetically steady-state delivery hormones are far less likely to develop the problem than men who receive intramuscular injections of testosterone. Topical preparations only cause the problem in up to 20% of cases. 5 to 15% of those who use testosterone patches develop polycythemia, while 10 to 20% of those using the testosterone gel develop the problem. Of course, the amount of testosterone delivered per day (50 to 100 milligrams) also affects the risk of developing polycythemia. Testosterone injections may increase hematocrit more than gels, patches, pellets, nasal or oral testosterone formulations.  Smaller injection doses given more frequently may increase hematocrit less rapidly than larger dose injections, but data are lacking to prove that fact. Men with sleep apnea or those who smoke are at the highest risk of high hematocrit since their bodies are trying to compensate for the decreased oxygen level by producing more red blood cells.  TRT enhances that red blood cell production.   How to Lower Hematocrit? So what can you do about the problem? Is there any way to manage it? Those undergoing TRT must be aware that polycythemia is a real risk, as do their doctors. They must keep a close eye on their hemoglobin and hematocrit levels. If hematocrit rises above 52%, further examinations may be necessary. Some doctors counsel reducing or stopping testosterone treatment. However, for those who are undergoing TRT as a means of restoring healthy hormone levels, this may not be an option. Some means of managing and reducing the risk of high hematocrit levels include: Scaling back on the amount of testosterone gel delivered per day (50mg or less) or injection dose. Changing the method of administration (using more frequent injections with smaller doses, or using a testosterone gel or cream) Making sure that you are hydrated when you get your blood drawn for lab tests Stopping smoking Getting sleep apnea diagnosed and treated with a CPAP machine to enhance oxygen saturation levels when sleeping. If these options do not work, a therapeutic phlebotomy (blood donation) may be the answer. Removing just one unit of blood can help to lower hematocrit by as much as 3%. For those with very high hematocrit levels, the therapy may continue for months, gradually reducing hematocrit to safe levels over time. Some physicians even prescribe regular phlebotomies (no more frequently that every 56 days is the safe frequency to avoid iron loss) as a means of preventing overly high hematocrit levels. While phlebotomies are not covered by your insurance, they can be performed at any blood bank. Even if your insurance company won't cover the cost, you can solve the problem by donating blood (provided you are free of hepatitis, HIV, and other blood-borne infections). Experts agree that donating every 2.5 to 3 months is safe, and it's a good way to keep your hematocrit levels under control. It is important to note that hematocrit can stabilize in men on longer term TRT, so many men do not have to donate blood after a few months on TRT. Warning: Donating more than 1 unit of blood more frequently than every 2.5 months can lower your iron and ferritin levels. This can cause fatigue. Make sure to replace the lost iron with a supplement in order to prevent anemia. You can check your iron and ferritin with this iron blood test. It's recommended that you donate when you are in the 51-52% hematocrit range. However, some organizations (like the Red Cross) will reject blood with a hematocrit higher than 53%, so it is good to avoid that hematocrit high level if you want to donate blood. Hematocrit is included in the CBC and other panels: Get Your Hematocrit Test Now Testosterone, Hematocrit, Ultrasensitive Estradiol and Prolactin Panel Hematocrit + Total and Free Testosterone   To find out more information, click  How to Manage Increased Hematocrit Caused by Testosterone Replacement Therapy