Page 3 - TRT Side Effects

  Since abnormally high hematocrit values can pose serious health problems, this article will analyze the correlation between testosterone therapy and high hematocrit. TRT, sleep apnea and smoking are contributing factors that can cause high hematocrit, which can increase cardiovascular risks if not properly managed. This article explains the basics of how to manage high hematocrit while using testosterone. High hematocrit: Why it is important? The red cells are some of the most important components of a person’s blood. The term hematocrit refers to the percentage of red blood cells in a human’s body. For women, normal hematocrit values should be around 42% and for men, it should be around 47%. A complete blood count test will show the number of red blood cells in the blood as well as the hemoglobin values, white blood cells, and platelets. When the hematocrit is too high, meaning that there are too many red blood cells, this condition is known as polycythemia. When the hematocrit values are too low, this condition is known as anemia. Abnormal hematocrit values can put one’s life in danger if not treated promptly. Since abnormally high hematocrit values can pose serious health problems, this article will analyze the correlation between red blood cell count and various medical conditions such as obstructive sleep apnea syndrome, erythrocytosis caused by testosterone replacement therapy and why people should be careful when donating blood more than once a year. It is important to also know the red cell distribution width (RDW), which is a laboratory measuring system that analyzes the size of red blood cells. Doctors frequently examine the RDW to determine the causes of anemia and to gain more insights about the severity of different cardiovascular diseases.  Platelets are cytoplasmic fragments that quickly react when bleeding is detected in the body. They help in the coagulation process to prevent infection and initiate the healing process. The mean platelet volume (MPV) is a way of measuring the size of the platelets. Both these terms, RDW and MPV, will be used to examine the link between obstructive sleep apnea syndrome and high hematocrit values. Obstructive sleep apnea syndrome (OSAS), red blood cells and high hematocrit values OSAS is a sleep disorder that is characterized by a collapse of the upper airway while sleeping. This leads to a low quality sleep, choking sensations, and even hypoxia (low oxygen saturation). A comprehensive study performed between January 2011 and June 2014 shows that high RDW might be a reliable marker when it comes to the severity of OSAS. Hematocrit TRT Study Material and Methods 264 patients were admitted to the sleep unit to undergo a polysomnographic evaluation and were subsequently diagnosed with OSAS. 116 of these patients met the criteria of the study and agreed to participate. These patients reported frequent unpleasant symptoms such as daytime sleepiness, severe snoring at nighttime, etc. The exclusion criteria left out patients who had various types of medical conditions that might have interfered with the results of the study. For example, patients who had known cardiovascular diseases, were smokers, had diabetes mellitus, lung disease or hypertension were not included in the study. The 116 patients who participated in the study were divided into several groups, depending on the apnea-hypopnea index (AHI) which basically indicates the severity of the sleep apnea. There were 3 groups – mild (AHI between 5 and 15), moderate (AHI between 15 and 30) and severe (AHI higher than 30). There was also a control group of 62 individuals who had an apnea-hypopnea index of less than 5. The study was performed using polysomnographic methods. Researchers have attached suprasternal microphones to assess the airflow of the patients during sleep. Blood samples were also drawn using a 21-gauge needle syringe after a fasting period of 8 hours. The apnea was defined as a stop of airflow for 10 seconds or more during sleep. Hypopnea was defined as a reduction of airflow between 30% and 50% as well as a decrease in capillary oxygen saturation. Sleep Apnea and Testosterone- Study Results At the end of the study, researchers have reached the conclusion that patients with severe OSAS have a higher RDW, a higher platelet count and MPV. In addition, the hematocrit and RDW are positively correlated with apnea-hypopnea index. This means that the complete blood count is very important for patients diagnosed with OSAS. It is well known that patients with OSAS experience a state of systemic inflammation due to a variety of causes. This state of inflammation can lead to a higher secretion of pro-inflammatory cytokines such as interleukin-6, which in turn can create erythrocyte deformability and a higher level of RDW. Other studies have shown that high RDW levels are also associated with a higher-sensitivity CRP level which is a known marker of inflammation. One of the most important reasons which make this study unique and highly accurate is the simple fact that patients who suffered from serious health conditions such as coronary artery disease, diabetes mellitus, and hypertension didn’t take part in the study. It is a well-known fact that these illnesses can lead to a higher RDW level which could have compromised the results of the study. Patients who suffer from OSAS also experience hypercoagulability which is caused by high blood viscosity. Hematocrit, erythrocyte behavior, and other factors all affect blood viscosity, which is defined as the resistance of blood to external forces. It has been established that hematocrit plays an important role in the coagulability of blood and can lead to increased blood clotting. When there is an increased blood clotting in the body, the natural flow of blood can be negatively affected and multiple cardiovascular issues can appear. Researchers believe that the hypoxemia experienced by patients with OSAS is caused by a release of inflammatory factors that negatively affect the blood and can lead to hypercoagulability. It has also been found out that the total platelet count in patients with OSAS was higher in comparison with the patients in the control group or those in the mild group. This is real evidence of the correlation between platelet activation and cardiovascular diseases in patients suffering from OSAS. This comprehensive study has shown evidence that RDW, MPV, and platelet count are increased in patients diagnosed with OSAS. The RDW index is also positively correlated with oxygen desaturation index and AHI. Since RDW is included in a standard blood count measurement, it can become an inexpensive and simple tool to diagnose the severity of the OSAS in patients of all ages. As a result, patients who suffer from a severe OSAS can be given priority when it comes to treatment, improving their chances of recovery.   Understanding the occurrence of high red blood cells and hematocrit on testosterone replacement therapy   Erythrocytosis is a medical condition that appears when the body is making too many red blood cells. RBCs are responsible for transporting oxygen to organs and tissues. When there are too many, the blood can become too thick and cause cardiovascular complications. There are 2 types of erythrocytosis – primary and secondary. Primary erythrocytosis is usually caused by bone marrow problems. RBCs are made in the bone marrow and something might trigger an increase in their production. Certain diseases or medications, such as testosterone replacement therapy, can cause secondary erythrocytosis. TRT is the go-to treatment for people who suffer from hypogonadism – aka androgen deficiency. This type of treatment is increasingly popular, especially among people over 40 years of age. It can increase libido, help to maintain muscle mass, improve mood and general wellbeing. However, one of the side effects of TRT is a simple fact that it can cause erythrocytosis. An increase in hemoglobin (Hb) and hematocrit (Hct) is indicative of this medical condition. When the Hb is higher than 18.5 g/dL and the Hct is higher than 52% in men, the patient suffers from erythrocytosis. Since the RBCs count is too high in people with erythrocytosis, the blood viscosity also increases, which can lead to various potentially life-threatening medical issues such as venous thromboembolism. This essentially means that small blood clots separate from their original source and travel through veins and capillaries, causing blockages that result in stroke, myocardial infarction, or other complications. CHECK YOUR HEMATOCRIT TEST WITH A CBC PANEL Testosterone replacement therapy formulations   Testosterone replacement therapy is recommended for men who have testosterone levels lower than 300 ng/dL. It is commonly accepted that T levels decrease by approximately 1% per year after 35 years of age. TRT has been shown to improve the mood of the patients, correct insulin resistance problems, and help increase bone density and muscle mass, among other positive benefits. Getting testosterone into the body can be done in various ways. There are injections, gels, buccal patches, pellets, and others. Some formulations show results much quicker (injections, for example) and each one of them has different effects on patients, depending on the dosage, administration option, etc. TRT-induced high red blood cell volume ( high hematocrit ) When the testosterone levels increase in the body, the hemoglobin and hematocrit levels also increase. Studies have shown that people who undergo TRT have higher blood viscosity and platelet adhesiveness, which can lead to thromboembolic risks. Although there are not many studies that link TRT-induced erythrocytosis (high red blood cells) with thromboembolism, one small research performed by Krauss et al on a group of 15 men can lead to interesting conclusions. The 15 men received short-acting IM TE (testosterone injection) every 21 days and had their bloodwork and testosterone levels monitored. The researchers discovered a correlation between transient ischemic attacks and men who had a mean Hct levels higher than 48%. Although the study was performed on a small group of men, it is an important research finding because throws a spotlight on the potential side effects of TRT. Additionally, the FDA also forces companies that make testosterone products to add a warning on the label stating “possible increased risk of heart attacks and strokes in patients taking testosterone”. High hematocrit: The effects of different testosterone products Researchers have discovered that various testosterone formulations have different effects when it comes to the occurrence of erythrocytosis in patients who undergo TRT. For example, short-acting injectables such as IM TC and IM TE render an incidence of erythrocytosis higher than 40%. The other formulations have a much lower incidence and are considered safer, although testosterone is absorbed much slower into the body. Men who are prescribed and use transdermal gels such as AndroGel 1.62% have an approximately 13% chance of developing erythrocytosis, according to some studies. These types of gels can have a dose of testosterone of 20–100 mg and can be applied to the shoulder area or directly on the skin. Similarly, crystalline pellets that are implanted under the skin have a T formulation of 75mg per pellet and can lead to a 35% chance of developing erythrocytosis in the long run. Studies define erythrocytosis as a hematocrit level higher than 52%. Researchers have found a possible link between high hematocrit levels and high hemoglobin levels in people who are on testosterone replacement therapy. However, more in-depth studies are needed to fully understand the molecular mechanisms that cause erythrocytosis to happen during TRT. Furthermore, some studies show that there is also a higher risk for patients who benefit from TRT to develop CV complications as a result of increased blood viscosity. It's important to also develop other treatment options for hypogonadal men, such as aromatase inhibitors, human chorionic gonadotropin, and others. Lastly, when TRT is absolutely necessary, patients might take into consideration safer testosterone products, such as undecanoates, which can be taken orally or as transdermal gels. Understanding why blood donations shouldn’t be done too frequently It is estimated that approximately 70% of the blood supply in the United States comes from repeat donors. Although donating blood is a commendable act, people should be careful when donating several times a year because they can develop iron deficiency. A plethora of men decides to donate blood to also decrease hematocrit levels. A study conducted on 235 men concluded that frequent blood donors can develop iron deficiency The group of 235 men was separated into 3 categories: – control group with no donations, group 2 with 2 donations per year and group 3 with 3 donations per year. The age of the donors was between 17 and 65 years and their hemoglobin values were higher than 12.5 g/dl. Donors who took iron supplements before were excluded from this study to avoid interfering with the results. The researchers looked at a couple of important values, such as hemoglobin and ferritin levels. Ferritin is a type of intracellular protein responsible for transporting and releasing iron throughout the body. Iron deficiency was defined as serum hemoglobin levels below 13 g/dl and serum ferritin levels below 15 μg/l. No participant in the study has donated blood in the previous 8 weeks. Researchers have found out that the patients in the case groups (2 and 3) had a decreased level of hemoglobin and ferritin in comparison with the patients in the control group. More specifically, men in group 3 had ferritin mean levels of 26 and a hemoglobin level of 13.8, those in group 2 had ferritin mean levels of 56 and hemoglobin levels of 15.4 while the control group had ferritin mean levels of 108 and hemoglobin levels of 15.9. Caution about frequent blood donations: The study presented evidence that donating blood more than once or twice per year can significantly deplete iron stores and can lead to anemia. Moreover, the medical industry relies on donations of a healthy supply of blood rich in iron, so certain donors (especially those who donate frequently) might not be eligible for repeat donations. Likewise, measuring the hemoglobin level only might not be a reliable indicator of a person being suitable for blood donation or not. The ferritin levels should also be taken into account to prevent anemia in various donors. Is supplementing with iron a solution for low iron/ ferritin caused by frequent blood donations? This is a good question, but the answer might not be that simple. It is a well-known fact that supplementing with iron should be done carefully since too much iron in the bloodstream can cause damage to organs and tissues. Additionally, those patients who have family members with cancer might not be eligible for iron supplementation. Speaking with a doctor before taking iron supplements is the best thing to do.   Buy a low cost testosterone test    References: Ohlander et al. Sex Med Rev 2018; 6:77-85 Yousef and Alkhiary, J Sleep Disord Ther 2015, 4:2

Testosterone is routinely associated with "manliness," strength, muscles, aggressiveness, and even roaring V8 engines sometimes. This is the main male sex hormone and women have a little bit of it too. However, the story behind testosterone is a little bit more complex and worth discovering. Free testosterone is usually the one that provides all the benefits when it comes to sex drive, muscle gains, and better cognition. Dive into this article to learn more about testosterone fractions, how to test your testosterone levels, and how to increase free testosterone. What is free testosterone? If you do a testosterone blood test, you're usually getting the total testosterone levels circulating through your bloodstream. Total testosterone is the sum of protein-bound testosterone and free testosterone. Believe it or not, free testosterone only makes up about 1-2% of your total testosterone levels. This substance is freely moving throughout your body, and tissues can easily absorb it to cause chemical reactions. Protein-bound testosterone makes up about 98% of your total testosterone. It splits into two categories: albumin-bound testosterone and SHBG-testosterone. SHBG stands for sex hormone-binding globulin. It's a substance that attaches to testosterone, making it unavailable for organs and tissues to absorb. Albumin is one of the most prevalent protein types in the human body. Approximately 38% of your total testosterone is bound to albumin. This binding is weak, meaning that some organs and tissues can still absorb the albumin-bound testosterone and use it for various purposes. Since 1-2% of your testosterone is free, the remaining 60% of your total testosterone is SHBG-bound. The sum of free and albumin-bound testosterone is also known as bioavailable testosterone. How to Increase Free Testosterone Remember that free testosterone is the one readily available for grabbing by tissues and organs. This is the one usually associated with muscle gains, male attraction, and libido. If you want to increase it, check out these science-based methods. Get More Sleep Believe it or not, sleep is closely related to the production of testosterone in your body. If you don't get enough sleep, your body doesn't produce as much testosterone as it should. This refers to the total level of T and consequently, your free T is also affected. Maintain a Healthy Weight Being overweight or obese can dramatically reduce your total testosterone levels and, implicitly, your free testosterone levels. This is true for both young males and seniors. Therefore, make sure that you lose the extra weight if necessary and this will naturally boost your free testosterone levels. Eat a Balanced Diet This is probably one of the most common pieces of advice you hear daily, but it's worth repeating. A diet filled with junk and processed foods, sodas, too much caffeine, and alcohol will ruin your testosterone levels over time. On the other hand, if you eat more vegetables and fruit, whole grains, and light meat such as fish and chicken, and incorporate regular physical activity, you'll be on the safe side. Normal and high levels of testosterone are commonly associated with a healthier diet that includes enough calories and healthy fats, as well as regular physical activity and training intensity. If you want to increase your free testosterone, you might need to make sensible diet adjustments such as incorporating a balanced mix of protein, fat, and carbs from whole foods into your meals to support optimal hormone levels and weight loss. A 2021 systematic review and meta-analysis suggests that a low-fat diet and regular physical activity may decrease testosterone levels, highlighting the importance of a balanced diet and physical activity for hormonal health. Get Rid of Stress Just like lack of sleep, too much stress is also bad for your testosterone levels. It will basically slow down the production of testosterone and make you feel tired, lethargic, and confused. Stress is inevitable, so you cannot eliminate it. But you can do something to reduce it. Learn what works for you. For example, you can go to a yoga class. You can practice breathing exercises. You might want to give meditation a shot. You could just watch your favorite series online and relax in bed for an entire afternoon. All these activities will reduce your stress hormones and let your body naturally increase testosterone levels. Do Resistance Exercises Lifting weights has a lot of benefits. You don't need to become a professional bodybuilder and sweat for hours in the gym every week. A few resistance exercises several times per week is usually enough to reap the benefits of this activity. Compounded exercises such as bench-press, deadlifts, and weighted squats are difficult, but they engage most of the muscle groups in your body. This will force your body to produce more testosterone to repair and rebuild stronger muscle fibers. You are not alone in your fitness journey, either. Hire a fitness instructor and follow his/her advice. This will keep you motivated and safe while performing weighted exercises. Get More Vitamin D and Zinc Your body metabolizes vitamin D as a result of direct sun exposure. However, most people around the world are deficient in vitamin D. You need to take it as a supplement to achieve normal vitamin D levels and correct deficiencies. Some studies show that vitamin D is commonly associated with normal and high levels of testosterone. If you take enough vitamin D, you're helping your normal production of testosterone and even increasing it slightly. Zinc is another mineral essential for testosterone production, particularly in postmenopausal women and older men. A zinc deficiency is correlated with a drop in testosterone levels, making it important for women and older men to consider taking supplements for men’s health. In fact, in one study, zinc supplementation increased testosterone levels and improved sexual function in postmenopausal women with low blood levels of zinc. Men usually need about 11 mg of zinc per day and you can easily get that from a supplement. Zinc also boosts muscle gain and libido, so you get additional benefits too. Additionally, optimizing vitamin D levels through lifestyle changes and testosterone therapy can also help improve daytime testosterone levels and increase hours of sleep. A year-long trial showed that daily supplementation of just over 3,000 IU significantly increased total and free testosterone in both men and women, correcting vitamin D deficiency and promoting optimal testosterone levels for men’s health. Before beginning high-dose vitamin D supplementation, it is best to know where both values stand. Increase Your Testosterone Dose if on TRT If you are on TRT, increasing the dose can decrease SHBG and increase free testosterone. However, be aware that increasing T dose may also increase hematocrit (blood viscosity) and decrease good HDL cholesterol, so talk to your doctor first. Check Out These Affordable and Accurate Testosterone Tests! Today you can test your testosterone levels and other hormones associated with them with a simple blood test. The liquid chromatography/mass spectrometry (LC/MS) testing technology has become very advanced and the results are increasingly accurate, so why not try it for yourself? For example, you can order this highly sensitive LC/MS total and free testosterone test plus bioavailable T and SHBG. This group of tests checks your total, free, bioavailable, albumin-bound, and SHBG-bound testosterone levels, providing important information about your overall health and potential health conditions, including testosterone deficiency or hypogonadism. There are no limits applied to this test panel, so you get a realistic result using the latest medical technology available. Additionally, you can also check your testosterone levels, physical performance, muscle mass, and potential for erectile dysfunction through affordable and accurate tests that require only small amounts of blood. These tests can also help identify symptoms of low testosterone, such as low libido, and provide insights into how to boost testosterone levels for improved physical performance and quality of life. If you're on TRT, you can also order the Basic TRT Monitoring Panel. This comprehensive test helps people who are on testosterone replacement therapy monitor their hormones. It includes a metabolic panel, blood count panel, sensitive estradiol, testosterone tests, and more. For more testosterone tests, check these testosterone test panels from DiscountedLabs.com Here, you will find the most affordable testosterone blood tests in the United States! Citations Grip Strength and Muscle Mass in Healthy Older Adults The Role of Testosterone in Male Reproductive Function Testosterone, Aging, and Male Osteoporosis The Effects of Testosterone on Cognitive Function Testosterone and Aging: Clinical Research Directions Free Testosterone: Understanding Its Role in Erectile Dysfunction Testosterone Therapy and Cardiovascular Risk The Benefits of Testosterone: Healthline Guide What’s the Difference Between Total and Free Testosterone? Testosterone and Male Behaviours: The British Psychological Society Testosterone and Mortality: JAMA Study University of Florida PathLabs: Free Testosterone Test How Much Testosterone Affects Muscle Growth: VICE Testosterone and Health Outcomes in Men Testosterone Total and Free: Rochester Encyclopedia Testosterone and Aggression: Manual Blog Free Testosterone vs. Total Testosterone: Maximus Tribe The Influence of Testosterone on Aggressive Behaviour: Britannica The Vital Role of Testosterone in Muscle, Bone, and Brain Health: The Vitality Clinic Harvard Health: Testosterone—What It Does and Doesn’t Do

Testosterone Replacement Monitoring Targets and Their Management (Consult Your Physician Before Any Treatment Initiation, Cessation or Changes). These are not absolute values and should be taken into context with symptoms. We will discuss various blood test targets for those undergoing testosterone replacement therapy (TRT). It covers key health indicators such as total and free testosterone levels, hematocrit, PSA, estradiol, blood pressure, kidney and liver function, thyroid levels, iron and ferritin levels, and cholesterol. Each parameter includes a target range and suggestions for management if the results are outside the normal range. This comprehensive approach ensures that individuals on TRT can monitor their health effectively and make informed decisions with their healthcare provider.     Total Testosterone Test above 500 ng/dL If low or hypogonadal symptoms are not improved, increase the testosterone dosage. High T levels (over 1500 ng/dL) with high hematocrit, low HDL, and/or side effects may require dosage reduction.  Free Testosterone ≥ 2 % of total T If low, test for sex hormone-binding globulin. Higher TRT dose may increase free T by decreasing SHBG. Low SHBG may be present in diabetes. Hematocrit ≤ 53 % If high, donate blood or ask your doctor for therapeutic phlebotomy order. If low, investigate anemia or stop donating blood more than every 3 months. How to Lower High Hematocrit PSA ≤ 4 ng/mL If high, talk to your doctor about potential prostatic infection or a referral to a urologist. TRT is contraindicated if PSA is 4 ng/mL or greater. Estradiol (UltraSensitive Test) = 20- ? pg/mL Most men on TRT do not need to use an aromatase inhibitor (AI). Some physicians prescribe low dose AI for what they consider high estradiol. If low, higher testosterone dose and/or cessation of AI may be required. The lab range was derived from men with heart disease and low testosterone, so there is still debate on what the range should be for men on TRT since  0.3 to 0.4 % of testosterone aromatizes to estradiol, so men with high T due to TRT will have higher estradiol.  No upper range value has been determined for men on TRT. Studies have shown that for gynecomastia to occur, high estradiol in the presence of low T and high IGF-1 may be required. Read Estradiol In Men – Why Is It Important For Optimal Health And Fitness Performance and The Top 18 Things You Did not Know About Estradiol in Men Blood pressure ≤ 135/85 mmHg If high, weight loss, exercise, T dose reduction, and/or blood pressure medications may be needed. If too low, blood pressure medication dose needs to be reduced, electrolytes checked or hypoglycemia excluded. Estimated Glomerular Filtration Rate (eGFR) (kidney function) ≥ 60 mL/min/1.73 m2 If low, good hydration, use of blood pressure medications, and/or stopping offending oral supplements may improve eGFR. Exercise, high protein intake, creatine supplements, and higher muscle mass can also increase creatinine and decrease eGFR. If under 60, explore getting a Cystatin C test. Liver enzymes ≤ 1.2 x top value of reference range If high, stopping oral supplements can help. AST and ALT can increase with exercise but this is not clinically relevant. If high AST and ALT, test GGT and bilirubin to ensure no liver toxicity is present. TSH ≤ 2.5 U/mL If high, test for other thyroid tests included in a thyroid panel like free T3, free T4, and antibodies to detect hypothyroidism. Why Only Using TSH to Diagnose Hypothyroidism is Wrong Free T3 ≥ 3.7 pg/mL If low, hypothyroidism may be present. See comment on TSH. If high (>5 pg/mL), explore hyperthyroidism. Ferritin 55-270 ng/mL & Iron 55-160 micrograms/dL If low, reduce the frequency of blood donations or phlebotomies and supplement with iron until it is back to normal. If high, donate blood or get therapeutic phlebotomy. HDL ≥ 40 mg/dL The most difficult parameter to manage. Higher TRT doses decrease HDL. Niacin may help increase HDL but may cause flushing. Prolactin ( ≤ 30 nd/dL) Test if Total Testosterone is below 150 ng/dL before TRT to detect potential pituitary adenoma or other issues. High levels (> 30 ng/dL) may cause sexual dysfunction and galactorrhea in men (milk production)     Here are panels that include these tests: Discounted Labs Panels   Buy a testosterone test on DiscountedLabs.com

Testosterone replacement therapy can be a great way to improve your health and vitality, but certain risks areassociated with it. One of the most important things you need to monitor when taking testosterone is your hematocrit levels. High hematocrit is one potential side effect of testosterone treatment that should not be ignored or overlooked, as it can lead to serious health complications if left untreated. In this blog post, we'll go over what high hematocrit is, how testosterone replacement therapy raises hematocrit levels, and how to reduce high hematocrit due to testosterone treatment so that you can benefit from all the advantages of hormone optimization safely and effectively. Table of Contents: What is Hematocrit? Definition of Hematocrit: How Does Testosterone Replacement Therapy Increase Hematocrit? a. Effects of Testosterone on Red Blood Cells: How to Lower High Hematocrit Caused by Testosterone Treatment? Monitoring and Managing High Hematocrit Levels with Testosterone Replacement Therapy Regular Blood Tests to Monitor Hematocrit Levels: Conclusion FAQs in Relation to High Hematocrit Should I worry if my hematocrit is high? What can cause high hematocrit? What are symptoms of high hematocrit? How do you treat high hematocrit levels? Conclusion What is Hematocrit? Hematocrit measures the percentage of red blood cells in your body. It’s an important indicator of overall health and can help diagnose various conditions, such as anemia or dehydration. Definition of Hematocrit: Hematocrit is a measure that reflects the ratio between the volume of red blood cells (RBC) and the total volume of whole blood in your body. The hematocrit value is expressed as a percentage, with normal values ranging from 40 to 54 percent for men and 36 to 48 percent for women. How is Hematocrit Measured? A hematocrit test measures how much space red blood cells take up in your bloodstream by spinning down a blood sample in a centrifuge machine. This separates different components within the sample, including RBCs, white blood cells (WBCs), platelets, and plasma. The amount of packed RBCs compared to other components gives you your hematocrit value. Normal ranges vary slightly depending on age and gender but generally range from 40–54% for men and 36-48% for women. Low levels could be a sign of anemia or bleeding disorders, whereas high levels might be the result of dehydration or specific cancer treatments like chemotherapy or radiation therapy. Hematocrit is an important measure of health and can be increased through testosterone replacement therapy. However, it is important to understand the potential risks associated with high hematocrit levels before beginning treatment. How Does Testosterone Replacement Therapy Increase Hematocrit? TRT has been found to have numerous health benefits, including improved energy levels, increased muscle mass and strength, and improved sexual function. One of the most important effects of TRT is an increase in hematocrit, which is the percentage of red blood cells in your bloodstream. a. Effects of Testosterone on Red Blood Cells: Testosterone helps stimulate the production of red blood cells by increasing the number of stem cells that produce them. It also increases their lifespan so they can circulate longer throughout your body before being broken down and replaced by new ones. This leads to an overall increase in hematocrit levels as more red blood cells are present in your bloodstream at any time. An increased hematocrit level can provide many benefits, such as better oxygen delivery throughout the body, improved stamina during physical activity, and reduced risk for certain diseases like heart disease or stroke due to higher amounts of oxygen-carrying red blood cells circulating through your system at all times. Additionally, some studies suggest that higher hematocrit may even improve cognitive performance since it provides more oxygen to the brain for mental processes like memory formation or problem-solving skills Testosterone replacement therapy can increase hematocrit levels, but it is important to know the potential risks associated with high hematocrit. We'll talk about lowering a high hematocrit that results from testosterone therapy in the following section. In a study done by Dr. Ramasamy and his team at the University of Miami Medical School, a total of 5,842 men who received TRT and developed polycythemia were matched and compared to 5,842 men who did not develop polycythemia. Heart problems or venous thromboembolism - VTE were more likely to happen to men with polycythemia (301 cases, or 5.15% of all cases) while they were on TRT than to men with a normal hematocrit (226 cases, or 3.87%) (OR 1.35, 95% CI 1.13–1.61, p <0.001). The same team later found out that greater changes in hematocrit predicted greater cardiovascular risks in men on testosterone therapy.   Key Takeaway: Testosterone replacement therapy (TRT) increases hematocrit levels, providing numerous benefits such as improved oxygen delivery throughout the body, increased stamina during physical activity, and better cognitive performance. How to Lower High Hematocrit Caused by Testosterone Treatment? High hematocrit levels caused by testosterone treatment can be a serious health concern. It is important to understand the causes and treatments available for this condition. Some physicians and TRT guidelines believe that stopping TRT is the best way to lower hematocrit.  But stopping TRT can have negative consequences for the quality of life, as men who do so tend to stay hypogonadal for months, and most do not return to “normal levels.”  Fortunately, there are several ways to decrease high hematocrit and potentially prevent it. How Can High Hematocrit Be Reduced Due to Testosterone Therapy? A severe health hazard might result from high hematocrit levels brought on by testosterone therapy. Understanding the underlying causes and available therapies for this illness is crucial. TRT guidelines and several doctors concur that the best strategy to reduce hematocrit is to cease TRT. However, discontinuing TRT can harm a man's quality of life because most men who discontinue TRT do not revert to "normal levels" and instead tend to stay hypogonadal for months. Fortunately, there are a number of strategies to lower high hematocrit and avoid it. Donate blood. Men on testosterone therapy can lower their hemoglobin levels with this tried-and-true method. And while you're doing it, you're helping someone else! Every donated unit of blood can reduce hematocrit by three points. Be careful not to donate more frequently than every 2.5 months, as the Red Cross advises, to prevent losing too much iron and ferritin, which can cause fatigue in men taking testosterone therapy. This iron blood test allows you to determine your iron and ferritin levels. It is advised that you donate when your hematocrit is between 51 and 52 percent. If you want to donate blood, you should avoid having a hematocrit above 53% because some organizations (like the Red Cross) would reject blood at that level. Men whose high hematocrit disqualifies them from blood donations may still donate blood if their doctors request therapeutic phlebotomy at the nearby blood center. Reduce the TRT dose. Your doctor could tell you to lower your dose if you have high hemoglobin or hematocrit levels as a result of testosterone therapy. This is not always a negative thing because some men take more testosterone than they need, which can have both long-term and short-term side effects. Make sure you drink water. It's critical to keep in mind that hematocrit is highly dependent on the amount of water you drink. This might have made things worse if you were already dehydrated when you had your blood drawn. Talk to your doctor about a repeat test if you believe you were dehydrated. Address thyroid problems. Your RBC counts can decrease with hypothyroidism (low thyroid function) and increase with hyperthyroidism (high thyroid function). Doing this could be a good idea if you have yet to examine your thyroid function. And if you can afford it, have a complete thyroid panel, including thyroid antibodies. [10] Think about testosterone applied topically to the skin. According to a research summary, intramuscular testosterone injections are the only form of testosterone that significantly raises hematocrit above normal levels. Topical testosterone creams or gels often do not have this effect. However, it does so strongly, changing up to 6% from the starting point. The testosterone gel comes in second place, with a 2.5% average increase over baseline levels. [7]. Therefore, switching to topicals may help if you are receiving intramuscular injections and experiencing high hematocrit or hemoglobin. Discuss this with your doctor. COMPOUND TESTOSTERONE CREAM AND GEL IS A CHEAP ALTERNATIVE Change from intramuscular to lower dose testosterone subcutaneous injections. 236 men participated in a study that the University of California conducted. All men's baseline values in each of the four measurement locations were noted, as well as those between 6 and 12 weeks after therapy. According to the findings, males who received subcutaneous testosterone injections (SubQ) exhibited an increase in total testosterone levels that was 14% greater than that of patients who had intramuscular testosterone injections (IM). Additionally, post-therapy, hematocrit was 41% lower in SubQ patients than in IM patients, and estradiol levels were 26.5% lower. No PSA readings were abnormally high in any group of men.  Steer clear of or consume less red meat. It's fascinating because one of the arguments used by meat eaters against vegetarians is that plant meals include a lot of "anti-nutrients" that might inhibit the absorption of or bind to minerals like iron. For instance, groups like Weston Price criticize vegetarians for consuming phytic acid. Plant foods contain phytic acid, which binds to calcium, magnesium, phosphorus, and iron. Mineral deficits may result from overuse. Dr. Bernard notes that because certain minerals, like zinc and iron, are neurotoxic at even very modest levels of tissue accumulation, they are often likely to be highly health protective for most people. Additionally, studies have demonstrated a connection between colon cancer, too much iron, and heart problems. If no other preventive measures are taken, avoiding red meats, which are heavy in iron, stands a decent chance of decreasing your hemoglobin levels and preserving your long-term health (such as by giving blood). The validity of this claim requires dietary research. Females had significantly lower hemoglobin levels, according to a study that compared vegetarians and non-vegetarians. Although it could not have been statistically significant, males had lower amounts. It was found in a more solid study that vegetarians had much lower levels of white blood cells, neutrophils, serum ferritin, and serum vitamin B12 compared to control patients. Vegetarians also had much lower levels of hematocrit and mean corpuscular hemoglobin. By the way, ferritin is a crucial indicator since it shows that tissue iron levels are lower, which suggests that there will likely be less long-term harm. It should be emphasized that this study did reveal that some vegans were iron deficient. Correct sleep apnea. Depleted oxygen saturation levels brought on by sleep apnea may encourage the body to create more red blood cells and hemoglobin in an effort to make up for the low oxygen levels in the blood during sleep. Indeed, there is research that backs this up as well.  Consider having a sleep apnea test done if your hematocrit, hemoglobin, or RBC levels are high. "One possible explanation is that repeated episodes of nocturnal hypoxia (low oxygen status) lead to a hypercoagulable state that predisposes individuals to thrombotic (blood clotting) events," a recent study stated. Research backs up a number of changes in the blood that affect hemostasis. These include higher hematocrit, blood viscosity, platelet activation, clotting factors, and lower fibrinolytic activity. Minimize inflammationInflammation can further reduce hepcidin, the hormone that controls iron absorption. It could be helpful to check for infections, CRP levels, etc., before treating the underlying reason. [13] Think about Curcumin (Turmeric).More research is being done on turmeric, or curcumin, as an anti-inflammatory and anti-cancer substance. It produces iron shortage in mice by binding to ferric iron in the stomach. According to a case study, a person consuming turmeric may have had iron deficiency anemia. Stop smoking. Smoking lowers the blood's oxygen saturation, which causes the body to create more red blood cells and hemoglobin to make up for it. [14] Talk to your doctor about Losartan, which is used to treat high blood pressure. You should think about taking Losartan if you have high blood pressure. [15] In patients with COPD and erythrocytosis, losartan can be administered safely and efficiently to normalize hematocrit, which may eliminate the requirement for therapeutic phlebotomy. Eat grapefruit. Grapefruit extract (narigin) may lower the hematocrit [16]. Although there was no discernible difference between eating half or a whole grapefruit each day, the effect of grapefruit consumption on hematocrit was statistically significant at the p 0.01 level. However, bring up with your doctor the possibility that grapefruit may elevate drug levels in the blood. Monitoring and Managing High Hematocrit Levels with Testosterone Replacement Therapy It is essential to monitor hematocrit levels while on testosterone replacement therapy (TRT). TRT can have an impact on hematocrit, which measures the quantity of red blood cells in the body. Regular blood tests should ensure that hematocrit levels remain within normal range. If high hematocrit levels are detected, some steps canbe taken to manage them. Regular Blood Tests to Monitor Hematocrit Level: It is recommended that men on TRT have their hematocrit tested every 3–6 months or more frequently if needed. This will help identify any potential issues with high hematocrit early on so they can be addressed quickly and effectively. High hematocrit may indicate an underlying medical condition such as polycythemia vera, which requires further evaluation and treatment from a healthcare provider. Adjusting Dosage or Frequency of Testosterone Injections as Needed: If high hematocrit levels are found during regular testing, adjusting the dosage or frequency of testosterone injections may help lower them back into the normal range. For example, reducing the dose or spacing out injections over longer periods of time could reduce the risk for complications associated with elevated hemoglobin and/or red cell counts due to TRT use. Additionally, lifestyle changes such as increasing physical activity level and making dietary modifications may also help lower high hematocritevels caused by TRT use. By closely monitoring hematocrit levels and adjusting testosterone dosage or frequency as needed, men can successfully manage high hematocrit levels while undergoing testosterone replacement therapy. Next, we'll discuss the key points to remember when managing this condition.   Key Takeaway: Regular blood tests should be done to monitor hematocrit levels while on TRT. If high hematocrit is detected, adjusting the dosage or frequency of testosterone injections and making lifestyle changes may help lower them back into normal range.   FAQs in Relation to High Hematocrit Should I worry if my hematocrit is high? Yes, you should be concerned if your hematocrit is high. Hematocrit is a measure of the number of red blood cells in your body and can indicate an underlying health issue. High levels may mean that there are too many red blood cells in circulation, which can lead to thickening of the blood and other serious complications such as stroke or heart attack. It's important to speak with your doctor about any concerns regarding your hematocrit level so they can determine the best course of action for managing it. What can cause high hematocrit? Dehydration, testosterone therapy, smoking, polycythemia vera (an overproduction of red blood cells), and specific medications are just a few of the things that can cause high hematocrit levels. Dehydration occurs when the body does not have enough fluids to function properly. Smoking increases the production of red blood cells in the bone marrow. Polycythemia vera is an uncommon disorder that causes too many red blood cells to be produced in the bone marrow. Certain medications, such as erythropoietin or testosterone, may also cause high hematocrit levels due to the increased production of red blood cells in response to these drugs. What are the symptoms of high hematocrit? High hematocrit is a condition where the percentage of red blood cells in the bloodstream is higher than normal. Symptoms can include fatigue, shortness of breath, dizziness, headaches, and pale skin. In more severe cases, it can lead to chest pain or heart palpitations due to an increased risk of clotting. It is important to seek medical attention if any symptoms are present, as high hematocrit levels can be indicative of underlying health conditions such as anemia or dehydration. How do you treat high hematocrit levels? High hematocrit levels can be treated by making lifestyle changes, such as reducing alcohol consumption and increasing physical activity. Additionally, medications may be prescribed to reduce the production of red blood cells or increase their breakdown. Other treatments include phlebotomy (the removal of excess red blood cells) and iron chelation therapy (the removal of excess iron). It is important to speak with a doctor about the best treatment plan for high hematocrit levels, as it will depend on the individual's medical history and current health status. Conclusion In conclusion, high hematocrit is a common side effect of testosterone replacement therapy and should be monitored closely. It's crucial to comprehend what hematocrit is, how testosterone replacement therapy raises it, and how to lower a high hematocrit that results from testosterone treatment. With proper monitoring and management of your levels with the help of your doctor or healthcare provider, you can reduce the risk of any health complications associated with elevated levels of hematocrit due to testosterone replacement therapy. Are you suffering from high hematocrit? ExcelMale is here to help. Our online men's health forum provides a wealth of knowledge and resources on testosterone replacement therapy, general health, and sexual dysfunction. Join our community today to get the support you need for managing your condition and improving your overall wellbeing. Register for this TRT forum .   REFERENCES   Secondary Polycythemia in Men Receiving Testosterone Therapy Increases Risk of Major Adverse Cardiovascular Events and Venous Thromboembolism in the First Year of Therapy GREATER CHANGES IN HEMATOCRIT PREDICT MORE FREQUENT MAJOR ADVERSE CARDIAC EVENTS IN MEN INITIATED ON TESTOSTERONE THERAPY - A LARGE CLAIMS DATABASE ANALYSIS The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 10, 1 October 2010, Pages 4743–4747 TRANSFUSION 2008; 48: 2197-2204

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        

Are you feeling fatigued, experiencing hair loss, or struggling with an unexplained weakness? It might be time to consider a ferritin blood test. Ferritin is a protein that stores iron in your body, and measuring its levels can provide valuable insights into your overall health. In this blog, we will cover everything you need to know about the ferritin blood test. From understanding its purpose and what it measures to when you should consider getting the test done, we've got you covered. We'll also discuss how to prepare for the test, what to expect during and after the test, and how to interpret the results. Additionally, we'll explore the causes of both low and high ferritin levels and recommend other tests that may be beneficial for your health. Don't wait any longer - take control of your health by learning more about the ferritin blood test today! Ferritin Test Quick Guide The ferritin blood test is a crucial diagnostic tool used to measure the levels of ferritin, a protein that stores iron, in your blood. By analyzing a blood sample taken from a vein, healthcare professionals can determine your ferritin level. This test is particularly important because abnormal ferritin levels can indicate various health conditions, such as iron deficiency, liver disease, or anemia. Interpreting your ferritin test results accurately can aid in the diagnosis, monitoring, and treatment of these conditions. About the Test The ferritin blood test is an important diagnostic tool used to assess iron levels in the body. It measures the level of ferritin, a protein that stores iron, in your blood. This test is used to diagnose conditions such as iron deficiency or iron overload, which can have significant health implications. It involves taking a blood sample, typically from a vein, and measuring the amount of ferritin present. Results are given as a numerical value, with normal ranges varying based on factors like age and gender. Following any pre-test instructions is crucial for accurate results. Purpose of the Test The purpose of the ferritin blood test is to measure the levels of ferritin, a protein responsible for storing iron in the body. This test is commonly used to help diagnose or monitor conditions related to iron deficiency or iron overload. Iron deficiency can result in symptoms like fatigue, weakness, and pale skin, while iron overload may indicate conditions such as hemochromatosis. By assessing ferritin levels, healthcare providers can evaluate a person's iron stores and determine if further investigation or treatment is necessary. The test involves extracting a small blood sample and sending it to a laboratory for analysis. Results are typically available within a few days. What Does the Test Measure? The ferritin blood test measures the amount of ferritin, a protein responsible for storing iron and regulating iron levels in the body. It is used to diagnose conditions related to iron deficiency or overload, helping determine if there is an imbalance of iron in your system. When Should I Get This Test? Consider getting a ferritin blood test if you have symptoms of iron deficiency or iron overload, a family history of iron-related conditions, are pregnant or planning to become pregnant, or have chronic conditions that affect iron absorption. Your doctor can provide personalized advice. Taking a Ferritin Test Determining your iron levels is crucial in maintaining optimal health. The ferritin blood test, which measures the levels of ferritin in your blood, plays a key role in this process. Ferritin is a protein that stores iron and regulates its levels in the body. By diagnosing conditions related to iron deficiency or iron overload, this test can help assess whether you have an adequate amount of iron in your body. If you're experiencing symptoms such as fatigue, weakness, or have a family history of iron-related conditions, it's important to consider getting a ferritin blood test. This test is also recommended for monitoring iron levels during pregnancy or for individuals with chronic conditions that affect iron absorption or utilization. Before the Test Before undergoing a ferritin blood test, it is crucial to carefully follow the instructions provided by your healthcare provider. These instructions may include fasting or refraining from specific medications. The procedure for the test involves drawing a blood sample from a vein in your arm, which is then sent to a laboratory for analysis. By measuring the levels of ferritin, a protein responsible for storing iron in the body, this test can help determine whether you have an insufficient or excessive amount of iron. Such indications can be linked to various medical conditions or deficiencies, such as iron deficiency anemia or hemochromatosis. During the Test It is vital to adhere to specific instructions provided by your healthcare provider before the Ferritin Test, which is used to measure the levels of ferritin, a protein that stores iron in the body. To ensure accurate results, you may need to fast for a certain period of time. During the test, a healthcare professional will obtain a small blood sample from your arm using a needle. This sample will be sent to a laboratory for analysis. Following the guidelines provided by your healthcare provider, such as avoiding certain medications or activities prior to the test, is of the utmost importance. After the Test Upon completion of the ferritin blood test, it is advisable to wait for a few days to receive the results from the lab. Once you have received the results, it is crucial to have a discussion with your healthcare provider to analyze and interpret them. If your ferritin levels are found to be low, it could indicate iron deficiency anemia, which might necessitate additional tests to identify the root cause. Conversely, if your ferritin levels are high, it may be indicative of conditions such as hemochromatosis or liver disease. Depending on your specific ferritin levels and any preexisting conditions, your healthcare provider will recommend appropriate treatment options and interventions. Ferritin Test Results A ferritin blood test measures the levels of ferritin in the blood, which is a protein responsible for storing iron in the body. The results of this test can provide valuable information about your iron level. Normal ferritin levels can vary based on factors such as age and gender. If your ferritin levels are high, it could indicate iron overload, liver disease, or hemochromatosis. Conversely, low ferritin levels may be indicative of iron deficiency anemia. It's crucial to consult with a healthcare professional to obtain an accurate interpretation of your ferritin test results and determine the next steps for your health care. Receiving Test Results After undergoing a ferritin blood test, your healthcare provider will provide you with the test results. These results can reveal the amount of iron stored in your body, allowing for a comprehensive understanding of your health. Interpreting these results is crucial, as normal ferritin levels can vary depending on age, sex, and overall well-being. If your ferritin levels are lower than the normal range, it may indicate iron deficiency anemia or other underlying health issues that require attention. Conversely, higher-than-normal ferritin levels could suggest iron overload or the presence of conditions such as liver disease or hemochromatosis. Make sure to discuss the results and any concerns with your healthcare provider to determine the appropriate course of action. Interpreting Test Results Interpreting the results of a ferritin blood test helps determine the amount of iron stored in your body. Normal ferritin levels can vary depending on age, gender, and other factors, so it's crucial to consult a healthcare professional for proper interpretation. Low ferritin levels can suggest iron deficiency, anemia, or other underlying health conditions. On the other hand, high ferritin levels may indicate iron overload, liver disease, or hemochromatosis. Consulting a healthcare provider ensures accurate analysis and appropriate treatment recommendations. What is a Ferritin Blood Test? A Ferritin Blood Test measures the amount of ferritin, a protein that stores iron in the body. This test is used to diagnose conditions related to iron deficiency or overload. It is often conducted alongside other blood tests to evaluate overall iron levels and status. What is it Used For? The ferritin blood test measures the amount of ferritin, a protein that stores iron, in your blood. It is used to diagnose iron deficiency or overload, monitor conditions like anemia and liver diseases, and guide treatment decisions based on abnormal iron levels. Why do I need a ferritin blood test? A ferritin blood test is necessary to measure the amount of ferritin in your blood, which indicates your iron stores. This test is helpful in evaluating iron deficiency or excess, monitoring conditions like anemia or liver disease that affect iron metabolism, and assessing symptoms like fatigue or joint pain. Will I need to do anything to prepare for the test? Typically, no special preparation is needed for a ferritin blood test. However, it's important to follow any instructions given by your healthcare provider. They may advise you to avoid certain medications or supplements prior to the test. If you have any concerns or queries, it's best to consult with your healthcare provider beforehand. What do the results mean? The results of ferritin levels in a blood test provide information about the amount of iron stored in your body. Low levels may indicate iron deficiency anemia, while high levels can signal conditions like hemochromatosis or liver disease. It's important to have a healthcare professional interpret the results based on your specific situation. Causes of Low Ferritin Blood Levels Low ferritin levels in a blood test can be attributed to several factors. The most common cause is iron deficiency, which can occur due to inadequate iron intake or absorption. Chronic blood loss, such as heavy menstrual periods or gastrointestinal bleeding, can also lead to low ferritin levels. Inflammatory conditions like rheumatoid arthritis and chronic kidney disease can cause low ferritin levels due to increased iron storage in immune cells. Certain medical treatments, like chemotherapy, radiation therapy, and certain medications, can affect ferritin levels. Other health conditions, such as hypothyroidism, liver disease, and malnutrition, can also result in low ferritin levels. Rare genetic disorders like hemochromatosis or atransferrinemia can cause abnormal ferritin levels as well. It's important to consult with your healthcare provider to determine the underlying cause of your low ferritin levels and develop an appropriate treatment plan. Testosterone replacement therapy can lead to a decrease in ferritin levels due to various mechanisms. Studies have shown that testosterone therapy increases hemoglobin and hematocrit levels, while not significantly affecting iron, iron saturation, or iron binding capacity. However, ferritin concentrations tend to decrease with testosterone replacement therapy, indicating increased utilization of iron[1]. Research has also demonstrated an inverse correlation between serum ferritin levels and sex hormones like total testosterone and free testosterone[2]. Furthermore, testosterone has been found to regulate ferritin synthesis directly, suggesting that decreased testosterone levels may result in higher serum ferritin levels[3]. To sum up, the drop in ferritin levels caused by testosterone replacement therapy is due to more iron being used, changes in iron-related parameters, and the way testosterone controls the production of ferritin. This relationship underscores the complex interplay between testosterone levels and iron metabolism in the body. Causes of High Ferritin Blood Levels High ferritin levels in a blood test can be indicative of several underlying conditions. Liver disease, such as hepatitis or cirrhosis, can cause an increase in ferritin levels. Hemochromatosis, a genetic disorder that causes excessive iron absorption, can result in high ferritin levels. Certain types of cancer, like leukemia or lymphoma, can contribute to elevated ferritin levels. Iron overload from excessive iron supplementation or transfusions can lead to increased ferritin levels as well. It's important to consult a healthcare professional for proper diagnosis and treatment. Elevated ferritin levels may also be associated with iron overload, iron-deficiency anemia, or hyperthyroidism. Other possible causes include alcohol abuse, inflammatory conditions like rheumatoid arthritis or Still's disease, and certain medications. If you experience symptoms like fatigue, weakness, abdominal pain, joint pain, or heart problems, it's important to get your ferritin level checked. Other Recommended Tests In addition to the ferritin blood test, it is important to consider other recommended tests that can provide valuable insights into your health. These tests can offer further understanding of potential underlying conditions or give an overall assessment of specific organ function. Along with the ferritin blood test, you may also consider the hemoglobin test, iron panel, complete blood count (CBC), liver function tests, and vitamin B12 and folate tests. These tests offer information on different aspects of your health, including anemia, iron levels, liver function, and vitamin deficiencies. Consulting with your healthcare provider can help determine which additional tests may be beneficial for you. Anemia Test An anemia test is essential to diagnose the cause of a low red blood cell count or low hemoglobin levels, which are indicators of anemia. When a ferritin blood test shows low levels, additional tests are recommended to identify the underlying cause. These tests measure various components, including red blood cell count, hemoglobin levels, and markers of iron deficiency or vitamin deficiencies. Accurate diagnosis assists healthcare providers in determining the specific cause of anemia and enables them to offer personalized treatment options. Women's Health Test The Women's Health Test plays a crucial role in evaluating the overall health of women. Along with the ferritin blood test, it is essential to consider other recommended tests to comprehensively assess women's health. These tests provide insights into hormone levels, reproductive health, and the screening of various diseases like cervical cancer, breast cancer, and osteoporosis. By engaging in discussions about individual health concerns and risk factors with healthcare providers, women can make informed decisions about which tests are most suitable for them, enabling them to prioritize their well-being. Standard Thyroid Test The standard thyroid test is a crucial companion to the ferritin blood test, as thyroid disorders can disrupt iron absorption and metabolism, resulting in diminished ferritin levels. Through this test, healthcare providers measure the levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and sometimes triiodothyronine (T3). If there are any irregularities detected in the thyroid test results, additional tests may be required to identify the root cause of low ferritin levels. To ensure accurate diagnosis and appropriate treatment, it is vital to communicate any concerns or symptoms to your healthcare provider. Fatigue Test Persistent tiredness and fatigue can be symptoms of underlying health issues such as iron deficiency, anemia, or thyroid disorders. To determine the cause of your fatigue, a fatigue test may be recommended. This test involves blood work to check for deficiencies in iron, vitamins, or other nutrients, as well as a complete blood count (CBC), thyroid function tests, and tests for liver or kidney function. By identifying any deficiencies, abnormalities, or underlying health conditions, the fatigue test can help guide further treatment or interventions to address your fatigue and improve your overall health. How to Buy an Affordable Ferritin Test on DiscountedLabs.com? To buy an affordable Ferritin test on DiscountedLabs.com, simply visit their website and use the search bar to find the Ferritin blood test. Add it to your cart, proceed to checkout, and enter any applicable discount codes to save money on your purchase.   Conclusion In conclusion, understanding your ferritin levels is crucial for maintaining optimal health. Whether you're experiencing symptoms like fatigue or suspect an underlying condition, a ferritin blood test can provide valuable insights into your iron stores. By getting tested and interpreting the results with the help of a healthcare professional, you can take appropriate steps to address any deficiencies or imbalances. At DiscountedLabs.com, we offer affordable ferritin tests that are convenient and reliable. Take control of your health by ordering your ferritin test today and start prioritizing your well-being. Order your discounted ferritin blood test now at DiscountedLabs.com   Sources [1] Effect of Testosterone on Hepcidin, Ferroportin, Ferritin and Iron Binding Capacity in Patients with Hypogonadotropic Hypogonadism and Type 2 Diabetes - NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065401/  [2] The Association between the Levels of Serum Ferritin and Sex Hormones in a Large Scale of Chinese Male Population - PMC - NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795691/  [3] Serum Ferritin Is Inversely Correlated with Testosterone in Boys and Young Male Adolescents: A Cross-Sectional Study in Taiwan | PLOS ONE https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0144238  [4] Ferritin Test - Discounted Labs https://www.discountedlabs.com/ferritin  [5] Testosterone Induces Erythrocytosis via Increased Erythropoietin and Suppressed Hepcidin: Evidence for a New Erythropoietin/Hemoglobin Set Point - Oxford Academic https://academic.oup.com/biomedgerontology/article/69/6/725/527925 

Except for estradiol, no hormone is more misunderstood than dihydrotestosterone, or DHT. Many men fear DHT, going out of their way to use a DHT blocker for their medical condition. However, DHT is a critical hormone, one that men need for sexual and prostate health, cognitive function, skeletal strength, and many other reasons. Like everything in life, there are downsides to DHT, but the upside of healthy DHT levels far outweighs the challenges it can present. It is crucial to choose a DHT blocker that has support from scientific research in order to ensure both safety and efficacy when considering its use for hair thickness and general health care. In the intricate world of hormones and their impact on men's health, Dihydrotestosterone (DHT) often emerges as a topic of considerable debate and intrigue. This potent androgen, frequently overshadowed by its more famous counterpart testosterone, plays a pivotal role in numerous physiological processes yet is often misunderstood or feared due to its association with certain medical conditions. Our journey in this article is to demystify DHT, unraveling its complexities to reveal not just the concerns it raises but, more importantly, the indispensable benefits it offers for male health. From sexual wellness to cognitive abilities and skeletal integrity, DHT's influence is far-reaching, making it essential to understand and appreciate its role in the broader context of hormonal balance and overall health. DHT – FRIEND OR ENEMY? Except for estradiol, no hormone is more misunderstood than dihydrotestosterone, or DHT. Many men fear DHT, going out of their way to lower it and frustrate its biological activity. However, DHT is a critical hormone, one that men need for sexual and prostate growth, cognitive function, skeletal strength, and many other reasons, such as hormonal health conditions. Like everything in life, DHT has downsides, but the upside of healthy DHT levels far outweighs the challenges it can present. DHT, the main hormone involved in male-pattern hair loss, can attach to receptors in your scalp and damage your hair follicles, leading to a receding hairline, hair thinning, and even severe hair loss. DHT – Where it Comes From The principal hormone produced in men is, of course, testosterone. When testosterone is produced by the testicles (or injected or absorbed by a man on testosterone replacement), an enzyme, 5-alpha reductase(5-AR), sets to work, converting a portion of that testosterone to DHT, which is the conversion of testosterone into the androgen hormone dihydrotestosterone (DHT). This conversion prevents some testosterone from reaching the androgen receptors in the brain, genitals, skin, and other tissues. Initially, that may sound like the body is deprived of a needed hormone, testosterone. However, for the most part, this conversion is actually in a man’s best interest. Though estimates vary, DHT binds much more efficiently to androgen receptors; DHT is 300 to 500 percent more efficient at reaching and binding to the receptors and is far more potent than testosterone. If tissues were deprived of DHT, 5-AR hadn’t done its job; there would be dramatic physiological changes. While it is true that testosterone remains the primary, active androgen in muscle and muscle development, DHT is still critical for testosterone's full performance-enhancing effects. Specifically, the impact of DHT on the central nervous system increases neurological efficiency and strength. The production of body hair DHT comes from testosterone, with the help of the enzyme 5-alpha reductase (5-AR). The production of DHT is a natural process that occurs when testosterone is converted into the androgen hormone dihydrotestosterone (DHT) with the help of the enzyme 5-alpha reductase (5-AR). DHT – Positive Effects  To understand DHT’s androgenic properties, consider the following. Male Development – Physical and sexual development in the human male is DHT-dependent. DHT is responsible for the growth and development of the penis, the prostate, and the testicles. It not only helps with sex differentiation during fetal development but also supports the changes that occur during puberty and adulthood. Libido – DHT supports a healthy sex drive. Men with optimal levels of the hormone report a far stronger drive than men with lower levels. Prostate Health – Men with balanced levels of DHT may have fewer prostate health issues. Cognitive Function – One study indicated that administering DHT to men between 34 and 70 resulted in memory improvements. The androgenic properties of the hormone encouraged the retrieval of stored memories and the archiving of new ones. Low/lower levels of DHT were linked to a decline in cognitive function in elderly men. Blood Sugar Management – Higher levels of DHT help to reduce the risk of diabetes by controlling sugar levels and preventing hyperglycemia. DHT can improve insulin sensitivity, support efforts to lose weight, and may provide adjunctive support in treating diabetes.  Cardiovascular Health – Men with coronary artery disease may benefit from higher levels of DHT since lower hormone levels have been shown to increase the risk of cardiovascular disease. It may be a simple association – higher levels of DHT might lower the mortality associated with heart disease. Stroke Risk – Researchers followed a group of men for six years and learned that higher levels of DHT and testosterone seemed to lower the risk of stroke.  Depression – In one study, men who used finasteride, a drug that blocks 5-AR and, thus, generates lower levels of DHT, had higher rates of depression than a control group. DHT may well be necessary to support mental and emotional health. Anti-Aging – Higher levels of DHT, testosterone, and estradiol seem to slow the decline associated with aging. Lower levels of all three hormones brought about cellular changes seen in the elderly. Higher levels were associated with “younger” cellular function. Bone and Skeletal Health – Along with estradiol, appropriate levels of DHT support and maintain bone density in men. DHT – The Downside The DHT story is firm but not universally positive. The drawbacks of DHT must be considered. Baldness – Hair loss is probably the number one DHT—harmful in the minds of most men who are involved in testosterone therapy. Studies have shown that higher levels of DHT are linked to increased male-pattern baldness. In women, elevated levels of DHT can lead to male-like hair growth patterns. Cancer – DHT is critical for the normal development of the prostate, but high hormone levels have been associated with prostate cancer risk. However, studies on DHT and prostate cancer are contradictory. Acne – Inflammatory acne flares have been linked to DHT.  DHT – The Bottom Line: A Friend or Foe? For men, DHT is a friend and an important one. However, like virtually every hormone in the body, the key to health is balance. If DHT levels drop too far, men open themselves to low libido.  DHT is not likely to be tested in most men undergoing testosterone replacement therapy. Some clinicians fail to recognize the importance of DHT for men’s health and libido, so they fail to monitor it. It’s entirely possible, even likely, that some men are not obtaining the maximum benefits of testosterone replacement because (unbeknownst to them) their DHT levels are not optimal.  DiscountedLabs.com offers a highly affordable DHT test to help you determine if your body is producing sufficient DHT. The DHT test is quick, easy to administer, and reliable.   How to Increase DHT There are natural ways to boost DHT levels if one is not on a testosterone replacement protocol. Here are a few things that can be done. Exercise more, particularly resistance training and high-intensity training. Increase your intake of caffeine, creatine, or green tea supplements. Boost the amount of zinc in your diet via the food you eat or a supplement. Take a DHEA supplement if your DHEA blood level is low. Get a DHEA blood test Lose weight. Optimize your testosterone blood level, which is low. Last but not least, use a scrotal testosterone cream. Applying compounded (alcohol-free) testosterone cream to the testicular skin has increased DHT considerably. Using a DHT Blocker to Lower DHT It should be clear that most men have no reason to suppress their DHT levels. However, Propecia is regularly prescribed as a DHT blocker for men anxious about losing their hair, specifically to address male pattern baldness (a.k.a. androgenic alopecia). As was noted, Propecia will stop or suppress the 5-AR activity that produces DHT, thereby reducing DHT production. By blocking or slowing the work of 5-AR, one of the possible adverse side effects that DHT can have, male pattern baldness, may be prevented or arrested. Unfortunately, there is scientific evidence that some men who take this medication may risk lowering their libido and mood. In many cases, using DHT blockers like finasteride can help you to slow down or stop androgenic hair loss and even stimulate growth, allowing people to slow down or prevent hair loss and maintain a full head of thicker, healthier hair well into their 40s, 50s, and 60s. Topical finasteride is not FDA-approved yet but has shown promise in clinical studies. It can be sold by compounding pharmacies with a prescription. For reasons still not clearly understood, this medication can produce a syndrome in some men very similar to those symptoms associated with hypogonadism. Loss of libido, weak erections, malaise, and fatigue plague many men even after they have stopped using the drug. While it’s true that no one wants to lose their hair, no man wants to wind up with what has come to be known as post-finasteride syndrome. With proper attention, DHT can be a friend and ally in the search for optimal health. Don’t fear it; accept it and have it work to your advantage. Conclusion Navigating the intricate landscape of DHT and its role in men's health requires a nuanced understanding that balances the pros and cons. While concerns like male pattern baldness and potential links to certain health issues cannot be overlooked, the substantial benefits of DHT in areas like sexual health, cognitive function, and metabolic regulation highlight its critical role. The key lies in achieving hormonal equilibrium and ensuring that DHT levels are maintained within an optimal range. For those considering testosterone replacement therapy or DHT blockers, it's crucial to make informed decisions based on a comprehensive understanding of DHT's impact and the latest scientific research. At DiscountedLabs.com, we offer affordable and reliable DHT testing, empowering you to make the best choices for your health and wellbeing. Remember, DHT is not just a hormone to be managed but a vital component of a balanced and healthy male physiology.   Buy Your DHT TEST on DiscountedLabs.com  

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

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