Men's Health

Testosterone Replacement Therapy (TRT) for Men

What is testosterone?

Testosterone stands as the most potent androgen. Its name comes from Greek words meaning “man maker”.  As men age, their testosterone levels decline gradually, triggering a cascade of physiological changes. This drop lowers bone calcium levels, reduces muscle mass, increases body fat, and slows cognitive function. In addition, less red blood cell production drains energy and diminishes sexual activity.

Around age 30, total testosterone falls by about 1 percent per year. Free testosterone, the active form responsible for these effects, declines even faster—about 2 percent annually.

How do I know if I need Testosterone Replacement Therapy (TRT)?

You can assess your hormone levels with a simple blood test. First, we draw your blood in the office during your initial visit. Once we receive your results, our physician reviews them with you, determines whether you need hormone replacement therapy, and creates a personalized treatment plan.

Most men with hypogonadism have total testosterone below 300 nanograms per deciliter, free testosterone below 5 nanograms per deciliter, and bioavailable testosterone under 150 nanograms per deciliter.

We focus on optimizing your testosterone within the highest quartile of the reference range instead of waiting for it to drop below 300. Above all, we track your symptoms and how you feel to make sure you reach optimal health and well being.

We commit to evidence based medicine and work to enhance your health and quality of life so you become the best version of yourself.

Treatment for Low Testosterone

We offer several TRT options tailored to your needs, and our medical provider will help you choose the best approach. Transdermal creams are common and well absorbed, while injections, our most effective method, can be self-administered at home with our guidance.

It is important to note that testosterone therapy may reduce fertility, so if you’re under 40, consider adding clomiphene or HCG. Finally, optimizing your levels works best when paired with a healthy lifestyle: balanced nutrition, regular exercise, and sensible dietary choices.

Clomiphene Citrate and Enclomiphene

Clomiphene and Enclomiphene are selective estrogen receptor modulators (SERMs) that serve as an alternative treatment for men with low testosterone who wish to preserve fertility. While testosterone is more effective in raising serum testosterone levels and improving symptoms, it can reduce testicular volume, which is linked to decreased sperm production and lower fertility. If you’re under 40, we strongly recommend considering SERM and/or HCG instead of testosterone to manage suboptimal testosterone levels.

Human Chorionic Gonadotropin (HCG)

HCG is a hormone produced in small amounts by the testes and pituitary gland that stimulates the body to produce more testosterone and can increase sperm production, helping to address infertility. HCG does not reduce testicular size and can be used alongside TRT or in cycles to preserve fertility and treat testicular atrophy caused by exogenous testosterone use.

Bioidentical Testosterone

Bioidentical testosterone is a form of testosterone that has the same chemical structure as the naturally occurring hormone in your body. It is available in various esters such as cypionate, enanthate, propionate, or a combination of all three. Each ester differs in its onset and duration of action as well as its side effect profile. Bioidentical testosterone is available in several forms, including creams, injectables, and implantable pellets.

Aromatase Inhibitors (AI)

Aromatase inhibitors (AIs) are medications that reduce estrogen levels by blocking the conversion of testosterone to estrogen. The three FDA-approved AIs are Exemestane, Anastrozole, and Letrozole, with Anastrozole being the most commonly used to manage side effects such as nipple sensitivity, breast tenderness, gynecomastia (man boobs), and puffiness while on TRT. In rare cases, Tamoxifen may be used to treat gynecomastia. Aromatase inhibitors should not be used indiscriminately and should be prescribed based on individual needs.

TRT Side Effect

Most patients do not experience significant side effects from testosterone therapy, often enjoying the added benefits. However, some adverse reactions may occur, though they are generally easy to manage.

Potential side effects can include an increase in red blood cell count, gynecomastia (rare), acne, fluid retention (rare), accelerated male pattern hair loss (if there is a genetic predisposition), and reduced sperm count (which may affect fertility).