Page 4 - TRT Side Effects

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

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

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

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

Table of Contents What are Estradiol and Aromatase? When aromatase is unbalanced, estradiol becomes an issue Low estrogen levels in men, not testosterone increases risk of heart disease Androgen deprivation therapy can cause cognitive decline Does estradiol restore cognitive function during ADT? Should high estradiol levels be treated? What are Estradiol and Aromatase? Estradiol is a form of the female hormone estrogen. Although estradiol production is typically considered a female concern, men also need to maintain healthy levels of this hormone for optimal health. Since men lack ovaries (where most estradiol is produced in women), estradiol in men is created by a process that uses an enzyme called aromatase (1) in testicles, liver and fat cells. Aromatase converts a very small portion of testosterone levels into estradiol, and health problems can arise when aromatase levels are too high or too low (1). When aromatase is unbalanced, estradiol becomes an issue As men age, they can experience excess aromatase activity, raising estradiol levels and reducing testosterone to unhealthy levels. Low T levels will adversely impact quality of life by reducing libido, ability to maintain an erection, mood, and muscle mass, among other health factors (2). However, when the body produces too little aromatase, men can experience other, potentially serious health problems. Men with diminished aromatase levels will have an estradiol deficit, which can create problems similar to low-T; diminished sex drive, loss of bone mass, and increased body fat (3). Men on testosterone replacement therapy (TRT) taking higher doses of aromatase inhibitors can also experience estradiol deficit. Let’s look at recent studies finding that low estradiol can play a critical role in increasing the risk of cognitive decline and increase the odds of experiencing cardiovascular disease. Low estrogen levels in men, not testosterone increases risk of heart disease A study led by Elaine Yu, MD, MSc, addresses the suspicion held by many medical professionals that testosterone can promote cardiovascular disease in men, and that estradiol provides protection against it (4). The researchers sought to determine whether it was estradiol or testosterone that regulated men’s cardiovascular risk factors by comparing two groups whose hormone levels were changed using a combination of medications (4). They looked at 400 healthy men, between the ages of 20 and 50. Study participants were weighed, had fasting blood tests for markers of heart disease and diabetes, and also had a thigh scan using quantitative computed tomography (CT scan) to measure muscle fat content before and after the study (4). Yu’s team found that while higher levels of testosterone reduced these men’s levels of healthy (HDL) cholesterol, changes in estradiol levels had no effect at all on HDL(4). However, they also discovered that low estradiol levels did increase the markers for diabetes, like increased insulin resistance, increased fat in the muscles, and higher fasting blood sugar levels(4). Diabetes is a major risk factor for heart disease (5). Additionally, the study found that neither estradiol nor testosterone affected the levels of LDL (unhealthy) cholesterol. According to Yu, these findings indicate that in men, it’s higher testosterone levels combined with lower estradiol levels that can worsen cardiovascular risk factors, somewhat explaining differences in the incidence of heart disease between men and women. Some studies have shown that it is the ratio of testosterone to estradiol that is important, not just the level of each of those hormones. As testosterone increases with TRT, so does estradiol to balance the effects of testosterone on lipids, mood and insulin action. Androgen deprivation therapy can cause cognitive decline Androgen deprivation therapy (ADT) is an often used method to slow the growth of prostate cancer. It’s also used for men transitioning to women (6, 7). ADT is typically prescribed on an open-ended (no fixed period) basis to help treat advanced prostate cancer. An estimated 44 percent of men with prostate cancer will undergo ADT at some point as part of a strategy to slow tumor growth (6). ADT therapy is used specifically to block the male hormones, particularly testosterone, from stimulating prostate cancer cell growth. Research has confirmed that ADT can cause significant cognitive decline in women with breast cancer (8), but few studies have investigated cognitive impairment following ADT for men being treated for prostate cancer. Using formal tests, scientists recently compared the cognitive ability of 58 prostate cancer patients receiving androgen deprivation therapy to 84 prostate cancer patients who did not receive ADT, and 88 cancer-free men (9). They found that those treated with ADT were 70 percent more likely to develop cognitive impairment after six months, and over twice as likely to have significant cognitive impairment after one year(9).   Does estradiol restore cognitive function during ADT? A 2018 study published in Current Neuropharmacology has examined whether estradiol supplementation is an effective way to prevent this side effect (9). Researchers performed a literature search using PubMed and Google Scholar to identify studies on this topic and discover any evidence that estradiol supplementation has a cognitive benefit for men on ADT. They examined studies involving the effects of estradiol treatment on cognitive function in three androgen-deprived male populations; prostate cancer patients, male-to-female transsexuals, and castrated male animals (9). A review of the literature found that while some studies show that estradiol supplementation resulted in cognitive improvement (especially in spatial ability), They couldn’t determine (9): Whether estradiol will improve cognition after long-term ADT How early or delayed estradiol treatment post-castration will affect cognition If estradiol affects memory retention They conclude that for androgen-deprived males, there is some evidence that estradiol supplementation may improve both verbal and visual memory (9). However the variability between the reviewed studies resulted in significant inconsistencies, making further study necessary to determine what estradiol treatment protocol can best maximize cognitive improvement for men using ADT (9). Should high estradiol levels be treated? Men on testosterone replacement therapy can experience an increase in estradiol that can sometimes reach clinically elevated levels (10). A study published in the Journal of Sexual Medicine (11) looks at the phenomenon of increased estradiol levels in men undergoing TRT to discover whether high estradiol levels in this population should be treated. Researchers comprehensively reviewed the published literature on the role of estradiols in male sexual function and testosterone deficiency to answer this question. The study findings reveal that (11): Although estradiol have been used at pharmacologic doses to suppress serum testosterone, there is no evidence that naturally occurring elevations of estradiol will cause a reduction in testosterone levels Absent testosterone deficiency, study findings suggest that elevated estradiol levels don’t seem to be harmful. Once again, monitoring and treating the ratio of testosterone to estradiol may be more important than either hormone alone. Estradiol could help maintain some sexual function in castrated men Given the evidence uncovered by this review study, researchers report that, although further research is needed, the existing evidence doesn’t support the treatment of elevated estradiol for men on testosterone therapy (11). WATCH LECTURE ABOUT ESTRADIOL IN MEN    BUY YOUR SENSITIVE ESTRADIOL TEST   References 1) Stocco, Carlos. “Tissue Physiology and Pathology of Aromatase.” Steroids 77.1-2 (2012): 27–35. PMC. Web. 11 June 2018. 2) Araujo, Andre B., and Gary A. Wittert. “Endocrinology of the Aging Male.” Best practice & research. Clinical endocrinology & metabolism 25.2 (2011): 303–319. PMC. Web. 11 June 2018. 3) Bulun, Serdar E. “AROMATASE DEFICIENCY.” Fertility and sterility 101.2 (2014): 323–329. PMC. Web. 11 June 2018. 4) Men's heart disease risk linked to high testosterone and low estrogen. The Endocrine Society. 5) Zhang PY. Cardiovascular disease in diabetes. Eur Rev Med Pharmacol Sci. 2014;18(15):2205-14. 6) Perlmutter, Mark A, and Herbert Lepor. “Androgen Deprivation Therapy in the Treatment of Advanced Prostate Cancer.” Reviews in Urology 9.Suppl 1 (2007): S3–S8. Print. 7) Unger, Cécile A. “Hormone Therapy for Transgender Patients.” Translational Andrology and Urology 5.6 (2016): 877–884. PMC. Web. 11 June 2018. 8) Wu, Lisa M., and Ali Amidi. “Cognitive Impairment Following Hormone Therapy: Current Opinion of Research in Breast and Prostate Cancer Patients.” Current opinion in supportive and palliative care 11.1 (2017): 38–45. PMC. Web. 11 June 2018. 9) Wibowo E. Cognitive Impacts of Estrogen Treatment in Androgen-Deprived Males: What Needs to be Resolved. Curr Neuropharmacol. 2017;15(7):1043-1055. 10) Tan RS, Cook KR, Reilly WG. High estrogen in men after injectable testosterone therapy: the low T experience. Am J Mens Health. 2015 May;9(3):229-34. doi: 10.1177/1557988314539000. Epub 2014 Jun 13. 11) Ravi Kacker, Abdulmaged M. Traish, Abraham Morgentaler. Estrogens in Men: Clinical Implications for Sexual Function and the Treatment of Testosterone Deficiency. The Journal of Sexual Medicine. (2012): Volume 9, Issue 6, Pages 1681–1696

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

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

When it comes to TRT blood pressure, understanding the various factors that can impact this crucial health metric is essential for men who use testosterone. In this blog post, we'll talk about the link between testosterone replacement therapy (TRT) and high blood pressure, as well as some of the possible side effects and problems that may come up during treatment. We'll talk about the dangers of TRT-induced high blood pressure and emphasize how crucial regular monitoring is. Additionally, we'll examine water retention and edema in men on TRT, shedding light on their causes and management strategies. Furthermore, our investigation into testosterone's impact on kidney functioning will provide valuable insights into how hormone therapy affects renal function. We'll also debunk common misconceptions surrounding estrogen conversion's role in extracellular water (ECW) increases while exploring alternative explanations for changes in fluid balance during TRT. Lastly, we'll address lifestyle factors influencing water retention during hormone therapy, such as sodium intake, alcohol consumption's effects on fluid balance, and the significance of regular exercise throughout treatment. By gaining a deeper understanding of these issues related to TRT, blood pressure management becomes an achievable goal for those undergoing hormone therapy. Table of Contents: High Blood Pressure and TRT Risks Associated with High Blood Pressure Caused by TRT Importance of Regular Blood Pressure Monitoring Water Retention and Edema in Men on TRT Causes Behind Edema-Related Swelling in Men on TRT Strategies for Managing Water Retention The Importance of Cardiovascular Workup Testosterone's Impact on Kidney Functioning The Role Played by Kidneys in Regulating Body Fluids How Testosterone Affects Renal Function Taking Control of Blood Pressure During TRT Estrogen Conversion Not Responsible for ECW Increase Debunking Misconceptions about Estrogen's Role in ECW Increase Investigating Alternative Explanations for Changes in Fluid Balance Moving Forward: The Importance of Ongoing Research Lifestyle Factors Influencing Water Retention During TRT The Role of Sodium Intake in Water Retention Effects of Alcohol Consumption on Fluid Balance Importance of Regular Exercise During Hormone Therapy FAQs in Relation to Trt Blood Pressure Does TRT therapy raise blood pressure? Does testosterone play a role in blood pressure? Can testosterone cypionate cause high blood pressure? Does low testosterone shots cause high blood pressure? Conclusion High Blood Pressure and TRT Several studies have determined that having low testosterone may increase the incidence of high blood pressure in men. TRT can improve blood pressure control in hypogonadal men. However, in some other men, testosterone replacement therapy (TRT) can increase blood pressure during the initial weeks of treatment. Monitoring your blood pressure is crucial to regaining control over it while on TRT. In this section, we will discuss the dangers of TRT-related high blood pressure and emphasize the significance of regular blood pressure monitoring. Risks Associated with High Blood Pressure Heart Attacks: Elevated blood pressure puts extra strain on your heart muscles, which may eventually lead to heart attacks. When arteries become narrow due to plaque buildup or a clot forms in one of these vessels supplying oxygen-rich blood to your heart muscle cells, it could cause permanent damage. Strokes: High blood pressure can also cause strokes, which occur when there's an interruption in the flow of oxygenated blood supply towards specific regions within our brains, leading them to not be able to function properly anymore, resulting in either death, tissue loss, or, depending upon severity, the location of the affected area(s). Kidney Damage: Prolonged hypertension may result in chronic kidney disease (CKD) due to the increased workload placed on these organs, which filter waste products out of the bloodstream efficiently enough for elimination via the urine production process, eventually leading to renal failure if left untreated over time. Erectile Dysfunction: High blood pressure can cause erectile dysfunction by damaging the lining of your blood vessels and limiting the flow of blood to your penis. This makes it difficult for men to achieve or maintain an erection during sexual activity. Brain Shrinkage: Studies have shown that high blood pressure may contribute to a reduction in brain volume, also known as brain shrinkage. This condition has been linked with cognitive decline and an increased risk of dementia later in life. Importance of Regular Blood Pressure Monitoring To mitigate these risks while undergoing TRT, it is essential to monitor your blood pressure regularly if it is increasing. Here are some reasons why regular monitoring is crucial: Detecting Early Warning Signs: Frequent measurements help identify any fluctuations in your BP levels before they escalate into more severe health issues such as heart attacks or strokes, allowing you to take preventive measures early on. Maintaining an Optimal Treatment Plan: By keeping track of how well current medications work in controlling hypertension symptoms (if applicable), doctors are able to adjust dosages accordingly to ensure the best possible outcome for patients' overall wellbeing throughout the duration of therapy sessions undertaken using testosterone replacement products/services available in today's medical industry standards, practices, guidelines, and recommendations set forth by medical groups. Lifestyle Adjustments: Tracking changes allows individuals to pinpoint specific factors contributing to their elevated pressure - whether it be dietary habits, stress levels, or lack of exercise regimen adherence, among others; thus enabling them to make necessary adjustments in order to improve their overall health status while still receiving the benefits associated with TRT treatments being administered under the supervision of healthcare professional team members involved in the case management process. In conclusion, understanding the risks of high blood pressure caused by testosterone replacement therapy and monitoring your BP regularly is essential for maintaining optimal health during treatment. By making lifestyle adjustments and working closely with your healthcare provider, you can effectively manage hypertension while reaping the benefits of TRT.   Key Takeaway:  In some men with metabolic syndrome, older age, and other factors, testosterone replacement therapy (TRT) can increase blood pressure, which poses long term risks such as heart attacks, strokes, kidney damage, erectile dysfunction, and brain shrinkage. Monitoring and treating your blood pressure is crucial to regain control over it while on TRT, and making lifestyle adjustments with the help of healthcare providers can effectively manage hypertension while reaping the benefits of TRT. Water Retention and Edema in Men on TRT One potential side effect of testosterone therapy is edema, particularly dependent edema, which is more common in older men [10]. Edema refers to water retention, and dependent indicates water retention towards the ground, such as when sock imprints are visible around the ankles after removing them. Testosterone-induced water retention can cause swelling in the extremities, particularly in the legs and feet, leading to discomfort and potential complications if left untreated. A study looking at various doses of testosterone enanthate in older men revealed nearly half experienced leg edema in the groups provided with supraphysiologic testosterone (300 and 600 milligrams per week of testosterone enanthate). A comprehensive cardiovascular workup may help identify any underlying issues contributing to this condition, while maintaining a low-sodium diet and drinking plenty of water can alleviate symptoms. In this section, we will discuss the causes behind edema-related swelling in men on TRT and strategies for managing water retention. Causes Behind Edema-Related Swelling in Men on TRT The primary cause of edema-related swelling during TRT is an increase in extracellular fluid volume resulting from testosterone's impact on sodium reabsorption in the kidneys. Testosterone stimulates sodium and water retention through an autocrine or paracrine mechanism that affects sodium metabolism, leading to elevated blood pressure levels experienced by some men undergoing hormone therapy. Men with pre-existing metabolic syndrome, obesity, baseline high blood pressure, and kidney dysfunction can be more susceptible than others to having this problem. Additionally, certain lifestyle factors, such as high sodium intake, alcohol consumption, and a lack of exercise, can exacerbate these symptoms. Strategies for Managing Water Retention To minimize the impact of TRT-induced edema and improve overall health outcomes, it is essential to adopt effective management strategies targeting both hormonal imbalances caused by treatment itself as well as lifestyle factors that contribute to fluid accumulation within the body: Maintain a Low-Sodium Diet: Reducing your daily salt intake helps prevent excessive fluid buildup around cells, which could lead to hypertension. Aim for less than 2300 mg per day, according to CDC guidelines. Stay Hydrated: Drinking adequate amounts of water helps flush out excess sodium and promotes healthy kidney function. Aim for at least eight 8-ounce glasses per day, or consult your healthcare provider for personalized recommendations based on individual needs. Incorporate Regular Exercise: Engaging in regular physical activity not only aids weight management but also improves circulation and reduces fluid retention. Choose activities that you enjoy, such as walking, swimming, or cycling, to maintain consistency. Minimize Alcohol Consumption: Alcohol can dehydrate the body and increase water retention by disrupting hormonal balance. Limiting alcohol intake will help minimize edema-related swelling during TRT. Monitor Blood Pressure Regularly: Keeping track of your blood pressure levels is crucial to ensuring they remain within a healthy range while undergoing hormone therapy. Invest in a reliable home blood pressure monitor and take readings daily until control is regained. Besides these strategies, it's essential to communicate with your healthcare provider about any concerns related to edema or other side effects experienced during TRT. They may recommend adjustments in dosage or additional medications such as diuretics (water pills), which aid in reducing fluid buildup within the body, if necessary. Physicians may also recommend lowering the TRT dose or switching from testosterone injections to gels to attain lower testosterone blood level peaks. The Importance of Cardiovascular Workup If you are experiencing persistent edema-related swelling despite implementing the above strategies, it might be time for a comprehensive cardiovascular workup conducted by a qualified medical professional specializing in men's health issues like testosterone deficiency (hypogonadism). A qualified medical professional specializing in men's health issues such as testosterone deficiency (hypogonadism) can perform a comprehensive cardiovascular workup to assess any underlying heart or vascular issues that may be contributing to fluid retention. In conclusion, managing water retention during TRT is crucial for maintaining optimal health outcomes while undergoing hormone therapy. By adopting effective strategies targeting both hormonal imbalances caused by treatment itself as well as lifestyle factors that contribute to fluid accumulation within the body, men on TRT can minimize edema-related swelling and improve their overall quality of life.   Key Takeaway:  Due to the effect of testosterone on kidney function, men receiving testosterone replacement therapy (TRT) may experience swelling associated with edema. To manage this side effect, men should maintain a low-sodium diet, stay hydrated, exercise regularly, minimize alcohol consumption, and monitor their blood pressure levels. If these strategies do not work, it is important to seek a comprehensive cardiovascular workup from a qualified medical professional specializing in men's health issues like hypogonadism. Testosterone's Impact on Kidney Functioning Increased extracellular water retention, which is a result of testosterone's impact on kidney function, may be the cause of elevated blood pressure levels in men undergoing TRT. One possible explanation for this phenomenon is the direct impact of testosterone on the way kidneys manage sodium in the body. In this section, we will explore the role played by kidneys in regulating body fluids and how testosterone affects renal function. The Role Played by Kidneys in Regulating Body Fluids Kidneys play a crucial role in maintaining overall health by filtering waste products from the bloodstream and excreting them as urine. Additionally, these vital organs are responsible for balancing electrolytes such as sodium and potassium while also controlling fluid balance within the body. This process involves adjusting both water intake through thirst signals and water output via urine production based on factors like hydration status, blood pressure levels, and hormone regulation. A key component of kidney function is its ability to regulate extracellular fluid volume (ECFV), which includes both interstitial fluid surrounding cells and plasma within blood vessels. ECFV directly impacts blood pressure since it determines the amount of circulating blood volume that needs to be pumped throughout the body by the heart. How Testosterone Affects Renal Function The primary effect of testosterone on the kidneys is the stimulation of sodium reabsorption. This means that the kidney cells are instructed to retain more sodium, which can lead to an increase in blood pressure. This is one of the reasons why testosterone replacement therapy is not recommended for men with hypertension unless blood pressure is managed first. Research has shown that testosterone could act directly on the kidneys through an autocrine or paracrine mechanism, stimulating sodium reabsorption along with increased water retention. This effect leads to a higher extracellular fluid volume, resulting in elevated blood pressure levels experienced by some men undergoing hormone therapy. Autocrine mechanism: Testosterone may act directly on the kidney cells that produce it, leading to an increase in sodium and water reabsorption. This process can contribute to elevated blood pressure levels by increasing extracellular fluid volume. Paracrine mechanism: Testosterone could also influence neighboring kidney cells through paracrine signaling, which involves the release of chemical messengers that travel short distances to affect nearby cells. In this case, testosterone might stimulate adjacent renal tubule cells responsible for regulating sodium and water balance within the body. In addition to these direct effects on kidney function, testosterone has been shown to impact other hormones involved in fluid regulation, such as aldosterone and vasopressin. For example, studies have found that men with low testosterone levels exhibit reduced aldosterone secretion, a hormone responsible for promoting sodium retention and potassium excretion by the kidneys. Consequently, when TRT is administered and testosterone levels rise again, there could be an associated increase in aldosterone production, resulting in greater sodium retention along with increased extracellular fluid volume. Taking Control of Blood Pressure During TRT If you are experiencing high blood pressure while undergoing TRT due to increased extracellular water retention caused by changes in renal function, hormonal imbalances related to treatment itself, or lifestyle factors like diet and exercise habits (as discussed earlier), it's essential to take proactive steps towards managing your condition effectively: Maintain regular check-ups with your healthcare provider. Your doctor will monitor your progress during TRT closely so they can adjust dosage if necessary or recommend additional interventions such as medication adjustments or lifestyle modifications aimed at reducing blood pressure levels. Monitor your blood pressure at home: Invest in a reliable home blood pressure monitor and take readings twice daily to keep track of any fluctuations that may occur during treatment. Maintain a healthy lifestyle: incorporate regular exercise, good hydration, a balanced diet low in sodium, limit alcohol consumption, and manage stress levels to help minimize the impact of TRT on blood pressure and overall health. In conclusion, understanding how testosterone impacts kidney function can provide valuable insights into managing high blood pressure during hormone therapy. By taking proactive steps towards maintaining optimal renal health while undergoing TRT, men can experience the benefits of this treatment without compromising their cardiovascular well-being.   Key Takeaway:  Testosterone replacement therapy (TRT) can lead to an increase in extracellular water retention, which contributes to elevated blood pressure levels. Testosterone impacts kidney function by stimulating sodium reabsorption and increasing water retention, resulting in a higher extracellular fluid volume that causes high blood pressure. To manage this condition effectively, it's essential to maintain regular check-ups with your healthcare provider, monitor your blood pressure at home, and maintain a healthy lifestyle. Estrogen Conversion May Not Be Responsible for Water Retention It was once believed that the increase in extracellular water (ECW) experienced by men undergoing testosterone replacement therapy (TRT) could be attributed to the conversion of testosterone into estrogen within peripheral tissues. However, recent research has debunked this hypothesis, indicating that other mechanisms must be at play when it comes to understanding how hormone treatments impact fluid balance within the body. In this section, we will explore why estrogen is not responsible for increased ECW and discuss alternative explanations for changes in fluid balance during TRT. Debunking Misconceptions about Estrogen's Role in ECW Increase The idea that estrogen might be responsible for increased ECW stemmed from its known effects on sodium and water retention. Indeed, studies have shown that elevated levels of estrogen can lead to an increase in total body water due to enhanced renal reabsorption of sodium and subsequent water retention. This led some researchers to speculate whether a similar mechanism might explain the observed rise in extracellular fluid volume among men receiving TRT. However, more recent investigations have demonstrated no significant correlation between circulating estradiol levels (the primary form of estrogen) and changes in extracellular fluid volume following testosterone administration. These findings imply that the aromatization, or conversion, of testosterone into estradiol cannot solely account for any increase in ECW experienced by men on TRT. Investigating Alternative Explanations for Changes in Fluid Balance In light of these discoveries, scientists are now considering other potential mechanisms that might account for the increase in ECW observed among men undergoing hormone therapy. One such possibility is that testosterone itself may directly affect kidney function, as discussed earlier in this article. Due to its modulation of secretion and action, testosterone levels may have an impact on vasopressin, a hormone that regulates the body's water balance.  Recent studies suggest that testosterone can also modulate vasopressin secretion. Vasopressin is a hormone that regulates water balance and blood pressure in the body. It is released from the pituitary gland and acts on the kidneys to regulate the amount of water excreted in urine. Research shows that testosterone can regulate the production and release of vasopressin in the hypothalamus, a region of the brain that plays a key role in regulating hormone secretion. Testosterone can enhance vasopressin secretion, which in turn can increase water reabsorption in the kidneys and reduce urine output. Therefore, testosterone can have an impact on the body's fluid balance, which can have implications for overall health and well-being. More research is needed to fully understand the complex relationship between testosterone and vasopressin secretion. A third hypothesis involves aldosterone, another hormone involved in maintaining proper electrolyte balance and blood pressure regulation.Testosterone has been found to stimulate aldosterone production, which could theoretically contribute to changes in ECW by promoting sodium retention and subsequent water reabsorption at the level of renal tubules. Another factor that may increase blood pressure is the effect of TRT on increasing red blood cells and hematocrit to high levels in some men.  High hematocrit can increase blood viscosity and blood pressure. In addition to these hormonal factors, it's important not to overlook lifestyle influences when examining changes in fluid balance during TRT. As mentioned previously, high-sodium diets, alcohol consumption, and a lack of exercise can all exacerbate water retention issues among men receiving hormone treatments. Moving Forward: The Importance of Ongoing Research While we now know that estrogen conversion is not responsible for increased ECW during TRT, there remains much work to be done when it comes to understanding how various factors influence fluid balance among individuals undergoing this form of therapy. Continued research into hormonal pathways - as well as individual differences related to both genetics and lifestyle choices - will help paint a clearer picture regarding how to best manage side effects like edema-related swelling while optimizing the overall benefits of TRT for men who need it. For now, it's essential that patients and healthcare providers alike remain vigilant when monitoring fluid balance during hormone therapy. By staying informed about the latest research findings and being proactive in addressing any potential issues related to water retention, men on TRT can minimize their risk of experiencing complications while maximizing the positive impact of treatment on their health and well-being.   Key Takeaway:  Recent research has debunked the hypothesis that estrogen is responsible for increased extracellular water (ECW) in men undergoing testosterone replacement therapy (TRT). Alternative explanations include direct effects of testosterone on kidney function, modulation of vasopressin secretion and action, and stimulation of aldosterone production. It's important to monitor fluid balance during hormone therapy and consider lifestyle influences such as high-sodium diets, alcohol consumption, and a lack of exercise. Lifestyle Factors Influencing Water Retention During TRT Men receiving testosterone replacement therapy (TRT) may experience increased water retention when consuming high-sodium foods, drinking alcohol, or skipping gym sessions for more than three days. Adjusting these lifestyle factors can help minimize the impact of TRT on blood pressure and fluid balance. The Role of Sodium Intake in Water Retention A diet high in sodium can cause your body to retain more water, leading to an increase in extracellular fluid volume. This is particularly true for men undergoing testosterone replacement therapy, as their bodies are already prone to retaining excess fluids due to the hormonal changes taking place. To combat this issue, it's essential that you monitor your daily sodium intake while on TRT. Limit processed foods: Processed and packaged foods often contain large amounts of hidden sodium. Opt for fresh fruits, vegetables, lean meats, and whole grains instead. Cook at home: Preparing meals at home allows you greater control over the amount of salt used in your dishes. Experiment with herbs and spices to add flavor without relying on salt. Read food labels: Pay attention to the nutritional information provided on food packaging so you're aware of how much sodium each product contains. Avoid dining out frequently: Restaurant meals tend to be higher in sodium compared to homemade options; limit eating out whenever possible. Effects of Alcohol Consumption on Fluid Balance In addition to increasing overall caloric intake and potentially contributing to weight gain, alcohol consumption can also have a negative impact on fluid balance in men undergoing TRT. Alcohol acts as a diuretic, causing your body to lose fluids and electrolytes through increased urine production. This loss of fluids can lead to dehydration, which may exacerbate blood pressure issues and water retention problems associated with testosterone therapy. To minimize the effects of alcohol on fluid balance during TRT: Limit alcohol intake: Aim for moderate drinking habits by consuming no more than two alcoholic beverages per day for men. Stay hydrated: Drink plenty of water throughout the day and especially when consuming alcohol to counteract its dehydrating effects. Avoid binge drinking: Consuming large amounts of alcohol in a short period increases the risk of dehydration and worsens blood pressure and water retention problems related to TRT. Importance of Regular Exercise During Hormone Therapy Maintaining an active lifestyle is crucial for overall health and well-being while undergoing hormone therapy. Regular exercise not only helps control weight gain but also plays a vital role in managing blood pressure levels and promoting healthy circulation. Additionally, physical activity has been shown to help reduce edema-related swelling caused by excess extracellular fluid buildup - one common side effect experienced by many men receiving testosterone treatment. Incorporate these tips into your fitness routine while on TRT: Create a consistent schedule: Aim for at least three days per week dedicated to cardiovascular exercises such as brisk walking, jogging, or swimming; consistency is key when it comes to maintaining optimal blood pressure levels during hormone therapy treatments like TRT. Incorporate strength training: Building muscle mass can help improve arterial stiffness and reduce the risk of cardiovascular disease and heart attacks. Monitor progress: Keep track of your progress and adjust your exercise routine as needed to ensure you're getting the most out of your workouts.   Key Takeaway:  Men undergoing testosterone replacement therapy (TRT) may experience increased water retention due to hormonal changes, which can impact blood pressure. To minimize the effects of TRT on fluid balance, it's important to monitor sodium intake, limit alcohol consumption, and maintain a regular exercise routine that includes both cardiovascular exercises and strength training. FAQs in Relation to TRT and Blood Pressure Does TRT therapy raise blood pressure? TRT therapy can potentially raise blood pressure in some individuals, especially if they have pre-existing hypertension or other cardiovascular risk factors. However, the effect varies from person to person and depends on individual health conditions and lifestyle factors. Regular monitoring of blood pressure is essential during TRT. Does testosterone play a role in blood pressure? Testosterone does play a role in regulating blood pressure by influencing vascular function, kidney function, and body fluid balance. However, its impact on an individual's blood pressure may vary depending on various factors such as age, overall health status,the presence of pre-existing metabolic syndrome or cardiovascular issues, hormone levels, and lifestyle choices. Can testosterone cypionate cause high blood pressure? Testosterone cypionate is a form of injectable testosterone used for TRT. It has the potential to cause high blood pressure in some men due to increased water retention or changes in renal function associated with higher testosterone levels. Monitoring your BP regularly while using this medication is important. Does low testosterone shots cause high blood pressure? Low-testosterone shots are typically administered as part of TRT when treating hypogonadism (low T). These injections can sometimes lead to elevated BP due to increased water retention or altered kidney functions; however, it doesn't happen universally among all patients undergoing treatment. Maintaining healthy habits like exercising regularly and reducing sodium intake will help mitigate the risks associated with elevated blood pressure. Conclusion Therefore, it is essential to monitor blood pressure regularly in order to avoid potential cardiovascular complications associated with TRT. Regular monitoring of blood pressure is crucial to preventing cardiovascular disease and other related health issues. While TRT can have a positive impact on muscle mass and metabolic syndrome, it's important to manage any side effects that may arise. If you're interested in learning more about the role of the pituitary and thyroid in the diagnosis and treatment of TRT blood pressure, check out this informative article from  Testosterone Wisdom. Take control of your health today by educating yourself on the benefits and risks associated with TRT blood pressure management!        

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