In men, testosterone is the main anabolic hormone produced by our bodies. Testosterone regulates fertility, muscle mass, fat distribution, red blood cell production, bone mineral density, mood, and libido. Male hypogonadism, or diminished testes function, can result in weight gain, loss of muscle mass, fatigue, an inability to focus, and waking without an erection. Men can actually experience low testosterone levels as early as their twenties. The good news is Testosterone Replacement Therapy (TRT) can help! But BEWARE – it is not a one-size-fits-all solution, as many providers treat it.
TESTING YOUR TESTOSTERONE LEVELS
When testing, most providers will test only the patient’s total testosterone. Now, this method is great if you are symptomatic and your numbers are actually low, but what if your numbers are only on the low end of normal, and you still have significant symptoms impacting your daily life? Free testosterone (free T) is the available testosterone active in your body and should be evaluated along with the total, especially when symptoms are present.
YOUR TRT OPTIONS
The most common form of testosterone administered in the U.S. is testosterone cypionate. Testosterone is a schedule III controlled substance. It was made a control III by Congressional Hearings that led to the Anabolic Steroid Act of 1990. It is labeled as such because of the potential to be abused; however, Testosterone is not a narcotic.
TRT can be administered three different ways; topical application, pellet implants, or injections. All three methods should be discussed and evaluated based on efficacy, ease of use, flexibility in dosage modifications, potential side effects, and insurance coverage.
With this method, you apply a testosterone cream to the skin, typically the shoulders or stomach. This method can be a good option for older males with thin skin. In my experience, most people have a difficult time getting to a therapeutic level using topicals. The cream takes time to absorb and should not be touched by any females in the home – it can cause masculine side effects, such as facial hair. As you increase the amount needed to get to your goal, it becomes even more difficult and time consuming to wait for it to absorb. Our skin is our largest organ and the biggest part of our immune system, often inhibiting the drug’s ability to pass through it. Testosterone creams are also expensive, even with insurance.
Pellets are tiny little rods placed under the skin by a minor surgical procedure. They are supposed to slowly release testosterone into the bloodstream. This release time varies by individuals and is supposed to last about 3-6 months. If your levels are too high or too low, they will stay that way until the medication dissipates over time. The procedure itself can result in minor pain, bleeding, bruising, discoloration of the skin, infection, extrusion of the pellet (pellet coming out), and scarring at the implant site. Pellets are an upfront cost, as they are not covered by insurance.
Testosterone injections are my preferred method of TRT. The half-life of testosterone cypionate is 6-8 days, meaning you should have an injection in the thigh or buttock approximately every 7 days. This method allows the patient to have a consistent dosing without significant highs and lows. Using blood work to monitor testosterone levels after therapy begins allows for optimal dosage levels. The only potential drawback for this method, although I’ll explain later on why it’s also a plus, is it does require weekly office visits. Injections are covered by most major insurances.
As with all sciences, there are best practices to consider. Some practitioners administer testosterone injections every 2-4 weeks, but this schedule can put your body on a roller coaster. It is also a common practice to start everyone on the same dose of testosterone, potentially causing overdosing or significant under-dosing and patients failing to receive actual benefits from therapy. There are also providers who send patients home with testosterone and syringes to inject themselves. This practice is DANGEROUS and can lead to some very significant side effects.
TRT is not a one-size-fits-all treatment, although some practitioners are treating it that way. Some providers even allow patients to administer their own shots, which can come with real dangers. Having untrained personnel giving injections increases the possibility of a negative outcome.
Local skin infections, called cellulitis, can be caused from unclean hands or skin. When an injection is placed into the muscle, a sterile abscess is created. If bacteria are introduced, a deep abscess can form in the muscle, requiring surgery. Using improperly sized needles or using the same needle to draw the medicine up and give an injection can cause tissue damage. Additionally, if the dose is larger and given in one location, the muscle can become hard and damaged.
One of the most dangerous practices is allowing patients to administer testosterone injections themselves. I have heard of some practitioners giving patients pre-filled syringes of testosterone to take home and inject. This practice is extremely DANGEROUS and should be avoided. A pre-filled syringe is only stable, or sterile, for about 12 hours. Pre-filling syringes is unsafe and can significantly increase your risk for infection.
Injections are ALWAYS best administered by someone with knowledge of anatomy – for one, avoiding hitting the sciatic nerve is a top priority. In addition, non-medical professionals following improper procedures during injection can accidentally inject testosterone into the bloodstream, leading to a pulmonary embolism, or a blood clot in the lungs.
REDUCING THE DANGERS
At Optimum Mens Health, we pride ourselves in doing the right thing for our patients when it comes to TRT. First-time patients will have their testosterone levels, including free T, checked and will answer questions regarding any symptoms they are experiencing. Together, these factors determine whether the patient is a candidate for TRT.
If TRT is the right move, we will administer injections on a weekly basis. Weekly visits consist of a weigh in, blood pressure, heart rate, and pulse oximetry. We discuss any new or changing symptoms or concerns and administer the testosterone injection. Lab levels are usually checked again at 4-6 weeks and then every 3 months during treatment. Ensuring lab work is done on a regular basis can help find something going on within the body before physical symptoms are manifested. Each patient is unique, however, so we may run labs sooner depending on the clinical situation, such as a failure to improve or suspected side effects.
Although rare, some patients may experience negative side effects with TRT. These effects are treatable and manageable when diagnosed early, which is an added benefit of weekly visits to our clinic. Weekly evaluations ensure any side effects are caught quickly and managed appropriately. For example, fluid retention and gynecomastia (man breasts) are both possible side effects that are simple to correct when caught early but may require surgical intervention if left unmonitored for an extended period of time. TRT should be closely monitored by a clinician who is familiar with diagnosing and treating these adverse symptoms.
THE OPTIMUM MENS HEALTH DIFFERENCE
At Optimum Mens Health, we also tailor your treatment to YOU as an individual. Often times, there is a misconception that weighing more, having more muscle mass, or being taller means you require more testosterone. TRT is not dependent on size; it all comes down to biochemistry. Since we are all unique individuals, how we process and absorb testosterone will be different.
Because of this individuality, I choose a tailored approach, treating your specific needs. I place everyone on a dose that captures about 70% of individuals; 10% of patients will need a little less, and 20% will need more. This approach is the best way I have found to safely and effectively administer TRT. I also personally give the injections in our clinic.
In addition to offering TRT, we also provide primary care services, so our patients have the unique opportunity to address any other health concerns they may have each week and receive quick and appropriate treatment. We also know your time is valuable, so at Optimum Mens Health, we strive to stand apart from most other health practices where you finally see the provider an hour past your appointment time. We are aware people have busy lives and need to get in and out as quickly as possible, especially when they are coming on a weekly basis. Our schedule is set to see patients at their appointment time with no wait.
I take pride in improving my patients’ lives. I opened Optimum Mens Health because I am passionate about TRT, and I know first-hand the positive results you can achieve. At Optimum Mens Health, we provide a level of healthcare that I would want for myself – the clinic is a comfortable atmosphere where men feel confident to share their health issues with a provider who will listen and take effective action. Our ultimate goal at Optimum Mens Health is to make you feel like you again.
If you’d like to set up a consultation, contact me via phone or email today.
Medical News Today, Why Do We Need Testosterone?
Live Long Stay Young, Why is Testosterone a Controlled Substance?
US National Library of Medicine National Institutes of Health, Adverse effects of testosterone replacement therapy: an update on the evidence and controversy.
Dopinglinkki.com, Risks of Intramuscular Injection.
The New England Journal of Medicine, The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men.
US National Library of Medicine National Institutes of Health, Prefilled syringes: An innovation in parenteral packaging.
US National Library of Medicine National Institutes of Health, A Review of Testosterone Pellets in the Treatment of Hypogonadism.