Page 4 - TRT Testing

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

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

Table of Contents Today's Young Men Have Almost 30 Percent Less Testosterone Sleep Disruption: Stress and Fatigue Can Reduce Testosterone Levels Carrying Too Much Weight Can Reduce Testosterone Levels Poor Diet and Consumption of Marijuana Might Be a Problem Lack of Physical Exercise Leads to a Decrease in Testosterone Levels Check Your Testosterone Levels Often References: There is no need to emphasize the considerable importance of testosterone in the human body, especially for men. This hormone helps build muscle, maintains healthy bones, improves cognition, and enhances sleep quality, not to mention its essential role in fertility. However, recent studies show an alarming drop in testosterone levels, particularly for young men. In other words, today's teenagers have less testosterone circulating through their bloodstream than the youngsters of 15-20 years ago. If you're curious to learn the causes of this drop in testosterone levels, keep reading this article. You'll find insightful answers to questions you already have about testosterone and know what lifestyle changes you can make to increase the production of this vital hormone. Today's Young Men Have Almost 30 Percent Less Testosterone It might be hard to believe, but recent studies show that men between 15 and 39 have almost thirty percent less testosterone compared to men within the same age group of 15-20 years ago. More specifically, if the average testosterone level was around 600 nanograms per deciliter of blood almost two decades ago, now it's about 400 nanograms per deciliter for men aged 15-39. That's a significant decrease caused by multiple lifestyle and environmental factors. Let's look at some of these causes and see why today's young adults experience this significant drop in testosterone levels. Sleep Disruption: Stress and Fatigue Can Reduce Testosterone Levels One of the most important causes of testosterone decrease is excessive stress. Today's young adults are very busy, and they're constantly bombarded with information and stimulation from social media and other platforms. They are sleeping less and exposing themselves to light from electronics late at night. This light can disrupt sleep patterns.  Several studies have shown that most hormones, including testosterone, peak during the sleep cycle.  A disrupted sleep cycle and circadian rhythm negatively affects testosterone, growth hormone, thyroid, and other hormones. This makes the adrenal glands release more cortisol which is the main stress hormone in the body. Too much cortisol coupled with fewer hours of sleep per night results in testosterone levels that can plummet faster than ever. Ideally, adults should sleep around 7 hours per night and engage in activities that decrease cortisol levels in the bloodstream. One of the best ways to reduce your stress levels is to go to the gym, walk or run, practice yoga, or play a musical instrument, not to mention spend more time with people you love. Carrying Too Much Weight Can Reduce Testosterone Levels Obesity and being overweight is another important factor that can explain the testosterone decrease in young men. Several studies show that higher body mass index (BMI) can result in lower testosterone levels.  There is an obesity epidemic in the US and most countries not only in adults but also teenagers and children. At the same time, being overweight increases your chances for chronic diseases, reduces your stamina and energy levels, as well as makes the body produce more toxic hormones. Do your best to exercise at least three times a week and your testosterone levels will eventually get back to normal. Poor Diet and Consumption of Marijuana Might Be a Problem Eating a diet that lacks nutritional value is hands-down one of the key factors when it comes to testosterone production. In other words, if you eat a lot of junk food, drink many fizzy beverages, and don't take a multivitamin supplement, your testosterone levels might significantly decrease each year. You should provide your body with vitamins, minerals, and other nutrients to help it function optimally. Try to eat more vegetables, fruit, and lean meats such as chicken and turkey, as well as healthy fats coming from seeds and olive oil. The Mediterranean Diet is one of the best ways to increase testosterone levels and longevity. At the same time, an increasing body of evidence suggests that excessive marijuana consumption is associated with a decrease in testosterone levels. The occasional joint might not do too much harm but smoking every day can have an impact on your hormones, particularly your testosterone. Lack of Physical Exercise Leads to a Decrease in Testosterone Levels As mentioned earlier, doing just three or four workouts per week for a minimum of thirty minutes can prevent a decrease in testosterone levels. Today's young adults spend a lot of time in front of their computers doing their work or getting entertained. This sedentary lifestyle is one of the most important causes of disease in the United States and throughout the entire world. It also makes testosterone levels drop at an alarming rate. The solution is not to quit your IT job and go work in a field. Instead, you should compensate by consciously engaging in physical activities a few times per week. Go for a jog, take your friends, and play squash or another racket-based sport. If you love it, go for a swim, as this is a wonderful cardiovascular activity that works the entire body. The bottom line is not to get stuck in front of your computer or on your sofa all day long. Work out a few times weekly to help your blood move better throughout your body and improve your testosterone levels. Check Your Testosterone Levels Often You might be happy to find out that checking your testosterone levels is very easy these days. You don't even need to talk to your doctor. You can order a direct-to-consumer lab test from trustworthy providers such as DiscountedLabs.com. When you do this, you get a form that you use to visit a nearby clinic to draw blood. Your blood is analyzed in a certified laboratory by medical experts, and your results will be emailed in a few business days. The process is fast, confidential, and secure. Checking your testosterone levels often helps you to see where you stand. You can compare the results against reference values and see if you need to readjust your lifestyle. For example, most experts agree that normal testosterone levels should be between 350 and 1,000 nanograms per deciliter of blood. Go to DiscountedLabs.com today and order your own testosterone test today! This test is the most affordable in the U.S. for a gold standard accurate test based on liquid chromatography, the most trusted test by top physicians and clinics.   ============= References: Alarming Drop in Testosterone Levels Stress and Fatigue Affect Testosterone Obesity Decreases Testosterone Levels Testosterone Information | Mount Sinai - New York