Category Archives: Testosterone Replacement Therapy

Understand the potential risks and consider alternatives before boosting your hormones indefinitely.

Millions of American men use a prescription testosterone gel or injection to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that treating "low T" this way can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone could face higher cardiac risks.

"Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs," says Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School. "Men should be much more mindful of the possible long-term complications."

MIND Depression Reduced self-confidence Difficulty concentrating Disturbed sleep

BODY Declining muscle and bone mass Increased body fat Fatigue Swollen or tender breasts Flushing or hot flashes

SEXUAL FUNCTION Lower sex drive Fewer spontaneous erections Difficulty sustaining erections

Images: Thinkstock

A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" of testosterone deficiency. "Virtually everybody asks about this now because the direct-to-consumer marketing is so aggressive," says Dr. Michael O'Leary, a urologist at Harvard-affiliated Brigham and Women's Hospital. "Tons of men who would never have asked me about it before started to do so when they saw ads that say 'Do you feel tired?'"

Just being tired isn't enough to get a testosterone prescription. "General fatigue and malaise is pretty far down my list," Dr. O'Leary says. "But if they have significant symptoms, they'll need to have a lab test. In most men the testosterone level is normal."

If a man's testosterone looks below the normal range, there is a good chance he could end up on hormone supplementsoften indefinitely. "There is a bit of a testosterone trap," Dr. Pallais says. "Men get started on testosterone replacement and they feel better, but then it's hard to come off of it. On treatment, the body stops making testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered."

This wouldn't matter so much if we were sure that long-term hormone therapy is safe, but some experts worry that low-T therapy is exposing men to small risks that could add up to harm over time.

A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.

Men on long-term testosterone appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on hormone treatments had noticeably more heart problems. "In older men, theoretical cardiac side effects become a little more immediate," Dr. Pallais says.

Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk.

For men with low blood testosterone levels, the benefits of hormone replacement therapy usually outweigh potential risks. However, for most other men it's a shared decision with your doctor. It offers men who feel lousy a chance to feel better, but that quick fix could distract attention from unknown long-term hazards. "I can't tell you for certain that this raises your personal risk of heart problems and prostate cancer, or that it doesn't," Dr. Pallais says.

So, keep risks in mind when considering testosterone therapy. "I frequently discourage it, particularly if the man has borderline levels," Dr. Pallais says.

These steps can help you feel more energetic today without drugs or dietary supplements:

Pace yourself: Spread out activities throughout the day.

Take a walk: It gives you a lift when you feel pooped out.

Snack smart: Have a snack with fiber and some protein between meals.

A large, definitive trial for hormone treatment of men is still to come. Until then, here is how to take a cautious approach to testosterone therapy.

Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone therapy.

If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?

If erectile dysfunction has caused you to suspect "low T" as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.

Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone, or the amount of the hormone that is able to have effects on the body. Consider getting a second opinion from an endocrinologist.

After starting therapy, follow-up with your physician periodically to have testosterone checks and other lab tests to make sure the therapy is not causing any problems with your prostate or blood chemistry.

Approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.

Ask your doctor to explain the various side effects for the differentformulations of testosterone, such as gels, patches, and injections. Know what to look for if something goes wrong.

Testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness. Do not seek therapy with these expectations in mind.

If erectile function has been a problem, testosterone therapy might not fix it. In fact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections.

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Is testosterone therapy safe? Take a breath before you ...

League City & Friendswood Testosterone Therapy

Welcome to Titan T-Center & Weight Loss, League City and Friendswood, Texas finest testosterone replacement therapy clinic. Our clinic is outfitted with the latest technologies to provide our patients with efficient,safe and accurate results. In addition to our modern equipment, the medical professionals at our facilityare some of the most skilled and knowledgeable individuals in the industry. To all of us here, providing premier testosterone therapy requires more than just basic medical treatment. Our staff believes in building relationships and improving the lives of each and every individual that walks through our door.

Low testosterone, or hypogonadism, is a condition in which the bodys natural production of the hormone is below normal levels. By the age of 30, it is very common for men to begin seeing a decline in testosterone. Men may see a variety of symptoms, including but not limited to, a decrease in sex drive. Although age plays a factor in the production of testosterone, diabetes and excessive weight, have been associated with the condition as well.

Although testosterone supplements may be available in several forms, testosterone injections are believed to be safer and more effective than a pill. Oral testosterone is available, however, it is believed that testosterone taken orally may damage the liver. Furthermore, testosterone injections go directlyinto thebloodstream, making each treatment more effective.

Titan T-Center & Weight Loss is here to help you determine whether or not youmay be in need of therapy to lift your testosterone levels. We encourage you to look through the rest of our website to learn more about low t and its impact on your day-to-day life. Should you have any questions or if you would like to come in for a visit, contact us your convenience. Titan T-Center serves patients residing all over the League City and Friendswood areas.

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Testosterone Replacement Therapy | Titan Men's Health

Introduction to testosterone replacement therapy

Testosterone replacement therapy is a treatment in which additional testosterone is added to a mans body (e.g. by injecting medicines that contain testosterone), to increase the concentration of testosterone in his body. It is used to treat hypogonadism, a condition characterised by low levels of testosterone in the blood and clinical symptoms of testosterone deficiency (e.g. lack of body hair, excessive breast growth). Hypogonadism occurs when a mans testes do not produce enough testosterone, either because the testes are not working properly, or because the hypothalamus or pituitary glandin the brain are not working properly. The hypothalamus and pituitary glands produce hormones that stimulate testosterone production in the testes.

The aim of testosterone replacement therapy is to increase blood testosterone concentrations to normal levels. In doing so, it can also restore the mans sex drive and expression of male sex characteristics (e.g. deep voice, body hair).

Testosterone is one of the oldest marketed drugs and has been used in testosterone replacement therapy since the 1930s.

Testosterone replacement therapy is used to treat men who have received a definitive diagnosis of hypogonadism. In order to be diagnosed with hypogonadism, a man musthave both low blood concentrations of testosterone and clinical symptoms of deficiency (e.g. lack of body hair, breast growth). As most of the causes that underlie testosterone deficiency (e.g. testicular dysfunction) are untreatable, most men who commence testosterone replacement therapy must be treated for the rest of their lives. In men with reversible or age-related causes of testosterone deficiency, testosterone replacement therapy is not used.

Ageing men (> 40 years of age)

As men age, their testosterone levels naturally decrease in a process sometimes called andropause or male menopause. This can lead to clinical symptoms of testosterone deficiency and/or low blood testosterone levels. There is no evidence that testosterone replacement therapy is beneficial for these men.

For older men, treatments that address the conditions causing or worsening testosterone deficiency (e.g.obesity, diabetes, chronic illness) may be effective.

Chronic or transient illness or recent trauma

Testosterone replacement therapy is rarely beneficial where hypogonadism is caused by illness (e.g. diabetes) or trauma (e.g. injury to the testicles). In these cases, the illness or trauma causing testosterone deficiency should be treated.

Prostate or breast cancer

Testosterone replacement therapy is not used to treat men with breast or prostate cancer, because there is a hypothetical risk that treatment may stimulate the growth of these cancers.

Competitive athletes

Use of testosterone replacement therapy may lead to disqualification for professional athletes.

Others

Testosterone replacement therapy is not used to treat men with the following conditions:

Testosterone replacement therapy is not used totreat infertility, erectile dysfunction or non-specific symptoms.

Certain conditions require special consideration before testosterone replacement therapy is used. Tell your doctor if you have:

The goal of testosterone replacement therapy is to restore blood testosterone to normal levels. When used to treat men with hypogonadism, it may also result in other benefits, including:

Improvements in blood testosterone levels and libido generally occur within the first week of treatment, and other benefits usually occur within two months.

It is important to note that testosterone replacement therapy typically induces a strong placebo effect in the initial stages of therapy. This means that many men who are treated with testosterone notice an improvement (e.g. bettersex drive), not because of the testosterone-containing medication has improved their testosterone concentrations, but because of the psychological effect of taking it. In short, some men think testosterone therapy is working and then feel better, even though the treatment does not work. This may lead to confusion and dissatisfaction as the placebo effect of treatment diminishes.

Most adult men begin receiving replacement testosterone at a dose sufficient for restoring blood testosterone to normal levels in men aged < 40 years. In boys who have not yet reached puberty and elderly men, lower doses are usually used at the beginning to avoid excessive increases in libido or energy, which may be dangerous. Once treatment has started, the doctor will monitor the mans blood testosterone levels and symptoms, and may need to adjust the dose depending on how these change.

Testosterone can be administered in various ways, depending on the person. Most men will first receive treatment in the form of testosterone injections every two weeks. Men who cannot receive injections (e.g. those with bleeding disorders) will receive different modes of testosterone treatment. The doctor may also change the type of testosterone administered if the man is dissatisfied with thecurrenttreatment. A doctor will try to prescribe a type of testosterone therapy that suits the patient in terms of cost, response and convenience, and individuals should talk to their doctor if they have concerns about any aspects of treatment.

Injectable testosterone

Injectable testosterone is the standard and most cost-effective treatment option. It can be used in all men except those with bleeding disorders. The injection is an oil-based solution containing testosterone. It is administered by intramuscular injection. Once injected, the solution gradually releases testosterone into the bloodstream.

The standard starting dose is one injection containing 200250 mg of testosterone every 23 weeks. The dose may be reduced to as little as 100 mg in very young or old men. The quantity and frequency of the dose will be adjusted by the doctor, according to the response to treatment. Men who do not achieve adequate increases in blood testosterone may have the dose increased, while those who gain too much blood testosterone may have the dose reduced.

Testosterone injections which are administered every two weeks are known as short-acting injectable testosterones(e.g. Sustanon). While they are effective in increasing blood testosterone levels and often improve symptoms (e.g.libido, mood, energy), testosterone levels and symptoms tend to fluctuate between injections. Men using these injections may experience very high peaks intestosterone levels and a resulting increase in libido and energy in the period immediately following the injection, followed by a period of much lower blood testosterone. Long-acting injections of testosterone (e.g. Reandron), which are administered every 3 months, provide an alternative for men who experience the peaktrough effect.

Long-acting testosterone injections provide testosterone replacement for 1014 weeks.They areadministered by injection deep into the gluteal muscle. The testosterone is released gradually into the bloodstream.

For more information on long-acting testosterone injections, see testosterone undecanoate (Reandron).

Transdermal testosterone patches

Testosterone patches that adhere to the skin may also be suitable for long-term testosterone replacement therapy. However, the patches contain substances that increase the absorption of testosterone, and these cause skin irritation in up to 50% of men who use them. Some 10% of men stop using testosterone patches because of skin irritation. Men may also discontinue use because they find the patches cosmetically displeasing. They may find other transdermal methodsof administrationmore appropriate (e.g. gels, creams).

Most men require a single patch containing 5 mg of testosterone daily. The patch can be applied to the abdomen, upper arm or thigh, and should be left in place for 24 hours after application, when a new patch should be applied.

For more information on testosterone patchess, seetestosterone (Androderm).

Oral testosterone

Oral testosterone therapy (e.g. Andriol Testocaps) uses testosterone undecanoate, the only natural form of testosterone that can be absorbed when taken orally. It may be more expensive and less effective than other modes of testosterone replacement, and is therefore usually used by men who cannot use other forms of testosterone. Oral therapy may also be used to treat older men who are starting therapy, as treatment can be stopped quickly if they are diagnosed with prostate cancer.

The starting dose varies and may be as low as 40 mg daily, although men typically require 160240 mg a day, taken in 24 doses. The doctor will adjust the dose, depending on the response to treatment. Oral testosterone should be taken with food, as this increases the amount of testosterone absorbed by the body.

Testosterone implants

Testsosterone implants contain 800 mg of testosterone (usually in the form of four 200 mg pellets). They are implanted into the buttocks or abdomen, and provide testosterone replacement for around six months. Implants are replaced periodically, once symptoms of testosterone deficiency recur. Inserting the testosterone pellets is a minor surgical procedure, requiring local anaesthetic; this is the major limitation of this method of treatment. However, men using this form of testosterone replacement are usually satisfied with the method, and are more likely to continue being treated than men using other modes of testosterone replacement.

Testosterone implants are not safe for use by older men, who have an increased risk of prostate cancer. If prostate cancer is diagnosed, testosterone replacement must be stopped immediately, which cannot be done if an implant is being used. Implants are also unsuitable for young men with bleeding disorders. Another form of testosterone replacement must be used first, so that a doctor can be sure they will not have any negative reaction to testosterone, before starting this long-term mode of treatment.

For more information on testosterone implants, see testosterone(Testosterone Implants).

Testosterone gel

Testosterone gels (e.g. Testogel)contain 1% testosteronethat is absorbed through the skin. The gel is applied to the skin on the abdomen, shoulder or arm on a daily basis. The standard dose is 5 g (50 mg testosterone), although the dose may be increased to as much as 10 g daily in some men, while others will respond adequately to 2.5 g daily.

Care must be taken to ensure the gel does not come into contact with the skin of individuals other than the man being treated (e.g. sexual partners, children) for at least six hours following application, as this may cause testosterone to be transferred to the contacts skin and absorbed by their body. Absorbing testosterone may be dangerous for children and women, especially pregnant women.

For more information on testosterone gel, see testosterone (Testogel).

Testosterone cream

Andromen forte (testosterone) is a cream containing 5% testosterone. It is ideally applied to the skin of the scrotum on a daily basis. The cream can be applied to the skin of the torso, back, chest, arms and legs, although a higher dose might be required if these sites are used, as less testosterone is absorbed compared to if the cream is applied to the scrotum. The usual starting dose is 1 g of cream (5 mg testosterone), but a doctor may adjust the dose depending on how the man responds to the treatment.

As the causes of testosterone deficiency are typically irreversible, testosterone replacement therapy is usually lifelong. Men who use testosterone replacement therapywill be monitored throughout their treatment to assess their response.

To assess the mans response to treatment, levels of testosterone in his blood are usually measured three months after the start of treatment. Levels of luteinising hormone (LH) may also be measured three to six months after treatment starts, as low levels of LH indicate that the treatment is effective.

If blood tests show that testosterone replacement therapy has failed to adequately increase concentrations of testosterone in the mans blood, hypogonadism may not be the cause of the symptoms. In these cases, testosterone replacement therapy will be stopped and the doctor will start treating other conditions that may contribute to testosterone deficiency.

A doctor will monitor changes to symptoms of testosterone deficiency and side effects of the treatment. This monitoring usually occurs three and six months after treatment commences and annually thereafter. A doctor will typically examine a man for signs of:

Tests that will usually be conducted periodically include:

Testosterone replacement therapy may sometimes be combined with treatment using PDE-5 inhibitors, a medication used to treat erectile dysfunction, for men with both hypogonadism and erectile dysfunction. It should be noted, however, that testosterone deficiency is rarely associated with erectile dysfunction.

Effective testosterone therapy has numerous immediate and long term benefits. These include:

Physical

Sexual

Psychological

The side effects associated with testosterone replacement therapy are rare and vary depending on the age of the man being treated, his life circumstances and health condition. They include:

Testosterone replacement therapy increases the risk of some health conditions, including:

The rest is here:
Testosterone Replacement Therapy in Men | myVMC

Hormone replacement therapy (HRT) of the female-to-male (FTM) type is hormone replacement therapy and sex reassignment therapy used to change the secondary sexual characteristics of transgender and transsexual people from feminine (or androgynous) to masculine. Usually called "cross-sex hormone therapy" (XHT) or "hormone therapy", it is one of two types of HRT for transgender and transsexual people (the other being male-to-female), and is predominantly used to treat transgender men. Some intersex people also receive this form of HRT, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect.

The purpose of this form of HRT is to cause the development of the secondary sex characteristics of the desired sex, such as voice deepening and a masculine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments (see below). The medications used in HRT of the FTM type include, mainly, androgens (namely testosterone) and GnRH analogues.

While HRT cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as the gender they identify with. Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity.

Several contraindications to androgen therapy exist.[1] An absolute medical contraindication is pregnancy.

Relative medical contraindications are:

Hormone therapy for transgender individuals has been shown in medical literature to be safe in adults, when supervised by a qualified medical professional.[2]

Testosterone is metabolized by the cytochrome P450 enzyme system (specifically CYP3A isoforms) in the liver. There are certain drugs that increase or decrease the activity of cytochrome P450 enzymes and may cause increased or decreased levels of testosterone:

Testosterone can also alter the effects of other drugs:

Because of these interactions, it is advised that trans men make their healthcare providers aware of their hormone therapy, when this is relevant to their treatment for other medical issues.

The terminal half-life of testosterone in blood is about 70 minutes, so it is necessary to have a continuous supply of the hormone for masculinization.

'Depot' drug formulations are created by mixing a substance with the drug that slows its release and prolongs the action of the drug. The two primarily used forms in the United States are the testosterone esters testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Delatestryl) which are almost interchangeable. Testosterone enanthate is purported to be slightly better with respect to even testosterone release, but this is probably more of a concern for bodybuilders who use the drugs at higher doses (2501000mg/week) than the replacement doses used by transgender men (50100mg/week). These testosterone esters are mixed with different oils, so some individuals may tolerate one better than the other. Testosterone enanthate costs more than testosterone cypionate and is more typically the one prescribed for hypogonadal males in the United States. Testosterone cypionate is more popular in the United States than elsewhere (especially amongst bodybuilders). Other formulations exist but are more difficult to come by in the United States. A formulation of injected testosterone available in Europe and the United States, testosterone undecanoate (Nebido, Aveed)[3][4] provides significantly improved testosterone delivery with far less variation outside the eugonadal range than other formulations with injections required only four times yearly. However, each quarterly dose requires injection of 4mL of oil which may require multiple simultaneous injections. Testosterone undecanoate is also much more expensive as it is still under patent protection. Testosterone propionate is another testosterone ester that is widely available, including in the United States, Canada, and Europe, but it is very short-acting compared to the other testosterone esters and must be administered once every 2 or 3 days, and for this reason, is rarely used.

The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection. Some side effects may be ameliorated by using a shorter dosing interval (weekly or every ten days instead of twice monthly with testosterone enanthate or testosterone cypionate). 100mg weekly gives a much lower peak level of testosterone than does 200mg every two weeks, while still maintaining the same total dose of androgen. This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections.

Injected testosterone esters should be started at a low dose and titrated upwards based on trough levels (blood levels drawn just before your next shot). A trough level of 500ng/dl is sought. (Normal range for a cisgender male is 290 to 900ng/dl).

Both testosterone patches, creams and gels are available. Both approximate normal physiological levels of testosterone better than the higher peaks associated with injection. Both can cause local skin irritation (more so with the patches).

Patches slowly diffuse testosterone through the skin and are replaced daily. The cost varies, as with all medication, from country to country, it is about $150/month in the US, and about 60 Euros in Germany.

Transdermal testosterone is available throughout the world under the brand names Andromen Forte, Androgel, Testogel and Testim. They are absorbed quickly when applied and produce a temporary drug depot in the skin which diffuses into the circulation, peaking at 4 hours and decreasing slowly over the rest of the day. The cost varies, as with all medication, from country to country, from as little as $50/month to about $280/month (in US Dollars).

Transdermal testosterone poses a risk of inadvertent exposure to others who come in contact with the patient's skin. This is most important for patients whose intimate partners are pregnant or those who are parents of young children as both of these groups are more vulnerable to the masculinizing effects of androgens. Case reports of significant virilization of young children after exposure to topical androgen preparations (both prescription and 'supplement' products) used by their caregivers demonstrates this very real risk.

Implants, as subcutaneous pellets, can be used to deliver testosterone (brand name Testopel). 6 to 12 pellets are inserted under the skin every three months. This must be done in a physician's office, but is a relatively minor procedure done under local anesthetic. Pellets cost about $60 each, so the cost is greater than injected testosterone when the cost of the physician visit and procedure are included. The primary advantages of Testopel are that it gives a much more constant blood level of testosterone yet requires attention only four times yearly.

Oral testosterone is provided exclusively as testosterone undecanoate. It is available in Europe and Canada, but not in the United States. Once absorbed from the gastrointestinal tract, testosterone is shunted (at very high blood levels) to the liver where it can cause liver damage (albeit very rarely) and worsens some of the adverse effects of testosterone, like lower HDL (good) cholesterol. In addition, the first pass metabolism of the liver also may result in testosterone levels too low to provide satisfactory masculinization and suppress menses. Because of the short terminal half-life of testosterone, oral testosterone undecanoate must be administered two to four times per day, preferably with food (which improves its absorption).

In 2003 the FDA approved a buccal form of testosterone (Striant). Sublingual testosterone can also be made by some compounding pharmacies. Cost for Striant is greater than other formulations ($180210/month). Testosterone is absorbed through the oral mucosa and avoids the 'first pass metabolism' in the liver which is cause of many of the adverse effect with oral testosterone undecanoate. The lozenges can cause gum irritation, taste changes, and headache but most side effects diminish after two weeks. The lozenge is 'mucoadhesive' and must be applied twice daily.

Synthetic anabolicandrogenic steroids (AAS), like nandrolone (as an ester like nandrolone decanoate or nandrolone phenylpropionate), are agonists of the androgen receptor (AR) similarly to testosterone but are not usually used in HRT for transgender men or for androgen replacement therapy (ART) in cisgender men. However, they can be used in place of testosterone with similar effects, and can have certain advantages like less or no local potentiation in so-called androgenic tissues that express 5-reductase like the skin and hair follicles (which results in a reduced rate of skin and hair-related side effects like excessive body hair growth and scalp hair loss), although this can also be disadvantageous in certain aspects of masculinization like facial hair growth and normal body hair growth). Although many AAS are not potentiated in androgenic tissues, they have similar effects to testosterone in other tissues like bone, muscle, fat, and the voice box. Also, many AAS, like nandrolone esters, are aromatized into estrogens to a greatly reduced extent relative to testosterone or not at all, and for this reason, are associated with reduced or no estrogenic effects (e.g., gynecomastia). AAS that are 17-alkylated like methyltestosterone, oxandrolone, and stanozolol are orally active but carry a high risk of liver damage, whereas AAS that are not 17-alkylated, like nandrolone esters, must be administered by intramuscular injection (via which they act as long-lasting depots similarly to testosterone esters) but have no more risk of liver damage than does testosterone.

For the sake of clarification, it should be noted that the term "anabolicandrogenic steroid" is essentially synonymous with "androgen" (or with "anabolic steroid"), and that natural androgens like testosterone are also AAS. These drugs all share the same core mechanism of action of acting as agonists of the AR and have similar effects, although their potency, pharmacokinetics, oral activity, ratio of anabolic to androgenic effects (due to differing capacities to be locally metabolized and potentiated by 5-reductase), capacity for aromatization (i.e., conversion into an estrogen), and potential for liver damage may all differ.

Dihydrotestosterone (DHT) (referred to as androstanolone or stanolone when used medically) can also be used in place of testosterone as an androgen. The availability of DHT is limited; it is not available in the United States or Canada, for instance, but it is available in certain European countries, including the United Kingdom, France, Spain, Belgium, Italy, and Luxembourg.[5] DHT is available in formulations including topical gel, buccal or sublingual tablets, and as esters in oil for intramuscular injection.[6] Relative to testosterone, and similarly to many synthetic AAS, DHT has the potential advantages of not being locally potentiated in so-called androgenic tissues that express 5-reductase (as DHT is already 5-reduced) and of not being aromatized into an estrogen (it is not a substrate for aromatase).

In all people, the hypothalamus releases GnRH (gonadotropin-releasing hormone) to stimulate the pituitary to produce LH (luteinizing hormone) and FSH (follicle-stimulating hormone) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH analogues, such as leuprorelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH analogues work by initially over stimulating the pituitary then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced. There is considerable controversy over the earliest age, and for how long it is clinically, morally and legally safe to do this. The Harry Benjamin International Gender Dysphoria Association Standards of Care permit from Tanner Stage 2, but do not allow the addition of gender-appropriate hormones until 16, which could be five or more years. The sex steroids do have important other functions. The high cost of GnRH analogues is often a significant factor.

Antiestrogens (or so-called "estrogen blockers") like aromatase inhibitors (AIs) (e.g., anastrozole) or selective estrogen receptor modulators (SERMs) (e.g., tamoxifen) can be used to reduce the effects of high levels of endogenous estrogen (e.g., breast development, feminine fat distribution) in transgender men. In addition, in those who have not yet undergone or completed epiphyseal closure (which occurs during adolescence and is mediated by estrogen), antiestrogens can prevent hip widening as well as increase final height (estrogen limits height by causing the epiphyses to fuse).

5-Reductase inhibitors like finasteride and dutasteride can be used to slow or prevent scalp hair loss and excessive body hair growth in transgender men taking testosterone.[7] However, they may also slow or reduce certain aspects of masculinization, such as facial hair growth and normal male-pattern body hair growth.[7] A potential solution is to start taking a 5-reductase inhibitor after these desired aspects of masculinization have been well-established.[7]

Depo-Provera (depot medroxyprogesterone acetate, or DMPA) may be injected every three months just as it is used for contraception. Generally after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy.

In those who have not yet undergone or completed epiphyseal closure, growth hormone can be administered, potentially in conjunction with an aromatase inhibitor or a GnRH analogue, to increase final height.

The main effects of HRT of the FTM type are as follows:[8]

Many transgender men are unable to pass as cisgender men without hormones. The most commonly cited reason for this is that their voice may reveal them.

Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age. Within a population of similar body size and ethnicity:

Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the cessation of menses with androgen therapy should have an endometrial biopsy (and possibly an ultrasound) done to rule-out endometrial cancer.

A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times. Sometime in the late teen years epiphyseal closure (in other words, the ends of bones are fused closed) takes place and the length of bones is fixed for life. Consequently, total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone. Many of these differences are described in the Desmond Morris book Manwatching.

The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most trans men report an increase of energy and an increased sex drive. Many also report feeling more confident.

While a high level of testosterone is often associated with an increase in aggression, this is not a noticeable effect in most trans men. HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most cisgender men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen. It is assumed that the effect of the start of physical treatment is such a relief, and decreases pre-existing aggression so much, that the overall level of aggression actually decreases.

Some transgender men report mood swings, increased anger, and increased aggressiveness after starting androgen therapy. Many transgender men, however, report improved mood, decreased emotional lability, and a lessening of anger and aggression.

During HRT, especially in the early stages of treatment, blood work should be consistently done to assess hormone levels and liver function.

Israel et al. have suggested that for pre-oophorectomy trans men, therapeutic testosterone levels should optimally fall within the normal male range, whereas estrogen levels should optimally fall within the normal female range. Before oophorectomy, it is difficult and frequently impractical to fully suppress estrogen levels into the normal male range, especially with exogenous testosterone aromatizing into estrogen, hence why the female ranges are referenced instead. In post-oophorectomy trans men, Israel et al. recommend that both testosterone and estrogen levels fall exactly within the normal male ranges. See the table below for all of the precise values they suggest.[15]

The optimal ranges listed for testosterone only apply to individuals taking bioidentical hormones in the form of testosterone (including esters) and do not apply to those taking synthetic AAS (e.g., nandrolone) or dihydrotestosterone.

Read the original:
Hormone replacement therapy (female-to-male) - Wikipedia

What is Testosterone?Testosterone is the hormone produced by the testicles. It is responsible for the proper development of male sexual characteristics. It helps promote the circulation of blood, and is responsible for the maintenance of muscle bulk. Without an adequate testosterone level there can be important psychological affects such as loss of libido, reduced brain and intellectual activity and mood changes. What causes the Andropause? As all men age there is a gradual decline in the level of testosterone. This natural decline starts after 30 and continues throughout life. By the age of 40, testosterone levels drop by 1% every year. Many men however can experience a lack of testosterone production sufficient to result in significant symptoms. This will apply to approximately 50% of men by age 55. Damaged testicles or disease will affect testosterone production as will long-term stress, smoking and excessive alcohol consumption. In 60% of cases no cause can be identified and hereditary factors are implicated. Are there any health issues associated with the Andropause? Low levels of testosterone may result in an increase in tummy and chest fat, a decline in the amount of muscle in the body and decline in strength. Low levels can also lead to Brittle bones, (osteoporosis) which may lead to hip and spinal fractures. In addition the bone marrow is less active and produces less haemoglobin and red blood cells to transport oxygen around the body.

A consultation is required and blood tests will be necessary. The blood tests include an examination for prostate cancer, as this is a contraindication to testosterone treatment. Any suspicion of prostate cancer may require further investigations. The aim of therapy is to return the blood testosterone level in the bloodstream to the normal range for the man's age. This is achieved by using bio-identical testosterone cream that is rubbed onto the skin daily.

IF YOU THINK YOU MIGHT HAVE LOW TESTOSTERONE, check out our quick online self assessment test.

View post:
TRT - Testosterone Replacement Therapy | Men's Health ...

Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone growth, a sense of well-being, and sexual function.

Inadequate production of testosterone is not a common cause of erectile dysfunction; however, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem.

As a man ages, the amount of testosterone in his body naturally gradually declines. This decline starts after age 30 and continues throughout life. Some causes of low testosterone levels are due to:

Without adequate testosterone, a man may lose his sex drive, experience erectile dysfunction, feel depressed, have a decreased sense of well-being, and have difficulty concentrating.

Low testosterone can cause the following physical changes:

The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. Because testosterone levels fluctuate throughout the day, several measurements will need to be taken to detect a deficiency. Doctors prefer, if possible, to test levels early in the morning, when testosterone levels are highest.

Note: Testosterone should only be used by men who have clinical signs and symptoms AND medically documented low testosterone levels.

Testosterone deficiency can be treated by:

Each of these options provides adequate levels of hormone replacement; however, they all have different advantages and disadvantages. Talk to your doctor to see which approach is right for you.

Men who have prostate cancer or breast cancer should not take testosterone replacement therapy. Nor should men who have severe urinary tract problems, untreated severe sleep apnea or uncontrolled heart failure. All men considering testosterone replacement therapy should undergo a thorough prostate cancer screening -- a rectal exam and PSA test -- prior to starting this therapy.

In general, testosterone replacement therapy is safe. It is associated with some side effects, including:

Laboratory abnormalities that can occur with hormone replacement include:

If you are taking hormone replacement therapy, regular follow-up appointments with your doctor are important.

Like any other medication, directions for administering testosterone should be followed exactly as your doctor orders. If you are unsure or have any questions about testosterone replacement therapy, ask your doctor.

SOURCE:

Get-Back-On-Track.com.

The Hormone Foundation.

News release, FDA.

See original here:
Testosterone Replacement Therapy - webmd.com

Many men with low testosterone report improved energy levels, sex drive, and mood after testosterone treatment. If testosterone is low, why not replace it?

Not so fast. A low testosterone level by itself doesn't need treatment. Testosterone replacement therapy can have side effects, and the long-term risks and benefits aren't known. Only men with symptoms of low testosterone and blood levels that confirm this as the cause of symptoms should consider testosterone replacement. Talking with your doctor is the only way to know if testosterone therapy is right for you.

The symptoms of low testosterone are sometimes obvious, but they also can be subtle. Testosterone levels decline naturally in men as they age over decades. But certain conditions can also lead to an abnormally low level. Symptoms of low testosterone include:

If a man has symptoms of low testosterone and tests show he has an abnormally low testosterone level, a doctor may suggest treatment. For millions of men who have low testosterone levels but no symptoms, no treatment is currently recommended. It is has also not been approved for treating men with low levels because of aging.

Testosterone replacement therapy is available in several forms. All can improve testosterone levels:

Why not a simple testosterone pill? Oral testosterone is available. However, some experts believe oral testosterone can have negative effects on the liver. Using other methods, such as skin patches, gels, orally disintegrating tablets, or injections, bypasses the liver and gets testosterone into the blood directly.

What can you expect from testosterone treatment? It's impossible to predict, because every man is different. Many men report improvement in energy level, sex drive, and quality of erections. Testosterone also increases bone density, muscle mass, and insulin sensitivity in some men.

Men also often report an improvement in mood from testosterone replacement. Whether these effects are barely noticeable, or a major boost, is highly individualized.

Karen Herbst, MD, PhD, an endocrinologist at University of California-San Diego, specializes in testosterone deficiency. She estimates about one in 10 men are "ecstatic" about their response to testosterone therapy, while about the same number "don't notice much." The majority have generally positive, but varying responses to testosterone replacement.

Testosterone replacement therapy side effects most often include rash, itching, or irritation at the site where the testosterone is applied.

However, there is also evidence of an increased risk of heart attack or stroke associated with testosterone use. Experts emphasize that the benefits and risks of long-term testosterone therapy are unknown, because large clinical trials haven't yet been done.

There are a few health conditions that experts believe testosterone therapy can worsen:

It will be years before large clinical trials bring any answers on the long-term benefits and risks of testosterone therapy. As with any medicine, the decision on whether the possible benefits outweigh any risks is up to you and your doctor.

Isn't taking testosterone replacement basically the same as taking steroids, like athletes that "dope"? It's true that anabolic steroids used by some bodybuilders and athletes contain testosterone or chemicals that act like testosterone.

The difference is that doses used in testosterone replacement only achieve physiologic (natural) levels of hormone in the blood. The testosterone forms some athletes use illegally are in much higher doses, and often combined ("stacked") with other substances that boost the overall muscle-building (anabolic) effect.

SOURCES:

Drugs.com: "Androderm Side Effects."

Swerdloff, R. Journal of Clinical Endocrinology & Metabolism, 2000.

Striant.com.

Wilson, J. American Journal of Medicine, 1980.

Bhasin, S. Journal of Clinical Endocrinology and Metabolism, 2006.

Karen Herbst, MD, PhD, assistant professor in medicine, University of California, San Diego.

News release, FDA.

View original post here:
Testosterone Replacement Therapy: Testosterone Injections ...

Testosterone is a hormone produced by the testicles and is responsible for the proper development of male sexual characteristics. Testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone growth, a sense of well-being, and sexual function.

Inadequate production of testosterone is not a common cause of erectile dysfunction; however, when ED does occur due to decreased testosterone production, testosterone replacement therapy may improve the problem.

As a man ages, the amount of testosterone in his body naturally gradually declines. This decline starts after age 30 and continues throughout life. Some causes of low testosterone levels are due to:

Without adequate testosterone, a man may lose his sex drive, experience erectile dysfunction, feel depressed, have a decreased sense of well-being, and have difficulty concentrating.

Low testosterone can cause the following physical changes:

The only accurate way to detect the condition is to have your doctor measure the amount of testosterone in your blood. Because testosterone levels fluctuate throughout the day, several measurements will need to be taken to detect a deficiency. Doctors prefer, if possible, to test levels early in the morning, when testosterone levels are highest.

Note: Testosterone should only be used by men who have clinical signs and symptoms AND medically documented low testosterone levels.

Testosterone deficiency can be treated by:

Each of these options provides adequate levels of hormone replacement; however, they all have different advantages and disadvantages. Talk to your doctor to see which approach is right for you.

Men who have prostate cancer or breast cancer should not take testosterone replacement therapy. Nor should men who have severe urinary tract problems, untreated severe sleep apnea or uncontrolled heart failure. All men considering testosterone replacement therapy should undergo a thorough prostate cancer screening -- a rectal exam and PSA test -- prior to starting this therapy.

In general, testosterone replacement therapy is safe. It is associated with some side effects, including:

Laboratory abnormalities that can occur with hormone replacement include:

If you are taking hormone replacement therapy, regular follow-up appointments with your doctor are important.

Like any other medication, directions for administering testosterone should be followed exactly as your doctor orders. If you are unsure or have any questions about testosterone replacement therapy, ask your doctor.

SOURCE:

Get-Back-On-Track.com.

The Hormone Foundation.

News release, FDA.

See the original post:
Erectile Dysfunction and Testosterone Replacement Therapy

The two major testosterone gel brands are Testim and Androgel. They are very similar and generally prescribed interchangeably, but sometimes insurance wont cover one or the other. Often, I hear that they wont cover Testim and people want to know if Androgel is just as good. So here is a general guide to choosing if you are lucky enough to have the choice which one is right for you.

Testim Vs AndrogelI would try whichever your insurance covers first. If your insurance covers both medications, try whichever one has coupons or kickbacks. Ive heard people say they didnt pay any/much for Testim for the first year because the company (Auxilium) that markets the drug has a financial assistance program available for the first year.

Now that price and availability are out of the way, lets deal with smell: Testim smells. Some people think it smells good, and some cant stand it. Personally, I like it and my wife likes it. Ive found that women ask me what cologne Im wearing, and mention that they like it too. Still, if you or your wife dont like the smell of something you have to put on every day, that would be a deal-breaker. So try out a tube and see what you and, if applicable, your partner thinks about the Testim scent. Androgel doesnt have much of a smell at all.

Testim is sticky. Androgel goes on much like that hand-sanitizer stuff, while Testim seems to remain stickier longer. Some say this is why Testim seems to work better for them: Because it stays on the skin and soaks in better. These personal statements of efficacy cant be relied on as empirical data, however. But the fact that you can feel it on your skin longer, does bring up a question about Testim gel Vs Androgel: Does it take longer to soak in and, if so, does that increase the exposure time I have to worry about when it comes to my wife and children? The short answer is: NO. In-fact, according to US National Library of Medicines website, the wait-time for AndrogGel is much longer:

You should not shower, bathe, swim, or wash the place where you applied the medication for at least 2 hours after you apply Testim gel or at least 5-6 hours after you apply AndroGel .

WasteTestim comes in little single-use tubes so you go through more of them and it generates more waste. If you are eco-minded this may factor into your decision. Androgel comes in a dispenser with a little pump on it (like soap) so there is less waste.

But the real question when considering AndroGel Vs Testim is: Which works better? Which is the best? Which testosterone topical gel is going to get my testosterone levels on track fast, keep my levels steady, and keep me there for the long term since Ill be taking this stuff for many years to come? As you might guess, both brands have their fans. Personally, I like Testim. And here is a study to back up my personal preference:

Efficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men.Grober ED, Khera M, Soni SD, Espinoza MG, Lipshultz LI.Division of Urology, Mount Sinai Hospital and Womens College Hospital, University of Toronto, Toronto, ON, Canada.Summary of the study:

A change in testosterone gel preparation among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive TRT. Changing from Androgel to Testim offers hypogonadal men the potential for improved clinical and biochemical responsiveness. Changing from Testim to Androgel is indicated to eliminate or minimize unwanted side effects.

Note: This study was done to find out if switching brands would help men who were unresponsive to one brand or the other.

More important to me than such a study is to find out from others who have been on TRT for more than a year, preferably several years or more, and hear about their experiences with both or either drug. Please comment below with your own experiences.

I am inclined toward a weekly injection over a daily application, but what does ones rear-end feel like after being used as a pin-cushion for decades? I dunno any bodybuilders out there want to elaborate on that?

See the original post:
Testim VS Androgel - Testosterone Replacement Therapy

Reprinted with the kind permission of Life Extension.

August 23 2017.An article appearing on July 18, 2017 in theJournal of Urologydocuments improvements in sexual function, urinary function and quality of life among men who receivedtestosterone replacement therapy.

The prospective registry study involved 656 men with low testosterone levels and symptoms of testosterone deficiency, among whom 360 were regularly treated with parenteral testosterone undecanoate for up to 10 years. The remainder of the subjects, who chose not to be treated with testosterone, received biannual routine clinic visits.

The researchers, from Boston University School of Medicine and School of Public Health in collaboration with German urologists, found that men who received testosterone therapy experienced significant decreases in their International Prostate Symptom Score, post-voiding bladder volume and Aging Males Symptoms scale, which assesses health-related quality of life. The percentage of patients without erectile dysfunction significantly improved in the testosterone treated group, from 17.1% at the beginning of the study, to 74.4% of the study at the last visit. In contrast, subjects who did not receive the hormone experienced deterioration in erectile function as well as in voiding functions. Prostate specific antigen (PSA), a marker which, when elevated, is associated with an increased risk of prostate cancer, remained unchanged in both groups over the course of the study.

While there were five deaths, 8 nonfatal strokes and 8 nonfatal heart attacks over the 8-month median follow-up period in the untreated group, none of these events occurred among those who received testosterone.

Long-term testosterone therapy, in men with testosterone deficiency, was well tolerated with excellent adherence suggesting a high level of patient satisfaction, authors Karim Sultan Haider and colleagues conclude. A progressive and sustained improvement in urinary and sexual function was recorded in men receiving long-term testosterone therapy, contributing to overall improvement in quality of life.

Continued here:
Testosterone replacement therapy associated with improved urinary, sexual function - ProHealth