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By Mike Kocsis | 7 minutes read | Last updated: February 21, 2021 |
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    Evidence Based Research

    Guys have 101 questions about TRT before they start.

    However, there is usually a core of basic questions that are asked over and over.

    In this article we answer 10 of your most common questions about testosterone replacement therapy.

    Do you need HCG with TRT? 

    When you take exogenous testosterone, your body detects this and stops producing its own testosterone.The production of testosterone is key to sperm production. Therefore, if you want to father children and remain fertile on TRT, you must take HCG.HCG or Human Chorionic Gonadotropin is a hormone that mimics the behaviour of luteinising hormone in the body. This sends a signal to the testes to produce testosterone, stimulating sperm production.

    A typical dose of HCG alongside testosterone to maintain fertility would be 1000-1500 iu’s weekly.

    HCG

    Do you cycle testosterone?

    The whole concept of ‘cycling’ comes from bodybuilding where individuals typically take supraphysiologic doses of testosterone and other anabolics.Doing this for prolonged periods can be extremely detrimental to health. That’s why bodybuilders tend to cycle these drugs.However, when you come off testosterone, it might take your body weeks to recover and start it’s own natural production of testosterone.

    This is not a nice place to be. This is both dangerous and stupid.

    TRT is administered with therapeutic doses of testosterone, e.g. 200-250mg weekly. This is beneficial to health and avoids the negative side effects at higher doses.

    If you cycle TRT, this means you lose the benefits of it each time you come off it. Therefore, it makes ZERO sense.

    Do you need to take an aromatase inhibitor (AI)?

    The use of an AI (aromatase inhibitor) has become a hot topic in recent times. An AI works by blocking the action of the aromatase enzyme, which is responsible for the conversion of testosterone into estrogen.Increased levels of testosterone through TRT will normally raise estrogen levels. And this is not necessarily a bad thing.

    However, too much estrogen can have unwanted side effects such as gynaecomastia, water retention, and nipple swelling.

    Some doctors say you need an AI to effectively mitigate negative estrogenic side effects. Some say AIs are the devil incarnate and are detrimental to your health.

    Ultimately, if the patient has a clinical need, and aromatase inhibitors are used in a sensible way, they are quite safe.

    Is testosterone really safe?

    Most of the hyperbole around testosterone comes from flawed studies and hearsay.The evidence is mounting in favour of testosterone. Studies have been done on large sample populations to show testosterone is safe and beneficial.There are millions of men all around the world who are testament to the efficacy of testosterone therapy.

    What’s more, testosterone is a hormone that is readily accepted by the body.

    We NEED it to live for heaven’s sake! This is not like some strange drug. Think about that for a moment.

    Do your own research and make your own conclusions. Don’t listen to the media hype.

    Can you trial TRT?

    When you are diagnosed with low testosterone, the idea is for you to trial it for several months to see if it relieves your symptoms.If you don’t see success with treatment, then you are under no obligation to continue.However, there are usually a couple of scenarios where this happens:

    Either the individual was not patient enough – because sometimes it can take several months to balance your hormones. Or the individual was given an ineffective treatment protocol by a doctor.

    Testosterone is rarely if EVER the real issue when treatment doesn’t work.

    How is TRT administered?

    There are several different ways in which TRT can be delivered, although tablet form is usually not one of them. It is possible to get oral testosterone but there are concerns that it can cause problems with the liver. Therefore, there is a focus on alternative delivery methods which bypass the liver and allow testosterone to get straight into the bloodstream. These include:

    • Transdermal testosterone (skin patch). These are typically applied once per day to the arm or upper body.
    • Gel form. Testosterone can be absorbed through the skin when a gel is applied. It is also possible to get a pump which ensures that the correct prescribed dosage is delivered.
    • Mouth patch. It is possible to get testosterone as a tablet which sticks to the upper gums in the mouth and releases it into the blood through the day. These are usually applied twice per day.
    • Injections and implants. Testosterone can be applied under the skin directly into muscles or as pellets which are inserted into the soft tissues of the body and slowly released.

    What are the risks associated with TRT?

    As we have already discussed, testosterone is safe and can be highly beneficial. However, like all medication, there can be some risks associated with taking TRT. Depending on the method of delivery, there may be a rash or itching at the site of application, but this is usually temporary and rarely serious.

    Testosterone use may also increase the risk of heart attack or stroke, but this is yet to be substantiated by large clinical trials. There are also some conditions which could be exacerbated by testosterone therapy, such as benign prostatic hypertrophy, sleep apnea or congestive heart failure, so men suffering from these conditions should be closely monitored by their physicians while taking testosterone therapy.

    Can TRT cause prostate cancer?

    The debate as to whether TRT causes prostate cancer is still ongoing, but to date there are no studies which have found a link between the two. There are a number of doctors who suggest that taking TRT can speed up the rate at which prostate cancer tumours grow but so far there is no clear evidence to support this.

    Is taking TRT like taking anabolic steroids?

    In a word, no. The anabolic steroids which are used to enhance performance usually include testosterone or a similar chemical, but at much higher levels than would be found naturally in the body. TRT is designed to replace natural testosterone levels so would never have that kind of dose. It is also common for performance steroid treatments to contain other drugs which increase muscle development.

    What tests will be carried out before you start taking TRT?

    First and foremost your doctor will establish that your testosterone levels are truly low. This means measurements which show testosterone is either low or absent in your bloodstream. Your doctor will also test for other hormones in order to make sure that your diagnosis is accurate and your treatment is carried out safely. These tests may cover:

    • Sex Hormone Binding Globulin (SHBG) which binds to testosterone and blocks its action. High SHBG in your blood may cause you to have symptoms of low testosterone when the hormone level is not actually lowered.
    • Oestradiol is a marker for oestrogen in the body so levels should be monitored before and during TRT as oestrogen can be made from testosterone in the body.
    • Prolactin at high levels can reduce the production of testosterone so may be the cause of low testosterone. Very high levels of prolactin may be caused by a type of pituitary gland tumour called a prolactinoma.
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    Evidence Based Research

    This article has been researched and written based on scientific evidence and fact sheets that have then been crossed checked by our team of doctors and subject matter experts.

    References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.

    Our team of healthcare experts and GMC registered doctors are licensed to UK GMC standards. We strive to provide you with the latest evidence based, researched articles that are unbiased, honest and provide you with accurate insights, statistics and helpful information on the discussed topic to ensure you gain a better understanding of the subject.

    We value your feedback on our articles, if you have a well-researched paper you would like to share with us please contact us.

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    About the Author: Mike Kocsis

    Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.

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    Last update: February 21st, 2021

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