Why You Shouldn't Be Worried About Testosterone Replacement Side Effects

[@klecoxs2]

Probably one of the best lectures I've seen on the testosterone puzzle not overly complicated and Simple enough for the Layman to understand Thank you very much. 👍

[@TCTmed]

@CAPTAIN CARIBE: Thank you very much for your feedback! I am glad you enjoyed it! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@goldo1107]

@@TCTmed Doc what about tgia i keep hearing about men going on trt after 60 and their chances of dying from a heart attack goung up by 35%. Is it true, and if so, why?

[@TCTmed]

@@goldo1107 The controversy surrounding this started primarily with two separate studies. One was published in JAMA in 2013, and the other on the online journal, PLOS One in 2014. As biased as I may be, I believe both were deeply flawed. Both articles suggested, through retrospective study, that testosterone "use" (the patients were not on what I would call TRT), increased the risk of embolic (blood clot related) events like stroke and heart attacks in men that already had a history of such cardiovascular problems. The entirety of the medical literature on the subject promotes and improvement in cardiovascular health. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@goldo1107]

@@TCTmed Gotcha. I thought as much myself. Im sure that if the individual is being health at that age they can minimize blood clots and or the thickening of the blood. Im aure that is closely monitored by whatever TRT clinic. I just wanted to hear your opinion. I'm 39 years old. Recently went for a quaterly checkup at the doc and asked for a teatesterone check in my Bloodwork. Comes back 268 and free 6.2. If it wasnt for the fact that I dont have children yet i would go on trt right away. But my fiance and I are not ready for another 2 years. I used to weigh 430 pounds a year ago. Started lifting weights 4 days a week and 30 min of steady cardio 6 days a week. Clean lean meats diet. About 3 months ago i just stoped losing weight even tgo im eating 1900 cal a day. Been very frustrating. I noticed im not as strong as i used to be in my early 30s and 20s thought that was odd too. Ao it led me to think maybe i have very low T. I was having most of the symptoms. Especially bad enxiety that juat came out of no where in the last 7 years. Depression as well. I started looking into reasons why low T and natural ways to bring it up. I asked for a copy of my bloodwork and noticed that i had really low vitamin D levels. Like really low. So ive been taking vitamin D for the last 3 weeks and im now practicing IF. I noticed this last week that my libido has gone up very much. So i thibk its working. I started losing a few pounds as well and im sleeping better. Soon as i have kids im going on TRT. I wanna have a quality life. I just want to do it safely wirh as minimal risks as possible. Hopefully they keep doing reaearch to help minimise the risk even further.

[@TCTmed]

@@goldo1107 Sounds you are evaluating things the right way! Best of luck with everything!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@KikkanGainz]

Wow, even i could be a doctor if i had a teacher like that. Really good!

[@SotoAdvert]

Fully agree

[@jck9590]

The only thing more impressive than his medical knowledge is his sterling penmanship!

[@TCTmed]

Haha, thank you @Jc Knight! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@wwhall3]

What other hormones or natural functions will be turned off or reduced by exogenous testosterone? I have heard that progesterone and DHEA will be lowered, which could have effects on memory Etc

[@TCTmed]

@W H: Progesterone and DHEA are both precursors to testosterone. Their levels don't change directly due to testosterone administration, but there can be variance. Via the Cytochrome P450 system, cholesterol is converted to pregnenolone, and both progesterone and DHEA are derived from this steroid. Vitamin D levels can affect progesterone levels, and progesterone can impact thyroid and metabolic functions. However, the most notable effects of progesterone deficiency are noticed further down the cascade. So, low progesterone may reduce your quality of sleep or your fat metabolism directly, or it may change due to the downstream drop in testosterone levels or resultant estrogen dominance. I have not found the need to treat progesterone deficiency in males when the other more impactful hormones are appropriately balanced. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@mr.c1136]

I didn’t realize Jon Favreau was so smart!

[@TCTmed]

@Mr. C: I tend to hear that from time to time. lol Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@mongoonlyprawningameoflife1218]

Penns younger brother

[@jezebulls]

Life’s been tough for Happy ever since Ironman died.

[@manulbhardwaj]

hahahahha, i was like....where did i see this guy before... thanks for clearing this up ! lol

[@christopherszwargulski7920]

I didn’t see it till I read your comment and now it won’t go away😂

[@travisfletcher7334]

Mr. Galindo 40 year old male who doesn’t feel like he used to. Several life changes over the past 5-7 years have occurred. Two kids and new job promotion with a lot more responsibilities has taken place in that time frame. When I tell people I feel tired, unmotivated, lethargic, etc., they respond with “that’s part of getting older…. You’re 40 now”. A friend of mine, who’s also PA, suggested getting bloodwork done to check my testosterone levels. So I finally did. My results: Albumin 4.7 HCT 49.1 Total T 333 ng/L SHBG 25 nmol/L Free T Calc 77.2 pg/mL FSH 5 LH 7.6 The APRN says I’m within range but on the low side. I know how I feel. Been on SSRIs for the past 7 years. Based on the numbers you see, should I look into TRT as a possibility? Thank you

[@augiegalindo]

@travisfletcher7334: Hello, and thank you for the question. Based on your numbers, yes. Based on your symptoms, the concomitant need for SSRIs, confirmed by your symptoms...it is ABSOLUTELY worth looking into. Your Free T Calc isn't adjusted for your actual albumin, and to convert it to the range of 9-30 ng/dL that I reference in my videos, you need to move the decimal one place to the left. So, using the website below, calculating your cFT correctly is only 7.34 ng/dL. I consider this well below normal, especially given your age. We chalk up far too many adverse effects to "getting older." Forty-year-olds should not be dealing with Low T. Everyone knows someone with diabetes; everyone knows someone with a thyroid problem. Simply because these problems are pervasive doesn't mean that their presence is normal. That said, if you want your Low T addressed appropriately, you will probably fair better with a provider that you do not need to convince or debate in order for them to initiate treatment. Look for a provider with sound judgment, a balance of monitoring and caution, and a track record of achieving positive outcomes. Calculate your free testosterone at www.issam.ch/freetesto.htm. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@travisfletcher7334]

@@augiegalindo thank you so much for taking the time to respond to my questions and concerns!

[@augiegalindo]

@@travisfletcher7334 You're welcome!

[@TCTmed]

You are very welcome, and thank you for taking the time to watch and comment, Sam!

[@yashwanthreddy5522]

Testosterone Centers of Texas

[@stauros12345]

hello and great video btw.I want to ask only one question.In the case of trt if you take aromatase inhibitors to keep estrogen low isnt a way for the fsh to keep producing?

[@TCTmed]

@Stauros Sotiriou: Thank you for the feedback! Lower estradiol levels may induce "more" pituitary secretion of LH and FSH, but it doesn't completely eliminate hypothalamic/pituitary suppression. Keep in mind that hypothalamic response to estradiol is only one factor that influences GnRH effect on the release of gonadotropins, and this is further modulated by other factors. Therefore LH and FSH secretion does not necessarily respond in lock-step with GnRH secretion. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@stauros12345]

@@TCTmed thank you very much for your answer :)

[@shumbane]

Does the body ever resume normal level production of Testosterone on its own after using TRT or would I have to take TRT forever once I begin treatment? This was very educational by the way. Thank you for making this video!

[@TCTmed]

@Sabino Humbane: Thank you for the feedback! What I tell patients with this question is that I have seen no evidence that suggests that you will not transition back to your pre-treatment levels if you stop TRT. The only caveat there is that your baseline production will naturally decline over time. So, if you are on treatment for 10 years of more, I would not expect that you would be at exactly the same levels of production after your natural production rebounds. Essentially, I assume your body would more likely settle into whatever your natural production would have been at that time. The hypothalamic/pituitary suppression has not shown to be permanent in my experience. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@mattmarkus4868]

A doctor told me you're not likely to stop once you start. That it's practically speaking a life-long decision.

[@bgoodorhell4u]

@@mattmarkus4868 that’s why you only take it if you really need it/ having symptoms or lowt .

[@infiniteg7852]

No, your sh!t plummets

[@del_boy_trotter]

I do so wish I had found this very much earlier! I'm sure your presentation will sound a little 'heavy' for some but, anyone who is receiving TRT will find much to understand and relate to! Many thanks for broaching a difficult subject with undoubted, well-presented and a common sense approach. Many thanks!

[@TCTmed]

@Delboy Trotter, I truly appreciate the feedback. From the beginning, the goal has been to be thorough and informative. There are a lot of ways to do TRT wrong, thank you for staying diligent in you research for how to do it right! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@OdinAesthetic]

One of the best, most informative, non bs video on trt. And I've seen them all.

[@TCTmed]

@Odin Aesthetic: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@princeprince6388]

This is the best explanation I have found on TRT at youtube. there are some other but they dont cover all essential things.

[@TCTmed]

@prince prince: Thank you very much for your positive feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@leeharley1315]

Hello there ...Great video btw ...I had my test levels done they have come back as 15.2 nmol ... could you advise if this is sufficiently low enough to start a low dose trt course every other day ... many thanks 😊

[@TCTmed]

@Lee Harley: Thank you for the feedback! Your symptoms and medical history play a profound role in decision-making about TRT. Keep in mind that there is more to account for than just the levels. That said, a total testosterone level of 15.2 nmol/L corresponds with a level of 439 ng/dL on the reference ranges mentioned in the videos. This is on the lower end of normal for most reference ranges, but still normal. Best regards, Augustine Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@lidd69]

Awsome explanation of TRT, I’m Sure your knowledge on this subject and breakdown in this video will help men understand this treatment and not to be afraid or worried about treatment.

[@TCTmed]

@lidd69: Thank you for the feedback! It is truly appreciated. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@GREATTECH1]

I agree. I learned a lot from this video. I'll watch it again. I hope he has or makes more videos.❤

[@TCTmed]

f@GREATTECH1: Thank you for the feedback! I am glad you found ithelpfull! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@eugenenayvelt9718]

I'm a little confused by this video. The title says "why you shouldn't be worried about side effects", then the last side effect... in my opinion, probably the scariest of all of them...low fertility and inhibited ability to father children, he says there's no reliable study that has shown that hcg can keep your sperm levels normal. Basically...saying if you go on TRT, that yes you will have reduced fertility and something you should be aware of, and hcg is not guaranteed to work and has no real studies behind it. I'm not supposed to be worried with this side effect?

[@grapas100]

Eugene Nayvelt - For most of us older users of TRT, infertility is an added bonus.

[@TCTmed]

@Eugene Nayvelt: How this affects you depends primarily on your stage of life, I suppose. Keep in mind that the suppression of fertility is only temporary. I have many patients, who want to maintain fertility, that are on testosterone and hCG concurrently. More specifically, I took this same approach and my wife and I had zero difficulty achieving her third pregnancy, and my third is now about to turn 4. Furthermore, I have a gentleman who had low sperm counts and motility prior to TRT, and hCG monotherapy was not addressing his symptoms. After length discussion with he and his wife, we decided on concurrent therapy. At his next semen analysis, his counts were slightly lower, but his motility was significantly improved. They conceived shortly after. Now, I do not manage the fertility side of things, and these are bits of anecdotal information only. However, I feel very confident in placing patients who wish to maintain fertility on testosterone with hCG concurrently. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@varunkamal91]

Is an aromatase inhibitor necessary if the dose is normal? My reasoning is ... If you are giving an aging male only the levels of a Genetically gifted 18 or 25 year old, wouldn't the body keep the estrogen levels exactly where it should be? Also, about blood thickening....or balding with too much dht or iron absorption increasing...wouldn't all this be out of question if the dose is kept natural...also what would be the dose to have a man at a genetically gifted 25 year old's levels of testosterone .

[@TCTmed]

@Varun Kamal: This is a common question we get. Unfortunately, even when normal levels are targeted, the use of an exogenous hormone (one that is not originally made by the body) will elicit changes that would not have happened in the setting of natural production, even to the exact same level. Increased iron absorption is what leads to "blood thickening" or an increased hematocrit, and is linked to the effect of exogenous testosterone on hepcidin. Balding occurs in those who are genetically predisposed to it, and not because DHT goes too high specifically. However, DHT is what "pulls the trigger" of the genetically "loaded gun". So, if testosterone levels are low, DHT will be relatively low, and any increase in testosterone will lead to an increase in DHT. Even just normalizing DHT is someone who is genetically predestined to experience balding can accelerate hair loss. Dosing is not cookie-cutter, so there is no single perfect dose that would recreate the internal environment of a genetically gifted 25 year old, and I fully expect any patient targeting high-normal levels to have at least some degree of side effects. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@varunkamal91]

@@TCTmed thank you so much for answering.... Do you have reason to believe that this is due to a weekly once shot peaking and lowering through the week in spite of a slow acting cypionate ester.... Unlike endogenous hormone which is released multiple times a day.... Without peaking unnaturally

[@TCTmed]

@@varunkamal91: That undoubtedly has some impact, but it doesn't explain all of it. That, of course, is largely dependent on how high the peak is and where the trough is maintained. I have many patients who have requested twice weekly injections, and those who have tried it have not exhibited a 50% decrease in side effects. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@samtaylor1010]

Man that was the best info I’ve heard so far. Thank you for taking the time to explain.

[@TCTmed]

Thank you for watching. We really hope the information is helpful to you!

[@digitaldood5252]

Great explanation! I can't understand why there are any dislikes... I'm using this exact regimen at a different facility and it was explained to me just like this - actually this might be a little better having the visuals! Thank you!

[@TCTmed]

@Jim Provenzale: Thank you so much, your comments are truly appreciated! Best of luck with your therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@lexpaterson6557]

Great videos , thanks Latest blood test , Total Test 234 Free Test 216 Pmol /L SHBG 15 Nmol /L FSH 7.5 U/L LH 3.0 UL Labs say Free Test is in ( range ) so no TRT Have plenty symptoms , what's your valuable opinion , Thanking you in advance

[@TCTmed]

@Lex paterson: Thank you for the positive feedback! I had to do some conversions to the units of measure I am accustomed to working with, but I show that a calculated free testosterone of less than 300 Pmol/L is low. The criteria I use for diagnosis is a total testosterone OR a free testosterone that is low on two separate occasions, before 10 AM in the morning, confirms the presence of hypogonadism in a symptomatic patient. Based on your levels and stated symptoms, you may want to seek a second opinion. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Founding Partner

[@53531640]

This is about the best explanation of the hormonal pathophysiology on You Tube. I have questions though: 1. After commencing testosterone replacement therapy, is the body's ability to produce its own testosterone forever effected? 2. Is it feasible to have short bursts of TRT to regain sex drive without effecting the body's own production permanently? 3. If I take a Estradiol inhibitor, would this be effective in raising my Testosterone levels?

[@TCTmed]

@Jaime Locke: Thank you for the positive feedback, I truly appreciate it! As for your questions... 1. There is no significant research that I am aware of that answers this question through formal medical study. That being said, I have not seen a case where TRT has forever compromised the body's ability to produce testosterone naturally, at its baseline level. Now, once stopping TRT abruptly, it will take some time to return to that pre-treatment, baseline production. 2. Yes, it is feasible to use TRT in this way without permanently affecting natural production, but I would not advise it. Keep in mind, with TRT (done the right way) there is no need to "cycle" on and off of therapy. And, your body prefers homeostasis, as opposed to the stop-and-go traffic type strain placed on it with the hormonal roller coaster of cycling. 3. Yes and no. Technically, it would keep your testosterone levels from being lowered, rather than directly increasing them. However, I have found that this effect is minimal to non-discernible both symptomatically and biochemically. I would expect that any positive change here would have less to do with a minimally higher testosterone level and more to do with the fact that there is a stronger androgenic effect when there is less, but normal, estrogenic opposition. I hope that answers your questions, thank you for reaching out! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Ta3iapxHs]

Testosterone Centers of Texas thank you. -Sam

[@madhousebaby]

Greta video thanks for giving us your time to do this video for the world to see thanks

[@TCTmed]

You're welcome, thank you for watching!

[@madhousebaby]

Testosterone Centers of Texas :)

[@Marc-Vickers]

If we could find a way to communicate to the brain to produce more testosterone, that would be nice.

[@TCTmed]

@Marcus Vickers, peptide research may be bringing us close to this. There are drugs like clomiphene that do affect pituitary stimulation for testosterone production. Still, it also leads to stimulation of sperm production (originally a female fertility drug), and it can lead to gonadal hyperstimulation and vision disturbance. I think we will get there eventually. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@hanktharipper10]

Good info. Im 38 years old and been on trt for a year now and its been grate for me. Before I started it i been losing weight i went from 210 to 190 and going to the gym. I would recommend it to any man thats older to get checked for low t. Before I got on trt my levels were 371 now I have them around any 600 to 1500 and I feel good. Just stay on top of my blood work...

[@TCTmed]

@hanktharipper10: Thank you for the feedback. I wish you continued success with TRT! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@Sarah-so7ye]

@@ArchiesBhanushali following

[@raziqcheck]

Does TRT makes men infertile?

[@lotfibouhedjeur]

I love this guy. So eloquent. No fluff. Kudos.

[@TCTmed]

@Lotfi Bouhedjeur: Thank you much, I appreciate the feedback! I hope the information helped. Best of luck to you! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@carlorocky]

I’m a 48 year old man and have been on TRT for ten years. The results of my blood test today was a testosterone level of 1500! Should I be worried?

[@TCTmed]

@carlorocky: That depends; while 1500 ng/dL is definitely elevated, many factors are considered. If your blood was drawn near the peak (~48 hours after injection), that would obviously lead to higher readings. Also, if your SHBG is elevated, you could still have a normal calculated free testosterone, which is more indicative of what is influencing your body. Generally speaking, though, if you are at 1500, you would likely be able to reduce your dose and still have an optimal response. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@johnmontana18]

Is there a way to balance testosterone and HCL so it stays at about 50, to avoid clots while getting as much of testosterone as that allows? Thanks, wonderful presentation.

[@TCTmed]

@johnmontana18: Thank you for the feedback! The risk of "cardiovascular events" and/or clotting due solely to TRT has been largely overstated. Two studies from 2013 and 2014 that received much attention have since been redacted, amended, and essentially debunked. Testosterone will cause most people to have some increase in hematocrit (HCT) levels, but this increase is typically minimal. People with difficulty maintaining a normal HCT level typically have other underlying concomitant conditions such as obstructive sleep apnea (OSA), polycythemia vera, or hemochromatosis. By far, OSA is the usual suspect. This includes disordered breathing that may not actually progress to frank apneic episodes. So, if you remove OSA from the equation, HCT levels are not a rate-limiting step in optimizing testosterone levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@johnmontana18]

@@TCTmed Thank you for the response. My HCT was 56.2 at the time I had PE. My PCP blames it on the HCT and says it should be kept below 55. I live at 7000 feet, if that affects HCT. I had to stop T but will restart when permitted because I am very low T without it.

[@TCTmed]

@@johnmontana18 You're welcome. Normal reference ranges are, to a degree, geographically specific. My elevation in North Texas is less than 700 feet above sea level. And, yes, an elevation of 7000 ft. would impact what is considered normal in your area. Still, even if your HCT was to blame, the portion of an elevated HCT due to the use of testosterone is minimal. If you haven't already, consider seeing a cardiologist and hematologist. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@TheProject-fw3qc]

Unless you have a doc NOT paying attention to your blood work, your hemo goes too high for too long and you get knocked down with systolic congestive heart failure.. yes it CAN happen if you are not vigilant about your treatment, do NOT fully trust your doc.

[@TCTmed]

@Teufelhund Odinic Rite: Agreed! With the PROPER management of potential side effects, TRT can be both effective AND low risk! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@BigYellow1500]

Teufelhund Odinic Rite just donate blood every six months

[@snailnslug3]

Mike Mcneill I do every other month

[@bigbud361]

@@snailnslug3 im 57 at 56 3x bypass 6 yrs cycles differnt compounds im currently on blood thinners and cholesterol meds blood pressure meds could be combination steriods and gentics but still want to do trt

[@artguzman1560]

@@TCTmed I have been going to low t center for low t treatment. They checked my blood when I first started and I have currently done 6 treatments without doing blood work. Should I be concerned?

[@SC-bb4mz]

I’d like to know if someone doesn’t suffer from low test, but wants to cycle trt in order to maximise his progression inside the gym. Are the fertility side effects limited? So on for 6 -8 weeks then off for 6 - 8 weeks ?

[@TCTmed]

@S C: All the same side effects would be in play. When you cycle to boost normal levels in a TRT-related asymptomatic patient, that wouldn't be considered TRT. So, explicitly gearing testosterone to bolster anabolic gains would create a more deleterious environment than we seek to maintain with TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@jap71173]

Very informative and actually useful videos! I would have liked to hear "why" its a lifelong commitment and what would happen if someone stopped TRT after 6 months to a year. Maybe another video?

[@TCTmed]

@Big John: Thank you for the feedback, I will add your suggestion to the queue! For now, let me give you a quick answer. The main reason TRT is considered a lifelong commitment is because, in the vast majority of cases, the symptoms of hypogonadism are also lifelong...and progressively so. The more precise characterization would be: TRT need only be continued for as long as you want relief from your symptoms of testosterone deficiency. Additionally, natural production is suppressed while on TRT. This is why it is so important to only intervene in broken systems. TRT should be used for those patients who are deficient and symptomatic. In this scenario, suppression of natural production carries little downside, because level are already so low that they have become disruptive to one's life. Now, within a very short time, pituitary control of testicular production is suppressed by the use of testosterone. So, when TRT is abruptly discontinued after six months to a year as in your proposed scenario, you don't fall to your baseline (pre-treatment) production; you fall further. The rebound to your baseline will take weeks, to even months. Also keep in mind, if you are on therapy for a longer period of time, say 10 years, your baseline would have deteriorated anyway. In this case, your "rebound" will also be limited. Ultimately, TRT is not a lifelong commitment, because you can always choose to live with the symptoms of Low T or with whatever improvement you can achieve through entirely natural means. We don't yet have a reliably safe way to make your body make more testosterone. Perhaps peptide research will change that, but I don't consider this a reliably safe way to treat Low T at its current state of research and advancement. Therefore, as long as you want relief from symptoms of hypogonadism, that's how long you will need to be on TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@leftie75]

I took it for 18 months. The only issue I had when I stopped was my depression levels rising. I had zero issues while taking T. I'd love to explain why I'm not taking it now, but it would take a while. Hopefully I can start again soon.

[@AbcDef-dz7no]

@@leftie75 why u stopped ?

[@Xdc5]

@@leftie75 did you get back on it?

[@bgoodorhell4u]

@@leftie75 hope you’re doing better now brother.

[@venetianmask]

Great information. Thank you. I’m naturally ripped now and my veins pop up. Some people where I work out have been asking me if I’m doing steroids or trt but it’s all diet and work outs. Thinking what would happen if I try it

[@anujbhardwaj3960]

Does we regrow hair back with trt..which is loss from low t level ?

[@TCTmed]

@anuj bhardwaj: That would be unlikely. Some body hair growth does improve with TRT, but the hair on your scalp will not regrow, on therapy. Best regards, Augie Galindo, Jr. MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@mancheapsterunited5125]

I really hope ull answer my question as it was an amazing video , trust me on this ive done almost everything to cure my low trt symptoms and very carefully did a TRT with A lot of hope but dont know why even after keeping everything in check it just made my symptoms worse and i was heart broken , i have low testosterone please help me what else can i do ive reseached a lot and lot i know what to keep in check like dht, blood pressure, estrogen everything but still my trt back fired raising my anxiety and even depression low energy which were main reasons i went on trt 😢

[@TCTmed]

@mancheapterunited5125: Thank you for the kind feedback! Unfortunately, some cases can get complicated. The best way to figure it out is to apply diligence to specific monitoring of symptoms, side effects, and dosing simultaneously. You may also need to have other potential issues investigated further. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@kadirkhan-hg6gx]

I have huge respect you doctor , your information helping millions of people around the world ,, great job 😆 I have low T symptoms but testerstone is normal so my doctor advised TRT maybe in future but not yet . I need a hair transplant now and my question is : Shall I wait or TRT and do the hair transplant or shall I wait ?? If my future is TRT what will happen to my hairs ?? Thanks in advance

[@TCTmed]

@kadir khan: Thank you for the kind words! Check out this link (tctmed.com/genetics-of-male-pattern-baldness/) for the complete answer to your question. Ultimately, whether you will lose hair due to DHT has little to do with your hormone levels and much to do with your genetics. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@thefinder8087]

If someone had total Test in the 700, but high SHBG (81) and low Free T (80 pg/mL), everything else is normal including liver enzymes, LH, and estrodial, would you treat them assuming they had symptoms?

[@TCTmed]

@thefinder808: We have treated patients with patterns like this. In my opinion, the calculated free testosterone value is the focal point of the laboratory evidence for the medical necessity of therapy. If there is a way to solve the SHBG dysfunction, namely isolated hyperestrogenism, then that may be the first option ahead of TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@thefinder8087]

@@TCTmed Thank you very much for your response. One follow-up, since my estrodial numbers are normal, I'm assuming TRT would be a valid next step at least for a 3 month trial?

[@TCTmed]

@@thefinder8087 You are most welcome! Yes, it does seem appropriate at this time.

[@finnanutyo1153]

@Testosterone Centers of Texas I'm 25 and just found out today I have low testosterone (133ng/dl) And it explains alot. I'm constantly depressed, anxious, have trouble sleeping, and I'm overweight. My doctor said it's really low and we are hopefully starting TRT next week. Can anyone fill me in on what I should expect? Like side effects, pros & cons, and how long I will be doing this? I'm excited and I hope this is the beginning of a new chapter in my life. Is there anyone out there my age who is suffering from this? I'm a former drug user so that may be a big reason for the low t. I'm currently in treatment for drug abuse and I take suboxone for opioid use disorder. I'm scared to take the testosterone. Also I had one doctor basically tell me I'll be miserable later in life because I won't be able to make my own testosterone if for some reason I dont have access to more. He said I'm too young and said it's because I'm fat and a former drug addict. But I feel these symptoms even when not using drugs for very long periods of time. Sorry for rambling. I eagerly await your response. .

[@TCTmed]

I am glad you are on your way to being treated. The advice you were given about being too young, that you would be miserable later in life, and that it would destroy your ability to produce naturally is categorically wrong. Go through all of my videos and then head to our blog at tctmed.com. You will find all the information you are looking for there. Suboxone is one of the reasons you are producing so little testosterone right now, but it may not be the only reason. Recent studies show that many younger men (20-39) with normal BMIs and therefore not overweight and without risk factors such as opioid use are experiencing hypogonadism at alarming rates. Testosterone production is on the decline, almost across the board. Yes, behaviors influence it, but not as much as genetic and environmental factors. You may be able to rebound to normal production once you're off Suboxone, but it is also very plausible that you will need TRT life-long to avoid those symptoms. Your level crosses a threshold into the range of "severe" hypogonadism. It certainly appears that TRT is right for you; just make sure that you are managed by an experienced provider. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@finnanutyo1153]

@@TCTmed thank you so much.. I needed this information. I feel so much better now.

[@TCTmed]

No problem!

[@mikephilpot]

I'm on TRT 200ml every 3 weeks. Just a month and a half in. Noticing some gyno and fluid retention. Would the anastrozole counter act that and get rid of the gyno and fluid retention? Outstanding presentation doc. 🤙🏻

[@augiegalindo3599]

@Mike Philpot: Thank you for the kind feedback! The role of anastrozole in TRT is to limit the overproduction of estradiol via altering the aromatization of testosterone. So, it can decrease the stimulation of breast tissue by keeping estradiol normal, but misuse may actually contribute to gynecomastia. Maintaining a normal estradiol level is also helpful for mitigating fluid retention. The bad news here is that once you have palpable gyno, your breast tissue is highly unlikely, if not altogether unable, to return to its "dormant" pre-stimulation state. To a degree, it will be irreversible. Think of it as male breast tissue, never being stimulated by abnormal estradiol influence, staying unnoticed and undetectable. However, once it grows, say to a six on a scale from one to ten, the now-disturbed tissue will not retreat back to zero even when you remove the offending stimulants. This is why great care needs to be taken in the management of TRT. If gynecomastia is significant enough, only surgery can improve upon the hypertrophic changes. And, even with such an invasive response, it can remain likely to recur. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@DarkVeghetta]

Fantastic explainer, Dr. Galindo. Much appreciated. Personally, while my testosterone levels are roughly 11 times lower than normal for my age (I'm 37), my spermatozoa count is quite high - about 4 times of what would be considered normal, with motility being double the minimum normal levels. I want to father multiple children, so that's the aspect that I worry about the most. Considering the way in which the chain reaction leading to the production of both testosterone and sperm was explained here, I do wonder if, given the huge disparity between my testosterone deficiency and my sperm production abundance, TRT would likely lead to lower-than-now but still normal levels of fertility overall. I fully intend to seek an experienced medical opinion on the matter before making any decisions, but it certainly seems like the most logical outcome, given my particular test results. Best wishes from Romania.

[@TCTmed]

@DarkVeghetta: Thank you for your reply and feedback! Fertility can be fickle. It could be that with robust sperm production and motility, you may be somewhat protected from severe TRT-related infertility. Still, you could potentially find yourself exquisitely sensitive to exogenous testosterone, too. Make sure to explore the options of sperm banking and the use of supplemental medication like hCG to preserve fertility should you start TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@DillyDogSays]

Why does TRT have side effects when its a normal chemical in your body?

[@TCTmed]

@Brad Phuck: Great question! Unfortunately, no exogenous hormone or biochemical is going to be able to be introduced to the body and still have all the EXACT same effects as it would if it is produced naturally, through its proper pathway. The balance created by negative feeback loops is delicate and is altered once any part of it is circumvented. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@johncooper7242]

This is still without question the best tutorial on Testosterone on the web. I'd like to request an update with the addition of information about Prolactin and Pituitary issues like Prolactinemia . I am a 67 year old male with a T level of 2-3nmol/L due to a macro prolactinoma . I have been in a dilemma about whether to accept treatment or not for the past 3 years. I am not inclined to take Cabergolin due to both the unpleasant side effects and the risk of rhinorrhea (leaking of CSF cerebral spinal fluid . I have been offered oral testosterone by my Endocrinologist but am concerned that T treatment might exacerbate my current symptoms as I also suffer with T2 Diabetes, Hypothyroidism, NAFL, HypoGonadism low GFH etc. I am managing my T2 and other chronic conditions with a Keto diet

[@TCTmed]

@John Cooper: Thank you very much for your feedback, kind remarks, and suggestions. I will add hyperprolactinemia to the list of future video topics. Pituitary adenomas can induce hypersecretion of pituitary hormones. The most common of these would be a prolactin secreting tumor, but they can also secrete growth hormone (hGH), adrenocorticotropic hormone (ACTH), etc. As the benign, non-malignant tumor grows, it can destroy pituitary function globally, leading to hypopituitarism, and under-functioning or non-functioning pituitary gland. This is why so many systems can be affected, as the pituitary gland is responsible for the secretion of FSH, LH, ACTH, TSH, Prolactin, hGH, MSH, ADH, and Oxytocin. This is also was even small tumors, microadenomas, are followed by neurology/neurosurgery to insure that the potential impact to the pituitary gland and surrounding structures is appropriately monitored. The treatment of the specific adenoma depends on its type, but dopamine agonists, drugs that activate dopaminergic receptors, are the first line treatment for prolcatinomas. I don't manage pituitary tumors, but do have some patients who have a known history of them. Without controlling prolactin levels, the benefit of TRT will likely be reduced, and may skew the risk/benefit ratio in a way that makes TRT an undesirable treatment. CSF rhinorrhea (rhinorrhea alone just being a runny nose) is definitely a serious complication. However, it is also an uncommon one, and is seen with invasive, large adenomas. More common adverse reactions include nausea, headache, dizziness, constipation, asthenia, fatigue, abdominal pain, somnolence, and hypotension, among others. Managing pathology without medication is almost always preferable, but I would just urge you to keep in mind the expected goal of treatment for each approach. I typically recommend the fewest interventions and use of the lowest effective dosing. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@johncooper7242]

@@TCTmed Dear Augie . I am astonished by your comprehensive and detailed response. Thank you so much for your advice and for giving so much of your valuable time to replying to my questions and comments. Since diagnosis of T2 Diabetes and Hypoprolactinemia in 2016 I have carried out much personal research and have received advice from a Consultant Endocrinologist however I have been questioning the advice I have received regarding taking Cabergolin and TRT treatment. Your warnings and advice regarding medication echo my own thoughts on the matter and my feeling is that at the moment as my macroprolactinoma is not causing me any significant health issues and has not changed in size in the past 3 years I will continue to defer any medical intervention . I do not see the potential benefits of medication being worth the potential risk of likely unpleasant side effects . When one has endured decades of ill health due to Hypothyroidism and undiagnosed Prolactinemia and T2 Diabetes ,... any period where one feels relatively well without migraine,headaches, nausea, fatigue, abdominal pain, constipation, brain fog , etc is priceless and very difficult to justify putting at risk by taking medication.

[@TCTmed]

@@johncooper7242, you are most welcome. Issues like these are often complicated, and ultimately, your comfort level with treatment options is all that matters. Even with straightforward TRT, I encourage patients to make sure that the symptoms they suffer with warrant a treatment, that like any other medical intervention, carries potential risk and some level of burden of therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@kadirkhan-hg6gx]

Can u pls explain ,, what is the probability that trt will shrinkage my testis due to side affect ,, this only side affect stopping me to to take trt

[@TCTmed]

@kadir khan: Testicular atrophy happens for most patients on TRT. The issue is rarely severe and can be successfully treated/prevented with hCG. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@tealdarin]

TRT and heart decease. I've seen research saying it's helpful or its bad for you. can you do a video on this?

[@TCTmed]

Excellent idea Darin! We'll add it to the list and let you know if we make the video. Thanks for the suggestion.

[@DenyBlackburn]

Testosterone Centers of Texas TRT LOWERED my blood pressure into the normal range. Had anemia coz low T so heart needed to work harder. I'm so happy now

[@ccmkoho]

Texas Boy , but it increases plasma count. One of the reasons you have more aerobic capacity on it.

[@MrAndy9188]

This is the best video I have seen on trt. Very well done to you. I have done so much research on this and you know what you are talking about and can deliver it in a straightforward way.

[@TCTmed]

@Andrew Sanderson: Thank you for the feedback! I am glad that you found the video to be helpful!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@lazmotron]

You know your stuff doc, more than others.

[@TCTmed]

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

[@whitejodeci8926]

I'm only in my 3rd injection, my highest blood test came in at 324 and 7.7 free. I'm 30 years old, my provider didn't explain if that's extremely low or if I'm just on the low end of the spectrum

[@TCTmed]

@White Jodeci: For most reference laboratories, your total testosterone would be considered to be "low-normal." However, because of your age, I would consider this a more marked deficiency. If the free testosterone level you provided is a calculated free testosterone (www.issam.ch/freetesto.htm), then I would characterize it as frankly low. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@p062161r]

Is trt safe for somebody with mild kidney damage? Such as efgr at 65? Or is there a big risk of increasing damage from the use of testosterone? Thanks for any help

[@TCTmed]

@p062161r: I haven't seen any evidence of negative impacts on the renal system with properly managed TRT. Testosterone is metabolized by the liver, so improper use or abuse of the medication (particularly in the oral form) can be injuries to the hepatic system. We routinely monitor kidney and liver function in our patients and have not seen a correlation between the use of TRT and harm to the kidneys in a decade of treating low T. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@p062161r]

Thw you very much for the info. Have your patients included people with kidney damage/renal problems? I appreciate your time helping me

[@TCTmed]

@@p062161r No problem at all! I know we have a handful of patients with renal insufficiency, but I do not recall treating any patients who were in frank renal failure (dialysis). Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@gingerbread1032]

Seems like the one thing we should have done for our 16 year old children is have a full work up done on all there hormone levels, this way they have the numbers they need to stay young there whole life. Or repair their counts when they get old as stale bread in the head.

[@TCTmed]

@ginger bread: Great point! Even a little more sobering, however, is the trend of younger and younger people suffering with confirmed testosterone deficiency. The standard itself (a healthy late teen to late twenties patient) is under the same assault. Studies show a progressive decline in testosterone production decade over decade. This isn't just an old person's problem. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@apoorvmishra6992]

I have negligible levels of testosterone and also ko LH in my blood and I'm 19 still no puberty. I don't have Kallmanns syndrome but I have been diagnosed with hypogonadotropic hypogonadism. If I still take the minimum effective does of testosterone what are my chances of getting thickened blood if I have no family history of heart problems?

[@TCTmed]

@Apoorv Mishra: It is improbable that increased blood thickness would be a significant problem for you, even with a family history of heart problems. Two main avoidable or treatable issues to keep in check are sleep apnea and smoking. Aside from that, if you don't have chronic conditions such as polycythemia vera or hemochromatosis, your hematocrit is likely to remain normal on well-managed TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@apoorvmishra6992]

@@TCTmed thank you so much this info means a lot to me.

[@TCTmed]

@@apoorvmishra6992 No problem!

[@kadirkhan-hg6gx]

I have normal testerstone , and normal all other hormone e g . FSh LH estrogen prolactine , I have no other medical condition at , my medicine doctor , endocrinologist done a lot of test but no medical issue at all , So why I have no libido and erection , it’s been 3 years now . Any help doctor ??

[@TCTmed]

@Kadir Khan: I suggest that you look for providers specializing in sexual dysfunction. There are specific treatments available for libido, but there can still be underlying issues despite you being told that all your hormones are "normal." Seek out a sexual medicine specialist. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@goyo2897]

I believe that the information in this video regarding the growth of prostate cancers during TRT is outdated. If you are concerned about this issue, do some research and get educated before you decide to NOT do TRT.

[@TCTmed]

@Goyo: There has definitely been some new information brought to the fore by ongoing research. A growing cohort of studies shows that optimizing testosterone levels can even be preventative with regard to prostate cancer. Also, adequately managed TRT often leads to early detection of problems, and when prostate cancer is found in men on TRT, it tends to be less aggressive. That said, I always recommend that a well-informed urologist guide patients through establishing dormancy once prostate cancer has been diagnosed and definitively treated. There are now well-documented pathways to reestablishing TRT in post-prostate cancer patients. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@gif24gt60]

Can pregnenolone be use instead of HCG to prevent testicular atrophy? Are injections a better method than creams for physiology? Can Calcium D-glucarate mitigate excessive estrogen instead of an AI? I've heard from another health professional that estrogen may play a major role in male pattern baldness and PSA enlargement opposed to DHT being the primary culprit.

[@TCTmed]

@Gif24 GT: There are proponents of pregnenolone for the treatment of atrophy, but many of them rely on studies from the 1940s. Given that there are multiple pathways for the metabolism of PG5, it would be difficult to isolate which byproduct was actually helping, if it does at all. I prefer injections to topicals. CDG can help estradiol metabolize down to more preferable metabolites, but it is not suitable for AIs. I have not found any evidence to show that estrogen is a key factor in male pattern balding or BPH. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@gif24gt60]

@@TCTmed thanks for such comprehensive explanations!

[@invictusdomini8624]

Why do you use the Caduceus, the symbol of commerce, and not the Rod of Asclepius, the symbol of healing?

[@TCTmed]

@D. Dillon Duffield: Good pickup! Most don't know the difference. This was something that I became aware of in 1996 when starting the fire academy and forming our class insignia. Asklepios and Hermes/Mercury both have mythical and storied histories that give rise to the two symbols. Ultimately the Staff of Aesculapius is more closely associated with physicians; Hippocrates even counted himself as a descendant of Hercules and Asklepios. But, the symbol recounts a story where a snake revived a fellow snake killed by Asklepios. If you follow that story, the saving totem should be the leaf that saved Asklepios' failure. Apollo was the patron god of physicians, but the faith healing of Asklepios and later, his children, Hygea and Panacea, whose names gave rise to still-common medical terms, brought fame to the Staff of Aesculapius. Hermes, like the other gods, filled several roles. One, as the messenger of the gods. This is where his staff comes in. It was a statement of peace and neutrality. It was used by the US Army Medical Corps in the 1800s, the AMA, NJEM, WHO, and the American College of Physicians. While confusion led to its widespread use, it is still linked to the medical field in general for Americans. And, aesthetically, it looks better in the "T". lol Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@vernschock7645]

Very good layman breakdown of process-great video;) very informative -thanks

[@TCTmed]

+vern schock Thank you very much, I'm glad it was helpful!

[@TheJdellinger]

This guy started me on TRT at 46 years of age after giving me a full, blood test. He’s got this entire Science of hormones completely dialed-in. I thank him for increasing my quality of life in a big way. Highly recommend subscribing to his channel. He’s the best. 💪🏼🙏🏼

[@TCTmed]

@Kevin St Clair: Thank you so much for the kind feedback! We take pride in helping our patients to enhance their quality of life, and getting back to feeling the way they are supposed to! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@alexvidu4517]

Winner of a video, I have been researching "at what age do men's testosterone levels decrease?" for a while now, and I think this has helped. Have you heard people talk about - Peyoraat Rudimentary Preponderance - (Have a quick look on google cant remember the place now ) ? It is a good exclusive product for discovering how to boost testosterone levels minus the hard work. Ive heard some unbelievable things about it and my brother in law got amazing results with it.

[@ashleytaylor994]

Did you notice more energy and less testosterone

[@TheJdellinger]

@@ashleytaylor994 can you please rephrase the question?

[@ChristopherMaier.]

Lol. Fucking RIP bones if you're taking an AI

[@chrismuniz8515]

I just graduated 🎓 I wish this guy was my Doc / coach ..

[@TCTmed]

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

[@77ponch77]

I've heard traumatic brain injury can cause problems with the pituitary and hypothalamus. I believe this is my root cause of my low t. I hit my head on the dashboard in a car accident at 7 years old in the 80's when TBI wasn't even known about I think so they didn't see anything but my broken jaw.

[@TCTmed]

@77ponch77: Injury to the pituitary gland or the infindibular stalk from which it is suspended is a possible cause of secondary hypogonadism, as it can keep the pituitary from commanding testicular activity as it would normally. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@rawhan8602]

My testosterone level when i was 30 years old was 3.4 now I'm 40 and my level is 3.4 i have all symptoms of low testosterone my doctor said it's normal above 3 but i do not think so... should i start trt...

[@TCTmed]

@rawad hanna: I recommend finding a clinician who specializes in testosterone treatment, and who understands the importance of you free testosterone levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@rawhan8602]

@@TCTmed thank you.. but i can't find a good doctors in my country..... What is the low rang of free testosterone for trt.... what is considered low free testosterone for trt

[@TCTmed]

@@rawhan8602 The reference range for a calculated free testosterone that we use is 9-30 ng/dL. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@vijeygopi4670]

Great info bro am 24yrs diagnosed low t and high estradiol if I go for TRT will last long 20 years

[@adamsuleiman5635]

Why just 20 yrs ? Living with low T also affect u

[@andetesfay4300]

I have seen people over 40 years on TRT.

[@alawartegketofast8916]

I have symptoms of low testosterone, but the results of my laboratory tests are normal testosterone levels. I am 57 years old, do I need TRT HRT?

[@TCTmed]

@AlaWarteg Ketofast: That depends. It is not helpful to exogenously raise the testosterone levels of a patient whose labs indicate a deficiency, but history reveals no evidence of related symptoms. On the other hand, we routinely see total serum testosterone levels "normal" in patients with significant symptoms. This could be because other processes are causing a similar symptom pattern as hypogonadism (Low T) does. A "normal" total testosterone level often fails to support a normal calculated free testosterone level. So, if you are significantly symptomatic with a low-normal total T level but still have a low calculated free T, you may still be a candidate for therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@crosisofborg5524]

I listen to testosterone replacement doctors say TRT is safe and urologists say it’s unsafe. Being almost 60 my prostate is enlarged like everyone else my age and my PSA is elevated (I don’t recall the numbers). I got TRT and the PSA jumped up. I had another test for a more sensitive PSA and it also showed elevated and the urologist said my numbers in that test indicated a 25% likelihood that I had cancer. I got a 12 point biopsy and it was clean but the urologist said my numbers made it very unsafe to ever get TRT again.

[@augiegalindo]

@crosisofborg5524: “While up to a third of men who are placed on testosterone therapy do not meet the criteria to be diagnosed as testosterone deficient,2, 3 there are a large percentage of men in need of testosterone therapy who fail to receive it due to clinician concerns, mainly surrounding prostate cancer development and cardiovascular events, although current evidence fails to definitively support these concerns.” (Mulhall JP, Trost LW, Brannigan RE, et al.: Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018; 200: 423) The above quote is from the American Urological Association’s (the national association for urologists in the US) position paper on the management of TRT. Many urologists treat testosterone deficiency, and in fact, there is a subspecialty of andrology within the field of urology hyperfocused on male hormonal issues. Our diagnosis and ongoing evaluation standards are more stringent than those advocated by the AUA and The Endocrine Society. We recommend treatment for roughly only 60% of the new patients we evaluate, and we never put “the bottom line” ahead of patient safety and sound medical ethics. A healthy amount of skepticism is good, but one must be careful not to let it persuade you into a hasty generalization fallacy. Our patients are well-informed and undergo a thorough introduction to the pros and cons, risks and benefits, and the rationale behind how we approach TRT. If, after that sort of detailed study, a patient is not comfortable with the associated risks, even free therapy would be wrong for them. Guiding values and foundational philosophies matter more than whether or not an advocate of a given treatment is also a practitioner of the same. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@crosisofborg5524]

Thanks for the reply

[@pekenjos]

Surely the most informative piece of information on TRT I have found on KZbin.. Highly recommended!

[@TCTmed]

Thank you for taking the time to watch, and we appreciate the feedback!

[@barouneroland5729]

Where do the doctors get the testosterone hormone from..is it derived from animals?

[@TCTmed]

@baroune roland: No, there is no widely available, naturally sourced testosterone. It is synthetic, but biomimetic. Meaning that it behaves the same way a natural molecule of testosterone would. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@smjastrzebski]

By taking HCG won't your body continue to produce testosterone even while on TRT? If HCG is treated like LH by the body then your testes would continue to produce testosterone regardless of the TRT right? So would you need a smaller dose of TRT to maintain a proper range?

[@TCTmed]

@smjastrzebski: The short answer is, no. The effect of hCG on testosterone production is scant when it is dosed for reduction of fertility suppression or reversal of testicular atrophy. You need much larger, and more frequent dosing of hCG to achieve even mediocre improvement of testosterone production. Concurrent use of hCG does not significantly reduce the dosing needs for testosterone. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@TheBigpappa160]

Hey TCT! I know this video is over 3 yrs old but I have been researching TRT the past couple of months! A little background of me, I'm a retired Army veteran, 53 yrs old and I have been seeing a Urologist for about 2 years about low T. So for the last 2 yrs, once a month I have been going in Dr office and been getting 1 injection of 200mg cypionate, 400mg. Now, been doing this for 2 yrs. Feel good probably the 1st week after shot then after that just start going down again. Around 1st week of Mar I was due for blood work, had that done then I got a message that my labs was on a my patients portal so I pulled them up and noticed that my Total Testosterone was 230.8, with the range being 300.0-800.0. So I contacted the nurse and she told me the reason it was low that I was due for a shot that month. But, I also ask her was a estrogen level taken for my labs and she said no so I requested that, but haven't gone in to do that. But fast forward to today. I found a place that specializes in TRT, it is called Hormone Therapuetics out of Dallas, Texas. I received my shipment to day but haven't been home to look at it. I've also been doing research on HCG and there's a lot of people that are taking trt and hcg therapy. If I'm on TRT shouldn't I be taking HCG also? I talked to another consultant from Prime Body and he said that they put their patients on TRT and HCG Therapy. So I emailed my consultant and ask about HCG, he said that they needed to see how I'm going to react to taking 1 shot every 7 days of 200mg cypionate, then If we need to we could add it. Whats your thought on taking TRT with or without HCG?

[@khannasrul6404]

can someone have healthy hair and can take TRT at the same time? I mean I want to take testosterone but at the same time I don't wanna lose my hair.....so is it possible?

[@TCTmed]

@Khan Nasrul: It is definitely possible. Genetics, not the use of testosterone, determine whether you will lose hair or not. Here is an article on the subject from our blog! tctmed.com/genetics-of-male-pattern-baldness/ Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@kiljupullo]

Side effects of TRT: Feeling Great!

[@TCTmed]

@Kilju Pullo: Love it!

[@laurenblanc7800]

Amazing video I have a question please. Does my fertility return to normal once I stop TRT or not ?

[@TCTmed]

@Lauren Blanc: Thank you for the feedback! In my opinion, without other underlying problems, yes. Now, it's important to note that there is no study on this and my opinion is based on clinical experience, but I have not personally observed a case where fertility did not return to function with a pause or cessation of TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@laurenblanc7800]

Thank you for your reply. Highly appreciate it.

[@madmechanic7976]

I'm 43 and I'm taking 1ml a week. I feel fine.

[@anthonygutierrez9375]

Im 36 n im taken 1ml every week alson n im fine..

[@DionysiosGiannopopulos]

@@anthonygutierrez9375 im 53 and i am taking 1ml pw 250mg and im feeling GRATE !!!

[@AbcDef-dz7no]

Someone is fine , someone is great, why i am still waiting ?

[@davidtorres7817]

Hello DR is there an estrogen test and how often should we test and in the results what numbers am I looking at for a good level Thanks

[@TCTmed]

@David Torres: Yes, what you should be looking at is estradiol levels. As far as the numbers go, it completely depends on you, other symptoms, risk factors. etc. There's no magic number and balancing takes some expertise and creativity. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@user-we4mr3uc7m]

is hcg an alternative to trt due to acne and concerns over potential hairloss? or it it better to just lower the dose to 50mg to keep some in the system instead of stopping altogether?

[@TCTmed]

Hello, @p! Monotherapy with hCG only for testosterone deficiency is a thing, but in my opinion, it's not at all optimal. Hair loss is directly related to your genetic predisposition for it. Limiting or avoiding testosterone may save someone who is genetically prone to male-pattern balding from loss. Still, it will be at the cost of all the symptoms of testosterone deficiency. On the other hand, if you are NOT genetically primed for balding, going on TRT will not make you bald. Acne will be stimulated by a rise in DHT, and again, will predominately affect those with a propensity for acne. I primarily prescribe hCG for one of two reasons: promoting fertility while on TRT or counteracting TRT-related testicular atrophy. I have not found it to be a good alternative to TRT altogether. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@user-we4mr3uc7m]

@@TCTmed thankyou. can taking finasteride while on trt offset the side effects or is trt strong enough to push through that medication

[@TCTmed]

@@user-we4mr3uc7m Finasteride is very good at blocking the conversion of testosterone to DHT, but remember that there are beneficial effects of DHT that you don't want to block. Also, it can mask prostate changes by making PSA tests less reliable. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@Northisbest]

I have very low T level of 0.4 I'm 51. What you think ? I'm very depression.

[@garysimone4977]

Wezilla i am starting the procedure. As i to suffer from mood etc I say go for it

[@TCTmed]

@Wezilla: There is quite a bit to consider beyond that, but I would definitely keep looking into this. Significant depression may very well have other sources, but I routinely see mood improvements once testosterone levels are optimized. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@pedroucb]

this doctor is a godlike at explaining medicine to average people

[@TCTmed]

We appreciate your kind words! We're just hoping to make the information accessible to everyone! We hope it was helpful to you.

[@vpagliocca]

How about heart issues? I started TRT a few months before having open heart surgery due to poor genetics and a life of poor decisions. I'm only 2 weeks post op but wondering off after recovery can I resume therapy??

[@TCTmed]

@Vinny: While there are very positive and promising studies being published on the benefits of TRT for cardiovascular health, it is best to see an open minded cardiologist and have them clear you for therapy before resuming. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@vpagliocca]

Testosterone Centers of Texas thank you for the reply

[@ramkumar-lc1st]

One f the best videos on TRT.. well detailed explanation.. Thank you doctor

[@eyestoenvy]

Superior teaching skills, very informative & well presented. Like'd & sub'd instantly.

[@TCTmed]

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

[@geraldfriend256]

Yeah ok boom- boom.Tell my friend who suffered insane cluster headaches(like a migraine) before getting off too late and subsequently getting bladder cancer.He had a great sex life in middle age but now can't really have sex at all.Plus lifetime ostomy bag.Trt bruh.I'll see if this comment survives deletion.Oh wait...getting off it is depressing too.BRUH.

[@TCTmed]

@Gerald Friend: I don't filter out dissenting comments as long as they are respectfully and legitimately submitted. I'll skip over the "boom-boom" moniker. I hate to hear of anyone having gone through such horrible medical tragedies as your friend has. I can certainly see how this would leave you with the take you have on TRT. I've read extensively about testosterone therapy, but I have not seen any causal correlations with cluster headaches or cancer of any sort. I am a bit perplexed about why you would be perusing our content when you hold the beliefs about TRT that you do. At any rate, I will leave your comment in place as long as you remove the link that seems to have been erroneously placed in it. I would encourage all readers to do their due diligence and look at what the entirety of the literature says about the safety of TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@geraldfriend256]

My apologies for the tone.I don't know why all.Plus is a link.or how to remove it.I believe longevity is impaired, but I understand wanting more vitality.

[@TCTmed]

@Gerald Friend: The pros and cons of every medical intervention should be carefully weighed by the patient. No medical treatment comes without risks. TRT can be a wonderfully positive thing, but it is not for everyone. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@teektalon3310]

Best video I've seen on this subject. Thank you so much for breaking it down and explaining.👍👍👍

[@TCTmed]

Thank you for the compliment, Mat. We're glad you found the video helpful!

[@SamNammoura]

Oh wow. So informative . Thank you.

[@TCTmed]

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

[@qfina]

One question, probably well outside the scope of this video, however since hCG stimulates LH, and LH only signals the testes to release more T, how will that help with fertility since what is actually required is FSH to produce sperm? Is there no synthetic version of FSH, and if not why not? :)

[@TCTmed]

@qfina: I apologize for missing this, and this, as this is an excellent question! Ultimately, the linear explanation of LH stimulation = testosterone production, and FSH stimulation = sperm production leaves a little bit of the equation out. Intratesticular testosterone production, supported by hCG, can directly increase spermatogenesis. There are synthetic versions of FSH (medications like Bravelle) and they are used for fertility treatment. Induction of spermatogenisis would require both hCG and an FSH analogue, but the treatment is expensive, cumbersome, and likely only worthwhile if the inability to father a child is directly linked to oligospermia. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@qfina]

Thank you very much Augie

[@TCTmed]

No problem!

[@TCTmed]

@Bootney Lee @Bootney Lee: It does, but it does not raise free testosterone well. While it can raised total testosterone, patients typically experience an elevation in SHBG and thereby a decrease in free testosterone. Not to mention the fact that Clomid can lead to vision loss. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@carl111658]

research clomid.... it turns on sperm production

[@008boot6]

Suppose a person working out a lot. Pushing their body to limit then can I keep my natural production of testosterone going. I am 24 but my body aches a lot. My life was very inactive when I was in school, college. Now I am working out and struggle to do at least 5or 7 pushups. Please provide some information I am so weak that I struggle to study or do any work in day to day life. Help me out

[@TCTmed]

@008 boot: In my opinion, the best type of training to raise or maintain naturally produced testosterone levels is High-Intensity Interval Training (HIIT). If your testosterone deficiency is present ONLY due to behavioral influences, then properly adding HIIT to your weekly regimen should help considerably. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@008boot6]

@@TCTmed thanks for replying. I can't afford to go to gym. But I do pushups, squats without any added weight but still no change in strength because as I mentioned I never worked out or done any physical activity in my whole life

[@TCTmed]

@@008boot6 Keep it up! You can definitely make some dramatically positive changes to your body composition without a gym. Look up "No Equipment HIIT" here on KZbin, and you will find all sorts of methods to challenge yourself with.

[@simonvsworld]

Will testicles shrink if using hCG (correctly) with TRT?

[@TCTmed]

@Simon J: Prescribing hCG can definitely counter the effect of testosterone on testicular volume. If there are other factors, there may still be some residual atrophy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@seufubeca1]

Question... If I'm already on T therapy and start taking HCG will my testes regain their size? Or would I have to stop the T for a while and then let them start working on their own before taking the HCG and T again?

[@TCTmed]

@seufeubeca: You should be able to attain benefit/reversal of atrophy without stopping TRT. You may need more frequent dosing to begin with, before backing down to maintenance dosing. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@seufubeca1]

@@TCTmed THANK YOU

[@TCTmed]

@@seufubeca1 You're welcome!

[@jonnybingo4062]

After watching this they should have titled it “Why you Should worry about side effects” oouuff

[@Gunnar.J]

2 Doctors told me there are definitely pros & cons on TRT. You can get heart problems from thickened blood and you can go bald! These are Major side effects for sure!! I need TRT but cannot risk my life for it. Plus it’s something u need to stay on for life they said. Once u get off TRT, your test levels will be much lower than when u started. Can also cause gynomastia (women like breasts).

[@TCTmed]

@Jeff Swope: I would encourage you to look past all bias; mine, theirs, perhaps any you may have developed over time. If you look for medical studies to support the claim that TRT causes heart problems, you will have to go back to 2013 and 2014 to find any substantial allegation in that regard. The first was done by a resident physician in the Dallas area who mined VA data to identify people who already had heart conditions that were "on TRT." Some of these people she tallied never actually received testosterone, many never made a follow-up appointment, and none of them were closely monitored. The study was supposed to be on only men, but women were accidentally included. Using an anomalous statistical model, the study authors counted each "cardiovascular event" as more than one event, purposefully. The study was published in JAMA and revised several times over due to its many flaws. The second study, from 2014, was from an online journal, PLOS ONE. It was also deeply flawed and was a retrospective study. The drug sildenafil (Viagra) is used for erectile dysfunction but is also used to reduce the workload for the heart by reducing pressure in the vessels the heart pumps blood to and from the lungs through. Despite this cardioprotective effect, it was used as the medication of the "control" group of individuals who, like in the first study, also had a history of cardiovascular events. Look at the studies from the last decade, and you will see that TRT has been shown to improve cardiac health. Testosterone can make you make more red blood cells by suppressing hepcidin, but if you aren't a smoker, don't have untreated sleep apnea (common and very treatable), polycythemia vera (rare), or hemochromatosis (also rare), the likelihood of you ever having an above-normal blood thickness (hematocrit) solely because of well-managed TRT is very low. You would have to have a significantly elevated, even neglected, hematocrit for it to be high enough to actually cause a "heart problem." I've never seen such a state develop in any patient under the care of our practice since its inception in 2013 or the 2 years before that when my fellow owners and I were working with another company. We administer more than 5,000 injections monthly. Check out the links below. Yes, TRT could make you bald -- but only if you were genetically programmed to go bald already. Theoretically, if you "would" have gone bald with normal or optimized T levels but your testosterone production drops earlier and harder than it should have, that lower T production could save you from balding, and starting TRT could pull the trigger of the gun that nature loaded. However, keep in mind that the trade-off is all the symptoms of Low T vs. an untouched head of hair. The claim that you must stay on it for life is wrong. However, no provider would recommend a patient who doesn't produce enough insulin or thyroid hormone to stop taking that hormone. Your natural production is suppressed while on therapy and will likely remain low for several weeks as you rebound to your baseline, should you stop. If you were on TRT for 3 months, your baseline would not have changed much, if at all. If you were on TRT for ten years and then stopped, your new baseline would be commensurate with what it would have been had you never started TRT. You can stop any time, but if you want your symptoms treated, yes, you need to stay on therapy to experience therapy benefits. Gynecomastia can occur, but this happens in a high-estrogen or "estrogen dominant" state. We monitor and maintain normal estrogen levels for our patients, so while this is a risk, we don't see this develop in well-managed care settings. Until a provider has seen the enormous benefit that properly managed TRT offers, until they realize that it can profoundly improve the life in their patients' years, they will be inclined to inflate and overestimate the potential risks. Every medical intervention comes with risks, but providers are prescribing antidepressants and a host of other treatment options for symptoms consistent with Low T, and never bat an eye at the laundry list of risks and side effects associated with those "mainstream" therapies. Scrutiny, temperance, and discernment should always be employed when evaluating whether a treatment is right for you, but it appears that you have been lead to believe that you have to choose TRT or death. That assessment doesn't hold up against the evidence. tctmed.com/trt-heart-attack/ tctmed.com/trt-cardiovascular-disease/ tctmed.com/trt-blood-clots/ Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

[@elvizco]

I have gynecomastia if I take testetrone would it affect it in any way

[@augiegalindo]

@j.r: It very well may be exacerbated with TRT, especially if you are not careful with your estradiol levels. However, I admonish you to not fall into the trap of overzealously blocking aromatization, or overusing AIs (aromatase inhibitors), like anastrozole. This can further complicate the management of gynecomastia. Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@JayMcCracken]

I know too many people that are on this stuff that have cardiovascular problems, heart attacks, sleep apnea, erectile dysfunction, the list goes on and on. Sure they look more masculine and have better gains but ultimately they are cutting into their health by a lot! Is vanity and instant gratification more valuable to you than healthier long term alternatives? Do your research

[@TCTmed]

@Jay McCracken, you may benefit from reading the studies on the effects of testosterone. The breadth of the literature on the subject shows that well-managed TRT serves to improve cardiovascular health and ED. Sleep apnea is in and of itself one of the causes of testosterone deficiency, and we diagnose and treat it alongside our TRT management. We turn away 40% of the new patients who come to see us and never start therapy for vain purposes. We very much support our patients doing their due diligence and thorough research. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@JayMcCracken]

​@@TCTmed I definitely think it should be a last resort. There are too many people out there that don't realize once TRT is started, it's likely going to be a life long commitment. It's not recommended to stop once you've started because your natural production of test in most cases does not come back to the same levels as it was once producing before. Sure there are medications to help your body continue producing it's own hormones but ultimately, if you stop, your levels are going to have a hard time going back, this is why your nuts also shrink when you're on test. If you have good test levels and feel fine, there's no reason to max them out to your highest recommended threshold. If they are below the line on the low end, or you're feeling symptomatic in some regard, then after putting in some effort to alter your lifestyle choices that may be effecting your levels (proper diet, stress reduction, proper sleep, exercise, vitamins, etc), and you still don't see any changes, then by all means do what's necessary. From what I gather through my research I've found there are not enough studies out yet to indicate how severe long term side effects are going to be anyway, but.. coming from the people I know, it's not some miracle cure-all for the average individual and definitely has it's share of negative effects. Also often times sleep apnea is caused by being overweight. If your body grows as it likely will on test if you are training in the gym.. what do you think will happen? Muscle or not, you're overweight medically speaking, and that will have effects on your body.

[@TCTmed]

​@@JayMcCrackenThat is a fair stance. However, TRT isn't a life-long commitment. The way I present it to patients is that there will be a definitive suppression of natural production while on therapy. Additionally, if you are on therapy for a long period of time (many years), your natural production would have declined over that time regardless. That said, once you stop therapy, your production will rebound to its respective baseline in a matter of weeks. So, you have to stay on therapy to enjoy the benefits of TRT, but it is not a death sentence for natural production. Thyroid medication, insulin, and other hormones are all used similarly. We give patients what they cannot make in sufficient amounts themselves. ​I have counseled many patients to employ behavior modification for a period of months and retest before making a decision on TRT. Even in the fittest individuals, however, we may still see testosterone deficiency. This isn't sequelae of behavior as much as it is the environment. Endocrine disruptors are ubiquitous in our environment. These can negate the positive effects of proper diet, stress reduction, proper sleep, exercise, and vitamins. Without significant symptoms, nobody should be placed on TRT. It should never be about just "running up the numbers". Testosterone has been in use since the 1940s. We have data on its use in many longitudinal studies. It is not without its risk, but dosing is what determines the difference between panacea and poison. Testosterone is not and should not be considered a cure-all, but it does play an integral role in human hormonal health. Our patients are generally not the type to target huge muscle gains in the gym. Instead, we frequently see improved body composition, and more often than not, it is a weight reduction. Many of our patients have been able to reduce their dependence on medications because of improved health. Many have seen a vanishing of symptoms their PCPs chalked up to depression. Unfortunately, not every TRT practice is the same, and not everyone on testosterone is being monitored appropriately, and sometimes not at all. With proper management of expectations, surveilling of potential risks, and careful medical management, TRT can profoundly and positively impact the lives of those suffering from true symptoms of deficiency. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@johnyfromaustralia7142]

Great vid. Wonderful to see support from a company. Every thing very clear and concise. After having done a lot of investigation on the net, your summary and teaching underlines so much in a short vid. Thank you so much.

[@TCTmed]

JohnyfromAustralia, you are most welcome. We appreciate the feedback!

[@kellywalker4494]

Best video I’ve seen on this , and I’ve been watching many. Great job. Super helpful and simply described.

[@augiegalindo]

@Kelly Walker: Thank you for the feedback! I appreciate you taking the time to comment, and I am glad you found the content helpful. Merry Christmas! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@arielrodriguez975]

Is there a great cardiovascular risk with cypionate?

[@TCTmed]

Hello Ariel, Thank you for your question! The short answer is no, but please look at the articles from our blog that address this same subject more completely. Ultimately, you can certainly find some studies that indicate that the risk of embolic events, like heart attacks and strokes, increases with TRT. However, the full body of research on the subject actually points toward cardiovascular benefits, a possible reversal of mild type II diabetes, along with a host of other benefits. tctmed.com/trt-cardiovascular-disease/ tctmed.com/trt-heart-attack/ tctmed.com/trt-and-diabetes-remission/ Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@2023-YesWeCan]

Hi im 3red injection of Nibido TRT which i do received every 3moths .. My T level is 15 ... so Blood pressure is going up ..my Gp has given me some tablet to easy ....Im stuck what should i do ... I canr bear the Low T side effects i would be able to work?..Please help

[@TCTmed]

@09YesWeCan: Nibido is not something I have much familiarity with, but testosterone effects are relatively universal. I have not seen hypertension as a common side effect of TRT. Underlying causes should be sought out. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@PS-gr5wh]

I get massive dry mouth on trt. Is this normal. Any way around this? I usually stop using it for a few weeks at a time just to help with the dry mouth.

[@TCTmed]

@PS 316: I have not encountered that as a reported side effects with my patients. If you are using an aromatase inhibitor, perhaps you could be using more than you need? Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@TCTmed]

@@PS-gr5wh: Unfortunately, sometimes even rare side effects can be a rate limiting step.

[@TheWolfgangfritz]

Here on the West Coast of Canada pretty well all of the GP Doctors I've spoken to have talked me out of TRT. They just can't be bothered! Would I be better to go to a Urologist, or Specialist in that area? ( I should mention that I'm almost 70.)

[@TCTmed]

@Egon Speneder: If you are already finding that primary care providers aren't gung ho about TRT, I would assume their inclination to treat would be driven even further down with an older patient. The "associated" risks become more common as we age. Urology and Endocrinology should be championing this effort, but sadly they are not. I would look more carefully to find any specialists for whom TRT is their sole focus. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@TheWolfgangfritz]

@@TCTmed - "The associated risks become more common as we age" - First of all thank you for responding! A few more questions if I may: I'm assuming that you mean the increased possibility of heart problems, high blood pressure and maybe prostate enlargement or cancer? What percentage of men in their 70's do TRT? Is it too risky for me at this age; and then how long do I do it for?

[@TCTmed]

@@TheWolfgangfritz, You are most welcome for the reply! Yes, the incidence of cardiac disease, hypertension, and prostate cancer increases with age, irrespective of outside influences. I can't quantify how many people over the age of 70 are on therapy, but a large portion of the medical literature on the subject is from studies done on older adults. I tell my patients that they need to be on TRT for however long they want relief from the symptoms of testosterone deficiency. For me personally, my father is 70, and I have him on therapy. I hope that helps. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@Rocko1990]

So what about when you get low iron/ferritin on TRT, I guess from the iron deregulation itself as well as frequent blood donations? Simply supplement iron? Isn't that bad when your blood is already thick?

[@TCTmed]

@Rocko1290: Great question! The way suppression of the peptide hormone hepcidin works serves to open up export channels from the gut into the bloodstream. So, this increases the availability of iron to the body. In turn, your body makes more red blood cells. Therefore, this is the reason for therapy-related increases in a patient's hematocrit (HCT) or "blood thickness". When this is combined with other processes that increase red blood cell production, like smoking, polycythemia vera, hemochromatosis, or the most frequent culprit, obstructive sleep apnea (OSA), is when we typically experience difficulty in managing a patient's HCT. If such a presentation is treated with therapeutic phlebotomy as the ONLY treatment, patients will invariably end up sapping their iron stores. This iron depletion leads to red blood cells (RBC's) becoming smaller than they should be (microcytosis), and can even lead to frank anemia. The same tunnel-visioned-approach will lead many clinicians to react by supplementing the iron that they are asking the patient to dispense with during too-frequent blood donations/phlebotomies. This isn't inherently "bad" just myopic, and it belies what should be the true focus of intervention. In contrast, the treatment of an elevated HCT while on TRT should be root-cause driven. And dose adjustments, suspension of therapy, referral to outside specialists, and more thorough workups need to all be considered as possible clinical responses to a stubbornly persistent increase in blood thickness. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@garysimone4977]

Doc i am on Coumadin for a heart valve Can i still go on TRT ?? Also have BPH my psa is 1.2 as of recent test Thaughts. Thks

[@TCTmed]

@Gary Simone: Thank you for the question, Gary! I am a physician assistant not a doctor, you can call me Augie. Being on Coumadin is not a contraindication to TRT, however, since we place patients on those types of meds to prevent clotting, it is important that you have your cardiologist/neurologist (physician who prescribed the Coumadin) clear you for therapy. Because TRT increases red blood cell production, it could potentially have an impact on your body's tendency to clot. Now, when we call Coumadin a blood thinner, that's actually a misnomer. I does not thin the blood, it affects the cascade of events that form a clot. Red blood cell increases directly impact the viscosity of blood. I do have patients on Coumadin and on TRT as well. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@garysimone4977]

My cardio doc clearned me for trt !!! Shoukd i use cream or shot s

[@TCTmed]

@@garysimone4977 I much prefer injections for my patients. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@medicineandbrazilianjiujit8511]

This is phenomenal, Doc. Great stuff. Cheers

[@TCTmed]

@medicineandbrasilianjiujit8511: Thank you for feedback. I am glad you found our content helpful! I also train in Brazilian Jiu Jitsu, and I love that your channel is talking about this!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@medicineandbrazilianjiujit8511]

@@TCTmed God bless!

[@ibberman]

What a great video, one of the best I have seen. If I may, I would like to ask if you ever encountered an experience like the one I had. About 6 years ago my then Md. suggested I try TRT, due to my low free test. It was below the normal range. I was taking 1/4 of a Proscar pill every day as well, and my sex-drive was to the moon with the extra test I was getting. After 3-4 months, asking for a refill of Proscar, the Md. suggested I take the whole 5mg pill instead of just a 1/4, so I did. My sex-drive totally disappeared after that, even though I was still getting the shots for several more months. Then my hair started to shed, so I quit the treatment. Sex drive never came back, and I was 55 at the time.

[@TCTmed]

@ibberman: Thank you for the kind feedback. I have not seen a case like this in my own practice, largely because I do not use finasteride in that manner, but I have come across cases similar to yours. It prompted me to do some digging and I found the following website: www.pfsfoundation.org/ It certainly seems plausible that you issues may have something to do specifically with your use of finasteride. The type of response you describe is highly abnormal in my opinion. I truly hope this helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@ibberman]

Thank you for the link, I really appreciate it. I was taking the 1/4 proscar for the hair and had never had side effects before he suggested taking the whole pill. Another problem I found was his inability to get my test levels right. My total level was 450, and by giving me 1cc every 10 days to get my low free test into the normal range, the total test levels went to 2000+. Thank you again for sharing your knowledge.

[@TCTmed]

No problem! I hope it helps. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@ortyrod4689]

I wonder how this treatment could potentially affect men with supernumerary nipples (given the estrogen changes and due to the increase in probability of developing breast cancer of this group). We need to also consider a family history of breast cancer as well.

[@TCTmed]

@Orty Rod: Correct! Noting the presence of a family history of breast cancer, particularly BRCA+ family history, is important to assess when contemplating TRT. Not all patients with supernumerary nipples have associated breast tissue, but risk stratification may differ in those cases. Maintaining normal estradiol levels is always an important piece of therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@ortyrod4689]

@@TCTmed thank you!

[@jmarxful]

What about high hematocrit but normal platelet,ferritin, and rbc?

[@TCTmed]

@jmarxful: An elevated HCT is thought to pose a risk in and of itself, even without other associated labs being abnormal. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@toofast75]

@@TCTmed Elevated HCT though can be also attributed to being dehydrated at the time of the blood test. I have seen HCT go up or down 3 or 4% points simply due to hydration levels, that's why I think it's also important to take into account RBC, platelet and hemoglobin levels. On that note, I would suggest one is well hydrated before taking blood work.

[@TCTmed]

@@toofast75: There can definitely be some changes with hydration, but I can't say that I've seen anything as high as a 3-4 point swing. Also, RBC counts don't account for body water, and therefore don't speak to viscosity. You are absolutely right, that every patient should be well hydrated heading into any blood draw. We can also look to changes in a patient's complete metabolic panel to identify laboratory signs of dehydration, and couple that with vital signs data. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@toofast75]

@@TCTmed Would taking a daily low dose aspirin help with elevated HCT or help with reducing the need for giving blood? I am assuming the need to donate blood is more of an issue when larger doses of T are given as well.

[@TCTmed]

@@toofast75 Actually, the use of aspirin or any "blood thinners" won't help at all. Those medications don't affect blood viscosity, despite their name. Instead, they slow any of the many processes involved in clot formation. The need for phlebotomy is only dose-dependent when dosing leads to supraphysiologic levels. Like under/untreated sleep apnea, other culprits are common factors in recurrent, significant HCT elevations.

[@1icky]

Augie.....I had a vasectomy 30 years ago so no concern for future kids I am in my early 60's. My last T test 3-4 years ago was 250....my GP thought that was fine considering my age. I have been a gym rat nearly all my life until I ruptured my Achilles couple years ago. I am fully healed but the time off has set me what I believe too far back to regain much. At 60+ should I not consider this program and live with my fate? When I was a young man back in my gym days I did three 16 week cycles over the course of 2 years and did my own injections (late 70's) so not afraid of self injection just dont want to waste my time and money so to speak. Thoughts.....?

[@TCTmed]

@William V: If symptoms consistent with low testosterone continue to plague you, then you likely owe it to yourself to seek out a provider with more experience and familiarity with TRT. I don't personally consider a total testosterone in the 200's t be normal for a man in his 60's, let along a man who has a history of high activity. Furthermore, your calculated free testosterone needs to be evaluated. So, if you find the right, conscientious and balanced provider, you will not be wasting your time. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@GREATTECH1]

I Just realized how old this video is. Is there an update?

[@TCTmed]

@GREATTECH1: We have a wealth of material on our website, but be on the lookout for some updates coming this year! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

[@laurynassmitas1090]

i'm 24y/o. And i already have bph feeling all terrible sympthomps. also my testo, fsh, lsh is low.(i think because of hipogandizm). should i already buy a rope and a chair or i have any chance to do something?

[@TCTmed]

@Laurynas Smitas: Definitely steer away from drastic measures. Seek out care from an experienced provider who understands that testosterone deficiency isn't just a problem of aging, that it is affecting men much earlier in life; including some 24 year olds. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

[@AbcDef-dz7no]

Chair and rope for what ?