Male testosterone: Further reading
More about treating male testosterone deficiency
Taking over the management of your hormones with male testosterone therapies

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Your sex hormones (testosterone and oestrogen) along with your gonadotrophins (LH and FSH) operate naturally in a tightly regulated and automated process. The brain creates a feed back loop which regulates how much testosterone is released. There is an interplay between the signal from the hypothalamus, the pituitary gland, and your testes. When you start Testosterone Replacement Therapy the regulated process will still occur but to a lesser degree and you will then take over control. You and your doctor determine how much testosterone your body receives, when it receives it and how often it receives it. Normally this is all managed for you by the Hypothalamus, but because age related Andropause or adult hypogonadism has blunted the response and has lowered your normal output to an unsatisfactory level it is now up to you to manage your hormones by topping them up with balanced testosterone replacement therapy including HCG.

How your body regulates testosterone through the hypothalamic gonadal axis

An analogy might be to think of your heating system. The thermostat would be the hypothalmus and pituitary gland and Boiler would be your testes. The thermostat releases a signal called gonadotrophin releasing hormones, which signals your pituitary gland (think of microprocessor in your thermostat) to release gonadotrophins (LH and FSH) which signal to the testes (boiler) to produce more testosterone and sperm for reproduction. This process keeps the testes functioning and healthy. The testes produce sperm and testosterone allowing them to maintain their size. The Leydig cells are responsible for the production of testosterone and are sensitive to the signal (LH) sent from your pituitary. Without this signal which can be blunted by taking testosterone then the Leydig cells will cease functioning causing testicular atrophy. This can be prevented using HCG or recombinant LH and FSH as an adjunct whilst on male testosterone replacement therapy.

Categories of low male testosterone
Age related testosterone deficiency can be described by several different terms:

  • Andropause
  • ManOpause
  • Adult onset hypogonadism
  • Male menopause
  • Low T
Other Names for low male testosterone or traditional/classical hypogonadism

  • Primary hypogonadism
  • Secondary hypogonadism
  • Idiopathic hypogonadism
Diagnosis for low testosterone

When you are being diagnosed for low male testosterone the LH will be looked at to determine if you have primary or secondary hypogonadism. In secondary hypogonadism the problem is with the Hypothalamus not signalling the Pituitary Gland to release it’s signal. The downstream effect being low LH and FSH and very little testosterone being produced. Primary hypogonadism occurs when the signal from Hypothalamus or Pituitary Gland are doing their job but when it reaches the testes it’s just not switching on production of testosterone. In this case you would have an elevated LH and FSH level with little testosterone being produced. When testosterone is produced and after a certain undetermined level is reached then enzymes known as aromatase begin to convert excess testosterone into oestrogens. These oestrogens are then sensed by the hypothalmus which then stops sending its signal to the pituitary and then the body stops sending its signal back to the testes. With no signal to produce testosterone or sperm the testes will begin to atrophy. Testosterone replacement therapy without managing oestrogen and using HCG will shrink your bollocks. The degree of atrophy depends on the individual. For some it may be hardly noticeable and body may still produce some of its own testosterone albeit at a greatly reduced level which will cause sluggishness in the whole system and eventually atrophy.

Our testosterone balancing treatments

Our doctors will order a blood test to try to determine the category of low testosterone you are suffering and come up with a bespoke treatment plan.

HCG + Testosterone + Oestrogen Control= Balanced TRT
The gold standard for Testosterone Replacement Therapy

There have never been more options available for treating low testosterone. The goal of therapy should be to keep your body producing natural endogenous testosterone whilst topping up what you may be missing. By correctly balancing your testosterone and other hormones you will mitigate the symptoms associated with low testosterone levels. After your doctor diagnoses you for low testosterone you can set out finding the right treatment.

Common Treatments for Testosterone in the UK
Injectable Testosterone Preparations
  • Sustanon®(Aspen), testosterone propionate 30 mg, testosterone phenylpropionate 60 mg, testosterone isocaproate 60 mg, and testosterone decanoate 100 mg/mL
  • Nebido®(Bayer), testosterone undecanoate 250 mg/mL in a 4ml amp or vial dosed 1gm ever 10-14 weeks by slow intramuscular injection
  • Testosterone Enantate (Non-proprietary) , testosterone enantate 250 mg/mL dosed 250mg every 10-14 days
  • Virormone®(Nordic), testosterone propionate 50 mg/mL, 2-mL amp Short Acting Testosterone ester dosed 2-3 times weekly
Topical Testosterone
  • Alcohol Gels commercially prepared
  • TESTIM®(Ferring),Gel, testosterone 50 mg/5 g tube, 30-tube pack
  • TESTOGEL®(Besin),Gel, testosterone 50 mg/5 g sachet, 30-sachet packs
  • TOSTRAN®(ProStrakan),Gel, testosterone 2% (10 mg/metered application), 60-g multidose dispenser
  • PLO Gel(Pluronic Lecithin Organogel) 10-20% concentration and prepared by a compounding pharmacy
  • Oral Androgens
  • Proviron®(Bayer), tablet, mesterolone 25mg, 30 tablets
  • HCG-Human Chorionic Gonadotrophin – used to help treat delayed puberty, undescended testes or oligospermia (low sperm count). This treatment can be used as monotherapy or as an adjunct with exogenous testosterone. Your doctor will discuss with you an individual treatment plan.
Our Recommended Treatment Plan based on data and best quality of Life

We will make every effort to focus on bespoke treatment and individualised care. From our experience we can share what has worked well for most of our patients. Your treatment based on a multi-faceted approach could include prescribing Sustanon®250 with Anastrozole for oestrogen control, possibly mesterolone to lower SHBG, and HCG to maintain the size and partial function of your testes.

HCG augments your Exogenous Testosterone by helping to maintain some of your endogenous production

When you start on TRT (testosterone replacement therapy) without HCG or an oestrogen blocker, the body begins to sense the elevation of testosterone through it’s conversion to oestrogen and then over time begins to slow down the production of any of your endogenous testosterone. You might not mind because the overall output of your endogenous testosterone was low or low normal to begin with. It may or may not completely shut down but it will be greatly diminished depending on how your body senses and responds to it. At the end of the day the benefit of TRT will outweigh the substandard levels and symptoms associated with it. When used in men as a therapeutic, HCG mimics the actions of gonadatrophins LH and to a lesser degree FSH. With HCG the testes are receiving a steady signal to produce more testosterone. Essentially you are bypassing the hypothalmus and the pituitary and providing a signal directly to the testes. This 3 part approach (Exogenous Testosterone, Oestrogen Control, and HCG) maintains function and size of your testes whilst also benefiting from exogenous testosterone.

What about oestrogen blockers or aromatase inhibitors, how do they make a difference?

We know that HCG signals the testes to produce keeping the circulation of testosterone flowing through signalling the testicles to “stay open for business” there will be a glut of testosterone which will most likely be converted by various tissues that contain the enzyme aromatase. We can control this conversion by taking a tablet called an aromatase inhibitor. This tablet was originally designed for woman undergoing breast cancer treatment to keep the levels of oestrogen in a women’s body very low and thus preventing oestrogen sensitive breast cancer for recurring.

In men they aromatase inhibitors also reduce the total amount of oestrogen in the body. The challenge for men is finding the right dose. Too much oestrogen causes increase breast growth in men known as gynaecomastia which then require surgical excision. Many of the side effects associated with male testosterone therapy can be mitigated with aromatase inhibitors such as anastrozole. There are other aromatase inhibitors besides anastrozole but the benefits of anastrozole tend to far outweigh those of the other drugs in its class. Anastrozole has a half life of around 3 days which means you can can dose less often and with far less than 1mg. In fact many men will dose 0.5mg once or twice a week. This is key as too much reduction of oestrogen will dampen a man’s sex drive just as too much oestrogen will do the same. In fact too much oestrogen can have a knock on effect and raise the level of prolactin which will definitely put a damper on a man’s sex drive. It comes down to creating the right balance. Unfortunately most hormone doctors and GPs will out right refuse to prescribe these very important ancillary medicines. Sometimes its for keep costs reduced, other times its beyond their remit or level of comfort. NHS GPs are very fearful of falling foul of any national guidelines set out by hospital endocrinologists. This is unfortunate as many men on TRT needlessly suffer.

Think of your male testosterone therapy as a 3 legged stool. A missing leg causes the stool to fall over.
Supporting Studies in the scientific literature

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