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Testosterone Replacement (TRT) in today’s Society


by Mike Arnold

As I was sitting on my couch the other night watching television, I flipped the channel and noticed, for the 100th time, an advertisement for testosterone deficiency…or as the prescription drug advertisements like to say, “Low T”. Not long ago, the term hormone deficiency was primarily associated with middle-aged women and brought to mind terms such as hot flashes and vaginal dryness, but with more and more men being diagnosed with low testosterone levels, menopause has now been joined by its male equivalent; andropause.

With all the recent publicity surrounding this condition, public awareness has skyrocketed. As a result, men all over the country are seeking out physicians for treatment. While acceptance of this therapy was long over-due, its timing is ironic given the current, anti-AAS sentiment echoed across the U.S. and abroad. However, with Big Pharma’s lust for dollars, this seeming contradiction is easily reconciled, especially when one realizes the low production cost of this 80 year old medicine. Regardless, recognition of this malady opens the door for men to get the help they need and that is good enough for me.

Unlike menopause, plummeting hormone levels in men are not necessarily due to a predictable, age-related physiological condition. We are seeing more and more men in their 20’s and 30’s (a time when testosterone levels should be near their peak) being diagnosed with inadequate testosterone. This is consistent with falling testosterone levels world-wide. While we cannot pinpoint the exact cause(s) of this troubling trend, there is strong evidence which suggests that environmental factors are at least partially to blame. In today’s society, the human body is constantly exposed to various xenobiotics (chemical compounds foreign to a living organism) through the food we eat, the water we drink, the air we breathe, and the products we use. Studies have shown that the average T level in men has been declining for generations, with a 15% drop in the last 25 years alone. In combination with other factors (e.g. steroid use), many men will become testosterone deficient early in life.

The normal reference range for testosterone in men, according to guidelines accepted by the A.M.A. (American Medical Association), is roughly 250-1,000 ng/dl. However, the word “normal” is deceptive in this instance, as there is nothing normal about this reference range in healthy young men. In order to understand why these figures are flawed, we must first learn where they came from. The current reference range was determined using a wide range of men aged 20-80. In addition, these men used in this study varied widely in both body composition and metabolic health, with some of the test subjects even displaying pituitary and other health conditions/illnesses capable of directly or indirectly exerting a negative effect on testosterone production.

So, while this reference range may indeed represent a normal testosterone level for men in general, it does not make any distinction between a healthy 25 year old man and an ill 80 year old man with a dysfunctional pituitary gland (i.e. the pituitary gland regulates many of the bodies hormones, including testosterone). This means a 25 year old man could walk into a clinic and be told that he is “normal” despite having the T level of a sick, elderly man. Without accounting for differences in age and health status, this reference range is basically worthless when attempting to determine whether or not someone is a viable candidate for TRT.

Fortunately, many doctors today are educating themselves on this issue and treating patients accordingly, but even more are not, making it difficult for some to find the help they need. Among the more progressive doctors, we are starting to see a shift towards optimization of T levels, rather than simply avoiding deficiency. As the evidence in favor of optimization continues to mount, no patient should accept the care of a doctor who refuses to look at the evidence and insists on treating the patient based on this out-dated reference range.

The benefits of optimal T levels are numerous. Improvements in mood, cognitive function, cardiovascular health, libido, sexual performance, bone density, confidence, and increased muscle mass are just some of the benefits associated with maintaining optimal levels of this critical hormone. With such a large percentage of today’s population exhibiting sub-par T levels, I recommend that any man age 21 and over should see a doctor for blood work. While some may think this is a bit extreme, I have seen far too many men in their 20’s with T levels in the 300’s and below, many of whom have had no prior steroid or prohormone experience. This is indicative of a widespread problem and consistent with the research efforts of others. Of course, anyone experiencing any of the traditional symptoms connected with testosterone deficiency should see a doctor for evaluation.
So, armed with this knowledge, what T reading should we be striving for? Opinions on this subject vary, but I believe anything under 600 ng/dl is unsatisfactory, while readings in the 800-1,100 range are ideal. Readings in this range will impart all the previously mentioned benefits, while avoiding any of the negative side effects typically associated with testosterone excess. Generally speaking, most men will be able to obtain these numbers by administering 150-200 mg/weekly.

I want to take a minute to address those who have or are using steroids and/or prohormones. In many cases, these men are much more likely to experience testosterone deficiency and subsequently require testosterone replacement therapy, as AAS can exert long-term suppressive effects on endogenous testosterone production. While the proper implementation of post-cycle therapy will increase one’s chances of maintaining a normal (i.e. 600 ng/dl or above) testosterone level, there is no guarantee. Those who are already teetering on the brink of sub-par levels will often be permanently pushed into the sub-par range after engaging in only short-term steroid use. Therefore, it makes sense for anyone who has used these drugs to get their blood levels checked. In order to obtain a reliable reading, one should have their levels checked about 90 days after discontinuation, assuming PCT was utilized immediately after the cycle.

There are different forms of TRT available. These include testosterone creams, gels, injections, and methods to boost endogenous production such as the use of HCG and/or HMG. Some physicians have begun to utilize A.I.’s and/or SERMS to increases endogenous T levels. Personally, I am opposed to use of A.I.’s & SERMS for this purpose, unless used short-term, such as during PCT. The long-term use of these drugs not only has potential side effects which are non-existent with traditional forms of therapy, but is generally less effective than other treatment methods. In my opinion, if the body is not able to maintain optimal testosterone levels on its own, why not just replace the lacking hormone (testosterone) itself, rather than use alternative treatment methods which are less effective and have potential side effects?

Now, some might argue that using A.I.’s and/or SERMS is preferable in younger men, as treatment methods utilizing exogenous testosterone can dramatically reduce sperm count & motility, in turn lowering one’s chances of conception, particularly if the individual previously had a low sperm count and impaired motility. I believe this argument is invalid, as one can easily counteract this problem through the concomitant use of HMG.

HMG is a newer drug containing a combination of leutinizing hormone and follicle stimulating hormone. Leutinizing hormone is produced by the pituitary gland, which then travels to the testes, signaling them to produce testosterone, while follicle stimulating hormone, also produced by the pituitary gland, signals the testes to produce sperm. By using HMG along with testosterone, the suppressive influence of the testosterone is over-ridden, allowing both natural testosterone and sperm production to ensue. Side effects with HMG and/or HCG are basically non-existent. Some patients may be able to get away with using only HMG and/or HCG as a form of TRT. As with all forms of TRT, lab work is required to verify that blood levels are elevated adequately.

Out of all the available TRT treatments, testosterone via injection produces the most notable improvement in the largest percentage of people. This is due to its superior absorption rate, which leads to higher serum testosterone levels. Creams and gels tend to vary widely in their efficacy. Some people respond well, bringing their T levels into an acceptable range with consistent application, while others seem to have a difficult time absorbing the drug, forcing them to switch to an alternate form of treatment. Many doctors begin with creams & gels and will only move to injections if absolutely necessary. Some will even refuse to use injections regardless of results, forcing the patient to use these less effective, newer, patent holding medications. Of course, the claimed reason for using these creams & gels is that they have a higher rate of patient compliance, although new research is beginning to prove otherwise. It is well known that these patented drugs bring much greater profits to pharmacies and while I am not going to make accusations of foul play in this article, I will let the reader take a guess as to why doctors are known for frequently pushing newer, patent holding medicines even when there are more effective, less expensive medications available.

If you are not familiar with the doctors in your area that treat low testosterone, you may need to do a bit of searching in order to locate one who is willing to conform to modern treatment guidelines. Testosterone deficiency is a real problem, affecting millions of Americans and. However, with growing public acceptance and new studies proving the safety and benefits of TRT, more doctors than ever are willing and able to competently treat the condition.

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