Testosterone Replacement Therapy (TRT) 101

[@ashleyallen7463]

This is a great video for education for health care providers! I will definitely use this to educate my patients on low testosterone and TRT

[@TCTmed]

@Ashley Allen: Thank you for the feedback! I am glad that you have found it helpful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@ypmm53]

This is the best info I have ever seen on TRT/HRT!!!! Talk about the A-Z of hormone replacement therapy! Thank you for the information. Wow! Awesome clip!!

[@TCTmed]

@Yves Patrick Mardice: Thank you for the feedback! I love hearing that our work is helping patients!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Blizzard56k]

Such an awesome explanation. I've watched this 5+ times to self educate myself after being put on TRT. I definitely have some questions for my doc. Lol Thank you! And btw you can write upside down very well! Hah

[@TCTmed]

Yep, the upside down thing took a while to master! I am glad you found the video informative, and I hope that leads to even better results for you! Good luck with your TRT!!

[@marccooper4318]

Testosterone Centers of Texas Wow you really put things into perspective and laymen terms, thank you. I wish I had gone to you first. Maybe you can answer these few questions for me please? When should you see a "difference" after starting TRT? I just got my first shot 2 days ago. Energy level may have gone up, or seems has. Is this a good sign that 8m making the right decision? Also my first reading was 191, after waking up 3 hours. My second time was 164, that was almost 5 hours after waking up. If that means anything.

[@BryanGibbons]

Probably the best video on the web, thanks!

[@TCTmed]

+Bryan G Thank you so much for the comment! Sorry we missed this somehow, but we appreciate your comment!

[@lotfibouhedjeur]

You're the best teacher.

[@augiegalindo]

@Lotfi Bouhedjeur: Thank you for the feedback! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@captaincairoPT]

Hands down best explanation of of Trt on KZbin. Thx Doc

[@TCTmed]

@Captain Cairo: Thank you, sir! That is much appreciated. I always feel obligated to say it, I'm a PA not a physician. Thank you for sharing your feedback!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@jonesyak]

Oh man. I had an appointment today at the Hurst location. I was in a bit of a rush to make the appointment as it all kind of fell in my lap at once this morning. The doctor sent me the link to this video but I didn't watch it. I feel like a total bum now. Luckily, he was very patient with me and took the time to explain everything to me and we discussed a lot of information. The amount of knowledge the team of this -association?- has is incredible. Even if it turns out that I may not have low T, I wouldn't be bummed. The doctor even helped me find a center to have my sperm count checked, which I've been meaning to do for years. I realize I'm on the younger side and I'm great full he didn't dismiss because of it.

[@TCTmed]

@Cameron Jones: Thank you for the positive feedback, and we are glad that you are taking a cautious approach in evaluating TRT, and that you have selected us to help in the process. We look forward to working with you more! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@tpfmike1976]

Cameron Jones have u gone back. are u on trt now?

[@l.robertvandyke4398]

Great description

[@TCTmed]

@l.robertvandyke4398: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@GlynRobinson]

My blood work came back with a testosterone reading of 58. I basically don’t have any. I’m starting trt next week. Thanks for this video.

[@TCTmed]

@Glyn Robinon: You are most welcome, best of luck!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@beansbeans4551]

Glyn Robinson mine 79. I felt like i was dieing. After a few weeks on the gel I felt great.

[@beansbeans4551]

It turns out that there is a problem with my pituitary gland. Maybe a tumor.

[@GlynRobinson]

Bill Jackson sorry to hear. Maybe they will get you fixed soon.

[@ismaelyoblonski3510]

Hands down most informative TRT video on youtube. Well done sirs

[@TCTmed]

@Fatt Saxx: Thank you kindly for the feedback! I am glad you found it useful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@kwater003]

I just started TRT, my Urologist allows his patients to inject themselves and they give instruction on how to do it. I get the medication and syringes at CVS pharmacy for $10 copay, .5ml per injection from a 10Mm bottle or about 20 shots per bottle so the 1 bottle should last 5 months. I just started so no noticeable improvemnts yet, but your video was great.

[@fhsgfhsgfhsgfhsg269]

Very cool and creative explanation

[@TCTmed]

@fhsgfhsg fhsgfhsg: Thank you for the feedback, I am glad you found it useful! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@austindreyer]

What happens if you stop treatment? Since this is replacement, does it surprise your bodies level to produce. Would your body start producing again, even at the low levels?

[@augiegalindo]

@Austin Dreyer: That is correct; your natural production will be suppressed while on TRT and for some time afterward. How long the suppression lasts varies. While there are reports that TRT will "decimate" your ability to produce naturally, I've never seen a case like that in over a decade of treating Low T. Generally, if you have been on TRT for a few years or less, you can expect your levels to return to pre-treatment baseline (or close to it -- production naturally declines over time) within 2-3 months of cessation. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@kylebang430]

Thank you for all that information. It definitely gives me more insight to what doctors are looking at. I'm a 28 year old male and my level is 266 nanograms per deciliter. My goal with testosterone therapy is to have a libido, reduce or hopefully get rid of my severe anxiety and depression, and passed that anything else is just an added benefit. Is trt the right treatment for someone in my predicament?

[@TCTmed]

@kylebang430: You are welcome! I am glad you found it helpful. Based on that information, I believe you could benefit significantly from optimizing your testosterone levels. Make sure to do your research on the practice you choose. Not all TRT clinics are the same. Best of luck to you! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@sheldonspaeth2070]

He’s the best upside down writer ever. Lol

[@TCTmed]

@Sheldon Spaeth: I've had quite a bit of practice! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@complot72]

That's the first thing I noticed!

[@bonfido]

Thank you for such an amazing explanation. My question is would natural testosterone levels come back to its original state if one stop the TRT treatment? Or it gets close to original levels. Thank you

[@augiegalindo]

@bonfido: You're most welcome! While I've heard anecdotal accounts of people saying they have seen a loss of the ability to naturally produce testosterone after prolonged TRT in over ten years focused on treating hypogonadism, I've not seen a case of this occurring. It's important to note, however, that your baseline production declines over time, so it should be expected that if you were on TRT for an extended period, the "baseline" production your body would return to after cessation of therapy would be lower than when you started TRT. The process of re-engaging the hypothalamic-pituitary-gonadal (HPG) axis would also take several weeks to even a few months to restore natural production. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@dr.francodebellefort4209]

Dr Galindo. Greetings. I'm a physician turned globe-trotter. I have not practised Medicine for a number of years now, nor am i anything more than a GP. I presume you're an Endocrinologist. I'm sorry that i'm about to make a nuisance of myself by asking you a barrage of questions ... if you'd be so kind as to answer them at your leisure and convenience. These queries have to do with the biochemistry of testosterone enanthate (henceforth TE), which comes in 250 mg ampules. 1. How much of it is metabolized in the first and second passages through the liver? 2. How does TE travel in the plasma? how much of it is linked to protein or other molecules? how weak/strong is that bond? 3. How long after the IM application do plasmatic levels of TE peak? Do circulating androstenedione, DHT, and estradiol increase concomitantly and significantly? 4. In regard to various target organs/tissues such as brain, skeletal muscle & adipose tissue, how does their response to TE compare to their response to TE's androgenic metabolites (say, DHT). I seem to recall (perhaps wrongly) DHT being far more potent than testosterone itself in most target organs. If this should indeed be the case, then shouldn't one be looking at DHT-based therapy rather than testosterone-based? 5. Would you recommend aromatase-blockers for TE dosages of 250 mg/week? If so, when to take them and at what dosage? Voila! ... long enough? ... easy enough? Thank you very much indeed for your time. And again, sorry for the trouble.

[@TCTmed]

@Alphaboy blah blah: Thank you for the kind feedback! I am actually a physician assistant, not an MD. I can't speak very definitively on TE, because we preferentially utilize testosterone cypionate. I have found it to have a more favorable side effect profile and stable (~8 day) half life. We typically see serum levels peak 48 hours after injection, and yes the circulating DHT and estradiol levels will increase commensurately, and usually immediately behind the testosterone curve. DHT is in fact a key component in the delivery of both androgenic and anabolic benefits of TRT. This is why I typically avoid DHT blockade (i.e. finasteride) whenever possible. The dosing of aromatase is tricky, and definitely has to be tailored on a patient by patient basis. I don't post dosing suggestions or rationales in this forum. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@sam187st]

Great video, well done for sure. thank you!

[@augiegalindo]

Thank you, @sam187st! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@solohour]

You are an upside down diagram master! SUPER informative, thank you.

[@TCTmed]

@The Solopreneur Hour Podcast with Michael O'Neal: Thank you for the feedback! I am glad it was helpful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

So me being at 216 is very very very low. Free T 30.6 again extremely low. 65 yr old male Been feeling like crap last 2 yrs So doc puts me on AD yet never ck my testosterone !!!!! Can low T be the cause of my mood issues???? Do all men get positive results From TRT ?? If not why not?? Thank you Augie been feeling awful last 2 yrs and these psych meds suck i want off Thank you Augie

[@TCTmed]

@Gary Simone: The rate of failure, once levels are optimized, is very, very low. Unfortunately, it is not at all uncommon for providers to treat the symptoms of low T as ADHD, depression, anxiety, etc. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@dewaynebraley2820]

On day 7 what size shot is administered in percentage in sequence of the first shot,?? Will it be more than the first injection, or smaller , and how much( vise versa) thanks for this fine presentation!

[@TCTmed]

@Dewayne Braley: Thank you for the kind feedback! Unfortunately, we do not give dosing advice. We recommend that TRT be closely and professionally managed. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@Justoaqui]

Thanks for enlightening us on this subject doc . God bless .

[@TCTmed]

Thank you very much for your feedback! We hope the information was helpful to you.

[@TCTmed]

@Justino Rosas: You are most welcome, sir! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Derrick1762]

I keep reading there is a much higher risk of heart attacks, strokes on TRT. This makes me very hesitant to do the therapy which has been suggested by my doctor. Very informative piece , but I would like to know how worried I should be with those risks.

[@TCTmed]

@Derrick Conner: How worried you should be is truly a personal decision. My best advice is to weigh, at least, a large portion of the longitudinal evidence that exists. That being said, there is no perfect, cradle-to-grave, double-blind, randomized control trial with a large enough cohort to answer ALL the questions. I will post the links to the 2013 and 2014 studies that ramped up the debate years ago. The first was written by a resident who used historical VA data to collect information on men with a history of heart issues, whose testosterone levels had been tested. Now, I am admittedly biased but not alone when I say that this study was deeply flawed. Again it was retrospective, not prospective. It accidentally included women, when it was supposed to only include men. It used a controversial statistical model that counted adverse events as more than one adverse event. In short, it is hotly contested and has been revised several times. The second study also had its challenges. It paired people on testosterone, with people on erectile dysfunction drugs like Viagra that are known to be beneficial to the cardiovascular system. Ultimately, it's these two (and similar) articles against a mountain of evidence on the other side that should be evaluated. However, be sure to note that the "version" of monitored TRT that I promote, was non-existent in BOTH of these studies. There is an ever growing body of medical literature that looks at this particular issue with a much more accurate approach. I urge you to go to Google Scholar and search for articles on testosterone replacement therapy and cardiovascular health/disease. I believe this will be the best way for you to make your decision on the safety of TRT. jamanetwork.com/journals/jama/fullarticle/1764051 journals.plos.org/plosone/article?id=10.1371/journal.pone.0085805 Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@jeromelucius1206]

I jeopardize get a check up on my test. Where do go to get it or where is your office located.

[@TCTmed]

@Jerome Lucius: Hello! We have five locations in the Dallas-Fort Worth area. They are in Lewisville, Frisco, Hurst, Flower Mound and Prosper. We also offer telemedicine services throughout Texas. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@randwhitney6989]

Very informative! He is a good teacher. One comment though - I use cream and it is not a hassle st all. No odor and about $110/ 90 day supply.

[@tonylowham3146]

Good review. Two issues. First, promotion of "Bioidentical" hormones by companies such as BioTe in regards to pellets has to do with using Estradiol and Progesterone (instead of CEE and Medroxyprogesterone). I don't think they are making a statement that their Testosterone is "natural" because the base molecule comes from Yams. I have used pellets and injections. If I had to pick one, I would go with injections in men. Because, you are correct, placing 10-12 pellets causes soreness for about a week. Also, I would argue they last only 3-4 months, not 5-6 months. On the other hand, testosterone pellets in women are fantastic. Its generally 1-2 small pellets, minimal discomfort and they last 3 months. In my opinion, pellets are best for women. Second, I'm not sure what you mean when you say exogenous Testosterone is not the same molecule as our body makes. How is it different. Otherwise, you seem like the kind of person a patient on TRT would do well with.

[@TCTmed]

@Tony Lowham: Thank you very much for your feedback. I do agree with what you are saying about what "bioidentical" should be used to represent, but at least locally, that is not what is being driven in the marketing stream. There is a rather strong push by providers to brand "their testosterone" as natural. And, since BioTe really just supplies the product and consumables, it is up to each individual practice to promote the science correctly. I do believe that women do better on pellets for a longer period of time than men do, but I consistently see improvements as my patients transition off of pellets and onto injections. As for your second issue, I was referring to the fact that we inject testosterone cypionate, not the naked molecule itself. I truly appreciate your time, thanks again for commenting. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@SamNammoura]

What a great Video.for sure I learned from you more then the two Doctors I am 7.1 nmol/L. 52y/o. I am fifhting low T via diet and workout. But the mental struggle is huge. not sure if my body will recover or I have no choice but replacement. 10 months of fighting

[@RickPiasecki]

Superb video - thank you so much for providing it in such clear and understandable language! II'm just one week into applying the 5mg gel dose, and wonder if you can comment on how long it takes for therapy to start showing benefit. I don't see any benefit yet, and am wondering when, on average, one should expect to see low-T symptom relief!?

[@TCTmed]

@Rick Piasecki: You're most welcome! If you are an absorber, remaining compliant, and assuming your dose is adequate, you should see benefits within 2-3 weeks of applying gels consistently. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@davids7096]

I would like to ask a question, I know this is an older video but no one has actually answered this question. I went to my primary care physician in 2017 with symptoms and he suggested we do a blood test. The result was that my total Testosterone Levels were around 247 ng/dl. He referred me to an Endocrinologist. I've seen her every 6 months since the beginning of 2017. I've had multiple blood tests done. My total T levels never go over 250 ng/dl. At one time they were as low as 205 ng/dl. I'm 37 years old, 5'7" tall, and around 180 lbs. I exercise 3 days a week, and yes it is heavy weight training. I try to eat clean, drink plenty of water, etc. The endocrinologist does not want to put me on TRT or HRT because the lowest my Free Testosterone percentage has been is 3.32% where normal ranges are 1.5%-4.2% and the lowest my Free Testosterone has been is 7.8 ng/dl, where normal ranges are between 5.00-21.00 ng/dl. My Bioavailable Testosterone has never been below 202 ng/dl @ 83%. My Sex Hormone Binding Globulin is fairly low at 12.5 nmol/L where normal ranges are 16.5-55.9 nmol/L. The endocrinologist rand blood work on my thyroid and other blood levels to rule out any underlying causes for the low SHBG levels and did not see any reason that level should be low. My prolactin levels are elevated. The lowest prolactin levels we've seen are 18.6 ng/mL and they have been as high as 24 ng/mL where normal ranges are between 4.0-15.2 ng/mL. I've had an MRI done on my pituitary to rule out a tumor causing those prolactin levels. With all of this information, what do you think about me being on TRT or HRT as compared to my Endrocronologists opinion? I still have symptoms even though my Free, and Bioavailable Test is normal so I'm thinking it may help me. I would like to feel better and my Endrocronologist doesn't know what to tell me. I'm not really overweight according to her and she isn't sure why I feel this way. My take was because these Free and Bioavailable percentages are percentages of a low total number, but I'm not a doctor by any means.

[@TCTmed]

@David s: For most lab tests, a total serum testosterone of

[@davids7096]

@@TCTmed, thank you very much for your descriptive response. I've asked that question on a few boards and to my PCP and no one has been able to answer me. I really do appreciate you taking the time to explain this to me. I talked to my PCP after my last test at the endocrinologist, my symptoms have been brain fog, lack of drive to do things (even the things I normally loved to do), erectile issues, and no morning wood in the last 8 months, so he sent me to a urologist. The urologist prescribed testosterone cypionate injections at 100 mg once per week. I'm a little nervous about the endeavor but your explanation makes me think this might be right for me. Again thank you very much.

[@davids7096]

@@TCTmed oh and yes I've had 7 tests done all in the morning before 10 AM in a fasted state. They have all been consistently lower than the 247 ng.dl. The last total testosterone level was 205 ng/dl.

[@TCTmed]

@@davids7096 You are most welcome! Be glad that you weren't immediately placed on antidepressants, I've seen that all too often. Kudos to your PCP for getting you to someone who will treat what appears to be the right underlying issue. Be sure to remain vigilant in making sure your care is directed by someone who listens well, is well aware of potential pitfalls with TRT, but who also in not afraid of testosterone. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@davids7096]

@@TCTmed the urologist seems legit, but I won't know how well he listens until my 6 month follow up. He did do 4 week lab tests and had his nurse call to say that everything looked good so far. My total levels were up and my hematocrit levels were not too high yet. As far as my wellness in the 4 week time frame; better mood, the brain fog is lifting a little and my sexual function has definitely improved. I'm actually hoping to talk to him about prescribing HCG. Not trying to be gross but I've read that without it I won't be able to produce as much fluid during ejaculation and that is something my significant other is a little worried about. Not necessarily to have more kids but for other reasons. Anyway, I don't want to waste too much more of your time. I know you normally get paid for conversations like this, so again I'm very thankful for your responses.

[@pravdasircone1691]

I am from Canada and our endocrinologists are more than happy to give HRT to trans-people switching their sex hormone panels but I can't for the life of me find a competent doctor willing to treat my secondary hypogonadism. It frustrates me beyond belief, they really don't care about people suffering low t here =(. Thank you for the educational video, very informative.

[@augiegalindo]

@Pravda Sircone: I am sorry that you are running into such difficulty. I am glad that the video helped! Be on the lookout; I will be uploading some updates soon! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@clipperbob960]

This is one of the best TRT explanations I have seen. You can see he does this for a living as his upside down skills are awesome. I can’t write that well the normal way lol. You all should know that the range keeps getting reduced over time as the government is anti-TRT. Current range is 250-827 ng/dL. FDA, DEA, and CDC are all onboard to kill TRT. Also be careful when your clinic/dr treats based on numbers and not on symptom relief. Fun fact look up Augie’s personal story. He is an amazing person.

[@BrainFester]

Question, you said the "Free" range you look for is between 9-35. My lab states a range of 6.5-18.1. It says the unit of measure is pg/Ml. How can I relate my number to your range so I know how close or far away that is to your preferred 15 number?

[@TCTmed]

@Brian Foster: The reference range we use is the same one that Blue Cross Blue Shield uses. It is for a calculated free testosterone only, and it states that the normal range is between 9 ng/dL and 30 ng/dL. Most lab values that are printed on a set of results are derived from an analog (direct) free testosterone assay. This test is deeply flawed, and The Endocrine Society has recommended that it not be used clinically. So, to calculate your free T you need your total serum testosterone, sex hormone binding globulin (SHBG), and albumin levels. Then, these numbers must be entered into the algorithm for calculation. You can find that here: (www.issam.ch/freetesto.htm). Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@nickbokowy1509]

Does a rise in DHT mean that I’ll lose my hair?

[@TCTmed]

@Nick Bokowy: In short, no...unless your Low T is protecting you from testosterone metabolizing into DHT and then triggering the follicle changes that your genetic predisposition has left you susceptible to. You can find a great article on it here (tctmed.com/genetics-of-male-pattern-baldness/)! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@tjl8884]

I wish this guy was my endo. I can't believe how crappy my doctor is.. Thanks for the video. Very informative.

[@TCTmed]

TJ L: Thank you for your feedback! Best of luck to you in finding great care. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@SnappyProductions]

Very helpful video! I was just diagnosed with Low T (114 ng/dl, 3.1 Free). I am now on TRT and my doctor has me on 50mg of clomid every day and .5mg of anastrozole 2 times per week. I literally just started my medication today. What is your opinion of this TRT protocol?

[@TCTmed]

+Bryan Peterson Fitness, I am glad you liked the video! I am glad to see that you have been preemptively placed on anastrozole. Our practice does not use Clomid. There are many side effects, over and above those seen with TRT via injection and topical medications, including vision disturbance (including vision loss).

[@SnappyProductions]

Testosterone Centers of Texas Thank you for your feedback! I will closely monitor the side effects and if anything starts looking strange with my vision I will immediately contact him.

[@TCTmed]

+Bryan Peterson Fitness: Of course! Best of luck to you, I hope you start feeling better soon.

[@solohour]

Not sure if you're still responding to this, but quick question: What kind of results have you seen in terms of natural remedies vs. TRT? Meaning, if someone is doing HIIT, supplementing well, and eating correctly. Have you heard of any results in terms of T numbers? I guess I'm just wondering about the overall range vs. TRT.

[@TCTmed]

@The Solopreneur Hour Podcast with Michael O'Neal: I have seen very limited to no improvement with this route, even when efforts and compliance were what I would consider exemplary. Typically, I have seen less that 100 ng/dL in shift. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@fedcordesign]

Thank you for taking the time to produce this informative and helpful video. One question I had: Do most of your patients prefer intramuscular or subcutaneous injections for trt? I know the standard has been IM for many years, but new information suggests that SubQ may be a more efficient way to administer.

[@TCTmed]

@John Fedorjaka: You are correct about current suggestions, but the available drugs have not caught up with these recommendations. So, if a medication is designed to be delivered intramuscularly, it should be given intramuscularly. The carrier substance must be altered to get proper and steady absorption. Subcutaneous absorption is typically more rapid, and in my experience, that does not foster a steady response as well as muscular absorption does. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@dennispaquette8693]

How long does it take to feel better?

[@TCTmed]

@ Dennis Paquette: Patient's typically report positive change withing 3-4 weeks of starting TRT, but most start to see more significant improvement in the second month of therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@MrThermostatic]

Ditto on all the thank you's....I've been on TRT 4 years, testicals practically gone, T falling, and no longer feeling the positive effects I felt at the beginning. I was told to wean off T as I start the HCG/clomid/arimidex. I'm feeling really slow/no sex drive etc. My question is, is it really necessary to go off T in order to get my body to start producing it naturally again, or will these 3 supplements added to the T therapy help raise my T and start producing it naturally again?

[@bgoodorhell4u]

Any progress in your situation?

[@robertmadda1161]

Are you still answering questions in response to this video? I love the video thank you for making it.

[@TCTmed]

@Robert Madda: Yes we are, and you're very welcome! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@robertmadda1161]

Thank you Augie... you you like DIM? When estradiol levels are measured that is a serum level not a tissue level. I know there is a lot of debate as to whether or not elevated estradiol levels are a problem. I would love your feedback... thanks in advance.

[@TCTmed]

@@robertmadda1161: I do like DIM, but I don't put as much faith in it as some of my colleagues. We test estradiol levels at baseline, and regularly throughout therapy. I can say that I am much less aggressive than I used to be when it comes to reducing E2 levels, but I do prefer low-normal levels. Many of my patients are on very small doses of anastrozole, but some need no estrogen blockade at all. Also, I have found that different patients react to levels in varied ways. For instance, an E2 level of 50 pg/mL may cause symptoms of hyperestrogenism in one patient, but not another. I typically use DIM when a patient may be having borderline hyperestrogenic symptoms that don't quite warrant use of aromatase inhibitors (AI's). Remember that AI's are very potent, and is used to prevent conversion to estradiol, but DIM only helps metabolize estradiol that is already present. This means that if your E2 levels are significantly elevated and causing unwanted symptoms, DIM is unlikely to be enough. I don't make blanket statements about estradiol levels "never" or "always" being a problem. It is another important metric to monitor in the setting of TRT, in my opinion. Sometimes that monitoring leads to interventions, sometimes it doesn't; it's a decision made on a case by case basis. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@chicagoground]

Very informative video, I learned more than my family doc said this morning actually 100% more. Today I was told my testosterone # is 245 for a 35 year old male, did another blood test today to compare, then will start on injections, what do I need to know or do to prevent testicle shrinkage and or breast development as I can not afford neither....

[@TCTmed]

Thank you for the feedback *****! The prevention of breast development (gynecomastia) and testicular shrinkage or atrophy is medically managed. Your provider needs to follow your estradiol levels and block overproduction. Loss of testicular volume can usually been averted by the addition of hCG (human chorionic gonadotropin). See tctmed.com/side-effects-of-testosterone-replacement-therapy-trt/

[@pendejo6466]

Testosterone Centers of Texas Oh man, you guys are only 45 minutes away from me: I should come see you. I'm 40 years old and T level was 455 (had it tested last week), should I visit your clinic and start TRT?

[@chicagoground]

Pendejo my level was tested about the same as yours and I'm younger, did a few injections of test did not notice anything at all difference, was hoping and imagining for an immediate sense of energy of some sort, our best bet is straight exercising

[@TCTmed]

Pendejo: We would certainly be happy to evaluate you. Your total testosterone level is in the normal range, but it is certainly possible for you to have a low free testosterone. Your free testosterone is the portion of the total that is actually working in your system. @chicagoground is correct, exercise (especially High Intensity Interval Training, HIIT) can boost test levels. It is important to look at all options and choose what is best on a case by case basis. We will be here when you are ready to look further into TRT.

[@TCTmed]

*****: Great advice on exercise! I am sorry to hear that your experience with TRT was not fruitful. The balance of lead time, dosing, intervals between treatments, and management of side effects come often take a while to get ironed out. I would encourage you to not give up on TRT too soon. It is entirely common for patients to not feel much different throughout the first 4-6 weeks of therapy, and it is very uncommon for someone to not respond at all.

[@ChaseWalling]

This video is so informative! Answered and covered everything I've been curious about. My test has dropped from 440ng/dl to 4.... That's total. My free has dropped from 8.8pg/ml to 2.8 Also, my LH and FSH are low. I'll be seeing the test center near me in Sugar Land Wednesday. Hoping this solves my chronic fatigue and mood swings. I turn 35 next month so I'm hoping this is normal?

[@TCTmed]

@Chase: Wow! I hope you got some questions answered at your appointment. If LH and FSH are low, that does raise the concern for a secondary (or hypothalamic/pituitary) cause. There may be quite a lot to rule out. Best of luck with everything. Keep me updated with your progress. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@ChaseWalling]

Testosterone Centers of Texas so my pituitary is fine. No tumor. Thyroid is low which could lead to fatigue. 2 weeks in and I feel amazing so far. 200MG boost shot and staying on 160 for 5 weeks then checking blood.

[@TCTmed]

@@ChaseWalling Glad to hear it! Looks like you are on the right track. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@lisacusick6550]

Interested to know if TRT would be helpful in stroke recovery?

[@TCTmed]

@Lisa Cusick: I have not seen anything in the literature that addresses this specifically, but I can certainly see how it could help with prevention of muscular atrophy and/or improved response to certain physical therapies. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

Augie thank you I got my first shot. Yesterday Doc tells me will take 13 weeks to get max results. If i do not feel alot better he will stop after 13 shots That right ?? Also how effective is TRT. For mood / depression My T was 216 age 65 ..thank you Sir

[@TCTmed]

@Gary Simone: Adjusting the dose based on response and potential side effects appropriately, leads to a very low non-response rate in my experience. The efficacy of treatment varies; as does the effect of TRT on psychological symptoms like depression. Best of luck!!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

@@TCTmed Hi Augie Sorry you lost me on this response can ya explain in a different way pls Sorry you mean dont treat symptons get to the proper levels and see how you feel??? appreciate your time I was on 200 mg 1x a week with AI today they changed. Two shots 2x a week 100mg ea and no AI. In shot no estrogen blocker Am i on the rigbt path at least In your experience have you seen good results for depression obce you reach optim levels ? thanks wish ya were in Ct.

[@TCTmed]

@@garysimone4977 Historically, I have only seen a very small number patients fail to respond to TRT. Now, TRT does improve mood, but is not to be considered a sole treatment for clinically significant, major depressive disorder. As far as being on the right path, that will be determined by your symptomatic response, avoidance of side effects, lab work, and time. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

@@TCTmed Augie i have mild to moderate at best depression I went to a new Doc today who changed my protocol from 200mg. 1x a week with AI added to taking 100mg 2x a week with no AI addex also had a calcium score taken today as well I so today was the first shot of 100 Mg I def crashed last week on 200mg on day 6-7 after the 200 mg shot. Also i understand if all is going ok symptom wise you do not plan to stop at 13 weeks that was bothering to me Cuz i would still be stuck ty with low T !! so i will rake my shot 2x a week and have PATIENCE this trt takes time a SOLID 6 mos i am learning. I am cautious optimistic this will improve alot It is not a silver bullet but i tex this as i am riding a ex bike first time. As the shot today has given me energy to get to gym Sorry one last question once started trt. WHEN get first blood test 2 wks 3 - 4 wks?? and how often tks soooo much Sir so much to know You help so many of us. THANK U A TON

[@TCTmed]

@@garysimone4977 It sounds like you're making progress, congrats! The retesting schedule depends entirely on the clinician, so it varies greatly from practice to practice.

[@MsSalim20001]

how long is the therapy ? Does normal production of testosterone become higher after the ending of therapy ?

[@TCTmed]

Salim Amrani With traditional TRT (not hCG monotherapy), the goal is to replace what your body no longer produces adequate levels of. This deficiency will only worsen with time. So, TRT should continue as long as you want relief from symptoms as it replaces & suppresses rather than augments natural production.

[@MsSalim20001]

Testosterone Centers of Texas so what's the solution to increase testosterone permanently ? (I don't want injections all my life)

[@TCTmed]

Salim Amrani That's certainly understandable. There is a burden of therapy, but you do have options. Topical medications, pellet therapy, and injections can all help. Newer medications and delivery methods will undoubtedly change the face of TRT in coming years. As it stands right now, however, I strongly believe that weekly injections are the best method of TRT. We use topicals occasionally, almost always use injections, and recommend against pellets. Here is an interesting article comparing the methods. www.newsmax.com/Health/Health-News/tesosterone-therapy-low-t/2015/05/05/id/642632/

[@fitybux4664]

Does Testosterone Centers of Texas do hCG monotherapy for the treatment of secondary hypogonadism? (Instead of TRT+hCG, specifically if I know my testes can produce enough testosterone but my hypothalamus is just having trouble producing gonadotropin.)

[@TCTmed]

@Fity Bux: Yes, we do. I don't typically recommend hCG therapy, as it is expensive and becoming more so. Soon, compounded hCG will not be available, raising the price even higher. To achieve therapeutic levels of testosterone, large, frequent doses hCG are needed; and even then, the response is typically suboptimal. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

[@fitybux4664]

@@TCTmed Thanks for your quick response. It was a question more out of curiosity of it this is something I can ask my PCP. Keep up the good work, I've watched a lot of your vids. The expense is an annoyance to me, but I want the better outcome and I think hCG can provide this for me.

[@TCTmed]

@@fitybux4664 Best of luck and thank you for the feedback, sir! Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

[@arielrodriguez975]

How soon after starting cypionate do you lose weight?

[@TCTmed]

@Ariel Rodriguez: Great question! First, not everyone will lose weight with TRT. If managed appropriately, you should start seeing improvements in body composition in the second month of therapy using injections. Injections are superior to topical medication (creams, gels, patches) in increasing lean muscle mass and strength. The increase in muscle mass can positively affect fat loss, and the improved sleep and increased energy that typically accompany TRT help promote higher activity levels, further promoting weight loss. Of course, maintaining a well-balanced diet and adequate exercise are still critical components to attaining or preserving a healthy body weight. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@arielrodriguez975]

@@TCTmed Thank you! In your experience what is the average testosterone dose that's provided great weight loss results with your patients?

[@FutureLaugh]

Thank you for the comprehensive explanation. There are many doctors quick to give testosterone injections, and i have never heard anyone address the obvious problems associated with this as well as your list of additional solutions. Concerning HCG injections, are there any long term side effects of this? With TRT you described in general, is the objective to get the body back to autonomously create its own natural levels or is it to just supplement what is missing? Does your natural T levels become even lower when finishing your TRT program as with traditional trt programs?

[@augiegalindo]

@FutureLaugh: Thank you kindly for the feedback! As for hCG, there are no specific long-term effects seen with its use as monotherapy for TRT, but the literature only recommends it's use for up to one year. This is largely because it hasn't been extensively studied. There is some suggestion, though I've never seen it happen, that short-term use of hCG monotherapy may induce the HPG axis to return to normal productions after cessation of treatment. I would consider this highly unlikely. For TRT, unfortunately, this is not augmentative, but rather, replacement therapy. So, this is why it's only advised to fix what's broken, to give a patient what they need, not just what they "want". Natural production IS suppressed while on therapy, but by and large, will return to baseline if therapy is terminated. This process could take weeks to months. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@FutureLaugh]

thank you for your time and expertise

[@TCTmed]

You're welcome!

[@kemo6310]

i was diagnosed with low t and levels come at 1.2 ng/dl and my doc urologyst put me on testosterone enathate 250 mg shots every 10 days and 1mg arimidex daily as my E2 level was 51 pg/dl and after 5 shots my level was total t : 7.8 ng/dl e2 : 60 pg/dl and then he decided to cut my protocol as i didn't feel any better . but i do know it takes a while for the body to regulate testosterone. again i quit and feel creppy again and the whole symtomps return again and then i decided to try nebido . i took the first shots and after 6 weeks i took loading dose , then after 10 weeks my trough levels come at 3.8 ng/dl . so i then take again one more shot and this time i start feeling better in morning erection and energy for a whole full month and i start feeling bad very depressed and shitty again . now i am confused whether to complete with nebido with switching the dose every 8 weeks or to switch to testosterone enanthate again thank you for your paitence doc

[@TCTmed]

@kemo6310: The issues you are running into have to deal with medication half-life and failure to manage side effects. I wish the explanation was less complex, but the provider's approach matters even more than the medicine here. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@scrabtree5824]

Hey Doc, great video! This is right on the money. How do you feel about Compounded micronized testosterone cream (10%) ? I've used it a 5% and 10% for a couple of years now. It keeps my levels around 750-850 - despite my super-high estrogen-E2 level. Have zero issue with PSA (0.3) or BP (normal). I should feel great, but feel lousy because of high estrogen (I think). Also, I have an ultra-rare benign disease where I have to take medication for it. It affects my T-levels, so I must have T-therapy. I'm getting NO benefits from the testosterone boost now, but do you think it is because of the super-high estrogen levels (253 pg/mL)? Insane level, I know! I have blood work from an Endo, but Endo's don't like AI's, which I can understand. Also, to anyone reading this - I've been to about 4-5 different Dr's- Endos and they are resistant to Low-T therapy, so you might ask before you go. And - even IF they toss you an RX of Androgel? They probably will not do anything about your high estrogen! That is a major part of T-Therapy. So, great vid, I'm super ready to feel normal again. btw, I'll be seeing you in early August as I have appt. on Saturday a.m.. Insurance covered it, which is great, because I desperately need an AI (Arimidex, yes!) to knock down the E2. Can't wait to see you at my Appointment! You don't know what a relief this is - I am really excited to finally see someone who understands this. Thanks for the video! Just turned 60, but look (and feel, mostly) about 40. Take care.

[@TCTmed]

@S Crabtree: I apologize for missing this, Mr. Crabtree. I trust all went well with your visit. I definitely see management of estradiol levels as being an essential part of TRT. The other big question mark, is where your free testosterone levels are. Your SHBG levels could be wreaking havoc. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@brettpower6508]

Hi there So my doctor has started me on trt reandrol 1000 injection have been on for two weeks and have really bad water retention he says this will go my question is should I be taking arimadex?

[@TCTmed]

@Brett Power: I agree that initial symptoms from increasing estradiol (E2, estrogen) levels do lessen after the first month, but opinions vary greatly on the subject of Arimidex (anastrozole). I typically do start my patients of on a very low dose of aromatase inhibitors, so in my personal opinion, you probably should be taking Arimidex. Keep in mind, however, I am completely uninformed on your medical history. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Davedublin]

Great video but how did u write so well upside down. Was it a mirror

[@TCTmed]

@Dave Dublin: Nope, no mirror. Just a bit of practice! lol Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@bub7771]

So I'm 41. Just had my blood work done twice in 4 months. My test is at 240. I want to increase it but my doc says my levels are normal. He claims 200-900 is normal range. As a teenager i had a left vericocele and surgery to correct it. I am wondering if that may have had an impact on my test levels and if so, how to correct it. Thanks!

[@DevilDocWold]

I started having low T symptoms since around 20 I'm 26 now so I've been trying to get treated for over 6 years. I'm active duty military and the MTF and military endocrinologist wont treat me. I've never been above 300 TT. My cFT is always around 8. Recently tested for estrogen at 113 and 39 e2. SHBG is always around 10 to 13. Albumin always around 4.2. LH LSH prolactin always in normal range. I have almost every symptom of low T. They still wont treat me. What can I do?

[@TCTmed]

DevilDocWold: I've never found a good outcome when a provider had to be "talked into" starting TRT. I do have a few active duty reservists for whom I have had to submit records proving the medical necessity for treatment. Perhaps seeing a civilian provider, if your schedule allows, and then being properly diagnosed outside of the military system would force their hand. I can imagine that military providers may be reluctant to even appear as if they are "juicing up" soldiers, but they do have processes by which they verify the diagnosis from an outside provider. This may be an option for you. Your numbers certainly seem to be consistent with hypogonadism. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@jcbassfishingchannel]

I just happened to see your video while researching for lowering my HCT and Hemoglobin. Im 55 and have been on TRT for over 6yrs now. The problem I have now is that my RBC is at 6.04, my HCT is at 54.2 and my Hemoglobin is at 18. My endocrinologist is having a hard time balancing these because he already lowered my TRT dose from 100mg a wk to .50mg a week and still they have not come down. any advice on how to lower these three side effects?

[@TCTmed]

@jcbassfishing channel: All three of those indices are the same singular problem. The more imposing of the numbers is your HCT, as it speaks directly to blood viscosity. Root causes here, aside from testosterone, are likely to be un/undertreated sleep apnea, or smoking. Testosterone will make you make more red blood cells, but so will oxygen deprivation. Both obstructive sleep apnea and smoking induce such a state. Your body responds by increasing RBC production, because RBC's carry Hgb and Hbg carries oxygen. So, if you are a smoker, this is just one more reason to quit. If not, it's time for a sleep study. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@EdiMeanG]

Hi Dr do you have any recommendations to doctors like you in California?

[@EiMpTv]

Great video you broke everything down very well, but I have a question. My 1st question is does Medicaid cover things like this? 2nd question, when doing testosterone therapy does your testicles and penile tissue receive any gains as well as body hair, and voice changes or will those things stay the same excluding the testicles and penis?

[@TCTmed]

@ERICINMYPOCKET: I think the chances of Medicaid covering this are slim. If ED is something a given patient is suffering with, and there is not another condition significantly contributing to the same issue, it is possible for strength of erections to improve. Often body hair increases and there may be slight voice deepening. Finally, it is common for testes to have reduction in firmness or volume while on TRT, but this can be easily prevented/treated. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@jmoreno22]

Any videos on how to cycle off TRT?

[@TCTmed]

Not at the moment Jesse, but that may be a topic we discuss in the future.

[@Aaaad4m]

+Testosterone Centers of Texas Hi there, I would also like to know whats the treatment for coming off trt, as in you don't want to completely stop trt as that will cause a big crash. I am assuming that the doses will reduce and monitored overtime untill completely off trt. Many thanks for the video.

[@TCTmed]

@aad4m: Since cycling off is not necessary when TRT is done appropriately, we don't actually focus on this, but going slow is definitely the right way to handle it. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Aaaad4m]

+Testosterone Centers of Texas Thank you for taking the time to reply. Much appreciated.

[@DonaldWooley]

How much does this TRT cost.

[@TCTmed]

@user-jf7kw9cw5v: Costs vary quite a bit, and like with many things, you often get what you pay for. Our Telemedicine Services are $200 monthly plus the cost of labs. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@garysimone4977]

Awsome vid a must listen and save for future reference

[@TCTmed]

@Gary Simone: Thank you, sir! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

Sir i m 4 weeks into trt first 2 weeks felt great since then i feel crap and like i did before trt Why is this I am very concern i take 200 mg a week I get blood test Tomorrow Any advice much appreciated sir

[@TCTmed]

@Gary Simone: I would definitely recommend giving it more time. I counsel my patients to be ready for a 90 day period of "dialing in". When taking over a broken system, and acknowledging that every body has it's own unique needs, getting back to good takes time. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

@@TCTmed thank you soo much I have been honestly scared discouraged and about to give up These docs want to keep giving me AD I am only 30 days in I feel it is best to wait for that 90 day period before anything is tried First two weeks had ton of energy the bang faded I assume this is normal as the body gets a jolt then adjust Augie can you treat me long distance ? i had blood work today would fax to you results etc My doc never talked to me about 90 days in fact he has told me not to expect much more results !!!!!! I am looking for a Center can you be of help Angie in all honesty and i know all different but i will get some results Hope we can work together

[@flodrummer100]

Great video man! So informative! 👍

[@TCTmed]

@Matt 'Flo' Howard: Thank you!! I am glad you found it helpful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@richardpatterson4312]

Wow. This was an excellent lesson with a lot of info. I appreciate you making it. Thank you. I have a couple questions for you, If you don't mind. I actually had a bunch but they were answered below. Do you recommend Intermittent fasting to raise Testosterone and GH naturally? I've seen a lot of youtube videos on it but not from any medical professionals. Any thoughts on that? I'm definitely interested in getting blood work done, my primary care physician is not impressing me...with anything. Who do I look for, an endocrinologist? There are anti aging clinics and such but from the websites they look like they give you what you want not what you need. I'm not looking to get on TRT I'm looking to find out if I need it or do i just need to keep on with the diet and exercise. Also, to track my levels if they're low. Thanks again.

[@TCTmed]

@Richard Patterson: Thank you for the feedback and kind words! For intermittent fasting, it certainly seems to be an effective way to control weigh, but while it has exhibited the propensity to increase natural testosterone and GH production, this is going to be transient at best. Keep in mind that testosterone production is much more labile than people tend to realize. Endocrinology should be the field with all the answers to TRT issues, urology would be the likely next-best-candidate. The problem here is that even most of those specialists don't seem to spend as much effort as is necessary to do TRT right. I fully understand that this is a blanket statement and that there are a multitude of exceptions. However, when evaluating who you want to manage your TRT, you should go with a provider who knows it well, if not focuses on it exclusively. Many "anti-aging" practices are about symptom control over science; both are important. The goal of TRT should be to reset life's "clock" to the correct time, not to turn in back to where it was in our teens. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Emp6ft10in]

If you want your blood work to read healthy level RBC counts when the doctor draws your blood how soon before the blood draw should you give a double red blood cell donation? I don't want to do it to close and have my blood work come back all jacked up in the opposite direction.

[@TCTmed]

+Emp6ft10in: Good call. I recommend having therapeutic phlebotomy done at least two weeks prior to blood work, if not more. Make sure you always hydrate (water only) well before the draw, even if it is a fasting study. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Emp6ft10in]

Testosterone Centers of Texas - Why two weeks or more? I was thinking 5 days prior. Is that to close to the blood work?

[@TCTmed]

+Emp6ft10in: Erythropoiesis, the process by which red blood cells are made, takes 4 days. So, I prefer to allow time for the body to recover and settle into its new baseline. Drawing blood too soon after a phlebotomy can lull you into thinking that the issue of erythrocytosis is solved, when there still might be more work necessary.

[@Emp6ft10in]

Testosterone Centers of Texas - Thank you for this information. I have been stressing about this hard. TRT has changed my life, a life I thought was over before it. My RBC is up and my Doctor didn't give me any feedback as to what I could do about it, just that if it stays up he will stop the treatment which as you can imagine has been a nightmare for me (I can't go back, also the thought of a 'crash' is terrifying as I don't know how I would react). When I look for alternative Doctor's who aren't so quick to pull the plug at the first sign of anything and actually work with the patients it all smells 'scam' to me. Do you have any recommendation for providers in San Antonio Texas, who are willing to be committed to make this therapy work with out gimmicks or add-ons?

[@TCTmed]

+Emp6ft10in: I am happy to help. Email me at a.galindo(at)tctmed..com (Altered to avoid bot spam), I may have some options for you soon.

[@TJTJTJ1]

wow great video answered all my questions b In words I could understand

[@TCTmed]

Thanks James, glad you found it useful!

[@miroslavsvraka]

Can we use aromasin for combating e 2?

[@TCTmed]

@Miroslav Svraka: Yes, Aromasin is another aroma tase inhibitor like anastrozole. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@tory1560]

Well done.

[@TCTmed]

Thank you, much! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@cstull]

You mentioned that the real goal is to get the free T numbers up but don't explain how that is done. Yes, total T is easy to increase but how do you increase the ratio of free T?

[@TCTmed]

@cstull: This part becomes more complicated and is at the heart of therapy, so since the scope here is to educate on the principles of sound TRT management, going into the nuts and bolts of how that is accomplished isn't plausible. In a nutshell, however, the relationship between total and free testosterone is a direct one. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@fredblahblah.6352]

Owing to geographical isolation lab tests are currently out of the question for me, so I'm going by clinical manifestations alone, such as loss of physical strength, loss of both spontaneous and morning erection, clouded thinking, general lack of energy and enthusiasm. I've got Rotexmedica's Testosterone enanthate, 250 mg, IM. I gave myself a shot of two ampules (= 500 mg) for the first time a couple of days back. No changes have been noticed at all thus far. The half-life of this TST is 10 days. My question is when should the next shot be, and how much. I am thinking 250 mg every 10 days. Would you be so kind as to offer me a few pointers?

[@augiegalindo]

@Fred blah blah: I am very sorry, but it would be malpractice for me to offer medical advice of this nature, in this format. I certainly understand your limitations, but strongly advise against treating presumed low testosterone; especially without the guidance of baseline and serial labs. I hope you can find an alternative. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@TCTmed]

@Sam Nammoura: Here is some information that I often give out to those seeking to boost testosterone naturally. The best type of exercise for boosting your testosterone levels naturally is High Intensity Interval Training or HIIT. Here is a video that explains the concept. (kzbin.info/www/bejne/j6utg5ymo8ucqsk) You may also want to try these dietary tips! (tctmed.com/5-diet-changes-help-boost-testosterone/) I recommend taking THIS PRODUCT (www.amazon.com/Vibrant-Health-Phyto-Boron-Vegicaps-60-Count/dp/B000Z91BQ8/ref=pd_sbs_hpc_1?ie=UTF8&refRID=16054D7M1Q7Z4SNX0B3S) or one with the same form of boron. This one contains calcium fructoborate at 3 mg per pill. I recommend taking two daily for 30-60 days and then retesting your levels. This may help to lower your sex hormone binding globulin (SHBG) levels, and thereby increase your free testosterone. You may also want to consider stinging nettle root.

[@Aaaad4m]

Great video, thank you for taking the time to do this. I have question regarding the fsh, since fsh is going to be low and as a result low sperm count. Do we not treat that also as in do we need to take something to mimic fsh? would really appreciate if you can answer this?

[@TCTmed]

@aad4m: I typically counsel those who are very adamant about preserving fertility to strongly consider postponing TRT. That being said, in my experience, I have found that using hCG as an LH analog does help to maintain fertility to some degree. We do not replace FSH as it doesn't directly serve the purpose of TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Aaaad4m]

+Testosterone Centers of Texas Thank you for taking the time to reply. I wished you were my doc or endo. I live in UK and the doctors and Endo here are uneducated with regards to TRT or just ignorant. NOT ALL. Most docs and endo go by numbers and not patient systems. I am 33 years old male and I believe I have syptoms of low TRT. This has been the the case for few years now. I had my blood drawn and my total test, lh, fsh have come back as normal but on the lower end. Since they go by numbers and because I fall within the normal range, I have been advised am normal. However I disagree and we should go by patient syptoms rather then numbers. Anyhow keep up the good work and your TRT uploads have really benefited me in understanding how the male HPTA system works. All the best.

[@TCTmed]

@Vince Young: Your calculated free testosterone levels mater more than anything else. Search out a provider that is proficient in managing your treatment base on your free T. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partne

[@simonlevite297]

So your considered hypogonadal if your total testosteone levels are normal but you have high SHBG and low free bioavailable testosterone? Confused a little.

[@DerickVonD]

Do you know if boron lowers testosterone levels? I had a blood test done and my testosterone level came back as 395. The thing is, my libido is high and increased once I started taking boron 9mg daily. I'm hoping that's what has caused my testosterone to be low. If that is the case, do you have any idea how long it would be until my levels go back to normal? I've been taking the boron for about three months. I'm almost 28 years old. Thanks in advance.

[@DerickVonD]

+DerickVonD Also, if they don't go back to normal, what are the odds of a doctor putting me on TRT at age 28? I'm very heavily into fitness and don't want to live a life where I have low test levels.

[@TCTmed]

+DerickVonD It has been suggested that boron deficiency can lead to decreased free testosterone levels. So, for some patients, taking boron can improve free levels, but there is no evidence that it will increase total testosterone production.

[@TCTmed]

+DerickVonD: Those odds vary greatly. The decision depends on a multitude of factors, not the least of which is the comfort level a provider might have in dealing with TRT in younger patients. Risks like suppression of fertility loom larger for younger patients.

[@busterc6600]

Do you have centers I georgia ?

[@TCTmed]

@buster C: Unfortunately, we do not. I wish you the best in your search for a great TRT provider! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@blackbirdx7777]

So how many mgs of test cypionate do you usually prescribe? FYI im 35 and around 320ng/dl

[@TCTmed]

@blackbirdx7777: I'm sorry, I don't recommend doses in this setting. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@nthewind081]

Will I grow more hair?

[@TCTmed]

fred lewis It is common for male patterned hair growth (facial hair, body hair, etc.) to be stimulated on TRT. This is not the same for your scalp. You can find more on that here: tctmed.com/low-t-faq-testosterone-reason-balding/.

[@TCTmed]

fred lewis thanks for sharing!

[@glee499]

Great Video!! I see positive reviews about doing t shots every 3 days vs 1 times a week due to feeling the best and also adding HCG shots to the mix with taking a estro blocker.. What is your opinion of this. I know without the HCG your balls will shrink which some guys might like depending how old you are ( cosmetically not hanging to your knees. ha) Is there any negative effect of shrinking besides fertility? Also for the T shots what do you recommend for location . butt/shoulder? some do leg and I hear negative effects of this location. Thanks

[@TCTmed]

@G Lee: Thank you for the feedback! I have found that the vast majority of patients do best with once weekly injections, mainly because the slightly larger amplitude of variance allows for a higher level for at least part of the week which seems to stimulate certain benefits, while still maintaining a trough above the symptomatic threshold. Estrogen blockers are virtually always needed, so I don't really see this as an option. However, hCG, is an option. If you are not concerned with fertility or testicular atrophy, I typically recommend against it. Now, I have seen testicular atrophy advance to the point where it contributed to testicular discomfort, obviously, you would need hCG in this instance as well. As for location, I recommend hip only. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@scottlandb6579]

If I have a normal free at 17.86 yet my total is 445 there’s gotta be a odd issue here? No? Anybody?

[@TCTmed]

@Scottland B: Thank you for your question! Sometimes lab results can be flawed or misleading, and they should always be evaluated through the lens of the entire clinical picture. Assuming you are using the same units of measure (ng/dL), this can happen when someone has lower albumin or sex hormone binding globulin (SHBG) levels. More often, this represents a "free T" that is a direct/analog value instead of a calculated one. The direct/analog test is clinically useless and should never be ordered; a calculated free testosterone level is much more reliable and correlated to symptoms. And one last caveat...when it comes to labs that don't make sense -- when in doubt, repeat the study. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@zzzfresh3138]

Im 33yrs old my testosterone is 440ng/DL my doc won't give me testosterone... any advice?

[@TCTmed]

@zzz fresh: I would recommend finding a practice that is familiar with properly interpreting a calculated free testosterone level. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@martyrman1807]

I need a doctor like this.. Who know what he's doing. My urologist gave me testosterone injections and pushed me out the door and now my e2 is though the roof..

[@TCTmed]

+Martyr Man Sorry to hear you had a bad experience. Are you in the DFW area of Texas?

[@martyrman1807]

Testosterone Centers of Texas no sir I'm in the central Florida area. I have gotten on blue Cross insurance which will kick in within a week then I'm going to start seeing endocrinologists about arimidex and hcg.

[@TCTmed]

+Martyr Man: Well, I thank you for the endorsement and I wish you the best in finding a great provider. You may want to expand your search to include urologists and dedicated hormone therapy practices like ours.

[@mbabazimakariusatwookiomug947]

how do i get the TRT in uganda?

[@TCTmed]

@Mbabzi: Unfortunately, I don't know anything about the process to obtain medical care in Uganda. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@pekenjos]

Good day, I need some assistance please. I am on TRT for moderately low Testosterone level. I was diagnosed by my GP (from Pathology results). I am only seeing the Endocrinologist on the 4th of November 2019. I have been on Andriol 40mg in the morning and 40mg in the evening for a month. My GP then increased the dosage to Andriol 40mg three times a day, until I see the specialist. BUT, I have been suffering from grogginess, aka a drugged feeling and severe fatigue and out of breath. I have also gained some weight. Can I please ask for a specialist at the Texas Centre to assist me. I unfortunately reside in New Zealand.

[@TCTmed]

@Morningglory: Thank you for reaching out. Andriol is not available in the US, so while I am somewhat familiar with testosterone undecanoate, oral forms of therapy are generally considered unsafe in the States. That being said, my research shows that the typical starting/loading dose of Andriol is 120-160 mg/day for the first three weeks, with maintenance dosing typically around 40-120 mg/day. Each 40 mg capsule yields 25.3 mg of testosterone, but what your body can actually utilize after it is metabolized in the liver is considerably less. So you are taking an equivalent of 75.9 mg of testosterone orally. The symptoms you are experiencing could be due to the form of the medication you are taking, the effect it could be having on your liver, side effects from increased serum testosterone levels (like increased estrogen or thickened blood), or any number of things unrelated to therapy. Without the benefit of a history and physical, followed by labs, I can only guess at things. If you want a consultation, you can send in a request through our website (tctmed.com) and indicate that none of our clinics are close to you. I do hope that your follow up goes well. It certainly sounds like there is some work to be done. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@pekenjos]

Hi Augie, yes I am aware of the dangers with the oral form of Testosterone. I am going back to the original 80mg dose, one 40mg capsule in the morning and then one 40mg in the evening until I see the Specialist. Something is up as I experienced hot flushes yesterday and increased heart rate, second time I noticed that particular reaction. I did discuss the options of using an Oestrogen Inhibitor, but my GP says that is something I can discuss with the Specialist. I think that may be a necessary step. Thank you so much for your precious time. I really appreciate your input. Take care

[@MrNew-dw4sk]

sehr guter Beitrag!!

[@augiegalindo]

@Günther Neubauer: Vielen Dank! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@MrNew-dw4sk]

your welcome - perfect information from you!

[@jennifertorres1683]

Hello, You may not see this, i really hope you do. Is normal to be prescribed Androgel on woman? My T levels came back super low according to my OBGYN and she recommended for me to start the gel 1/10th of what a male would use? Ill be honest i haven't started because i am afraid of voice changes Ect? She says thats why i have NO Libido :(

[@augiegalindo3599]

@Jennifer Torres: We have many female patients on TRT. We use injections rather than topicals (like Androgel), because I still find it to be the best solution for testosterone deficiency. Deepening of voice and clitoral enlargement certainly are potential side effects of therapy, and understand, that there is no FDA approval for the use of testosterone in women. That said, with careful oversight and replacement to therapeutic ranges, TRT for women can be very beneficial. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@jennifertorres1683]

Augie Galindo wow! I wasn’t expecting a response! Thank you! I will start my journey carefully. I am thinking if I do see changes I will contact my doctor asap. Wish I was closer to your office , your videos are so helpful!

[@TCTmed]

@@jennifertorres1683, thank you! I am glad you found them helpful! If you are in Texas, we do offer telemedicine!

[@jennifertorres1683]

Testosterone Centers of Texas I wish! I am in Pennsylvania, can you please just answer one question for me? Have you have any female patients that have benefit from Androgel if you have prescribed it to them. I apologize I am just so discouraged!

[@TCTmed]

@@jennifertorres1683 I have not personally prescribed Androgel to females, but have used compounded creams. With topical preparations, your first barrier is your skin. Up to 40% of patients don't absorb the medication. If you are an "absorber", you must use it right, every day. Showering or getting dressed too soon, sweating to heavily, and/or inadvertent mechanical removal can further affect efficacy. Also, transference to someone who DOESN'T need extra testosterone (think small children) could be an issue. None of that means it won't work, it just isn't my modality of choice. Best regards, Augustine Galindo, MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@elchulo13agt]

If my FSH and LH are both normal why is my levels of test low ? I’m 37years old with total test of 222 with a healthy thyroid

[@TCTmed]

@elchulo13agt: Look for my answer on your comment on our side effects video. I will also copy and paste it here. However, I also wanted to let you know that thyroid issues aren't always examined as deeply as they should be. Just like with testosterone, the free hormone theory matters. Here it is free T3 and free T4, and in my opinion these must be evaluated alongside a TSH and symptoms to determine thyroid health. ***Answer from the other comment is below: So, a normal LH and FSH in the face of low testosterone levels can mean a few things. While your pituitary gland may be working fine, it can also be said that you should have a higher LH and FSH, as the hypothalamus and pituitary attempt to increase testicular production of testosterone. Now, in your case, which is the one I see most often, the numbers don't really give us a clear delineation between primary (testicular failure) and secondary ("brain" failure) hypogonadism. It is in these cases where there may be other factors that are influencing the Hypothalamic-Pituitary-Gonadal (HPG) axis. The possibilities here are myriad. Is it other physical issues, is it xenoestrogens, phytoestrogens, and endocrine system disruptors? I have come to label this tertiary hypogonadism, where there is a breakdown in the communication pathway or negative feedback loop of the HPG axis. Either way, the treatment here (once confirmed by the presence of symptoms and repeat testing) is TRT. Ultimately, yes your pituitary gland IS working, but perhaps not responding the way it should. Also, your testes ARE working, but not at the level they should be. Your FSH and LH levels are in the normal range, but also not responding as we would expect. The books will still call this primary hypogonadism, and with all other criteria met, it is most likely treatable via TRT. I hope that helps. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@elchulo13agt]

Testosterone Centers of Texas thank you so much for responding I’m at a stand still at the moment my primary doctor prescribed androgel alone for 6 months it did nothing for me so we moved to the cypionate he prescribed that alone and 100mg once a week after the 3rd shot my anxiety was crippling and panic attacks so I told my doctor he told me to quit and that trt was out of his hands as far as expertise so he recommended me to a endocrinologist I went thru labs and he also said yes your levels are low for your age he didn’t want trt for me so he put me on clomid 50mg every other day and that medicine really messed with my head I started having severe anxiety suicidal thoughts panic attacks unwanted obsessive thoughts crying episodes it was horrible finished my treatment to only raise my total numbers by 20 went from 200 to like 222 so he said that didn’t work and I was too young for trt and to lose weight to get my testosterone up so that’s the last of this ... I’m very scared to try trt because of the side effects I’ve suffered from depression and anxiety my whole life but my attempts to correct my low T made my anxiety even worse so I’ve been really hesitant but after watching your videos it made me comfortable enough to possibly trying again BUT under expert supervision to avoid bad side effects you guys seem to be experts at this treatment ... my question would be can you guys treat me if I travel to you ? I live in Kansas City I’m willing to travel if that’s what it takes to feel better I’m 37 years old as of two months ago my total TEST was 222 not sure if that’s horrible but I believe I’ve had a hormone deficiency since puberty my major symptoms have been fatigue most of the time but not always I live a busy lifestyle work 12hrs a day and workout out 1.5 hrs a day ... my depression and anxiety have been very bad but my sex life is normal my erections and sex drive are ok no issues there thanks hope to hear back from you

[@TCTmed]

@elchulo: I wish I could say that your story is unique, but it is not. I would not recommend ANY of the regimens that have been prescribed for you, but I have no doubt that it can be done better. Do me a favor and go to our website (TCTmed.com) and fill out a contact form. Select Prosper as your location of choice and I will follow up with you from there. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

Hey Auggie ok I'm exactly 2 months into trt my last blood test was 688 and my estrogen 56 I feel better in certain areas but far from were I hope thus far my PSA is 2.0 I was hoping for more mood relief but not much luck a little but wish better My t doc says I won't see any mood help until 3 to 6 months He tells me even through I maybe at 688 test my body cells are in the process of putting it all together true ??? Any thoughts do I need to

[@TCTmed]

From what it sounds like, I manage my patients differently than you're being managed. That being said, it is a process and there is no overnight success. Watch that estrogen level and hang in there!

[@garysimone4977]

@@TCTmed thank you yes I am very concern about m.j y estrogen level may I ask what range can I be looking for yes this is a longer process then I ever thought a good 6 most I feel but I worry about the estrogen and help much appreciate a ton

[@garysimone4977]

05 a plan to call my doctor ASAP I don't know if it was the Astra gin or what but this past weekend my anxiety has never been so difficult normally do not have anxiety so of course all things go through your head wondering what's going on with your hormones so IO player and calm the doctor to find out what the story is in again I agree with you that he has to needs to be watched and I don't know if this did ticular doctor puts the emphasis on that yet estrogen like I heard other doctors talk about

[@garysimone4977]

@@TCTmed Is there any person you know that I can seek a second opinion I my treatment because I'm really at the mercy of whatever the doctor tells me as I know very little about this process or can I seek a second opinion from yourself and will be gladly reimburse you also is there a crash it seems like the day before my shot I feel awful next day I take the shot and few hrs later feel better Today the 19th is exact 8 weeks I am 65 hope you do consults even better could you treat me via long distance I see many do this my email is [e-mail] cell 203 448 6719 honestly I need help on this trt thanks SHBG what is a level I should be after 2 months thanks again reading your post I am guessing my estrogen at 56 might be heading to high I dont see my doc again for 60 days I am getting sec thoughts about him I dont feel anything special after 2 months

[@TCTmed]

@@garysimone4977 Unfortunately, opinions vary widely on this. Estradiol levels definitely need to be normal, but that does not mean they need to be ignored while on TRT. Anxiety issues are common when estrogen receptors are hyper-stimulated. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@yesdvt]

Could injections be the preferred method of treatment because they make more money for the clinic? Why couldn't they be self administered? Just saying.

[@TCTmed]

@yesdvt: Self injection is often used; on the other hand, self injection is often misused, both unintentionally and intentionally. The perfect patient, with adequate training/appropriate background and reverence for the use of a DEA controlled substance and a keen understanding of the potential pitfalls can certainly be a good self injection candidate. In my experience, patients like these are few and far between. I have found that human nature prevails and many think, "if some is good, more is better". This can, obviously, lead to deleterious effects in an escalating manner. There is a balance in everything, and so it goes with the viability of a clinic and patient safety vs. convenience. The investment of overhead, the acceptance of liability and risk, and the impact of the burden of treatment should ALWAYS be measured against all the factors that contribute to optimal patient outcomes and guided by good medical and business ethics; with patient care and the dedication to medical ethics being given their due deference. So, to answer your question more directly, clinic profit SHOULDN'T be, but sometimes IS the driver of a given approach, and SOME patients can do well with self injection, but from what I have seen throughout the years, that is NOT a safe option for all. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@bunkerbob25]

Thanks for your great content. As I teacher, I can appreciate the use of illustrations to simplify what can be considered a confusing topic. I have a question I was hoping you could answer. I love in Papua, Indonesia and have somewhat limited access to modern medical care. I do have a physician and a host of nurses who are Western trained, and they do what they can given their constraints. On a visit to my physician it was determined I should see an endocrinologist on an upcoming trip to Singapore to rule out thyroid or other issues. The endocrinologist found my t-level at 255 (I'm 34) and outlined some treatment options. The first recommendation he made was Clomid because my wife and I my want to have children at some point. His second recommendation was 1000 mg of test undecanoate every 8-10'weeks. With my limited access to lab testing, I had a strong concern about how to manage TRT. I went with the Clomid. Do you have any thoughts and can you tell me anything about test undec?

[@TCTmed]

+bunkerbob25: Thank you very much for the kind feedback, and you are most welcome for the content! I often find that thyroid issues accompany testosterone deficiency, so I am glad you are looking into that as well. This is something I manage for my patients regularly. I don't personally use Clomid or undecanoate, but both are common means of treating hypogonadism. Clomid and hCG are both methods that could increase testosterone levels while preserving fertility. Out of those options, I choose hCG but it can be cumbersome and carry with it a lackluster response. Clomid, on the other hand, is more easily administered, but can have negative effects on vision, up to and including blindness. So, in my opinion, testosterone injections are far superior. That being said, I don't care for the long dosing intervals and short half-life associated with testosterone undecanoate. It is marketed in the UK as Nebido, and in the US as Aveed. While there is a large base of literature and anecdotal evidence that supports its use, I have not seen quality results achieved with Aveed, here in the states. Ultimately, I believe you probably made the best choice out of those options, just be careful to be on the lookout for vision disturbances. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@bunkerbob25]

+Testosterone Centers of Texas You had me up to "...anecdotal evidence..." I had read about the side effects of Clomid but figured it was safer than taking injectables without being able to run any blood work. The doctor also had a third recommendation that was injectable every other week. I cannot remember the name of it though. Can you make any recommendations about managing TRT in situations like mine? Also, is likely that I can find a prescribing physician from within the US that may be willing to treat a patient through less than desirable oversight?Finally, can you tell me a rough estimate on cost, or direct me somewhere to find answers, for all fees associated with a service like yours? I am insured, so is this a likely means of cost reduction? Thanks again for all you're doing. Oh, the thyroid was peachy.

[@craiglilley8531]

your a super smart guy man like seriously smart in real-time as well especially while writing backwards for the camera ha what's your secret?

[@yherschlag]

Thank you for your very informative video. I'm 53 years old, and my total testosterone levels are a meager 251. Life just feels like I'm swimming upstream... very frustrating. But I'm not sure if I'm ready to commit myself to a lifetime of testosterone replacement therapy. How much could Hcg boost my testosterone levels? Could it bring the levels above 500? Maybe that with antiestrogens could get me sufficient free-testosterone to function optimally. I also have about 29 pounds of excess fat. And like I said, trying to get rid of that is like trying to swim upstream. Do you think a combo of HCG treatment with Sermorelin, a careful diet and serious exercise would work for me? I would greatly appreciate your advice on this.

[@amadeus5403]

Yonason Herschlag HCG only works if your testis still work so give it a trial run to see if it works. You’ll also need a anti aromatase agent like anastrazole to prevent estradiol from going to high .

[@marcialbode7770]

When you inject testosterone less will be bonded to shbg when you take it exogenously your free t will always be higher plus how your body metabolizes it my levels are at 750 at only 100mgs a week and 155 free that's on day 7 1100 on day 2 after injection and free at 300 so basically 100mgs puts me above range other ppl 200 dont put them in range so it's hard to tell what's normal and not

[@ArchiesBhanushali]

Exactly

[@garysimone4977]

I see by this video free t best in mid 20 range

[@TCTmed]

Best levels really depend on individual response, and safety metrics like estradiol, hematocrit, and PSA levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@tjl8884]

I've been noticing something about our current medical care. Everything seems to stop our bodies natural production of certain chemicals or hormones in this case. Why can't they augment things better?

[@TCTmed]

In some cases, the scientific community is just now learning how these substances act in your body (and how they interact with other substances). Your body is an incredibly complex system, and discovering why a particular substance acts a particular way in one person, but not in another, can be years worth of research in itself. It takes a while to proceed through the scientific process, and even then, hypotheses can be incorrect (or may seem to be correct for one reason when they're actually correct for an entirely different reason). This is part of the problem - continuing to build the body of knowledge takes time.

[@lanceseaman88]

So you treat them like heroin addicts going to a methadone clinic once a week????? Why wouldn't they come once a month like EVERY OTHER medication?

[@TCTmed]

@Lance Seaman: Actually, the vast majority of medications, across all aspects of medical care, require MUCH more frequent than monthly doses. Even when it comes to injections, treatments for vitamin deficiencies, RA, fertility, and anemia (and more) require weekly doses. It is pharmacokinetics that determines how a drug needs to be dosed. Testosterone cypionate has an 8 day half life. Trying to maintain a therapeutic trough at the end of one month would require an overdose with each injection. The risk associated with such an approach is, without a doubt, mismanagement. This is why we use weekly injections. It allows us to use the lowest effective dose to optimize testosterone levels and minimize risk. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@marrbrown1234]

Did you even watch the video?! The levels work best administered once a week. Period

[@nandadulalbakshi3121]

Hbli sahar testosterone activity very poor