Testosterone plays a key role in your:
- muscle mass and bones
- facial and pubic hair
- body’s development of deeper voices
- sex drive
- mood and quality of life
- verbal memory and thinking ability
What is Testosterone?
Testosterone is known as the male sex hormone. It is is found in men and women and both require it. Men produce around 5-10mgs per day and Woman produce testosterone in much smaller quantities. Despite this lower production it is still very important for women to have an adequate amount, usually in the range of 0.5-3 nmol/l. Men require much higher levels around 20-30 nmol/L for optimum health.
What does testosterone do for a man?
Testosterone is not only important for sexual and reproductive development but plays a huge role in health and longevity. In fact testosterone has an anti-ageing effect by enhancing an enzyme called telomerase it may restore the ends of the telomeres which tend to unravel due to ageing or exposure to toxins. Testosterone is required for cognitive function, sex drive, energy, muscle mass, fertility, bone density and mood amongst other very important bodily functions.
What does testosterone do for a woman?
Oestrogen is the predominant sex hormone in women as testosterone is the predominant sex hormone in men. Both men and women need Testosterone and Oestrogen and if lacking either can experience unpleasant symptoms
In women Testosterone is produced in the ovaries and a smaller amount is produced from the adrenal glands. Testosterone is important for both men and women to improve and maintain bone density, lean body mass, mood, energy, drive and libido. If lacking Testosterone some of, if not all, these symptoms can occur.
What’s the difference between Menopause and Andropause?
Men as they age have a more gradual onset of diminished hormone activity despite remaining still fertile. This is usually referred to as Andropause. Testosterone deficiency is also often accompanied by oestrogen deficiency and men can also experience bone loss as well as women. Men need to have an adequate amount of oestrogen although in a much smaller quantities . Levels of around 100 pmol/L are often ideal for a man.
Women as they age will reach a point of diminishing fertility and produce less oestrogen, progesterone and to a certain degree testosterone. This time usually starts in the early to late 40s is referred to as menopause (there are rarer cases of it happening earlier in life). Women and men require hormones to be balanced and this includes optimal levels of testosterone.
What testosterone treatments are there for women?
Women need testosterone too in doses less than men but it is important all the same. Treatment for women include bio-identical Testosterone in a cream, or sublingual lozenge or troche. It is recommended to be used in combination with oestrogen or progesterone in the correct balance in menopausal and post menopausal women.
Do women need testosterone?
Women like men need testosterone. Testosterone in woman is very important and insufficient levels can cause body fat to increase, cause low mood and anxiety, reduce sex drive, cause brain fog and reduce recovery from physical activity. If testosterone is low in women the doctor will offer treatment ensuring balance with other hormones. When women have their hormones optimised they often feel relief of the above symptoms and this greatly improves quality of life.
Can women have testosterone treatment as part of their HRT (hormone replacement therapy)?
Normally peri-menopausal women or menopausal women can benefit from TRT along with bio-identical HRT. It’s important to get the right balance between Oestrogen,Testosterone and progesterone in women. This is done through treatment and monitoring of blood levels and symptoms.
What is TRT (testosterone replacement therapy)?
Testosterone Replacement Therapy is the medical treatment of a patient that provides restoration of testosterone levels back to a optimal physiological range. It is used to treat symptoms that arise from having insufficient levels of testosterone in the body. It involves providing the body with bioidentical (the same as the body normally produces) testosterone to provide an increase in levels and provide relief of these symptoms. The way in which this is done is personal and unique needs to be monitored to ensure hormones associated with testosterone are also balanced (such as Oestrogen)
What is TOT (Testosterone Optimisation Therapy)?
Testosterone Optimisation is a recent term for describing optimal testosterone therapy and first appeared in Jay Campbell and Jim Brown’s 2018 #1 rated book on Amazon called THE TESTSOSTERONE OPTIMIZATION THERAPY BIBLE, THE ULTIMATE GUIDE TO LIVING A FULLY OPTIMIZED LIFE.
The average testosterone level or “normal range” for men is shifting to lower levels than in previous generations (see below). It is not ideal to merely replace one’s low blood levels of endogenous testosterone( testosterone made by a man’s testes) with a dose of exogenous testosterone that provides similar low levels.
Aiming to just obtain levels in a range reported by laboratories, who are in fact actively lowering the stated average levels of testosterone, in correlation with the declining average levels in the male population, is nonsensical. Therapeutically it is ideal to optimise levels to that which is required, to provide symptomatic relief (after all that is the aim of the treatment). Above that Testosterone Optimisation Therapy is a lifestyle change that encompasses multiple factors such as good nutrition, exercise and mindset with optimal testosterone being at the cornerstone. These in synergy provide enhanced therapeutic benefit and a global positive shift in quality of life.
The average and median testosterone levels are dropping. What does this mean? Are men evolving to require less testosterone? This is doubtful. The researchers couldn’t pinpoint the exact reason for this significant drop. There is some speculation around increased obesity levels as a cause but is it the low testosterone causing the obesity or obesity causing the low Testosterone?
In any case the evidence is clear that men today have less testosterone than those from previous recent generations. Testosterone Replacement Therapy can help tip the balance back in favour of optimal levels and lower the prevalence of symptoms caused by Low T.
Testosterone levels are also decreasing in Europe and not just he USA. A danish study look at levels of testosterone compared to their fathers. They found after looking at 5000 Danish men born in the 1960s to have 14% lower levels of testosterone compared to their fathers who were born in the 1920s. The very essence of what makes a man a man is on the decline. Worldwide we are seeing an increase in testosterone therapy provision to counter this.
Is TRT always necessary/needed?
Testosterone replacement therapy (TRT) is NOT ALWAYS needed. Occasionally there are ways to boost border line testosterone levels without actually shutting down the pituitary axis. Younger patients can be assessed for testosterone boosting protocols prior to full TRT.
During investigation by your doctor, your hormones levels must be screened for other possible causes of symptoms. This involves comprehensive blood testing. As previously mentioned there are other medical treatment options, that can improve testosterone levels, prior to considering full TRT as not everyone is a candidate.
If you are suitable for TRT then recipients often notice fast, dramatic positive improvements in symptoms and quality of life.
What are common signs of low testosterone levels?
Men and Women:
- increased body fat
- decreased muscle mass
- brain fog
- loss of height
- loss of confidence
- sleep disturbances
- inability to stay asleep
- sleep apnea
- Low sex drive (libido)
- Difficulty concentrating
- lack of morning erections
- lack of energy
- Weak Erections
- inability to maintain an erection
- frequent urnination at night
- Erectile dysfunction.
- Body and facial hair loss.
- Pelvic floor pain
- How does the body produce testosterone?
When a testosterone (temperature) drop is detected by the hypothalamus/pituitary (thermostat) a signal (LH/FSH from pituitary) goes out to tell the testicle/testes/balls (heater) to switch back on and produce testosterone (heat).Once the testosterone (temperature) climbs back up to the required/set temperature it is detected and the signal that caused the increase to begin with drops/switches off. This continuously happens in the body, much like heating in a house, to keep levels of testosterone relatively stable.
The LH/FSH (Gonadatrophin releasing hormones) not only tells the testicles to produce testosterone but also sperm. When the cells in the testicles are stimulated it allows testicular size to be maintained . Without this signal, which can be blunted by taking testosterone alone, then the activity of the Leydig cells can lower and sometimes cease. When this happens testicular atrophy can become apparent. This can be prevented using HCG or recombinant LH and FSH as an adjunct whilst on male testosterone replacement therapy.
In summary your sex hormones (testosterone and oestrogen) along with your gonadotropins (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. This process keeps the testes functioning and healthy.When you start Testosterone Replacement Therapy your doctor will be taking control of your insufficient production of testosterone and optimising it. The naturally regulated process will still occur but to a lesser degree. You and your doctor determine how much, how often and how much testosterone your body receives. Age related Andropause or adult hypogonadism blunts your natural hormone production and this is treated with balanced TRT with or without HCG.
What are average testosterone levels for men in the UK?
The average man’s testosterone level can vary. We know from lab reference ranges that the levels are anywhere from 8nmol/L to 32nmol/L. It’s quite a large range which doesn’t delineate between those who are truly deficient and those who are optimal. Falling within the range does not mean that you are not without testosterone deficiency and certainly does not necessarily mean you are optimal. The lab reference ranges are intended to be a guide. The ranges are usually developed by the labs and includes sick as well as healthy patients. It defies logic that those who fall outside of the range are deemed as not having testosterone issues and are told they are not candidates for treatment from the traditional sickness focused health care models in Europe and the UK’s NHS. Many men and women suffer needlessly as they are told it’s just in their head.
We know from previous studies using a non-diabetic population that the average testosterone level for a 30 year old is 21.5nmol/L. Those who are blessed with more generous levels of testosterone or those in the 95 percentile who are non-diabetic have average testosterone levels around 32.8nmol/L.
- 25-29yo average male has a total testosterone level of 23.2nmol/L
- 25-290yo 95th percentile male has a total testosterone level 32.8nmol/L
What causes low testosterone?
When assessing someone for low testosterone one must look at their total and free levels. and not just their total alone. These can be can compared to the laboratory Reference ranges but doing this does not tell the whole story. Reference ranges merely combine all patient data from tests that have been taken. This includes everyone from all ages, quality of life, medical backgrounds and lifestyle factors.
This will include co-morbidities like diabetes and cardiac disease, people from all walks of life with good and bad diets, no alcohol intake to high levels of alcoholism, drug use or smokers. These laboratory ranges do not reflect optimised health range and should not be used to determine if one needs TRT. Experiencing symptoms primarily and a comparison of your hormone levels to the average range of a healthy 20 year old is the preferred way to determine if you are optimal and if TRT may be required. Time of day can also influence testosterone levels. Levels taken at the end of the day may appear lower than when taken in the morning.
Medical laboratories define low TOTAL testosterone as anything less than 7.20 nmol/L. In recent years some laboratories have lowered this level by shifting the range so that only any level below 7 nmol/L is considered below the range.
We know that for those under the age of 40 testosterone tends to be slightly higher in the morning and lower in the evening. Over the age of 40 however, there, tends to be more variability in this trend. Those who do shift work may see a different pattern as disruptions in circadian rhythm can change when and how your testosterone is produced. This is called the diurnal rhythm. There are also seasonal fluctuations of testosterone where testosterone can be lower during various times of the year. How these factors effect testosterone are either by affecting testicular function, affecting the signal from the brain to the testes or may be idiopathic and of an unknown nature. Whatever the cause, low testosterone can decrease your quality of life.
Testicular issues that can cause low Testosterone
- Varicocele are bundles of veins that can prevent heat loss from the testes which is sub-optimal for the production of sperm and potentially testosterone.
- Blunt trauma causing damage to the testes(testicles)
- Testicular Cancer
- Hydroceole causing inflation.
- Removal of Testicle/testicles
- Undescended Testicles
- Mumps causing orchitis or inflammation of the testes.
- Pituitary Gland issues that can cause low Testosterone
Elevated prolactin or Hyperprolactinaemia is often insidious in that it subtly removes much of ones sexual desire and can lead to impotence and low testosterone. It can be caused commonly by a pituitary tumour called a Prolactinoma. These are often benign but can cause other problems like headaches and vision issues alongside other hormonal effects. Prolactin is produced in women and it helps the mammary gland produce milk for offspring. In men this hormone can wreak havoc on desire, sex drive, and erectile function if too high. If your Testosterone is around 3-4nmol/L it is best to have prolactin measured and, if elevated, an MRI scan of your brain may be warranted. Other causes for elevated Prolactin can be hypothyroidism, low subclinical hypothyroidism, from medication such as SSRIs, or proton pump inhibitors used for acid reflux or heart burn”.
Pituitary dysfunction where your HPTA axis stops releasing or slows down the release of gonadotropins LH and FSH that stimulate your leydig cells in your testes to produce testosterone. This causes low Testosterone and can be caused by head injury or other unknown causes.
Other Causes of low testosterone
- Lack of sleep or shift work
- Thyroid issues. Hypothyroidism can sometimes mimic the symptoms of low testosterone and when thyroid hormones are optimised testosterone levels can recover as well as reducing the levels of prolactin.
- Exposure to toxins, chemicals in the air and water and the environment
- Street drug use can diminish testosterone.
- Licroice root overconsumption
- Certain prescription drugs for heartburn may raise prolactin and potentially lower testosterone (ranitidine/omeprazole)
- Overtraining in the gym can lower testosterone levels.
- Marathon running can lower testosterone.
- High blood glucose can lower testosterone.
- Too many refined carbohydrates
- Genetic conditions such as Klinefelter syndrome, Kallman Syndrome, Prader Willy Syndrome, Myotonic dystrophy, haemachromotosis
- Age can affect testosterone levels as leydig cells in the testicles decrease with age
- Alcohol, beer, your favourite IPA
Does TRT cause prostate cancer?
There is no credible evidence to date that testosterone causes prostate cancer. Below are some of the latest studies considering prostate cancer and TRT. The researchers in these studies may not directly advocate TRT for men with diagnosed prostate cancer since this isn’t actually their job (clinicians have to do this) but in every study the researchers clearly imply that TRT is safe and beneficial for those men.
In the presence of a low SHBG level, testosterone enters prostate cancer cells at a faster rate, forcing them to inactivate and efflux testosterone out at a faster rate also. This phenomenon provides extreme stress to prostate cancer cells leading to significant changes in their morphology associated to cancer cell death (growth inhibition/proliferation). This reflects that the testosterone is needed for prostate health.
Does TRT increase risk of heart attack/stroke?
There are mixed studies on the risks and benefits of testosterone treatment and the effects on the heart. There is a passionate debate amongst practioners and researchers alike around the use of testosterone in ageing men and women. With the studies published there may be bias either for or against testosteroen treatment. There have been studies showing a link between heart attack and stroke and there have been studies showing that Testosterone treatment may reduce the incidence of heart attacks or stroke. Some of the studies which showed a link between testosterone treatment and heart issues had underdosed men to the point of having no benefit at all. The types of studies and the way they are set up have been critically analysed by some forward thinking doctors in the USA to uncover deceptions in the data. Some recent studies putting testosterone in a bad light used composite prescription data which failed to discern if the prescription was actually taken after being dispensed by the pharmacy. Without proper controls you can’t be sure the patients in the study even took the treatment prescribed. Some in the medical community seek to diminish the benefits of TRT and use outdated evidence or inconclusive evidence to link testosterone to heart issues in order to scare the public or misinform them.
In the past there were some researchers making claims that Testosterone was linked to heart disease. Some argued that since women lived longer than men and women had less testosterone then somehow testosterone was to blame. It was false logic and not backed by any solid evidence. What we do know from recent studies is the link between low levels of Testosterone levels in men and a link to a greater risk of cardiovascular disease.
- Low Testosterone shown to be associated with an increased risk of all cause mortality independent of numerous risk factors.
- Serum tetosterone levels were inversely related to mortality due to cardiovascular disease and cancer. This means the lower the Testosterone level the greater the risk.
- Haring, R., et al., “Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20-79,”European Heart Jour 2010; 31(12):1494-1501.
- Vermeulen, A., “Androgen replacement therapy in the aging male—a critical evaluation,” Jour Clin Endocrinol Metabol 2001; 86:2380-90.
- Hyde, Z., et al., “Low free testosterone predicts mortality from CVD but not other causes: TheHealth in Men Study,” Jour of Clin Endocriol and Met2012; 97(1):179.
- Guder, G., et al., “Low circulating androgens and mortality risk in heart failure,” Heart 2010; 96:504- 09.
- Jankowska, E., et al., “Anabolic deficiency in men with chronic heart failure: prevalence and detrimental impact on survival,” Circulation 2006;114:1829-37.
Will TRT cause my prostate to grow?
Prostate growth is normally referred to as Benign Prostatic hyperplasia. It is a benign condition and is not to be confused with prostate cancer. The growth of the prostate can put pressure on the bladder and may cause frequent urination which can be disruptive.A hormonal imbalance is often the cause. In the past it was easy to blame testosterone but it’s more likely to be the metabolite of Testosterone, Oestradiol, and the ratio of androgens to Oestradiol that may be the real culprit of the enlargement. It may also be due to the local activity of the aromatase enzyme in the prostate causing an overgrowth of the stromal cells which are mostly responsible for the growth of the prostate(BPH). It’s been found that using an aromatase inhibitor could help prevent this growth. Low dose cialis in has also been proven to reduce the symptoms of BPH and acts as a mild aromatase inhibitor.
Will TRT cause hair loss?
Testosterone therapy on it’s own may not be the main cause of hair loss but once your Testosterone levels are corrected to the correct levels for a man of your age, then you may be susceptible to male pattern baldness as is any other man.Hair loss is not caused by testosterone or DHT (produced from testosterone) alone. Your genetics determine whether you will lose your hair. If you have the genes for hair loss you will lose your hair regardless. Having optimal levels of testosterone and DHT will allow you to optimally express those genes you already have and you will lose hair at an optimal rate. In the same way that if you have the genes for hair loss and you were to remove your testosterone and DHT this may slow the process, emphasis being slow (as your genes sill cause you to lose your hair anyway). Doing this however would obviously cause awful symptoms of a low androgen state and cause negative health effects.
If hair loss is a worry for you then it is really a choice you have to make and balance the benefits versus the risks of TRT. In our experience clients that had initial worries pre TRT, once they feel the therapeutic benefit of testosterone, fell less worried about this issue once on therapy. There may be options to lessen the affects of hair loss if you are prone to it. The doctor can discuss this with you should you have concerns. These can include other medications. Others may opt for hair transplantation products such as (Regain®)monoxidil.
Will TRT cause my balls/ testes/(testicles) to shrink ?
Will testosterone replacement therapy cause my penis to shrink?
Low testosterone may cause the penis to atrophy replacing smooth muscle fibres in the corpus cavernous with with collagen. This would affect both size and function of the structures of the penis. Micro-penis occurs in an environment of low testosterone in the womb and treatment with androgens may help reverse the shrinkage.
Does Testosterone impact the growth of the penis? Will TRT make my penis bigger?
Testosterone is a natural substance made primarily in the male testis From the scientific data the natural molecule called Testosterone is known to be responsible for the masculinisation of secondary sex organs during puberty and other stages of development including in the womb and shortly after birth. Testosterone is responsible for the growth and maturation of the male genitalia. There is evidence from the scientific literature that there may be a correlation between testosterone treatment for microphallus and normalisation after treatment. There is no current indication on the package leaflets of testosterone products to warrant such a claims and use in various studies around the world is strictly off label use. The androgen receptor is present in the penis and in the corpus cavernosum which are the chambers that fill with blood when an erection occurs. These chambers of smooth muscle can atrophy and be replaced with collagen when testosterone levels are low which may cause issues like venous insufficiency and difficulties maintaining an erection. As a result there may be a certain amount of perceived penile shrinkage when testosterone levels are low. Having adequate amounts of testosterone may help improve your smooth muscle cells restoring their function and perhaps bringing you back to where you would have been if your testosterone was optimal. TRT most likely will not make the penis of an adult male longer. The manufacturer of Testosterone Cypionate, a testosterone prescription only product available in the United States, in the leaflet that accompanies the medicine, states that a potential side effect in adolescents or children may be increased erections or may cause phallic enlargement. There is no evidence that testosterone therapy will enlarge you penis.
What are the side effects of TRT?
If TRT is managed and administered properly the side effects can easily be avoided and quickly dealt with if they arise. Testosterone use, if not monitored properly or if used in excess, may cause some unwanted side effects. These can be an increase oily skin, fluid retention or oedema, hair loss, hair growth, enlarged breasts, enlarged clitoris (in women), gastrointestinal symptoms, drowsiness, acne, irritability and mood changes. If treatment is provided as an injection, it is possible one may experience soreness or pain and possible infection at the injection site.
If extra fluid in the body occurs as this can cause problems for patients with pre-existing heart, kidney, or liver disease.
There may be sleep disturbances, slight insomnia or an undiagnosed sleep apnea may become apparent/exacerbated. Sleep apnea is more likely to occur with patients who have lung disease or are overweight.
If a person receiving TRT does not monitor oestrogen and it climbs too high in relation to the levels of androgens then some may experience benign prostate enlargement which may cause problems with urinating or cause an urgent feeling to urinate even if the bladder is empty. There may be changes in cholesterol levels, red blood cell levels, PSA levels, liver function enzymes, and other hormone levels, which will be monitored with periodic blood tests. It is important whilst on TRT to have periodic blood tests to monitor various blood levels for hormones and other health indicators. If treatment is stopped symptoms associated with low testosterone may return or get worse. Long term testosterone replacement therapy may reduce ejaculate volume and reduce sperm count, possibly affecting fertility especially if HCG, HMG or exogenous gonadotropins is not used concomitantly. Whilst rare there may be an increased chance of hair loss or thinning especially if one is genetically predisposed to this.
Are there alternatives to TRT ?
There are alternatives to TRT. Without trying to sound smart, the first option is to do nothing and wait to see if things improve. Some attempt to adjust lifestyle factors such as diet and exercise. We often find however that if your body is not producing effective levels of testosterone then doing these things is often ineffective and can make symptoms worse. The second is to speak to the doctor about whether you personally (following blood test etc.) may be suitable for a therapy that may boost your own levels if effective. This can be the use of a SERM or HCG alone to try and improve responsiveness of the testicles. This option sometimes works in younger men but often therapeutically it lacks effectiveness. The third is the possibility of being treated to change your SHBH which is some men can improve symptoms. To discuss a blood test, getting a blood test or whether you may be a candidate for TRT or an alternative contact us and book in a call.
Does TRT cause infertility?
Testosterone is critical for the production of sperm but what is more important is where in the body this testosterone is located. Intra-testicular testosterone (the testosterone with in the balls/testes) are present at levels 100x greater than the systemic circulating Testosterone (as measured by a standard blood test). When receiving TRT with exogenous testosterone you provide the body with the testosterone it needs BUT this doesn’t increase intra-testicular testosterone. Actually the contrary happens. The brain detects that there is enough testosterone (as you have provided this via injection or cream etc.) so it switches of the signal (LH and FSH) from the brain that tells the testicles to produce testosterone and sperm. This causes a drop in intra-testicular testosterone and sperm production which can reduce fertility in some men, despite having good levels of systemic circulating testosterone.
HCG can be used alongside TRT to restore the signal from the brain, increase intra-testicular testosterone and restore/maintain sperm count. This is why our Doctors at Balance my hormones provide HCG alongside a balanced TRT protocol to maintain fertility whilst optimising testosterone and other hormones.
So testosterone treatment on its own or with anastrozole may be even easier to recover from should fertility be desired and HCG is not available or wanted when starting TRT.
Can I maintain fertility on TRT
One way to maintain fertility whilst on TRT is to keep a very high level of testosterone within the testes. This is achieved by ensuring the testes produce testosterone locally. The most common and cost effective method is to add HCG to a TRT protocol and ensure estradiol is managed. HCG mimics the actions of gonadotropins LH and to a lesser degree FSH to maintain fertility. Many of our clients choose Balanced TRT with HCG and oestrogen control so they can essentially have both the benefits of exogenous Testosterone whilst keeping the signal to the testes present.
Can I take HCG on it’s own
Some men may choose for various reasons not to start full TRT with exogenous testosterone. For some men who have highly efficient testes, adding a stronger signal than the brain can provide, via HCG or HCG combined with HMG, can help provide enough testosterone without adding and outside exogenous source from injections or creams. We have had a few of our patients opt for this. Exogenous HCG causes milder suppression of the HPTA axis than exogenous Testosterone does. In one paper in 1978 it actually showed an improvement in LH from the pituitary whilst on exogenous HCG. Whilst on HCG the signal the testes receives is amplified and you can have an increase in testosterone levels if the testicles respond. There are cases where the testes are inefficient at producing testosterone despite the signal reaching it. This is called primary hypogonadism and in these cases HCG will not help you make adequate amounts of testosterone and you may still be rendered hypogonadal. In these cases the doctor would recommend exogenous Testosterone, with out HCG.
Does TRT or HRT have an anti-ageing effect?
We know from studies that the telomeres through the actions of hormones may have an anti-ageing effect. One study recently published, shows women on long term HRT had the longest telomeres. It is thought that longer telomeres are associated with longer lifespans and greater potential longevity. Shorter telomeres are related to ageing and disease.
Testosterone has been shown to increase the production of an enzyme called telomerase. This enzyme keeps the telomeres from shortening and thereby having an anti ageing effect.
Can TRT help grow my facial hair?
Testosterone is the precursor hormone for Dihydrotestosterone or DHT. DHT is the androgen responsible for masculinising features including the growth of facial hair during puberty in males and menopause in women. Men with low testosterone may complain of lack of facial hair. Anecdotal as well as published evidence suggests some role for testosterone and facial hair growth. This is multifacetd and genetics may play a big part in hair growth as well as auto-immunity. Some of our clients have noticed increased facial and body hair growth after starting TRT treatment. For some clients despite having more than doubled their Testosterone levels from baseline and after more than a year still had some patchiness or areas of no hair on their face. These cases are usually due to the lack of hair follicles in the area of the face and also due to a genetic predisposition of not having thick beard hair growth.
I have a patchy facial hair and I can’t grow a beard. Does this mean I have low testosterone?
No not necessarily. Men who can’t grow a beard or have patchy beards usually have normal testosterone levels. There is a perception that men with little facial hair do not have sufficient or may have low testosterone but this is usually not the case. Hair growth on the face and elswhere have much to do wiht the sensitivity and distribution of the hair follicle and androgen receptor and its sensitivity to androgens.
Testosterone is the hormone responsible for growth and maintenance of lean muscle mass. Having optimal levels of your own natural testosterone levels may help improve your ability to build muscle and lose fat more easily in comparison to being deficient in testosterone. These effects are amplified when the body produces optimal testosterone levels. Of course those who are gifted with above average levels of natural testosteorne and combine that with an effective exercise programme and diet may find increase in lean muscle mass. This characteristic of testosterone is also why it was investigated and used medically for some people experiencing muscle loss through illness or trauma. In recent times because of the potential for abuse testosterone as a therapy is strictly controlled and is not reccomended by the manufacturer of various products. The use of testosterone therapy for muscle building is strictly prohibited and discouraged by the medical community and doping agencies.
Whilst testosterone and it’s anabolic cousins have been used medically for cacachia or muscle wasting in the past, or severe burns, the general trend has been to prescribe this in only the most rare cases for this use which would be an unlicenced use for testosterone.
Does low testosterone cause fatigue? Can TRT help with fatigue?
Fatigue is one of the symptoms mentioned by patients who also have suboptimal levels of testosteorne. Fatigue can be related to many other conditions besised low testosterone. A full hormone panel can help your doctor discover which hormones may be out of balance. There are anecdotal cases of Testosterone treatment improving or helping improve symptoms related to fatigue but the doctor will need to get to the source of what is causing fatigue. There are cases of non Testosterone related fatigue due to other factors, such as lack of sleep, stress, or hormone deficiencies like cortisol, and thyroid which may need to be addressed separately. We’ve heard from some patients who have self reported impovments in their fatigue symptoms after TRT. Some have reported being able to get through their day without coming home from work and crashing on the sofa. We cannot make the claim due to strict UK censorship laws that testosterone treatment will correct fatigue as improvments in symptoms of fatigue after starting testosterone treatment may be due to many factors some not related to testosterone deficiency. In addition, the symptoms of low testosterone and low thyroid may overlap with one another and thyroid hormones may be prescribed in addition to testosterone treatment if there is an underlying or masked hypothyroidism.
Does TRT cause man boobs (gyno)(gynocomastia)?
In the male body, testosterone converts into oestrogen through a process known as aromatisation.
And when testosterone rises, so does oestrogen. But if there’s too much oestrogen in the body, this can cause nasty side effects, including:
- Gynaecomastia (Man boobs)
- Swelling / Puffiness
- Poor erection quality
- Moodiness and irritability
- Water retention
- Poor libido
- Oestrogenic body fat deposition
This is one of many factors that needs to be monitored closely on TRT. Levels will be checked before and during TRT regularly to ensure symptoms don’t arise from too high (or too low!) Oestrogen. This way they can often be prevented and if they do occur then quickly and effectively treated.
These side effects can usually be managed quite easily if they come up. Balance My Hormones can facilitate sensitive estradiol tests for men to give a true indication of your estradiol level.
Can TRT improve interest in sex (libido)?
The answer is yes. People with low testosterone often see a massive improvement in libido once levels are optimised. It must be noted however that libido is multifactorial. Testosterone is one of the hormones responsible for sex drive in both men and women. Many chemical pathways can affect desire. Having optimal testosterone is only one of many factors. There are occasions where levels of testosterone are optimised yet people still have lack sex drive. In these cases it is key to work closely with the doctor to look at other causes.This can be balancing of other hormones, other medical issues including effects of medication past or present, environmental issues or psychological issues/past trauma. This can be investigated and treated accordingly.
What blood tests are needed for TRT in the UK
The world of testosterone replacement therapy is often difficult to navigate. It is filled with misinformation and bro-science on forums. You may have many of the symptoms of low testosterone, but confirmation is needed via blood tests. When undertaking this next step you must be tested for the right things. Testing for testosterone alone will not tell the full story the reason being your body is complex and hormones don’t work in isolation.
Going to your NHS doctor for a blood test is the first port of call for most men. The problem is, they often lack specialist knowledge in hormones – especially testosterone.
Often they dismiss your symptoms out of hand – because you ‘don’t need to worry’ about testosterone and if you do manage to get a test through the NHS, they usually don’t test for the right things anyway.
So what’s the alternative?
We offer a comprehensive hormone panel that can be done from the comfort of your own home at competitive price.
We recommend this hormone panel for individuals that want to find out what’s going on, and who are perhaps unsure if TRT would be for them.
The hormone Pre-TRT panel tests for:
- Serum testosterone
- Free testosterone(calculated) as assays tend to be unreliable from lab to lab
- Sex Hormone Binding Globulin
- LH-Luteinising Hormone
- FSH-Follicle Stimulation Hormone
Hormones are the foundation of your health as a man, and testosterone is central to that. Creating a picture of the hormonal system with your body and how effectively it is working
is the first step on the road to getting symptomatic relief
COMPREHENSIVE TEST FOR CONFIRMATION AND TREATMENT FOR TESTOSTERONE DEFICIENCY
A second test is also required to ensure the safety of starting TRT and to create a clearer picture of the consistency of levels of hormones in your blood.
The tests required give you a picture of how the rest of your body is working. The test will check things like Haematology including red and white blood cells, Biochemistry, Liver function, Kidney function tests, Lipid levels, PSA, Testosterone, SHGB, Oestradiol, Prolactin and a Full comprehensive thyroid panel.
What are HIGH SENSITIVITY OESTRADIOL BLOOD TESTS or LC-MS or Liquid C Estradiol Tests?
Standard testing for oestradiol uses a technique that may provide a slightly different result than the LC-MS test used in the US. The standard oestrogen assay via RIA(Radio Immuno-Assay) method whilst the standard in the UK is falling out of favour with TRT providers in the United States and elsewhere.
The standard RIA Oestradiol test is a very precise tool however it may lack accuracy to the gold standard LC-MS. In other words every time we measure your oestradiol with RIA test then there may be slight fluctuations but you can still create a useful picture of where your Oestrogen sits and when comparing to symptoms can guide adjustments in therapy. There are times when the levels are borderline or whether symptoms demand it that would warrant the use of the high sensitivity Oestradiol test using LC-MS method.
Balance My Hormones can arrange to have these blood tests done through a specialty lab. Often people will use the same blood sample to test the RIA tests and LC-MS test for comparison.
How much does TRT cost in the UK?
TRT can cost anywhere from your time and excess prescription fee from the NHS or thousands of pounds at private insurance based clinics.
Balance My Hormones offers sustainable support packages that focus on support through the process. Our introduced Doctors and experienced medical case manager team act as patient to patient advocates, and a support structure whilst you are going through your journey of TRT.
Contact the team today to discuss potential costs
How do I get TRT in the UK with the NHS?
Because of its centralised structure, it is usually shacked and inflexible when trying to treat patients for low testosterone.
First you should to visit your GP to explain your symptoms you’re experiencing. Depending how sympathetic they are, they will send you off for a testosterone blood test.
They will normally send you for two lab tests to confirm a diagnosis of low testosterone. Tests are typically done before 9am, which in theory is when testosterone is at its highest.
Once the GP gets the lab results back confirming you have low testosterone, they will refer you to an endocrinologist.
The endocrinologist upon examination and review of your labs that must fall with in a narrow unforgiving reference range of under 6 nmol/L in some cases may then reluctantly prescribe you TRT treatment usually in the form of a 4ml slow release testosterone injection once every 4 months which leaves you in a hypogonadal state for a third of the time, or. topical that does not provide enough testosterone.
Generally speaking, the NHS standardised model of care works well for many medical conditions. Patients visit their doctor with symptoms and have tests to validate the symptoms, they are then treated accordingly.
However, the NHS has serious flaws when it comes to treating a condition as nuanced as low testosterone. The need for an underfunded service to always be comparing cost to efficacy limits this provision.
Firstly, most doctors, let alone GPs are not well informed on testosterone replacement therapy. So you might end up being treated for depression with medication instead of a testosterone deficiency.
Although you may have open-minded GP who is willing send you for further tests, if your blood tests show your total testosterone within the so-called ‘normal’ range, then in most cases you’re out of luck. This is because
doctors are trained to treat for testosterone deficiency only when patients’ testosterone levels are outside the normal reference range regardless of their symptoms.
Even if they want to help, their hands are tied.
If you do manage to get a referral to an endocrinologist, you may have to wait several months for an appointment. Furthermore, once you do get to see an endocrinologists, there is no guarantee you will get the right type of treatment.
The method of treatment tends to vary significantly between specialists. Some may prescribe testosterone gels to their patients, whereas others may ask you to inject every 2 weeks (help!) or a massive injection every 12. Every one of these options either leaves you with periods of high then low testosterone or not enough from the therapy at all. The NHS will not monitor oestradiol levels, and rarely will they monitor prolactin or free testosterone levels. We have even seen men end up with lower testosterone levels ON therapy than before they started!
This entire process could take many months.
For those that do receive effective testosterone treatment on the NHS are very fortunate. But there are many that fall foul of the standard care model and end up frustrated because they cannot get treatment or get a treatment that causes them to feel worse than before.
There are no doubt GPs and endocrinologists in the NHS who do an excellent job. But in order to qualify for testosterone replacement therapy on the NHS, patients have to jump through countless hoops as described above. It can be a painful time-consuming process where you will either feel like you have been fobbed off or if you are extremely lucky and find a doctor that knows how to provide TRT effectively then it can feel like hitting the lottery.
Using the Balance My Hormones as your support and introductory service you won’t have to wait months to see a specialist. You can get the process started with an open-minded and experienced hormone replacement therapy doctor.
You can get approval for treatment in as little as 48 hours if you have all the appropriate blood tests and forms complete. If you don’t get a diagnosis for TRT then you don’t pay the doctor’s fee. And we aim to treat our clients as individuals – not just as a lab number.
What’s more, you don’t always have to go out and physically visit your doctor. You can have a remote consultation in the comfort of your own home that is flexible and fluid once a relationship with your doctor is established.
The service is concierge so you have the doctor’s email address if you have questions. Also staff at Balance My Hormones are always on hand to assist in other aspects related to supporting you through your TRT journey. So if you think you’re suffering from the symptoms of low testosterone, get in contact with us today.
How do I get TRT on the NHS? Will my GP prescribe TRT in the uk?
In our experience many of our clients come to us following a search for an open minded GP that had then referred then to a consultant endocrinologist. This usually takes 6-8 months. After having seen the consultant and having further tests which may show levels above the NHS threshold for treatment they are often simply fobbed off and told there is nothing wrong and treatment is withheld. This not only is disappointing for the client but it exposes them to s further 6-8 months of low Testosterone symptoms. We have heard from clients who had gone to the NHS and were refused treatment despite them having total levels of testosterone as low as 6 nmol/L.
If attempting the NHS route you would have to find an open minded GP that is willing to treat you. For this you would need two blood tests that show levels under the NHS threshold for treatment. Even if this happens your treatment options will likely be a 4ml large injection every 12 weeks (NEBIDO) or a low strength Gel (ANDROGEL or similar alternative). Neither of these options show great efficacy in practice, they cause fluctuations in levels or don’t provide enough Testosterone at all. In rare cases we have heard that Sustanon has been used but only dosing every 2-4 weeks. So even if you get one of these options the NHS will not monitor Oestradiol (oestrogen) levels and rarely will they monitor prolactin or free testosterone levels.
How to get private TRT in the UK and Europe?
There are private doctors who may be willing to prescribe TRT. Some can be found on Harley Street or in a few towns and cities throughout the UK. It can be a bit of trial and error trying to find the doctor with the right understanding of modern TRT.Balance My Hormones was founded to take the guesswork out of the equation and allow finding an effective TRT/HRT doctor easy. Many doctors may only deal with a part of TRT and be unable or unwilling to help you when you have unwanted side effects. Our associated doctors are experienced and together we have help hundreds of patients to date.
Balance My Hormones is a unique service which combines an online platform with full support level of service for clients looking for assistance with accessing TRT in the UK and Europe.
Balance My Hormones is under the supervision of independent medical doctors, and pharmacists and as such provide administrative and logistical support in a seamless way as a conduit between the patient our clients and the private independent doctors, pharmacies and laboratories. Balance My Hormones brokers and provides adult safeguarding and patient to patient advocacy support whilst creating an open environment to discuss personal experiences and the collective experience of others on TRT so as one who is new to TRT , you don’t have to feel that you are going through the process by your self.
Many times with traditional doctor practice set ups there just is not the support capacity. The balance my hormones team is there to provide this support and coordination and reassurance. We offer support to both clients who are our doctors patients and health care providers. Balance My Hormones does not act as the provider of care nor do they diagnose or treat medical conditions.
Our clients are at all times are diagnosed, treated, and monitored by their assigned doctor and the use of our medical case managers to assist our doctors in the logistical and administrative tasks. Our medical case managers are either have personal experience or formal training in hormone therapy and some have previous health care experience with the NHS, or in private healthcare and they may have been patients on hormone therapy as well. Having this background can offer a unique insight that you will not find anywhere else in the UK and Europe. TRT Medical Case Managers will help you complete your patient intake forms and help get you efficiently to blood testing services and then introduce your to your doctor and coordinate with the pharmacy.
All of the logistical parts are handled by our staff so you don’t have to collect at the pharmacy. You can get the process started by contacting us and filling out a confidential online form.
Will Brexit affect getting TRT in the UK?
Brexit has the potential to affect many elements of society and commerce. The government has been making preparations to stockpile products being imported into the country. Our pharmacy partners are aware of this and have been “Brexit-proofing” in anticipation of potential supply chain issues.We recommend all of our clients keep a surplus as a backstop against potential shortages at any time. Even the government has admitted to plans to stock pile medicines in the event of a No Deal Brexit.
For our European clients we have an EU partner pharmacy, and doctor partners in Europe.
There is a good chance TRT will be available but preparations for the event of a no deal Brexit is the most prudent course of action. We can work with you, the doctor and pharmacy with logistics of future issues.
Do I have to be on TRT for life?
This is a common question/concern. In this situation the question that must be asked is what the alternative is. The options being to continue as you are with sub-optimal or dangerously low levels of testosterone for life with all the symptoms it causes or would you like medical treatment to optimise these levels and bring symptomatic relief.
There are Testosterone boosting protocols other than TRT but stopping these therapies does not often sustain the increase in levels achieved. You may be worried about the perceived dependence of having to take a hormone for life to allow symptomatic relief and bring about health benefits but if it allows all these things it must be considered against the alternative.
Another common question is if your body can start making testosterone again on its own after discontinuing treatment. In nearly all cases and from the literature the answer is yes. It takes time with the median being 3.5 months but we have seen from experience that within a few weeks those that stop can recover to at least the baseline from where they started. It must be noted that the baseline was insufficient and was causing symptoms however.
A common and antiquated opinion is that cycling testosterone is beneficial but there is no benefit for going on and off testosterone. It just causes periods of hormonal deprivation, disrupts homeostasis and caused Hypogonadal symptoms to come back.
What happens if I stop TRT? What happens if I need to come off TRT?
If testosterone replacement therapy relieves your symptoms of low testosterone, then often ceasing will cause symptoms to recur. It is for this reason that TRT is usually a lifelong commitment. This may sound daunting, but once you feel the symptomatic relief and benefits of testosterone therapy, stopping treatment often becomes less of a concern.
Should you need to stop TRT there are ways to assist the body in producing its own levels of testosterone faster than just stopping TRT alone. In some studies the median time for recovery of sperm is around 3.5 months. Testosterone production can return in some individuals in as little as 3-6 weeks. Factors affecting how quickly your testosterone will return depends on the original strength or signal from the pituitary gland (Leutinising Hormone and Follicle Stimulating Hormone), and how sensitive or efficient your Leydig cells (testosterone producing factories) located in your balls(testes) are.
In our experience this can occur quite quickly. It must be noted that if you are starting from a low baseline before beginning TRT restoration back to this lower level is likely all you will achieve.
What if I can no longer afford treatment?
You are under obligation to continue treatment. It is a private service and therefore a personal choice. However, in the grand scheme of things our treatment packages are affordable and sustainable and priced around your budget and medical advice from the introduced doctor. Please contact us and we can work with you and the doctor to find a package that is right for you.
What is the best type of TRT in the UK and Europe?
The best type of TRT depends on what is best for you the client as determined by symptoms and blood testing and discussions with the medical facilitators and doctors.
Some prefer injections, some prefer topical formulations. The doctor can determine administration dose and frequency depending on blood tests, age, medical history etc. It is highly individualistic the type of treatment that may be needed and a careful process must be undertaken to find what is best for you.
Injectable Testosterone Preparations
- Sustanon®(Aspen), testosterone propionate 30 mg, testosterone phenylpropionate 60 mg, testosterone isocaproate 60 mg, and testosterone decanoate 100 mg/mL. If you are allergic to peanuts or benzyl alcohol then this preparation would not be for you.
- Testosterone Enantate or Testosterone enanthate(Non-proprietary) , testosterone enantate 250 mg/mL dosed 250mg every 10-14 days- this is a more expensive option as there are limited manufactures in the UK. If you are allergic to castor oil, or benzyl benzoate then this would not be for you.
- Testosterone Propionate 100mg/2ml 2-mL amp Short Acting Testosterone ester dosed 2-3 times weekly
Topical Testosterone Options
Bespoke bio-dentical topical testosterone for HRT and TRT
- Bespoke testosterone lozenges made in the right formulation for women and can be combined with bio-identical oestrogen’s and progesterone.
- Bespoke high concentration cream prepared by a compounding pharmacy
- Branded Testosterone Creams and Gels (often least effective)
Are higher doses of testosterone Dangerous?
Our doctors are looking to find the optimal dose of testosterone for you. Some men feel better with higher doses than others. The lowest effective dose is always preferred but this can vary between individuals. Factors such as age, metabolism, location of injection site, SHGB levels, can affect the ideal dose. Frequency and timing of dosing is often more important. Normal is a relative term. There is some variability between individuals, as some men may have had higher than average levels as teens and young adults only to have a lower levels as middle age men. These lower testosterone levels could still sit in the middle of the range but these men would have suffered a vast drop in the levels that the body is used to.
What would be a high dose of testosterone and is it dangerous?
Traditionally testosterone is prescribed at a dose of 250mg every 2-4 weeks. We know this treatment regime leaves a man with large peaks and low troughs. This roller coaster effect is not optimal, cause unwanted symptoms and should be avoided.
A more current dose would be 100-125mg of injectable testosterone every 5-7 days.
What would the effect of an even higher doses be on fertility and and safety?
A 1990 study looked at the safety of various doses in the range of 25,50, 100, or 300mg of injectable testosterone enanthate injected weekly. The conculusion was with exception of body acne, mild elevation of haemtocrit, weight gain no significant adverse health effects of chronic high dosage were found. In fact the 300mg dose did not reliably suppress the production of sperm. This demonstrated that even a 300mg weekly dose of testosterone would likely be ineffective as a form of male birth control. Whilst we are not advocating taking more than you need, it’s important to understand that Testosterone treatment doses can vary between individuals and when monitored by a doctor can be safe even at slightly higher doses.
Should Testosterone Replacement Therapy be offered on the NHS ?
How do I administer TRT and do I have to inject on TRT?
There are several ways to administer Testosterone Replacement Therapy. However, the most commonly prescribed methods are testosterone injections testosterone gels and testosterone creams.
Before undergoing TRT, it’s important to understand the main distinction between these methods. You should also understand the pros and cons of each, so you can make an informed decision on your treatment.
Transdermal Testosterone Gels and Creams
The reason they’re so popular is because they’re simple to use. They are usually applied to the skin in the morning and the evening before bed for best results. . Typical areas of application include; the shoulders, upper arms and scrotum. Gels and creams tend to come in various concentrations.PROS
- They are easy to use and apply
- Absorption through the skin cause testosterone levels to fluctuate, thereby closely mimicking the body’s own production
- Absorption through the skin may be inefficient, due to sweat, food consumption, etc
- May produce oily skin due to elevation of DHT and cause estrogenic side effects
- Unable to wash, swim or engage in vigorous exercise for hours after application
- Possible transfer risk to others
Intramuscular testosterone Injections
Testosterone injections are another form of commonly prescribed TRT treatment. It has been considered the standard of care. Treatment efficacy is dependant on the type testosterone preparation used, e.g. Sustanon, Enanthate, Propionate and administration frequency.
Testosterone can be injected one of two ways; subcutaneously (subQ) – i.e. through fat, or intramuscularly (IM). Doctors prescribe testosterone injections because of their predictability and titratable nature. This allows stability of blood testosterone levels.
- Injections allow testosterone to effectively reach the bloodstream, minimising loss of T through absorption that may happen with topical testosterone preparations.
- Helps to maintain stable levels of testosterone, avoiding so-called ‘peaks and valleys’ and is easily adjusted
- Doesn’t prohibit you from engaging in other activities
- Requires training to practice correct injection technique
- Takes practice before being confident filling testosterone into a syringe and self-injecting
- Using needles is daunting for some, and they must be disposed of properly
There is no right or wrong choice. Both injections and some topical formulations can be effective methods of treatment for low testosterone. The question is, which one is right for you? Ultimately it depends on your individual circumstances.
Using a topical formulation would be the easiest route for administering testosterone replacement therapy if you are not able to comfortably inject. They’re easy to apply with minimal hassle.
But if you are someone who leads an active lifestyle then they may not be for you. Sweating interferes with the absorption of the testosterone if you’ve recently applied it, requiring reapplication. Similarly, the topical formulation such as a cream or gel can be transferred to another person if contact with skin where it was applied. This is often why scrotal application can be beneficial.
Remember, any decision on treatment should always be taken under the supervision of a qualified doctor. If you want to book an appointment with a doctor to discuss testosterone treatment options, then get in contact with us.
Are there famous people or celebrities on TRT and hormone therapy?
Yes, we have made a blog post listing famous people on TRT.
Dorian Yates on TRT- former bodybuilder discussed the benefits of optimal testosterone on health for ageing men.
Balance My Hormones takes patient confidentiality seriously and would never divulge any of our clients details celebrities or not. We have helped many men and women from all different careers and walks of life optimise their hormones and health including: doctors, people in entertainment industry, law enforcement members of the military, executives in business and finance. We do not facilitate professional athletes and have a strict anti-doping policy. It really shouldn’t matter whether or not those more publicly visible are using testosterone if it is needed.
Is TRT the same as anabolic steroids?
Testosterone Replacement Therapy is medically restoration and optimisation of testosterone levels using bio-identical testosterone. The treatment aims to reduce the symptoms of low testosterone and to actually feel the absolute best you can. Options include testosterone injections, testosterone creams or testosterone gels, testosterone lozenges or testosterone pellets. These all contain testosterone and need to be utilised in a way that releases optimal amounts of the hormone in a steady and stable manner. Anabolic Steroids were developed for medical use. They were made by altering the structure of hormones, like testosterone to make them more anabolic and often less androgenic. Alongside testosterone these were used to maintain muscle mass and function in cases of people suffering with disease or episodes of illness or trauma that caused muscle wasting.
The testosterone molecule is the base model that Anabolic Steroids are built from.
As mentioned anabolic steroids are modified synthetic versions of testosterone that have similar structures but are not quite the same. They differ to testosterone in anabolic and androgenic effects. Androgen hormones bind to the androgen receptor. This begins a cascade of effects on the body. Like testosterone, anabolic steroids can fit into androgen receptor and activate it like testosterone can. Once bound the exert differing effects. Anabolic steroids vary in level of activity at the androgen receptor. Their effects are androgenic and anabolic at different ratios.Alongside this, Anabolic Steroids have different metabolites that also can cause other effects in the body.Some anabolic steroids improve nitrogen retention rapidly, leading to enhanced lean body mass. This can be at a greater degree than natural testosterone. They do not exert the same effects on the body that testosterone does so cannot be a substitute. They also will suppress the body’s natural testosterone levels causing impotence.
Anabolic steroids are used medically and in some cases as an adjunct to TRT. Nelson Vergel. mentions this in his book- Built to Survive where Anabolic Steroids were used with testosterone to maintain muscle mass in wasting diseases like HIV.
The base of TRT treatment is testosterone and long term use of only anabolic steroids may not always be ideal and is normally not recognised as the standard of care for TRT as a monotherapy.
How is low T (testosterone) diagnosed?
Low testosterone is diagnosed by looking at symptoms and confirming with blood tests. The doctor will need to at least 2 blood tests within the last 3 months. It’s important to have testosterone measured at 2 different time points. In addition to testosterone, the doctors will look at other values including SHGB, Free Testosterone, Oestradiol, and Prolactin.
A second test looking at a repeat of the first test plus Haemotology, Liver function tests, biochemistry, thyroid panel, and PSA are also needed.
How can I stop high oestrogen (estrogen) on TRT
Please check out our useful blog post on high estrogen in men
How is HCG used with TRT?
HCG can be used in many ways to enhance TRT. HCG is important as it mimics the signal going to your testes, from the pituitary, that stimulates Testosterone and Sperm. It is used alongside TRT to help maintain fertility and prevent testicular atrophy.
If responsive it allows steroidogenesis to occur where hormones are made from cholesterol in the testes. It allows intra-testicular testosterone(testosterone that is produced in your testes locally) to be produced. This can be reduced with TRT alone. High intra-testicular testosterone is needed to maintain fertility. Studies show when 500IU of HCG is used 2-3 times per week along with exogenous testosterone, in males fertility can be maintained.
In some cases HCG can be used at higher doses as a mono-therapy starting at 500IU every other day and, in rarer cases, as high as 3000IU every other day.
How quickly does TRT work?
Some notice a slight difference after the first injection or application and for others it may take a little longer. Usually energy is the first to come back, but others have mentioned noticing increased morning erections, improvements in mood, and lifting of brain fog.
Female client have reported feeling more assertive and increased sex drive. It’s very individual and making sure your hormones are balanced plays a big part in how quickly TRT will work for you.
What changes will I expect on TRT?
Some people experience increase in mood, energy, erections, sex drive, muscle growth, facial hair growth, body hair growth. Side effects may include mild acne, and some scalp hair loss. It’s all very individual. The majority of people see a massive improvements in symptoms associated with low testosterone.
What happens if TRT doesn’t help/work?
It is important to get blood tests regularly whilst on TRT. Frequent blood testing helps the doctor identify why your treatment may not be providing symptomatic relief. In some cases the doctor may alter your dose, dose frequency or add in ancillary medications to manage other hormone imbalances.
Can I cycle TRT?
TRT works best when it is used continuously. Cycling has connotations with illicit anabolic steroids in bodybuilding and really doesn’t have a place in TRT. Steady stable levels in the optimal range provide the best therapuetic benefits. Ups and downs of cycling may cause harm or frustrate the balance that has been created.
Can I take TRT with other medications?
There are very few contraindications and reactions with TRT and other medications. Our doctors will review your case and determine if any medications you are on will conflict with your existing medications.
Will TRT help with depression?
We believe so, check out our blog post on the link between low testosterone and depression.
Will TRT help anxiety?
Low testosterone can cause anxiety. Anxiety is multifactorial. Contrary to popular belief anxiety also extremely common. If low testosterone has worsened anxiety then optimising can improve these symptoms. If there are other contributing factors these can also be investigated and treated accordingly examples being talking therapy and counselling in conjunction with TRT, other hormone imbalances or medical issues Some studies have shown men with general anxiety disorder have had improvements with the use of TRT.
BMH clients who experienced anxiety before starting TRT have noticed improvements in their symptoms.
Can I have TRT with antidepressants?
Some anti-depressants can raise levels of prolactin. Hyperprolactinaemia (high prolactin) can be a cause of testosterone deficiency. If taking an anti-depressant, or other medications for that matter, then your TRT doctor will ensure it is suitable to begin TRT alongside these. Many of our clients have worked with their GP and our TRT doctor to wean off the anti-depressants as symptoms improve. Ideally you should not need to have an anti-depressant when on TRT but for some it is preferable, but be sure to consult with your GP or original anti-depressant prescribing doctor, and your Balance My Hormones facilitated doctor to find synergy for you.
One type of anti-depressant or note, should you need it, that has reported very few sexual side effects or raises in prolactin is Bupropion. It is not offered widely in the UK and is also known as the smoking cessation drug ZYBAN. This medication may be beneficial in increasing dopamine and improving mood and may even help you quit smoking. This particular anti-depressant is routinely prescribed as and adjunct outside the UK to offset the negative sexual side effects whilst on an SSRI anti-depressant.
A 2018 study looked at low circulating testosterone and the association with dementia. Previous studies were inconsistent. A prospective study was done looking at over 4000 older men who did not have dementia between 71 to 88 years of age. They found that men in the lowest quartiles of calculated free testosterone had an increased risk of developing dementia compared to those in the higher quartile. This study shows an association and further studies may help determine if Testosterone treatment can help ameliorate or prevent the risk of dementia in older men with low testosterone.
What is prolactin?
Prolactin is a hormone secreted by the pituitary for the purpose of lactation in women and after pregnancy. In men elevated prolactin can be a cause of erectile dysfunction, impotence, and low testosterone. All hormones are needed in the right balance but prolactin is ideal in men between 100-280 mIU/L. Hyperprolactinoma or adenomas are normally seen with levels greater than 5000 mIU/L but can be present at lower levels. Prolactin also is produced in men after orgasm and adds to the refractory period where libido drops, fatigue ensues, and ability to get an erection decreases temporarily.
What causes high prolactin?
Elevated prolactin levels in men or women can be a cause of concern as this may be a sign of a benign tumour or growth located near the pituitary gland. If the growth continues then there is a risk of vision loss as the growth may put pressure on the optic nerve. Elevated prolactin may be responsible for mammary gland growth in females and in men may be a cause of gynecomastia or man boobs. The increase in prolactin can cause low testosterone levels and erectile dysfunction.When men initially start TRT there may be a transient elevation of prolactin. One reason for this may be due to a decrease in the activity of the pituitary axis. When starting TRT the exogenous testosterone replaces your body’s naturally produced testosterone. This means the signalling from the brain including LH and FSH(gonadotropins) switch off. The lack of this signal corresponds with an elevation of prolactin seen in some men and women in the first 6 months to 1 year on TRT.
Not everyone starting TRT experiences this increase in prolactin due to lack of gonadotropin signalling. The increase in prolactin can also be attributed to rising oestrogen levels, or an underlying hypothyroid issue which may be unmasked when replacing and optimising testosterone levels.
When starting TRT elevations of oestrogen often occur as larger amounts of testosterone are being received into the body. The enzyme aromatase converts testosterone to oestrogen and becomes more active than it was when the man was in a hypogonadal or low testosterone state. The rise of oestrogen from aromatisation of testosterone can cause a rise in prolactin in some men at this point, but does not occur in all men.
Hypothyroidism causes a shut down in the feed back of a hormone signal called TRH (thryoid releasing hormone) which stimulates and enlarges the pituitary. This can stimulate lactotroph (prolactin producing) cells that increase the production and release prolactin.
Other causes of high prolactin may be from certain medications which interfere with the action of dopamine such as:
- Dopamine receptor blockers and antipsychotics
- Dopamine synthesis inhibitors
- Catecholamine depletors
- Heartburn medications both prescription and over the counter such as:
- H2 antagonists- Tagamat®(cimetidine), Zantac®Ranitidine
- Tricyclic antidepressants
- Elavil®(amitriptyline), Asendin®(amoxapine)
- Selective serotonin reuptake inhibitors
- Fluoxetine (Prozac)
- Sertraline etc.
- Calcium channel blockers
- Exogenous and endogenous elevations of Oestrogens
Can elevated prolactin affect my sex drive and ED (erectile dysfunction)?
Elevated prolactin can certainly affect men and women’s sex drive. After ejaculation the levels of dopamine drop and prolactin rises. Normally sleep is induced and there is little desire to ejaculate for some time. The time between desire to ejaculate is known as the refractory period.
Men with longer refractory periods may also be high prolactin producers. Prescription medications that enhance dopamine are called dopamine agonists and can be helpful in lowering levels of prolactin. Many of the dopamine agonists come with side effect of tiredness and fatigue. They are usually of a class called dopamine agonists such as premipexole or roprinole used for Parkinson’s or restless leg syndrome which are the result of diminishing dopamine levels and these drugs help improve the dopamine in the brain.
Cabergoline is a drug that differs from other dopamine agonists. It is an ergot drug which has been approved for use in hyper-prolactinaemia. In small doses taken once or twice per week, cabergoline can lower elevated levels of prolactin, enhance mood, and reduce the refractory period. In one study young healthy males treated with cabergoline demonstrated the ability to have multiple orgasims in quick succession compared with the placebo that required 15-30minutes of rest.
Can TRT help with my ED (erectile dysfunction)?
TRT can help with ED especially when low testosterone is the cause of erectile dysfunction. Some patients are refractory to PDE-5 inhibitors when they have low testosterone. When the testosterone level is optimised PDE-5 inhibitors work even better. The longer you have suffered with low testosterone the longer it may take to reverse the changes caused by chronically low levels. Low testosterone over prolonged periods of time can cause tissue remodelling of the corpus cavernosim (penile shaft). The shaft consist of spongy smooth muscle tissue which can be replaced by collagen if damaged or are exposed to a low testosterone environment. The corpus cavernous structure allows for rigidity in the erect penis by relaxing and engorging with blood. If collagen is present then the engorgement doesn’t happen.
What is Pro-Viron® (PROVIRON) used for?
Proviron is a non-aromatisable androgen that is very similar to the hormone DHT (dihydrotestosterone) which is the metabolite of testosterone. It is used for fertility, and as a monotherapy for TRT in those who have elevated SHGB. It works as an adjunct therapy alongside exogenous testosterone for those with elevated SHGB to bring it back down in range.
Has Proviron been discontinued?
Bayer has confirmed that they have discontinued Pro-Viron® mesterolone in the UK. They would not confirm or could not report that it has been discontinued in other countries. We are looking for alternative options. At the moment our partner pharmacies are trying to secure what is available. The good news is there may be other methods of bringing down stubbornly elevated levels. This includes keep the oestrogen in the optimal range, or using other medications for a short time alongside TRT.
Would it be possible to proceed without the addition of proviron to my treatment? How can I lower SHBG?
If you have high SHBG it could take much longer to lower it with exogenous testosterone alone. Proviron is added as a more aggressive approach, so therapeutic benefit can be reached more efficiently. Nonetheless, it could take several months until your treatment is ‘dialled in’ even with proviron therapy. There are other options for lowering of SHBG. Once lowered often you do not see a rebound in SHGB as the optimal exogenous testosterone can maintain it. We are looking at other options for obtaining Proviron as it has other benefits including improving mood when added to TRT treatments. One way to keep SHGB in check is managing elevated oestrogen. When oestrogen rises SHGB can rise along with it so having an aromatase inhibitor like anastrozole or exemestane alongside TRT can help bring down these levels.