Testosterone Replacement Therapy – Maui Athletics

Testosterone Replacement TherapyMale Testosterone Replacement Therapy (TRT) is treated by many doctors as taboo. This is mainly due to under-education on the topic, stigma from the public, and fear of litigation in todays society. Due to liability issues, a large percentage of doctors are not willing to even educate themselves on the matter. In reality, TRT is a valuable treatment modality that can greatly increase quality of life for many men, with minimal risk in otherwise healthy individuals (as long as some precautions are followed). A competent doctor will focus on treating symptoms and root-cause, not numbers on a blood panel.

This compilation intends to provide the most up to date information on all things TRT. Bare in mind that this research does not look into supra-physiological use. It is also not intended to diagnose or treat any medical condition, please talk with your physician if you suspect you are a candidate for TRT.

Testosterone preparations come in various forms (injectable, cream, pellet, etc). My number one recommendation is always injectable as you can more safely and accurately tailor the dose to your own body. Testosterone is generally bound to an ester in injectable form. The type of ester yields vastly different speeds of absorption. Fast acting (short-acting) esters such as Propionate produce higher blood levels much quicker, but also come at the risk of more side-effects.

One such side is the aforementioned erythrocytosis. This is why longer esters such as Cypionate or Enanthate (or in the future Undecanoate) are typically used for TRT. Benefits of these long-acting esters include decreased side effects/risks as well as the requirement for less frequent injections. Another way to mitigate red blood cell production (and estrogen conversion) is to inject smaller doses more frequently to produce smaller blood level spikes of testosterone. Blood panels to monitor hematocrit are of paramount importance during TRT. Luckily, a therapeutic phlebotomy can take care of the issue of erythrocytosis should the need arise. The trick is regular monitoring to catch this before it becomes a significant problem. In many following a TRT dosing protocol, this is never an issue.

When monitoring estrogen, especially in men, I recommend an E sensitive test rather than the standard test. Standard estrogen tests can give false values as they can be altered by C-reactive protein. E sensitive tests take this into account and provide a more reliable reading.

All graphics credited to their respective authors.

https://www.ncbi.nlm.nih.gov/pubmed/18160461

https://www.ncbi.nlm.nih.gov/pubmed/28526632

https://www.ncbi.nlm.nih.gov/pubmed/29933385

https://www.mayoclinicproceedings.org/article/S0025-6196(17)30824-8/fulltext

http://www.societaitalianadiendocrinologia.it/public/pdf/bellastellanovembre2017.pdf

Testosterone Therapy Coronary Plaque and Calcium Score

https://www.ncbi.nlm.nih.gov/pubmed/29542875

https://www.ncbi.nlm.nih.gov/pubmed/29978359

https://www.ncbi.nlm.nih.gov/pubmed/29974886

https://www.ncbi.nlm.nih.gov/pubmed/28202344

https://www.nature.com/articles/ijo2016242