The TRT Protocol
For Men Suffering from Testosterone Deficiency Related Syndrome


Testosterone Deficiency

Testosterone Replacement

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Testosterone Replacement Methods

Supplemental Support

Disclaimer : nutritional products are not sanctioned by the FDA for the treatment of medical conditions

People often ask if there is anything from the vitamin store that may help support healthy testosterone levels.  Reviews are mixed, thought the use of certain supplements continues in an attempt to support the body's production pathways.

1) DHEA --Dehydroepiandrosterone, is used as un "up-stream" precursor to to hormone production. 

Recommend Dosing: (Recommendation to be monitored by a Health Care Professional )

Women:  Start at 10 mg a day. May increase in 10 mg increments to 30mg max.*

Men: Start at 50mg.  May increase upto 300 mg a day. *

*Persons with hormone sensitive cancers or liver dysfunction should use caution when using DHEA

Creams and Gels

This method comes in pharmaceutical preparations or compounded preparations.  While easy and cost effective, some problems with maintaining proper levels can occur utilizing testosterone creams. The skin and subcutaneous fat  has enzymes that break down testosterone as it is absorbed.  5 alpha reductase converts testosterone into dihydrotestosterone (5 DHT).  Aromatase converts testosterone into estrogen. In men, elevated levels of estradiol, and/or 5 DHT can cause problems.  Additionally, creams and gels need to be applied daily. In women the sites need to be rotated as testosterone cream in the same place can lead to hair growth in that area. 

Intramuscular Injections

Intramuscular injections of testosterone bypasses the enzyme conversion in the skin, and can decrease the aromatization into estrogen.  Usually given in 1-3 week intervals, injections initially give a peak level that gradually dissipates and sometimes returns the patients testosterone level to below normal levels.   Because hormone levels are regulated by the brain through feedback loops, the injected testosterone signals the testicles to quit producing what ever amount they are naturally.  In an a testosterone deficient male, this is usually a low level of production from the testicles, but supplementing through injection can lower that even more. So once the injected testosterone is metabolized, the normal body levels drop even lower. Additionally, the serum testosterone bioavailability curve  looks more like a line of peaks and valleys. While this method is better for maintaining testosterone levels than creams, it is not problem free. 


Testosterone Pellets

Testosterone pellets insertion using the SottoPelle technique, provides the best option of maintaining physiologically similar testosterone levels.  The heat fused pellets are placed in the subcutaneous tissue, several inches below the belt line in the buttocks. Using a small surgical instrument and local anesthetic, the pellets are places every 4-6 months.  The pellets provide a good supply of testosterone, and if demand increase because of increase activity, the resulting increase in blood flow increases testosterone absorption. 

Additional Issue with Testosterone Replacement / Supplementation

Testosterone supplementation requires monitoring with lab work.  In the first year you usually have blood labs drawn 3-4 times.  Initially, prior to first visit to determine if there is a deficiency, then at 6 weeks post therapy, again at 3 months, 6 months, and 12 months. After the first year, if your history, physical, and labs remain normal, then lab work is done every 6 months. 

It is important to make sure your physician doesn't just monitor your testosterone levels.  Intermittent lab test should look at estradiol levels, as well as PSA, and Hemoglobin/Hematocrit levels. 

Important Note:   Testosterone replacement therapy is for recognized medical conditions.  Testosterone therapy is not prescribed for those seeking increase athletic performance, competitive or not. Testosterone therapy will only be prescribed to those after the appropriate lab testing, coupled with a history and physical that ascertains a medical condition exists. Acceptable conditions include androgen deficiency.




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