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Testosterone Replacement Therapy

As men age, their testosterone levels tend to drop. This causes many symptoms including loss of libido (sexual desire), impotence, weight gain, fatigue, fuzzy thinking, insomnia and more. The cause is not known. Although diet and exercise can help, for many men replacement therapy will be needed to get rid of their symptoms.

Testosterone replacement therapy needs to be monitored by a licensed medical physician. The physician will most likely want to get some baseline blood work to confirm the diagnosis. Having the symptoms is not enough. Baseline blood work will probably include a total testesosterone, free testeosterone, sex hormone binding globulin, dihydrotestosterone, estradiol, a CBC (complete blood count), FHS (follicle stimulating hormone), LH (leutinizing hormone) and PSA (Prostate Specific Antigen). Some of these tests are used to determine the severity of the testosterone deficiency. Others are used to monitor the therapy. Testosterone can be provided in many ways. Some methods actually deliver testosterone. Other methods attempt to make your body make more testosterone. There are pros and cons of each method.

To deliver testosterone, the doctor can use injections, prescription testosterone gels and creams, compounded testosterone gels and creams (this is usually much less expensive than the name brand topical testosterone and works just as well), implantable pellets and troches (testosterone that is absorbed through oral mucous membranes). The major side effect of providing testosterone directly is that the testicles will stop producing testosterone. This can lead to testicular atrophy (small testicles), low sperm count (infertility) and lower ejaculatory volume. To stimulate the testicles to make testosterone, the doctor can prescribe HCG injections, LH injections (very expensive), Clomid and Nolvadex. HCG and LH injections will stimulate the Leydig cells in the testicles to make testosterone. Clomid and Nolvadex block the brains ability to see estrogen. All men need some estrogen, and estrogen can be made in the body from testosterone. When a man gets Clomid or Nolvadex, the brain will make more LH (leutinzing hormone) in order to stimulate the testicles.

The disadvantage of using Cloimd and Nolvadex is that they may increase the risk of getting blood clots. Also since men tend to function better with small amounts of estrogen, and these medication block almost all estrogen, the overall result may not be as good. Once Testosterone Replacement Therapy has begun, the doctor will need additional blood tests to follow your progress. Testosterone can be converted into estrogen and DHT which can cause problems if too much is converted.


Low Libido, Impotence, Weight Gain, Insomnia, Fatigue, Fuzzy thinking