About Testosterone Replacement Therapy

Overview of Testosterone Replacement Therapy (TRT):

• TRT is a treatment for individuals with low testosterone levels.

• Different methods of delivering testosterone can be used, such as transdermal (gel/cream) or intramuscular (injections).

• The choice of delivery method should be based on patient preference, individual response, and medical considerations.

Monitoring and Adjusting TRT:

• Regular monitoring of testosterone levels is essential to ensure the therapy's effectiveness.

• A 24-hour urine panel is recommended for transdermal TRT as it provides a comprehensive view of testosterone and its metabolites.

• Serum testing is preferred for intramuscular TRT, usually done two hours after the injection.

• For IM TRT, avoid adding HCG to the regimen during the week of testing to assess testosterone delivery more accurately.

Starting and Adjusting TRT:

• Start with a testosterone gel if possible, as it's easy to use, and results are quickly observable.

• If necessary, switch to intramuscular testosterone cypionate.

• Patient response to different doses and delivery methods can vary significantly, so adjustments should be made as needed.

• Adjustments should be conservative to avoid potential side effects from elevated testosterone levels.

Managing Hormone Levels:

• Elevated estrogen levels can occur during TRT and may need to be addressed.

• An aromatase inhibitor (like Arimidex) can be used to control estrogen levels.

• Side effects like nipple sensitivity can be managed with selective estrogen receptor modulators (SERMs) like Nolvadex.

• Testosterone should not be increased too quickly, as this can lead to patients becoming "spoiled" at higher levels.

Adding HCG to TRT:

• Human Chorionic Gonadotropin (HCG) can be added to the TRT regimen to support testicular function.

• HCG stimulates the production of pregnenolone, benefiting all three hormonal pathways.

• Patients often report feeling better with the addition of HCG.

• Some practitioners add HCG intermittently, but the author suggests a continuous approach to maintain testicular function.

Incorporating Additional Hormones:

• DHEA and pregnenolone can be added to the TRT regimen to restore natural hormonal pathways.

• These hormones help support overall health and well-being.

• While the exact mechanisms are not fully understood, this approach is considered advanced in TRT medicine.

The author emphasizes the importance of regular monitoring, individualized treatment, and conservative adjustments in TRT.