Nearly every franchise clinic supplying men with testosterone could possibly be doing more harm than good. Many good-intentioned physicians are also most likely harming their male testosterone replacement therapy (TRT) patients. It’s not their fault. They simply are not educated on how to properly and safely support the man’s system while supplying testosterone.
There are a few different ways to get testosterone into the body. Many physicians will write a prescription for a cream. The cream is applied daily to the skin and the hormone is absorbed into the bloodstream. There are two major problems with testosterone creams. The first is cross contamination. Only about 50% of the testosterone is actually absorbed through the man’s skin. The remaining 50% gets on his clothes, his linens, his towels, his wife, his mother, his son, his daughter, and anyone and anything he comes in contact with. To make matters worse, his clothes are mixed with his family’s clothes during the wash, contaminating everyone in the house. For this reason, none on my male clients use testosterone cream.
The second issue with cream is the conversion of a large percentage of testosterone into estrogens as it passes through the skin. Men make estrogens by converting testosterone into estrogens via the aromatase enzyme. Males need estrogens, just a much smaller amount than females. This conversion through the skin cannot be stopped or blocked. The end result is an increase in testosterone but also a significant increase in estrogens.
Another way to administer testosterone is through a sublingual tablet or troche. The tablet or troche is placed between the cheek and gum once or twice a day. As it dissolves, the testosterone moves through the lining of the mouth and into the body. This method is acceptable but the absorption is erratic. Each person holds the tablet in their mouth for a different length of time before swallowing. Testosterone does not survive in the digestive system and is destroyed before it ever reaches the bloodstream. Food, drink and brushing your teeth can also alter absorption.
A third way to receive testosterone is via an implanted pellet. This involves a surgical procedure to implant several testosterone pellets into the hip area. The pellets dissolve over the course of 2 to 4 months, depending on the individual. This process is expensive, painful, and has a higher risk of infection. Also, I’ve seen several patients whose body rejected the implants and literally pushed them back out of the body.
The pellets dissolve based on surface area. Freshly implanted pellets have the largest surface area and therefore release the most testosterone. As time goes on, the surface area of the pellet gets smaller and smaller. Therefore, the amount of testosterone being released gets lower and lower. Eventually, the man feels worse than before he started therapy and makes an appointment for fresh pellets. This procedure causes a tremendous increase in testosterone followed by a steady decrease of the course of several weeks.
Arguably the best way to administer testosterone is through intramuscular injection. This is the way my clients receive their testosterone therapy. A once a week injection provides a steady level of testosterone. Once steady state is reached, the testosterone level remains stable with little fluctuations.
The injection is taken in the gluteus muscle. This area shows the least amount of risk for hitting a larger blood vessel. Some men inject in the thigh or shoulder. I do not recommend this area as there are larger blood vessels that can be pierced by the needle.
Perhaps the greatest lack of understanding with TRT involves the adjunct medications that the man should be receiving. As mentioned before, males make estrogens by converting testosterone. Theoretically, the more testosterone in the body, the more estrogens are being manufactured. Without blocking this conversion, the man’s ratio of testosterone to estrogens will continue to be unbalanced. A once a week tablet of anastrazole is all that is required to inhibit this process and keep his estrogens at bay.
The subject of human chorionic gonadotropin (HCG) is one I am passionate about. Our brain detects the level of testosterone in our body. When the level is low, it sends out a signal to the testicles “telling” them to produce the needed testosterone. Due to many different factors, the testicles are no longer producing the required testosterone and the man should start TRT. When testosterone is returned to the proper level, the brain recognizes this and does not send out the signal to the testicles.
Like anything else on our body, lack of use causes atrophy and dysfunction. Over time, the testicles shrink in size. After a long period of time of not working at all, the testicular function ceases. If the man decides to stop TRT, the testicles will no longer function to provide the necessary testosterone. They will also be significantly smaller.
The body recognizes HCG as this signal from the brain to the testicles. Since the brain is no longer sending that signal, it must be provided to avoid these issues. HCG must be given as a subcutaneous injection, it cannot be swallowed and does not absorb through the skin or mucus membranes. There are several different regimens for administering HCG with most of them being effective in keeping testicular function. Too much HCG can cause desensitization, making the testicles resistant to the dosing. Too little HCG will not be effective.
As with any specialized area of medicine, hormone replacement is very specific to the individual patient. Simply adding a hormone here or there is not the answer. Going to a well intentioned physician is not always a good option. Hormone clinics are franchises like McDonalds that can pop up anywhere to make a quick buck and disappear.
Before starting your testosterone replacement therapy, be sure to study the subject and become educated. This is your body and you want it to perform optimally.
