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.
- Adult onset hypogonadism
- Male menopause
- Low T
- Primary hypogonadism
- Secondary hypogonadism
- Idiopathic hypogonadism
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 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.
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.
- 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
- 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.
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.
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.
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.
- An update on male hypogonadism therapy Expert Opin Pharmacother. 2014 Jun; 15(9): 1247–1264. Published online 2014 Apr23.doi: PMCID: PMC4168024. NIHMSID: NIHMS627664 Prasanth Surampudi, MD,1 Ronald S Swerdloff, MD,2 and Christina Wang, MD‡†,3
- Testosterone Therapies. Urol Clin North Am. 2016 May;43(2):185-93. doi: 10.1016/j.ucl.2016.01.004. Epub 2016 Mar 18. Khera M1.
- Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes.Wang C, Jackson G, Jones TH, Matsumoto AM, Nehra A, Perelman MA, Swerdloff RS, Traish A, Zitzmann M, Cunningham G.Diabetes Care. 2011 Jul;34(7):1669-75. doi: 10.2337/dc10-2339. Review. No abstract available.
- Changes in testosterone related to body composition in late midlife: Findings from the 1946 British birth cohort study David Bann, Frederick C. W. Wu, Brian Keevil, Hany Lashen, Judith Adams, Rebecca Hardy, Graciela Muniz, Diana Kuh, Yoav Ben‐Shlomo, Ken K. Ong Obesity (Silver Spring) 2015 July; 23(7): 1486–1492. Published online 2015 June 5. doi: 10.1002/oby.21092 PMCID: PMC4744737
- Testosterone and weight loss: the evidence Abdulmaged M. Traish Curr Opin Endocrinol Diabetes Obes. 2014 October; 21(5): 313–322. Published online 2014 August 28. doi: 10.1097/MED.0000000000000086 PMCID:PMC4154787
- Effects of testosterone on spatial learning and memory in adult male rats Mark D. Spritzer, Emily D. Daviau, Meagan K. Coneeny, Shannon M. Engelman, W. Tyler Prince, Karlye N. Rodriguez-Wisdom Horm Behav. Author manuscript; available in PMC 2012 April 1. Published in final edited form as: Horm Behav. 2011 April; 59(4): 484–496. Published online 2011 February 2. doi: 10.1016/j.yhbeh.2011.01.009 PMCID: PMC3081396
- Protective role of testosterone in ischemia-reperfusion-induced acute kidney injury Andrea Soljancic, Arnaldo Lopez Ruiz, Kiran Chandrashekar, Rodrigo Maranon, Ruisheng Liu, Jane F. Reckelhoff, Luis A. Juncos Am J Physiol Regul Integr Comp Physiol. 2013 June 1; 304(11): R951–R958. Published online 2013 April 3. doi: 10.1152/ajpregu.00360.2012 PMCID: PMC4074000
- Diagnosis and management of testosterone deficiency James A McBride, Culley C Carson, Robert M Coward Asian J Androl. 2015 Mar-Apr; 17(2): 177–186. Published online 2014 December 5. doi: 10.4103/1008-682X.143317 PMCID: PMC4650468
- Endocrinology of the Aging Male Andre B. Araujo, Gary A. Wittert Best Pract Res Clin Endocrinol Metab. Author manuscript; available in PMC 2012 April 1.Published in final edited form as: Best Pract Res Clin Endocrinol Metab. 2011 April; 25(2): 303–319. doi: 10.1016/j.beem.2010.11.004 PMCID: PMC3073592