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TOPICAL TREATMENTS FOR hair loss. Gummy multivitamins. Generic formulations of Viagra. The online market for mens wellness is booming. And in the last couple years, that includes testosterone, which is easier to get than ever before.
Critical for regulating the male sex drive, testosterone plays a number of other key functions in the body. Its required for generating sperm. It helps to increase muscle mass, distribute body fat, and generate red blood cells. For men lacking in testosterone, the symptoms can be debilitating. Severe fatigue and depression. Irritability. No sex drive, brain fog, and anemia. Low-T guys have a harder time putting on muscle, and generally see more fat around their abdomen.
Testosterone levels, which are measured in nanograms per deciliter of blood, naturally wane as we age. The conventional wisdom, as spelled out by the American Urological Association, is that a healthy level is higher than 300 ng/dL; some experts argue that low is a little lower and starts at 264 ng/dL. Either way, doctors who specialize in hormone therapies say they are seeing a glut of guys whose testosterone levels are above 300 and are dealing with all the symptoms associated with a clinical diagnosis of testosterone deficiency.
Various boutique health companies, in response, now offer a spectrum of testosterone therapies, which have been extolled by the likes of Joe Rogan and Sylvester Stallone. There are straight-up replacement therapiesTRT, as its calledthat replenish levels of the hormone via creams, gels, pellets, or injections of either the subcutaneous or intramuscular kind. Tablets and supplements, intended to optimize the testosterone a guys already got, are also increasingly available. And forget in-person visits: The wellness businesses of today sell products that are shipped directly to consumers.
Administering testosterone is not like popping a multivitamin, to be sure. Replacing testosterone exogenously shuts down the bodys own production, which means you have to stay on it to maintain any positive effects. Younger guys should also consider their own fertility, since TRT can hinder or stop sperm production. And there are certainly ways to naturally keep your own testosterone levels at their peak: proper exercise, a good diet, and sufficient sleep are all good places to start. But many men with low or lower-than-average levels notice that their moods, muscles, and movesin the gym and in the bedroomare all improved by boosting or optimizing their T.
We recognize, though, that sifting through the options out there can be a bit daunting. What you need and where to get it are important questions. To say nothing of if you need testosterone therapy at all. So consider this your what-to-know-before-you-go shopping guide to online testosterone therapy.
Roman is a wellness company known for its array of services and its simplicitythat is, ease of use. Part of the reason is how Roman gets you going: a DIY blood test shipped to your home. The kit comes with all the materials required for finger-prick draws on two consecutive days. A smartphone app guides you step-by-step through the draws. The kit also comes with pre-printed postage so you can mail it back for analysis, which is completed in a week.
The other part? Roman has only two offerings. One is a supplement billed as testosterone support for guys with healthy levels. It contains ingredients common in multivitamins, as well as ashwagandha, a plant that has been shown, in some studies, to modestly increase your bodys natural testosterone levels.
Clomiphene citrate is the other, although its better known by its brand name, Clomid. Assume your blood test comes back showing low or lower-than-average T. A call with a doctor or nurse practitioner follows, and theyll help you decide your dosage of Clomid (if signs point to that drug being right for you in the first place, of course). The drug itself is not testosterone replacement at all. Rather, Clomid is a pill that stimulates more natural testosterone production, which it does by blocking estrogen receptors in the brain. (When that happens, the pituitary gland boosts production of luteinizing hormone, which acts on the Leydig cells in the testes to make more testosterone endogenously.)
Clomids main advantage is fewer of the side effects associated with traditional testosterone replacement, which can include testicular shrinkage and, in some cases, infertility. Our approach really has to do with maximizing the interaction between safety and efficacy, says Tzvi Doron, D.O., Romans chief clinical officer.
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Maximus caters to all men looking to optimize their testosterone, but its an appealing option for young guys who want to maintain their fertility but also need a boost in T.
Founded by clinical psychologist Cameron Sepah, Maximus doesnt offer testosterone replacement therapy at all. He calls it testosterone stimulation rather than replacement. (And his personal view is that TRT should be a last resort.) The company prescribes custom compounds of pure enclomiphene, one of Clomids two ingredients. Sepah says the reason for this is that Clomids other ingredient, zuclomiphene, can have estrogenic side effects. His sales pitch is pretty easy to boil down: The enclomiphene will quickly help your body generate more natural testosterone, minus the side effects that sometimes accompany replenishing with synthetic testosterone or popping Clomid.
Of the options here, Maximus is the quickest way to get going on testosterone optimization. You start with a quantitative ADAM, a series of questions on symptoms associated with low testosterone. Within 24 hours, a doctor makes an eligibility decision, and initiates a blood test thats shipped to consumersin this case, a shoulder-mounted device that uses microneedles to remove about a pinky-tips worth of blood. Within a week of shipping your blood sample back, youll have your first bottle of enclomiphene, if you qualify. A follow-up blood test after 30 days determines if your dosage needs any tinkering.
All Maximus patients are assigned a physician; all communication is done asynchronously through text and email. The company also provides health coaching to help guys optimize their diet, exercise, sleep schedules, and stress levels.
Our philosophy is that pharmacology and behavior change are synergistic, says Sepah. One of the biggest benefits of testosterone is increased motivation. We find it helps people make the behavior changes.
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If youre unclear about whether testosterone therapy is right for you, try Hone Health. According to Jack Jeng, M.D., Hones chief medical officer, the company only accepts patients with lower-than-normal testosterone levels. For guys who are borderline, Hones clinicians might suggest lifestyle changes (sleep, exercise, diet) for three months before jumping into a prescription.
We turn away a lot of patients, Dr. Jeng says. You have to make sure the benefits of treatment outweigh the risks.
You start with a blood test, usually self-administered at home via finger prick, to check biomarkers such as your levels of testosterone and estrogen. A 30-minute telehealth visit follows, and if the doctor deems you a good candidate for testosterone therapy, a second blood test is ordered to confirm the first reading. Within a few weeks, you could be on testosterone replacement, delivered at home in the form of creams, injections, or troches, depending on your preference.
If replacement isnt warranted, Hone can instead send Clomid. Unique to Hone is anastrozole, an inhibitor that blocks the conversion of testosterone to estrogenthat conversion can happen when aromatase, an enzyme contained in fat cells, breaks down testosterone. Whatever the case, patients receive follow-up blood tests and telehealth visits every three months in the first year to check for side effects and titrate dosages if necessary.
Give it at least 10 weeks before deciding whether or not this is working for you, says Dr. Jeng. Thats around the time when people start to notice that the benefits have started to really kick in.
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Blokes is for anyone who wants doctors controlling their testosterone therapy from start to finish. Every interaction with Blokes begins with a blood test, but these arent self-administered. Instead, Blokes schedules an appointment at a Labcorp or Quest Diagnostics facility. (For a surcharge, a phlebotomist can meet you at your home or workplace.)
These tests are the more conventional CBC, or complete blood count. Testosterone and estrogen levels are assessed, and so are your levels of luteinizing and follicle-stimulating hormonesthe pituitary hormones responsible for testosterone and sperm production, respectivelyas well as your cholesterol and lipids. A one-on-one clinical visit of at least 30 minutes then follows.
You want to know who that patient is before you start prescribing anything, says Amy Killen, M.D., one of Blokes clinicians. You dont want to throw this stuff out like candy.
Once youre in the Blokes system, youre assigned a physician and health coach who guide your therapy and make recommendations on nutrition, exercise, and other lifestyle factors. Testosterone replacement options include creams, injections, and troches, as well as nasal sprays and pellets (inserted into the body via a minor procedure). Clomid is on hand, too, as is pure enclomiphene. After 30 days: another blood test, along with another telehealth appointment. Its usually at this mark that Blokes consults with you to figure out if youre on the right form of testosterone therapy or drug.
We prioritize service over automation, says founder Josh Whalen. Every patient is getting some type of one-on-one follow-up with a provider.
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If youre as interested in health span and longevity medicine as you are in testosterone, then Opt Health is for you. Graham Simpson, M.D., one of the cofounders, has himself been on testosterone therapy for 27 years; hes 72, but doesnt look much older than 50.
Opt Health starts its prospective patients with a blood draw like all the other companies. These are done at a local Labcorp (or at home, with a visit from a nurse or phlebotomist). The blood test triggers an initial consultation, at which point Simpson, his cofounder Jeremie Walker, M.D., or one of Opts other half-dozen clinicians can take you through their testosterone options, which include creams, injections, and Clomid that are shipped directly in three-month allotments. Chances are that any testosterone treatment you end up taking will be paired with Opts offerings of amino-acid peptides or nutraceuticals.
Testosterone is a big part of our business, says Dr. Walker. But I actually have guys that are not on testosterone. Were focused on lifestyle optimizations.
Every three to four months, Opt Health repeats a blood draw followed by a consult with your clinician. A personalized online dashboard helps you track your progress, side effects, symptoms, and something Dr. Simpson calls your DNA age. (Theres your chronological ageyour birthdayand your biological age, he says.) In Opts view, fighting insulin resistance and inflammation is just as important to Opt as prescribing the right form of testosterone treatment.
Were very focused on reversing biological age, Dr. Simpson says. We look at nutrition, we look at exercise, we look at hormones, we look at stress, we look at sleep. We look at many, many things that optimize mens health.
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Andrew Zaleski, a writer based near Washington, D.C., covers science, technology, and business.
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