TRT Side Effects Tests

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  1. 17 Hydroxyprogesterone Test
    $87.10

    To find out if sperm count is normalized in men using hCG plus TRT, several studies have found that 17OH-P blood level is correlated to intratesticular testosterone (ITT) required for the testicles to make sperm, so testing for this hormone could not only save time while optimizing HCG dose/frequency but also eliminate the need to perform testicular aspirations, a very difficult procedure to do. Sperm count does not stabilize until 6-8 weeks after starting hCG plus TRT, so knowing your 17OH-progesterone blood level can give you a quick way to determine if your hCG dose and frequency is adequate before your first follow-up semen analysis after 8 weeks.

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  2. Blood Donation Safety Panel
    Special Price $35.00 Regular Price $55.15

    This blood donation panel includes these tests: Hematocrit, iron & total iron binding capacity (TIBC), and ferritin.This panel is designed to determine if: 1- Your blood donation or therapeutic phlebotomy was effective in lowering your high hematocrit without negatively affecting ferritin or iron. 2- It is safe to do another blood donation or therapeutic phlebotomy depending on ferritin or iron levels.

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  3. Bodybuilder Blood Test Panel- Basic
    $250.90

    This panel provides smart bodybuilders with information that can help minimize potential short- and long-term side effects and risks. This basic bodybuilder panel includes the following gold standard tests/panels: Cystatin C (the only accurate kidney function test for bodybuilders), hematocrit (blood viscosity factor), CMP (glucose, liver & kidney function, and electrolytes), total and free testosterone (LC/MS assay—no upper limit and no interference with anabolics), ultra-sensitive estradiol (the only accurate estradiol test for men), & lipid cholesterol panel. Fasting is required.

     

     

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  4. Elite Male Blood Test Panel
    $683.09

    The most complete of all blood test panels for men that include: Total and Free Testosterone, Ultra Sensitive Estradiol, IGF-1, Prolactin, DHT, DHEA-S, PSA, SHBG, Lipids, CBC, CMP, and Thyroid Function (TSH, Free T3, Free T4).

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  5. ESTRADIOL , Sensitive (LC/MS/MS)
    $35.69

    THIS IS THE MOST AFFORDABLE AND ACCURATE ESTRADIOL TEST IN THE U.S. This ultrasensitive estradiol test is based on liquid chromatography/mass spectrometry (LC/MS), an assay technology that has been shown to more accurately measure estradiol in men and women than the old immunoassay-based test. 

    Important note:  The blood sample is sent out to Quest Diagnostics Nichols Institute San Juan Capistrano, Caifornia.  Overnight delivery and testing is performed on Sunday and Friday.  Reports are available within 5-7 business days from the time the specimen is collected.

     

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  6. Estradiol Ultra Sensitive (LC/MS) and Testosterone, Free (Dialysis) and Total, MS
    $88.20

    This panel includes the two gold standard tests for estradiol and testosterone (Total and Free) that use liquid chromatography/ mass spectrometry for best accuracy and no interactions.

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  7. Ferritin
    $18.74

    Ferritin is a protein that stores iron. Red blood cells need iron to form normally and carry oxygen around your body. Low levels of ferritin lead to iron deficiency anemia, which means you have too few red blood cells. High levels of ferritin can damage your joints, heart, liver, and pancreas.

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  8. Gynecomastia Blood Test Panel
    $401.49

    This panel includes hormones that have been implicated in gynecomastia by several studies. Gynecomastia is a benign enlargement of the male breast resulting from a growth of the glandular tissue of the breast. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important, and patients usually seek medical attention. Causes include hormone imbalance and genetic predisposition.

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  9. Hematocrit HCT Blood Test
    $10.52

    The volume measurement, or hct blood test, is the proportion of blood that the red blood cells take up. Hemoglobin, on the other hand, is a density or concentration measurement and is expressed in grams per liter or deciliter. (Hemoglobin is, if you will recall from your high school biology, the iron-based protein that transports oxygen.) RBC is a simple count and is usually expressed as the number of million red blood cells that you have per microliter. Usually, hematocrit is three times the amount of hemoglobin.

    Testosterone replacement therapy (TRT) increases hematocrit in most men.  Read more about how to decrease hematocrit.

    NOTE: Hematocrit is also part of the CBC panel, so there is no need to order separately if your order already includes CBC.

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  10. Hormone Panel for Men on TRT- Upstream & Downstream
    $575.57

    This hormone panel for men on testosterone replacement therapy (TRT) contains upstream and downstream hormones to testosterone.  TRT has been shown to decrease upstream hormones like pregnenolone and progesterone, and slightly decrease DHEA. Downstream hormone metabolites like ultrasensitive estradiol and DHT are also included.  Lastly, prolactin is added since high prolactin can decrease sexual function.  No LH and FSH were included since TRT shuts them down.

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  11. Post PCT Panel
    $200.06

    This PCT after cycle panel is designed to measure the health and recovery of the Hypothalamic-Pituitary-Testicular Axis (HPTA) after attempting to normalize it spontaneously or with the use of Post-Cycle Therapy (PCT) . PCT is prescribed by some physicians for men who stop testosterone replacement therapy (TRT) or other androgens. Fasting is required for CMP (glucose test).

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  12. Pre- TRT MALE Hormone / Wellness Panel
    $275.63

    This hormone panel can be used to diagnose primary or secondary hypogonadism (testosterone deficiency), prostate health and potential thyroid dysfunction prior to initiating testosterone replacement therapy. This hormone panel contains over 20 tests that can be used to diagnose primary or secondary hypogonadism (testosterone deficiency), prostate health and potential thyroid dysfunction prior to initiating testosterone replacement therapy. It also includes information about hematocrit , and liver and kidney function. Panel includes: LH and FSH (Pituitary hormones that stimulate testicular cells that can help diagnose primary (testicular) or secondary hypogonadism), Total and free testosterone (LC/MS assay. No upper limit restriction), Prostatic specific antigen (PSA) (TRT is contraindicated for PSA equal or above 4.0), Estradiol (sensitive. LC/MS assay), Lipids (LDL, HDL, Triglycerides), Comprehensive Metabolic Panel (CMP) (Glucose, electrolytes, liver/kidney functions), Comprehensive Blood Count (CBC) (Immune cells, red blood cells, hemoglobin, hematocrit) 

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  13. Pre- TRT MALE Hormone / Wellness Panel

    As low as $275.63

     Panel includes:

     - LH and FSH (Pituitary hormones that stimulate testicular cells that can help diagnose primary (testicular) or secondary hypogonadism)

      - Total and free testosterone (LC/MS assay.  No upper limit restriction)

    - Prostatic specific antigen (PSA) (TRT is contraindicated for PSA equal or above 4.0)

     - Estradiol (Ultra-sensitive. LC/MS assay)

     - Lipids (LDL, HDL, Triglycerides)

     - Comprehensive Metabolic Panel (CMP) (Glucose, electrolytes,  liver/kidney functions). FASTING IS REQUIRED FOR ACCURATE GLUCOSE TEST.

     - Comprehensive Blood Count (CBC) (Immune cells, red  blood cells, hemoglobin, hematocrit). 

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  14. PSA
    $23.14

    Prostate Specific Antigen (PSA) is produced exclusively by cells of the prostate gland. Used in conjunction with the digital rectal examination, PSA is a useful screening test for benign prostate enlargement, prostatitis and prostate cancer development.

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  15. Testosterone (T+F), Estradiol and DHT Panel
    $187.43

    This panel contains testosterone and its downstream metabolites: Estradiol and DHT. All three hormones are measured using Liquid Chromatography/Mass Spectrometry (LC/MS), the most accurate assay for hormones. No interactions with supplements like biotin are present.

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  16. Testosterone (T+F), Hematocrit, Ultra Sensitive Estradiol and Prolactin Panel
    $187.43

    This discounted lab test panel for men includes total testosterone by liquid chromatography/mass spectrometry (the most accurate testosterone test), free testosterone (Dialysis), hematocrit, ultrasensitive estradiol test and prolactin hormone. 

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  17. Testosterone (T+F), SHBG, Hematocrit, Sensitive Estradiol, and PSA
    $205.63

    This economical lab test panel includes: Most accurate Testosterone, Free (Dialysis), Bioavailable and Total (LC/MS),  Sex Hormone Binding Globulin -SHBG,  Complete Blood Count (CBC panel) Including hematocrit, PSA and Ultrasensitive Estradiol

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  18. Testosterone (Total + Free), Ultrasensitive Estradiol & Hematocrit
    $120.17

    The most economical lab test panel with 4 tests for men on TRT:

    1. Total Testosterone, Liquid Chromatography/ Mass Spectrometry
    2. Free Testosterone, Equilibrium Dialysis
    3. Ultrasensitive Estradiol, Liquid Chromatography/ Mass Spectrometry
    4. Hematocrit
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  19. Testosterone + LH + FSH Panel
    $127.08

    This panel includes: Total and Free Testosterone (LC/MS), Luteinizing Hormone (LH), and Follicle Stimulating Hormone (FSH) at substantial savings that buying each test separately.

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  20. Testosterone, Free (Equilibrium Dialysis) and Total, MS
    $45.15

    THIS IS THE MOST AFFORDABLE TESTOSTERONE TEST IN THE U.S. The most accurate way to measure total testosterone is with liquid chromatography/mass spectrometry. This panel also shows free testosterone percent by equilibrium dialysis and free testosterone calculated from percent free T. This test is more accurate for low and high testosterone blood levels (for men who expect high testosterone blood levels over 1,500 ng/dL, women, and children who usually have low T levels). It has no interferences with supplements or anabolics. Note: Results may take 5-7 business days. For a faster turnaround, choose this test instead: Testosterone, Free, Bioavailable and Total (With Lower & Upper Limit) plus SHBG

     

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  21. Testosterone, Thyroid and Estradiol Panel
    $174.20

    Ordering these 6 hormone tests as a panel saves you over $20 when comparing it to buying tests separately.

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  22. Testosterone, Total ( LC/MS), Free T , Bioavailable T, and SHBG- No Upper Limit
    $98.12

    This Testosterone Panel Includes 5 Tests:

    • Testosterone, Total, LC/MS (most accurate testosterone test for men with high testosterone and women, no upper or lower limit)
    • Testosterone, Free. Free testosterone is best calculated based on the LC/MS-derived total testosterone and equilibrium dialysis-derived percent free levels. 
    • Testosterone, Bioavailable. Bioavailable testosterone is calculated based on the LC/MS/MS-derived total testosterone,  free testosterone levels, albumin and SHBG.
    • Sex Hormone Binding Globulin (SHBG)
    • Albumin

    Note: Despite SHBG not being listed on the lab requisition form under "Testosterone, Free, Bioavailable, and Total, Males (Adult)," rest assured the results include this critical component, as it's necessary for calculating bioavailable testosterone.

     

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  23. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit
    $93.80

    This is a very economical panel that includes: 1- Hematocrit: Portion of total blood volume made up of red blood cells. Testosterone replacement therapy can increase hematocrit. Hematocrit over 52 may increase blood thickness and cardiovascular risks. 2- Total (LC/MS- No upper Limit) and Free Testosterone by Equilibrium Analysis.

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  24. TRT Basic Monitoring Panel
    $121.28

    This TRT basic lab test panel includes essential tests (CBC, CMP, ultrasensitive estradiol, and total & free testosterone) to monitor treatment in men on that have been testosterone replacement therapy for a few months. Test included:

    • CBC (White and red blood cells, hematocrit, etc)
    • CMP (glucose, liver & kidney function, etc)
    • Estradiol Ultra Sensitive
    • Total Testosterone (LC/MS)
    • Free Testosterone (Equilibrium Dialysis)

    Fasting is required for proper glucose testing as part of CMP.

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  25. TRT MALE Hormone/Wellness Follow Up Panel
    $219.40

    This popular and cost-effective panel includes main blood test variables monitored by many clinics that treat men with low testosterone. This panel is for men who are already on testosterone replacement therapy (TRT) and who want to monitor their main blood tests. You save substantial amounts of money by ordering these tests together rather than one at a time. The panel includes: Total and free testosterone (LC/MS assay. No upper limit restriction), Sex hormone binding globulin (SHBG), Estradiol (sensitive- LC/MS assay), CBC (includes glucose, hematocrit and immune cells), CMP (includes liver and kidney function, eGFR), Lipids (LDL and HDL cholesterol and triglycerides) 

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  26. Water Retention Panel: Aldosterone/Plasma Renin Activity Ratio, LC/MS/MS
    $188.95

    Renin, also known as angiotensinogenase, is an enzyme that the kidneys produce to regulate aldosterone production. It’s also essential in the renin–angiotensin aldosterone system (RAAS) which maintains your body’s fluid balance and blood pressure. Aldosterone is the primary of several endogenous members of the class of mineralocorticoids in humans. Aldosterone tends to promote sodium and water retention, and lower plasma postasium concentrations.

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Testosterone Replacement Therapy (TRT) has changed the lives of many men around the world.  As any therapy, it can have great benefits if properly managed but negative side effects if not.  This article will briefly and simply review the different TRT tests that most physicians use to monitor your progress while minimizing potential side effects.  

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.

So, let's say you go to a doctor, go get your blood levels measured and also do the diagnostic questionnaire, and you were diagnosed with hypogonadism or having low testosterone. The doctor will prescribe either a testosterone injection of cypionate or enanthate or even propionate or Aveed (Nebido), or put you on a cream, either a gel 1%, 1.6, 2% Androgel or Testim or Axiron or a compounded cream. He or she may also talk about also testosterone pellets, like Testopel, and some compounded pellets that can go up to even 200 milligrams per pellet. There are buccal options like Striant, and nasal gels like Natesto that you apply inside nostrils twice a day. So, there are several options to increase low testosterone for TRT and your doctor will help you determine which one is best for you.

 

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 two-to-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 it later. Keep in mind that donating more frequently than every 3 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 it as part of the CBC panel.

 

Avoiding Low Ferritin and Iron

 

When your hematocrit is over 53 and you donate blood frequently than every 3 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 it 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, to cognitive functioning, to cardiovascular health, even to 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 after you start TRT of 700 nanograms per deciliter, obviously your estradiol is going to be higher than when you 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 over prescribed 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 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 increasing 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 is 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 have an artificial 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 that recommend different schedules for monitoring men on TRT, and a few of them agree with each other. Rarely 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're having 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 reasons for high prolactin could be a benign tumor called pituitary adenoma (diagnosed by MRI), that 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 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 10 weeks of testosterone replacement therapy and/or you are having high prolactin symptoms, like lactation. That's actually a very rare symptom that actually occur 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 provides 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