TRT Guidelines

Testosterone is more than just a sex hormone. It plays a crucial role in a range of physiological processes, including the development of muscle mass, bone density, and even the modulation of blood sugar levels. While high levels of testosterone can have their own set of complications, this article focuses on the often-underestimated risks associated with low testosterone levels. What is Low Testosterone? Low testosterone is a condition where the body does not produce sufficient amounts of the hormone. The threshold for low testosterone varies, but it is generally considered to be below 300 ng/dL (nanograms per deciliter) for adult men. The condition can lead to various health issues, ranging from metabolic syndrome to increased risk of death from all causes. Understanding the Causes of Low Testosterone:  Testosterone, the primary male sex hormone, plays a crucial role in maintaining a range of bodily functions, from muscle mass and fat distribution to bone density and red blood cell production. While it's common for testosterone levels to decline as men age, significantly low levels can lead to a host of health issues. But what causes low testosterone levels? The reasons are many and can range from genetic conditions to lifestyle choices. Let's break it down. Secondary Causes: Hypothalamic-Pituitary Dysfunction Idiopathic GnRH Deficiency, Kallman Syndrome, and More Sometimes, low testosterone can be due to issues with the pituitary gland or the hypothalamus, parts of the brain that signal the testicles to produce testosterone. Conditions such as Idiopathic GnRH deficiency and Kallman syndrome can disrupt these signals. These conditions are examples of hypogonadotropic hypogonadism (Bhasin et al., 2010). Inflammatory Causes Inflammation of the pituitary gland can also result in low testosterone. This inflammation can be due to a variety of factors, including autoimmune reactions and certain illnesses (Dandona & Rosenberg, 2010). Trauma and Tumors Blunt head trauma or postsurgical complications can affect the pituitary gland, leading to low testosterone. Tumors like pituitary adenomas or craniopharyngiomas can have similar effects (Wu et al., 2010). Vascular Insult Issues with the blood vessels that supply the pituitary, such as pituitary infarct/apoplexy or carotid aneurysm, can also be a culprit. Drug-Induced Causes Certain medications like anabolic steroids, opioids, and drugs that induce hyperprolactinemia can contribute to low testosterone. Always consult your doctor if you are on medication and experiencing symptoms of low testosterone (Bhasin et al., 2010). Systematic Illness and Autoimmune Causes Chronic illnesses such as anorexia nervosa, chronic renal failure, and liver failure can result in low testosterone. Autoimmune conditions that attack the pituitary gland (autoimmune hypophysis) can also be a factor (Dandona & Rosenberg, 2010). Primary Cause: Testicular Dysfunction Chromosomal and Genetic Factors Issues right at the level of the testicles can also be causes. Conditions like Klinefelter's syndrome, XX male gonadal dysgenesis, and defects in androgen biosynthesis are all chromosomal abnormalities that can lead to low testosterone (Wu et al., 2010). Infections and Surgeries Orchitis (inflammation of the testicles due to infections like mumps or HIV) and orchiectomy (surgical removal of the testicle) can directly affect testosterone production. Other Factors Chronic infections like tuberculosis, irradiation, testicular torsion, and certain medications can also be responsible. Lifestyle and Other Factors Factors like obesity, aging, malnutrition, and exposure to toxins such as heavy metals and alcohol can also influence testosterone levels (Dandona & Rosenberg, 2010). Low testosterone can result from a variety of causes, ranging from medical conditions and medications to lifestyle choices. If you're experiencing symptoms, it's crucial to consult a healthcare provider for a comprehensive diagnosis and treatment plan. Risks Associated with Different Levels of Low Testosterone < 450 ng/dl (15.3 nmol/l) - Risk of Metabolic Syndrome Metabolic syndrome is a cluster of conditions that include high blood pressure, elevated blood sugar levels, excess body fat, and abnormal cholesterol levels. Testosterone plays a significant role in regulating these physiological functions. Research by Dhindsa et al. has highlighted the increased risk of metabolic syndrome in men with testosterone levels below 450 ng/dl1. < 400 ng/dl (15.3 nmol/l) - Venous Leakage (Internal Penile Damage) Risk Venous leakage is a condition that can result in erectile dysfunction due to internal penile damage. According to a study by Yassin and Saad, men with testosterone levels below 400 ng/dl are at a higher risk of developing this condition2. < 350 ng/dl (11.9 nmol/l) – All-Cause Death Risk and Anemia Risk Khaw et al. conducted a study that showed men with testosterone levels below 350 ng/dl had an increased risk of death from all causes, as well as a higher risk of developing anemia3. < 300 ng/dL (10.2 nmol/L) - Lowered Libido, Weight Gain & Diabetes Risk Increased A low level of testosterone can also have a detrimental effect on sexual health, including a decrease in libido. Furthermore, it is associated with weight gain and an increased risk of developing diabetes. Traish et al. discussed these risks in their research4. < 300 ng/dL (10.2 nmol/L) - Quartile Risk of Fractures (Osteoporosis), Memory-Related Issues & Depression Risk Increases Testosterone is crucial for bone density. Low levels can increase the risk of fractures, memory-related issues, and even depression. A study by Orwoll et al. emphasized these risks5. < 250 ng/dl (8.5 nmol/l) - Arterial Plaque (Arteriosclerosis) & Sleep Quality Affected Vlachopoulos et al. found that men with testosterone levels below 250 ng/dl had a higher risk of developing arterial plaque, which can lead to arteriosclerosis. Additionally, these men experienced a reduction in sleep quality6. < 235 ng/dl (8.0 nmol/l) - Hardening of Arteries (Dialysis Patients) Carrero et al. identified that low testosterone levels can increase the mortality risk among male dialysis patients by promoting the hardening of arteries7. < 200 ng/dl (6.8 nmol/l) - Morning Erections Decrease A study by O'Connor et al. showed that men with testosterone levels below 200 ng/dl experienced a decrease in morning erections, which is often a sign of erectile dysfunction8. < 150 ng/dl (5.1 nmol/l) - Increased Inflammation (TNF-alpha) Malkin et al. found that extremely low levels of testosterone, under 150 ng/dl, were associated with increased inflammation markers like TNF-alpha9. Conclusion Low levels of testosterone are linked to a wide range of health issues. While testosterone replacement therapy is often recommended for men with low levels, understanding the risks associated with varying degrees of low testosterone is crucial for effective treatment and prevention. Always consult your healthcare provider for diagnosis and treatment.   Buy a Low Cost Total and Free Testosterone Test on DiscountedLabs.com: Testosterone test near me.   Low Testosterone: What Do Different Medical Guideline Groups Say? Understanding the guidelines for diagnosing and treating low testosterone is crucial for both healthcare providers and patients. Different medical organizations have released various guidelines over the years, making it essential to know how each defines low testosterone levels. This article aims to shed light on what various medical guideline groups have to say about low testosterone, focusing on cutoff values and expert opinions. Expert Opinion Before delving into specific guidelines, it's worth noting that expert opinion often plays a significant role in forming these guidelines. Medical professionals and researchers contribute to these guidelines based on clinical experience, existing studies, and ongoing research. Therefore, guidelines are not static but evolve over time, reflecting the current state of medical knowledge. Year of Release and Update Knowing when a particular guideline was released or updated is important as it indicates the currency and relevancy of the information. Here is a brief timeline:   ISSAM: 2005 Endocrine Society: 2006 ISSM: 2008 AUA: 2015 ICSM: 2015, updated in 2018  Cutoff Values of Testosterone for Laboratory Diagnosis One of the most critical aspects of diagnosing low testosterone is determining the cutoff values. Various organizations have different parameters. Here's a summary: Guideline Group Cutoff Values for Total T (TT) Cutoff Values for Free T Year ISSAM TT < 231 ng/dL (8 nmol/L) N/A 2005 Endocrine Society TT: 231-346 ng/dL (8-12 nmol/L) Free T < 52 pg/mL 2006 ISSM TT < 230 ng/dL (8 nmol/L) Free T < 52 pg/mL 2008 AUA TT: 230-350 ng/dL (8-12 nmol/L) Free T < 65 pg/mL 2015 ICSM TT < 300 ng/dL Free T < 5 ng/dL 2018 Definitions and Abbreviations: ISSAM: International Society for the Study of the Aging Male ISSM: International Society for Sexual Medicine ICSM: International Consultation for Sexual Medicine AUA: American Urological Association TT: Total Testosterone Free T: Free Testosterone SHBG: Sex Hormone-Binding Globulin Understanding the various guidelines for diagnosing low testosterone is crucial for appropriate treatment. It's evident that different medical organizations have varying cutoff values, and these may be subject to change as more research becomes available. Always consult your healthcare provider for the most current and personalized advice. By keeping updated on these guidelines, both physicians and patients can make more informed decisions regarding the diagnosis and treatment of low testosterone. Sources: International Society for the Study of the Aging Male (ISSAM), Guidelines, 2005. Endocrine Society, Clinical Guidelines, 2006. International Society for Sexual Medicine (ISSM), Guidelines, 2008. American Urological Association (AUA), Guidelines, 2015. International Consultation for Sexual Medicine (ICSM), Guidelines, 2015, updated in 2018.   Footnotes Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192. PubMed ↩ Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed ↩ Khaw, K. T., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luben, R., ... & Day, N. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 116(23), 2694-2701. PubMed ↩ Traish, A. M., Saad, F., & Guay, A. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. Journal of Andrology, 30(1), 10-22. PubMed ↩ Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E., ... & Cummings, S. (2006). Testosterone and estradiol among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed ↩ Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men. Atherosclerosis, 233(1), 278-283. PubMed ↩ Carrero, J. J., Qureshi, A. R., Parini, P., Arver, S., Lindholm, B., Bárány, P., ... & Stenvinkel, P. (2009). Low serum testosterone increases mortality risk among male dialysis patients. Journal of the American Society of Nephrology, 20(3), 613-620. PubMed ↩ O'Connor, D. B., Lee, D. M., Corona, G., Forti, G., Tajar, A., O'Neill, T. W., ... & EMAS Study Group. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1577-E1587. PubMed ↩ Malkin, C. J., Pugh, P. J., Jones, R. D., Kapoor, D., Channer, K. S., & Jones, T. H. (2004). The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 89(7), 3313-3318. PubMed ↩

Testosterone is an essential hormone in both males and females, but it plays a particularly crucial role in male development and reproductive health. Testosterone levels can fluctuate throughout life, and low testosterone levels can have a significant impact on overall well-being. Getting a testosterone blood test can provide valuable information about hormone levels and help diagnose any underlying conditions or imbalances. Here are some reasons why getting a testosterone blood test is important and the difference between the available testosterone test assays in the market. Table of Contents The Importance of Getting a Testosterone Blood Test 1. Diagnosing Hypogonadism 2. Monitoring Hormone Replacement Therapy 3. Identifying Underlying Health Conditions 4. Assessing Fertility 5. Monitoring Overall Health Differences, Advantages, and Disadvantages of Different Testosterone Tests 1. At-Home Testosterone Kits 2. Saliva Testosterone Test 3. LC/MS/MS Total Testosterone Test 4. Immunoassay-Based Testosterone Test Citations: The Importance of Getting a Testosterone Blood Test 1. Diagnosing Hypogonadism Hypogonadism is a condition characterized by low testosterone levels, which can lead to a range of symptoms such as fatigue, decreased libido, erectile dysfunction, and mood changes. A testosterone blood test is the primary method used to diagnose hypogonadism[1]. Identifying and treating hypogonadism can help improve quality of life and alleviate symptoms. 2. Monitoring Hormone Replacement Therapy Testosterone replacement therapy (TRT) is a common treatment for individuals with low testosterone levels. Regular monitoring of testosterone levels through blood tests is essential to ensure that the therapy is effective and that hormone levels are within the optimal range. Adjustments to the dosage or treatment plan can be made based on the results of these tests[1]. 3. Identifying Underlying Health Conditions Low testosterone levels can sometimes be a symptom of an underlying health condition, such as pituitary gland disorders, testicular tumors, or chronic illnesses. A testosterone blood test can help identify these conditions and guide further diagnostic investigations[2]. 4. Assessing Fertility Testosterone plays a crucial role in sperm production and male fertility. Low testosterone levels can contribute to infertility. A testosterone blood test can provide valuable information about hormone levels and help determine the potential causes of infertility[2]. 5. Monitoring Overall Health Testosterone levels can be an indicator of overall health and well-being. Low testosterone levels have been associated with an increased risk of cardiovascular disease, metabolic syndrome, and osteoporosis. Regular testosterone blood tests can help identify any potential health risks and allow for early intervention and treatment[1]. It is important to note that testosterone blood tests should be conducted by healthcare professionals and interpreted in the context of an individual's symptoms, medical history, and other relevant factors. At-home test kits may provide convenience, but they cannot diagnose underlying health conditions or provide a comprehensive assessment of hormone levels[2]. Differences, Advantages, and Disadvantages of Different Testosterone Tests 1. At-Home Testosterone Kits    - Collection Method: At-home testosterone kits typically involve collecting a blood or saliva sample using a finger prick or saliva swab.     - Advantages:      - Convenience: At-home testosterone kits provide the convenience of testing testosterone levels from the comfort of your own home.      - Privacy: Some individuals may prefer the privacy of conducting the test at home.     - Disadvantages:      - Limited Accuracy: At-home testosterone kits may have limitations in terms of accuracy and reliability compared to tests conducted in a clinical setting.      - Lack of Professional Interpretation: Results from at-home kits may not come with professional interpretation, requiring individuals to seek medical advice for proper understanding and guidance. 2. Saliva Testosterone Test    - Collection Method: Saliva testosterone tests involve collecting a saliva sample using a swab or collection device.    - Advantages:      - Non-Invasive: Saliva testosterone tests are non-invasive and can be easily self-administered.      - Convenient: Saliva samples can be collected at any time and do not require a blood draw.    - Disadvantages:      - Limited Availability: Saliva testosterone tests may not be as widely available as blood tests.      - Potential Variability: Saliva testosterone levels may not always accurately reflect total testosterone levels in the blood. 3. LC/MS/MS Total Testosterone Blood Test    - Collection Method: The LC/MS/MS (Liquid Chromatography-Mass Spectrometry) total testosterone test requires a blood sample typically collected from a vein in the arm.    - Advantages:      - High Accuracy: LC/MS/MS is considered a highly accurate method for measuring total testosterone levels.      - No Upper or Lower Limit: Unlike the immunoassay testosterone test, the LC/MS testosterone test is accurate at very low or very hight testosterone blood levels.    - Widely Accepted: LC/MS/MS is a commonly used method in clinical settings for testosterone testing.    - No interference by supplements like biotin.    - You can buy the LC/MS testosterone test on DiscountedLabs.com    - Disadvantages:      - Requires a Blood Draw: Some individuals may find the process of having blood drawn uncomfortable or inconvenient.     - Laboratory Processing Time: Results from LC/MS/MS tests may take longer to obtain compared to rapid tests. 4. Immunoassay-Based Testosterone Blood Test    - Collection Method: Immunoassay-based testosterone tests also require a blood sample, typically collected from a vein in the arm.    - Advantages:      - Rapid Results: Immunoassay-based tests can provide relatively quick results.      - Cost-Effective: Immunoassay-based tests are generally more cost-effective compared to LC/MS/MS tests .    - Disadvantages:      - Potential for Interference: Immunoassay-based tests may be susceptible to interference from certain substances or conditions, potentially affecting accuracy.      - Lower Sensitivity: Immunoassay-based tests may have lower sensitivity compared to LC/MS/MS tests. It is important to note that the choice of testosterone test should be made in consultation with a healthcare professional. They can guide you in selecting the most appropriate test based on your specific needs, medical history, and the accuracy and reliability of the available testing methods. BUY TESTOSTERONE TESTS Citations: 1] Diagnosis and Treatment of Hypogonadism in Men [2] Testosterone Test: What It Is and What the Results Mean [3] Testosterone Levels Test [4] Testosterone Treatments: Why, When, and How? [5] Low Testosterone [6] Criteria for Low Testosterone as a Public Health Issue [7] Testosterone Tests [8] Clinical Interpretation of Testosterone Test Results [9] Testosterone Test: Types and Interpretation [10] At-Home Testosterone Test: Overview and Information [11] Understanding Testosterone Levels Test [12] Everlywell: At-Home Testosterone Test

Did you know that testosterone deficiency has a prevalence of up to 40% in adult males in the United States? A man is deficient in testosterone when his T levels fall below 300 ng/dL of blood. Although this is slightly worrisome news, there are multiple testosterone replacement options you can take advantage of these days. This article focuses on some of the most important testosterone products in 2023. Keep reading to learn key facts, statistics, price ranges, and optimal dosages related to your favorite testosterone products. Top Testosterone Replacement Therapy Options You Have in 2023 Fortunately, there are many ways you can get more testosterone into your system. There are patches, pellets, gels, injections, and even oral capsules that you can take once or twice a day. If you don't really fancy having to inject testosterone once a week, you can take capsules orally and reap all the benefits of testosterone replacement therapy. The following is a quick list of testosterone replacement products you can take advantage of to increase blood T levels. Administration of T products should only be done according to the strict guidance of your TRT doctor. FDA-Approved Testosterone Brands Androderm: Androderm is a transdermal testosterone patch that delivers testosterone through the skin. It is applied daily to maintain stable testosterone levels in men with low testosterone due to certain medical conditions[1]. This option is no longer used by most doctors since its efficacy was not good and it caused skin irritation. AndroGel: AndroGel is a topical testosterone gel that is applied directly to the skin, typically on the upper arms, shoulders, or abdomen. It is designed for daily use to help maintain consistent testosterone levels for men with low testosterone[1]. It comes in two concentrations. Fortesta: Fortesta is another topical testosterone gel applied to the skin, usually on the front and inner thighs. It is used for testosterone replacement therapy in males with low testosterone levels[2]. Testim: Testim is a testosterone gel applied daily to the skin, typically on the upper arms and shoulders, to help maintain consistent testosterone levels in men with low testosterone due to certain medical conditions[1]. Depo-Testosterone: Depo-Testosterone is an injectable form of testosterone prescribed for men with low testosterone levels. It is administered by a healthcare professional at regular intervals, typically every two to four weeks[2]. Testopel is a subcutaneous testosterone pellet that a medical professional implants under the skin. The pellets release testosterone over an extended period, typically three to six months[2]. Aveed: Aveed is an injectable testosterone undecanoate solution designed for long-acting testosterone replacement therapy. It is administered by a healthcare professional at regular intervals, typically every 10 weeks after an initial loading phase[2]. Natesto: Natesto is a testosterone nasal gel that is applied inside the nostrils for testosterone replacement therapy. It is used to treat men with low testosterone levels due to certain medical conditions[2]. Vogelxo: Vogelxo is a topical testosterone gel applied daily to the skin, usually on the upper arms, shoulders, or abdomen. It is used for testosterone replacement therapy in males with low testosterone levels[2]. Xyosted: Xyosted is a subcutaneous testosterone enanthate autoinjector for weekly self-administration. It is prescribed for men with low testosterone levels due to certain medical conditions[2]. Jatenzo: Jatenzo is an oral testosterone undecanoate capsule that the FDA has approved to treat certain types of hypogonadism in men. It is taken orally to help maintain stable testosterone levels in men with low testosterone [2] Testosterone Treatment Prices and Dosing Androgel 1% Price for a 30-day supply (in USD): 55-85 for the generic pump, 90-190 for 50 mg generic packets; also, around 650 USD for Brand 50 mg packets Delivery mode: pump and/or packet Dosage: 25 mg/2.5 g or 50mg/5g Where to apply shoulders, upper arms or on the abdomen Starting dosage: 50 mg daily dose early in the morning When to measure: in the morning before applying the gel Androgel 1.62% Price for a 30-day supply (in USD): 40-140 for the generic pump, 620-640 for Brand pump Delivery mode: pump and/or packet Dosage: 20.25 mg or 40.5 mg Where to apply shoulders or upper arms Starting dosage: 40.5 mg daily dose early in the morning When to measure in the morning before applying the gel Testim 1% Price for a 30-day supply (in USD): around 600-610 for packets Delivery mode: pump Dosage: 20.25 mg per actuation Where to apply shoulders or upper arms Starting dosage: one pump on each shoulder for a total of 40.5 mg early in the morning, it can also be applied on inner thighs When to measure: in the morning before applying the gel Fortesta 2% Delivery mode: pump Dosage: 50 mg or 100 mg Where to apply shoulders or upper arms Starting dosage: two pumps daily in the morning on each thigh When to measure: 2 hours after applying a dose Vogelxo Price for a 30-day supply (in USD): 100-350 for 1% pump, 120-350 for generic packets Delivery mode: shoulders or upper arms Dosage: 50 mg from 4 actuations of 12.5 mg testosterone Where to apply shoulders or upper arms Starting dosage: 50 mg daily in the morning When to measure before applying a dose Androderm Delivery mode: patch applied at night after 10 PM Dosage: 2 mg per day, 2.5 mg per day, 4 mg per day or 5 mg per day Where to apply: abdomen, upper arms, thighs, back Starting dosage: 4 mg per day When to measure: 12 hours after skin application Natesto Price for a 30-day supply (in USD): 195-300 for 5.5 mg/actuation Delivery mode: intranasal pump Dosage: 5.5 mg per pump actuation Where to apply intranasal Starting dosage: 11 mg (2 actuations) 3 times per day at an interval of 6-8 hours When to measure: 2 hours after nasal application Jatenzo Price for a 30-day supply (in USD): around 950 for 237 mg BID pill Delivery mode: oral capsule Dosage: 158 mg, 198 mg, or 237 mg Where to apply oral Starting dosage: 237 mg capsule twice a day (one in the morning, one in the evening) When to measure: 6 hours after the morning dose Testopel Delivery mode: pellet Dosage: 75 mg per pellet Where to apply can be inserted under the skin, in the fat of the buttocks, thigh or lower abdominal wall Starting dosage: 150-450 mg every 3 to 6 months When to measure: at the end of the dosing interval Aveed Delivery mode: injectable solution Dosage: 100 mg/10 ml vial, 200 mg/1-10 ml vial or 750 mg/3 ml vial Where to apply: intramuscular in the glute or thigh muscles Starting dosage: 750 mg (3 ml) in the beginning, then after 4 weeks then after every 10 weeks; 75-100 mg/week also or 150-200 mg every 2 weeks When to measure: injections are administered every 10 weeks and T measurement should be done somewhere in between injections (after 5 weeks or so since the last one) Xyosted Price for a 30-day supply (in USD): 455-575 for 50 mg, 75 mg and 100 mg injections Delivery mode: the solution is placed in the autoinjector Dosage: 50 mg, 75 mg or 100 mg respectively Where to apply: in the abdominal region under the skin Starting dosage: 75 mg applied under the skin once a week When to measure T levels: trough concentrations are measured 7 days after the most recent dose and only after 6 weeks since the beginning of treatment. These are just a few popular testosterone replacement products available in the US. Keep in mind that you can also procure testosterone enanthate in 5 ml (1000mgs) vials from certain pharmacies. This option usually costs less than $30 for a 30-day supply and the testosterone can be injected by each patient without requiring a doctor's visit. Similarly, TRT patients can also choose to use generic testosterone cypionate or enanthate as 400 mg to 800 mg per month that can be injected into muscle (deep IM or shallow IM) or under belly fat (subcutaneous) . The price for a 30-day supply starts at around $30 and it can go up to $85 . (Source: GoodRx). Other affordable sources of testosterone treatments can be purchased from compounding pharmacies like Empower in Houston. Check Out How AUA and ES Guidelines Differ on Testosterone Ranges AUA stands for American Urology Association and ES stands for Endocrine Society. They provide detailed insights and standards on how to interpret hormone levels and blood test results. In some cases, these committees can give different interpretations when it comes to testosterone levels. AUA Guidelines: What is a Normal Testosterone Range and Follow Up? According to the American Urology Association (AUA), you should measure your testosterone levels in the morning in a fasted state to get accurate results. The normal range is between 450 ng/dL and 600 ng/dL of blood. If your levels fall below 300 ng/dL of blood, you are considered to be deficient in testosterone. If you start testosterone replacement therapy, your first evaluation should be between 2 and 4 weeks after beginning treatment. You will also have to attend follow-up visits 6 to 12 months after starting TRT. ES Guidelines: What is a Normal Testosterone Range and Follow Up? On the other hand, the Endocrine Society (ES) gives slightly different reference ranges. For example, the normal testosterone range is between 264 ng/dL and 916 ng/dL of blood. The best moment to test your T levels is early in the morning in a fasted state. Testosterone deficiency is confirmed if your T levels fall below 264 ng/dL of blood.  TRT follow up visits should be done after 2-3 months and after 6 to 12 months from the start of your testosterone replacement protocol. How to Get Your Own Affordable Testosterone Test Remember that now it's easier than ever to check your testosterone levels and see if you are a suitable candidate for testosterone replacement therapy. If your T levels fall below 350 ng/dL and have low testosterone symptoms then you should talk with a TRT doctor and see what testosterone replacement options you have. Check your testosterone levels quickly and confidentially by ordering a total and free testosterone test from DiscountedLabs today. Key Terminology and Facts About Testosterone It's important to also have some basic understanding of how testosterone works in the body, so you can make better decisions when talking with your TRT doctor. For instance, the Leydig cells in your testicles produce more than 95% of your testosterone. Testosterone daily production ranges from 3 mg to 11 mg and it peaks early in the morning. Healthy adult males have the highest concentration of testosterone early in the morning and it gradually drops throughout the day. That's why the best time to measure your T levels is early in the morning to get accurate results. Natural Testosterone Short half-life - your testosterone has a half-life between 10 and 100 minutes. It peaks once every 3 hours as the luteinizing hormone stimulates the Leydig cells to produce more testosterone. With the passing of time, these cells become less sensitive to LH and they produce increasingly low T levels. It's estimated that males lose about 1% of their testosterone production every year after the age of 30. 2 percent is free; about 2% of your total testosterone level is free. This means that it circulates freely through the bloodstream and it can bind to other organs or tissues. 70% of your testosterone is bound to sex hormone-binding globulin and nearly 30% is bound to albumin. Testosterone metabolism - fractions of your testosterone are converted into other hormones and substances. For example, from 5% to 8% of your testosterone is converted into dihydrotestosterone (DHT). This hormone is responsible for prostate maturation and the growth of the body, as well as facial and pubic hair. About 0.3%–0.5% of your testosterone is also converted into estradiol by the aromatase enzyme. Some of the main roles of estradiol in men are involved with libido and bone health. Trough concentration - this refers to the lowest  concentration of a drug in the bloodstream immediately before injecting or administering another dose. It's highly recommended to measure your testosterone levels at trough concentration because this will produce the most accurate results. Based on these results, TRT doctors can make more accurate adjustments to your protocol. Find Out More About Testosterone Products! This is just a brief overview of some of the most popular testosterone products in the US, but there's plenty more high-quality information out there. Visit Excelmale.com and learn everything you need to know about testosterone, TRT, how to interpret your blood test data, and how to tweak your protocol for optimal results. Also, you can download the Testosterone Replacement Options paper from this link.   References: [1] "FDA-approved testosterone formulations include the topical gel, transdermal patch, buccal system (applied to upper gum or inner cheek), and injection. The manufacturers of two prescription..." URL: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/testosterone-information [2] "by Drugs.com Brand names of testosterone include Androderm, AndroGel, Fortesta, Testim, Depo-Testosterone, Testopel, Aveed, Natesto, Vogelxo, Xyosted, Jatenzo, Tlando, and Kyzatrex. Testosterone is an androgen indicated for testosterone replacement therapy in males." URL: https://www.drugs.com/medical-answers/brands-testosterone-3510863/   Recommended Sources: Testosterone Replacement Therapy Options | Excel Male TRT Forum Testosterone Replacement Products in the U.S.: Video Review by Nelson Vergel - ExcelMale Testosterone Test Near Me: Your Complete Guide Testosterone levels show steady decrease among young US men        

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

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

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

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