Testosterone Replacement Therapy (TRT) for Men
Testosterone is produced in the ovaries, adrenal gland, and through peripheral conversion from circulating androgens. As you age, your energy levels, muscle mass, strength, sleep patterns, mood, libido and mental clarity may begin to decline, and can leave you felling old and less capable than you were as a younger man.
Testosterone is the key male hormone that is responsible for keeping you feeling and looking young and vibrant. When men experience a decline in testosterone, associated symptoms can be extremely difficult to live with and make life less fulfilling.
What is Testosterone Replacement Therapy?
While the transition from feeling youthful to feeling old seems swift in your mind, in reality, the biological transition happens very gradually. Testosterone Replacement Therapy is a program to restore the testosterone levels in your body that have declined due to the aging process. When your testosterone levels are returned to an optimized level, you will experience all the benefits that are associated with the testosterone levels of your youth.
What Is Testosterone?
Testosterone is a hormone produced in the body that begins to increase during puberty and begins to decline around age 30. Improved testosterone levels will result in higher energy levels, improved muscle mass, less intraabdominal fat, improved bone density, improved mood, increased libido, improved sleep quality and mental clarity.
Benefits of TRT
There are a multitude of benefits men can enjoy with Testosterone Replacement Therapy, including the following:
- More energy
- Increased libido
- Enhanced muscle mass
- Better mood
- Leaner body
- Less intraabdominal fat
- Prevention of neurologic conditions such as Alzheimer’s disease and dementia
- Mental clarity
If you are ready to realize the benefits of Testosterone Replacement Therapy for yourself, contact Ontario Regenerative Medicine or use the contact form below to schedule your consultation.
Signs and Symptoms of Testosterone Deficiency (TD) and/or Late On-set Hypogonadism (LOH)
- Increased fatigue
- Increase in depression and anger
- Decrease in lean body mass
- Decrease in muscle volume and strength
- Decrease in body hair
- Changes in mood
- Decrease in cognition
- Decrease in spatial orientation
- Decreased bone mineral density
- Diminished sexual desire and erectile quality
Risks Associated with Low Testosterone
Low Testosterone can increase the risk of certain conditions including the following:
- Alzheimer’s disease
- Cardiovascular disease
- Osteoporosis-related fractures
- Poor prognosis for prostate cancer
- Diabetes mellitus
- Sarcopenia
International Expert Consensus Resolutions
A group of experts across a broad range of medical specialties convened in Prague in 2015 in order to address widespread concern regarding the condition of testosterone deficiency (TD) and its treatment with TRT.
Nine resolutions were debated and unanimously agreed upon. The resolutions are as follows:
- TD is a well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health, and quality of life.
- TD is a global public health concern.
- Symptoms and signs of TD occur as a result of low levels of T and may benefit from treatment regardless of whether there is an identified underlying etiology.
- T therapy for men with TD is effective, rational, and evidence-based.
- There is no T concentration threshold that reliably distinguishes those who will respond to treatment from those who will not.
- There is no scientific basis for any age-specific recommendations against the use of T therapy in men.
- The evidence does not support increased risks of cardiovascular events with T therapy.
- The evidence does not support increased risk of prostate cancer with T therapy.
- The evidence supports a major research initiative to explore possible benefits of T therapy for cardiometabolic disease, including diabetes.
References:
Morgentaler, A., Zitzmann, M., Traish, A. M., Fox, A. W., Jones, T. H., Maggi, M., Arver, S., Aversa, A., Chan, J. C., Dobs, A. S., Hackett, G. I., Hellstrom, W. J., Lim, P., Lunenfeld, B., Mskhalaya, G., Schulman, C. C., & Torres, L. O. (2016). Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions. Mayo Clinic proceedings, 91(7), 881–896.
Testosterone, Inflammation and Chronic Pain
Testosterone plays an essential role in limiting inflammation throughout the body. Low testosterone can be the cause of joint pain.
Effects of Testosterone on Joints and Inflammation:
- Testosterone improves most forms of chronic joint pain.
- Testosterone improves most types of chronic muscle pain, including symptoms of osteoarthritis and fibromyalgia.
- Testosterone can lower inflammatory markers.
- Most autoimmune patients notice a decrease in symptoms and pain (including those with rheumatoid arthritis).
The Benefits of Testosterone for Chronic Pain Patients
- Necessary for opioid receptor bonding.
- Increases exercise tolerance.
- Maintains sexual drive and function.
- Affects mood (decreases depression/anxiety).
- Maintains the blood-brain barrier.
- Maintains muscle and bone mass.
- Prevents opioid complications, such as osteoporosis.
References:
Bianchi VE. The Anti-Inflammatory Effects of Testosterone. J Endocr Soc. 2018;3(1):91-107. Published 2018 Oct 22. doi:10.1210/js.2018-00186
Hillary D. White, Thomas D. Robinson, A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients, International Immunopharmacology, Volume 27, Issue 2, 2015, Pages 244-248, ISSN 1567-5769, https://doi.org/10.1016/j.intimp.2015.05.020.
Am I A Candidate for TRT?
Those looking to undergo Testosterone Replacement Therapy are men who are experiencing some or all of the following:
- Low energy levels
- Decrease libido
- Decreased stamina
- Significant weight gain
- Loss of muscle mass
- Have decreased testosterone production / levels (determined by appropriate medical testing)
Personal Consultation
During your private consultation at Ontario Regenerative Medicine, you will have the opportunity to discuss your concerns regarding low testosterone. We understand the challenges many men experience and will answer your questions and provide detailed information about Testosterone Replacement Therapy.
You will be asked to complete questionnaires that will provide an understanding of many symptoms that are related to suboptimal testosterone levels and give you an understanding of what improvements you can expect after treatment. We will also review your medical and health history and organize a detailed analysis of your blood to assess your health and hormone levels.
The results of these questionnaires, medical exams and blood work, will determine your candidacy for Testosterone Replacement Therapy and allow us to create a customized treatment plan for you and your unique needs.
Testosterone Replacement Treatment
When you visit Ontario Regenerative Medicine for your Testosterone Replacement treatment, we will review the results of your blood test with you, discuss the treatment and address any questions you may have.
If you are a candidate for pellet therapy, we will do a small procedure under local to insert testosterone pellets. These are placed through a microscopic incision into the thin fat layer under the skin of the buttock. The pellets are the size of a grain of rice and will slowly release Bioidentical Testosterone over the next 3 to 4 months. The use of pellets creates a constant level of testosterone and eliminates the fluctuations related to other modalities of testosterone replacement.
Occasionally we will recommend intramuscular injections of testosterone if the insertion of pellets is not possible. We will administer the testosterone treatment directly into your gluteal muscle on a weekly basis.
As a patient of ORM, we will facilitate repeat blood work throughout the year and modify your dosing as required. All patients are enrolled in an annual program and undergo ongoing medical assessment and blood work to adjust hormone dosing and ensure your best quality of life. Patients are required to attend these follow up appointments so we can monitor their progress and testosterone levels.
What is Bioidentical Hormone Therapy?
At Ontario Regenerative Medicine we utilize plant-based hormone replacement medication for our patients. The molecular structure of the medication is identical to the testosterone produced in the body, making it bioidentical. While animal-derived and synthetic hormone replacement therapies cite a number of risks and side effects for patients, our bioidentical hormones pose less risk and fewer potential side effects.
Testosterone Method of Delivery (Why it MATTERS)
ORAL:
- Requires daily administration.
- First-pass effect (pharmacological phenomenon in which a medication undergoes metabolism at a specific location in the body and decreases the active drug’s concentration upon reaching systemic circulation or its site of action).
- May cause GI upset or nausea.
- Not as effective as other methods.
- Methyltestosterone can sometimes cause hepatotoxicity, for instance elevated liver enzymes, cholestatic jaundice, peliosis hepatis, hepatomas, and hepatocellular carcinoma, with extended use.
- With buccal/sublingual forms, must be dosed 3x per day.
TRANSDERMAL:
- Requires daily or twice daily administration.
- Avoids first-pass metabolism by the liver.
- Can cause skin irritation.
- Some individuals are unable to properly absorb.
- Blood levels will vary.
- Possible transfer to others through skin-to-skin contact.
INJECTABLE:
- Weekly or biweekly administration.
- Inconsistent, fluctuating levels, creating a “roller coaster” effect.
- Hormone level rapidly increases.
- Injection causes some pain.
- Some individuals may have allergic reaction to carrier oils
PELLET:
- Administered every few months
- Steady, stable hormone levels over time.
- Some pain with insertion.
- Possibility of extrusion.
- Activity restrictions after procedure.
- Difficult to adjust the dose.
References:
Čeponis, J., Yadav, P., Swerdloff, R.S., Wang, C. (2017). Testosterone Therapy: Transdermal Androgens. In: Hohl, A. (eds) Testosterone. Springer, Cham. https://doi.org/10.1007/978-3-319-46086-4_11 https://medlineplus.gov/druginfo/meds/a614041.html
Testosterone Pellets
- Multiple and customized dosing options.
- Consistent, steady levels.
- Predictable absorption.
- Pellets kick in at about a week.
- Patient stops other forms of Testosterone at one week.
- Rise and peak around weeks 4-6.
- Reduced risk of platelet aggregation.
- Convenient option with fewer office visits for maximized patient satisfaction and compliance.
- 1-4 times per year for women.
- 1-3 times per year for men.
References:
1497 A MULTI-INSTITUTIONAL OBSERVATIONAL STUDY ON TESTOSTERONE LEVELS AFTER TESTOSTERONE PELLET (TESTOPEL™) INSERTION Andrew McCullough, Mohit Khera, Wayne Hellstron, Abraham Morgentaler, Larry Levine and Irwin Goldstein
Results
Overall, men who undergo TRT report feeling more energized, enjoy improved mental clarity, have better sleep patterns, have more sexual interest and improved sexual performance, gaining enhanced strength, and experiencing improved well-being. In addition, Testosterone is associated with improved long term brain health and less Alzheimer’s.
Following insertion of the pellets under the skin, you may experience some tenderness at the implantation site. Any discomfort should resolve within 24 to 48 hours. As the pellets or injection release the hormones, you may experience an increase in sex drive as soon as 3 weeks after administration. You may notice an improvement of mood between 3-6 weeks. Enhancement of muscle mass and strength may be evident at around 12 weeks. We will discuss additional effects of Testosterone Replacement Therapy with you during your consultation.
FAQ
What Are The Side Effects Of Testosterone Replacement Therapy?
During your consultation at Ontario Regenerate Medicine, we will detail the risks and benefits of Testosterone Replacement Therapy. The impact of TRT is based on your unique presentation of symptoms, body chemistry, and medical history.
How Much Testosterone Will I Be Given?
The dose of the testosterone you will be prescribed will be determined by a number of factors. In order to determine the therapeutically effective dose for you and your needs, we will inquire about your symptoms and health history. We will also require blood work to be completed in order to determine your candidacy for Testosterone Replacement Therapy. After beginning treatment, you will need to return to the clinic for routine follow-up visits so that we can make any necessary adjustments to your dosage based on your reports and additional testing.
How Much Does Testosterone Replacement Therapy Cost?
Your TRT plan is tailored to you and your goals. As such, the cost for Testosterone Replacement Therapy will also be unique to you. After your private consultation, you will be provided with a breakdown of costs for your treatment based on your specified plan.
Testosterone and Prostate Cancer
Testosterone Replacement Therapy (TRT) and the Prostate:
- TRT does NOT increase the risk of prostate cancer
- TRT for survivors of prostate cancer does not pose an increased risk of recurrence or persistence
- TRT is not associated with an increase in the progression of prostatic intraepithelial neoplasia (PIN)
NOTE: Androgen deprivation therapy (ADT) for cancer treatment increases risks of DM, hypertension, dementia, dyslipidemia, and CVD
References:
Rhoden EL, Morgentaler A. Testosterone replacement therapy in hypogonadal men at high risk for prostate cancer: results of 1 year of treatment in men with prostatic intraepithelial neoplasia. J Urol. 2003;170(6 Pt 1):2348-2351. doi:10.1097/01.ju.0000091104.71869.8e
Ramasamy R, Fisher ES, Schlegel PN. Testosterone replacement and prostate cancer. Indian J Urol. 2012;28(2):123-128. doi:10.4103/0970-1591.98449
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We treat our patients for their unique needs and symptoms, rather than simply viewing lab results. We go beyond the numbers to alleviate our patient’s symptoms and get them back to living the lives they want to live.
