Testosterone Replacement Therapy (TRT) – FAQ

Testosterone is a hormone made by the body that is responsible for the normal growth and development of the male sex organs and for maintenance of other sexual characteristics. In men, testosterone is produced in the testes, the reproductive glands that also produce sperm. The amount of testosterone produced by the testes is regulated by the hypothalamus and the pituitary gland. Testosterone can affect the following:

• Growth and maturation of prostate and other male sex organs
• Development of male hair distribution such as facial hair
• Changes in body muscle mass and strength and fat distribution
• Sex drive and sexual function
• Mood and energy level
• Bone strength

In healthy men, testosterone levels between 350 ng/dL and 1000 ng/dL are referred to as “normal.” Normal physiology allows the brain and the testes to work together to keep testosterone in this range. The brain produces “signal” hormones that are responsible for stimulating testosterone production. These signals are periodically released, which in turn stimulates testosterone production. When levels of testosterone are in an acceptable range, the production of the signal hormones are slowed, which in turn allows the testosterone levels to decrease.

Hypogonadism, in a male, refers to a decrease in either testosterone production, sperm production, or both. The medical professionals at Low T Center address the testosterone aspect of this condition. Decreased sperm production requires a careful, thorough evaluation by a fellowship-trained specialist.

To determine a diagnosis of hypogonadism, the medical professionals at Low T Center will first confirm your symptoms, and then perform a simple blood test, the results of which you will know in about 20 minutes. If your total or free testosterone is below the normal range, you may be diagnosed as hypogonadal.

Testosterone treatment is the practice of diagnosing hypogonadism (low testosterone) through a combination of symptoms and testosterone blood values below the lower limit of normal and treating with testosterone injections, gels, patches, surgically implanted pellets, or oral applications. Low T Center uses injection therapy to treat low testosterone in hypogonadal men.

Benefits of testosterone replacement therapy vary based upon the pre-therapy symptoms and other factors, but they can include the following:

• Increased energy
• Decreased irritability and depression
• Improved muscle mass and strength
• Improved sexual desire
• Improved visuospatial cognitive function and verbal memory
• Higher motivation
• Decreased body fat (optimal results received through accompaniment of a diligent diet and exercise regimen)
• Possible improvement in erectile function
• Thicker skin

Some patients could experience one or more of the following side effects from testosterone replacement therapy:

• Increase in red blood cells. This can be beneficial if you have anemia. However, it can be potentially dangerous because an increase in red blood cells can lead to blood clots, heart attack, or stroke.
• Prostate effects. If you have an enlarged prostate, testosterone may worsen your symptoms, particularly if you are more than 50 years of age. If you have a history of prostate cancer, you cannot receive testosterone therapy without prior clearance from the urologist who is overseeing your care.
• Skin reactions. Acne, oily skin, increased body hair, and flushing have been reported. These side effects are not very common, but if they occur, often they are transient.
• Infertility. Testosterone therapy down regulates production of a man’s sperm. Be upfront with your medical provider about your desire for children, and be sure to discuss the situation with your spouse or partner, if appropriate.
• Fluid retention. Although uncommon, you must use caution if you have a history of heart failure or kidney disease.

See the complete list of potential low testosterone treatment side effects for more information.

Most health insurance is accepted, in which case you are responsible for any applicable deductibles or co-pays under the terms of your health insurance plan. Learn more about the cost of low testosterone treatment, including information about our self-pay option.

Only your physician can fully answer this question; however, in general, testosterone replacement therapy is not recommended for, or should be avoided by, patients with the following conditions:

• Breast or prostate cancer
• A palpable prostate nodule
• Erythrocytosis
• Hyperviscosity
• Severe benign prostatic hyperplasia symptoms (AUA prostate symptom score > 19)
• Uncontrolled severe heart failure
• Unexplained PSA elevation
• Severe lower urinary tract symptoms associated with benign prostatic hypertrophy
• Unstable severe congestive heart failure (class III or IV)

The proper method of testosterone delivery for you is a matter for your physician to determine; however, many find that some gels tend to be messy and less convenient than other treatment modalities. In addition, there can be a risk of unintentional transmittal to children or others with whom you may have physical contact.

Testosterone patches can create a significant rash at the site of application. They also don’t stick well, especially during the summer months.

Experience has shown that gels and patches may require dosage adjustments to obtain medically appropriate blood concentrations, and some patients may never absorb enough testosterone from gels or patches to improve symptoms. These modalities often have a higher conversion to less desirable hormones in the process of transfer through the skin.

The physicians at Low T Center regularly employ intramuscular testosterone injections because of their clinical effectiveness and convenience.

Learn more about adverse reactions and side effects of low testosterone injections, including inflammation and pain at the site of the intramuscular injection.

At your first appointment, you will need to fast 8 hours prior- and be scheduled before 10:30a. Upon arriving you will complete a one-page questionnaire on primary and secondary symptoms you may be experiencing. Our medical staff will take your vitals as well as administer labs for a testosterone test (total testosterone level), with results in about 25 minutes. You will also meet the provider for a quick introduction about symptomatic hypogonadism (low testosterone) and treatment. The medical provider may also need to run an SHBG lab (your free testosterone level) to determine if you are treatable. If your lab results determine that you have low levels, you will schedule your second appointment. This initial T-Test is $25 and the SHBG lab is $15.

At the second appointment you will again need to fast 8 hours prior. Upon arrival you will complete past medical and family history forms, and new patient paperwork. Once paperwork has been completed, our medical staff will take your vitals and more labs will be drawn- including Testosterone and PSA- (in-office lab results) as well as general wellness labs that will be sent out. You will meet with the medical provider, have a physical exam, and then go over lab results and develop a treatment plan. If you are deemed treatable and are a candidate for testosterone therapy, you can receive your first injection that day. If you are not treatable and/or do not elect to do treatment, your cost for this visit will be $40 ($25 testo/$15 PSA labs).

Our health assessment is offered to existing Low T Center patients and includes a consult with a medical provider as well as data gathering. We capture your medical history; any symptoms you are experiencing; and a quantification of how you are feeling, which will result in your LTC Vitality Score. If you are billing through your insurance company- this annual visit is typically completely covered by insurance. This service is available and included in self-pay pricing for patients.

In addition, we take your vitals — blood pressure, pulse rate, weight — and do a full blood panel:

• Testosterone
• PSA
• SHBG
• Diabetes testing
• Cholesterol testing
• Thyroid function (TSH)
• Liver and kidney function
• Blood counts (red blood cell, white blood cell, and platelets)

Yes, fasting is required for 8 hours prior to the first and second appointments. We also recommend that you drink plenty of water prior to your appointment, to make sure you are hydrated. You may have black coffee or tea.