Why You Shouldn't Be Worried About Testosterone Replacement Side Effects
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- Опубліковано 28 тра 2024
- Read our Complete Guide to Testosterone Replacement Therapy to learn more about potential side effects, treatment timelines, why injections are the only form of TRT we recommend, and more: tctmed.com/resource/testoster...
Although Testosterone Replacement Therapy (TRT) is a safe and effective treatment for the vast majority, some patients still experience a few side effects during treatment. Any quality medical provider should be monitoring you closely for potential side effects. We work tirelessly to monitor and maintain safe hormone levels in all of our patients through a variety of techniques.
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
@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
@@augiegalindo thank you so much for taking the time to respond to my questions and concerns!
@@travisfletcher7334 You're welcome!
Wow, even i could be a doctor if i had a teacher like that. Really good!
Fully agree
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. 👍
@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
@@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?
@@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
@@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.
@@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
I love this guy. So eloquent. No fluff. Kudos.
@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
You are very welcome, and thank you for taking the time to watch and comment, Sam!
Testosterone Centers of Texas
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?
@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
@@TCTmed thank you very much for your answer :)
The only thing more impressive than his medical knowledge is his sterling penmanship!
Haha, thank you @Jc Knight!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
One of the best, most informative, non bs video on trt. And I've seen them all.
@Odin Aesthetic: Thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Man that was the best info I’ve heard so far. Thank you for taking the time to explain.
Thank you for watching. We really hope the information is helpful to you!
this doctor is a godlike at explaining medicine to average people
We appreciate your kind words! We're just hoping to make the information accessible to everyone! We hope it was helpful to you.
Augie - another PA-C here... thank you for your excellent work on this presentation. I am seeking as much insight into TRT before I commit to starting and found your vid helpful. As an aside, great to see you propelling our profession farther with practice ownership/leadership.
@cap'n sean: Thank you for the feedback! I am glad you found it useful. Practice ownership has definitely broadened my scope in health care. I wish you the best on TRT!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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. 💪🏼🙏🏼
@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
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.
Did you notice more energy and less testosterone
@@ashleytaylor994 can you please rephrase the question?
Lol. Fucking RIP bones if you're taking an AI
Surely the most informative piece of information on TRT I have found on UA-cam.. Highly recommended!
Thank you for taking the time to watch, and we appreciate the feedback!
This is the best explanation I have found on TRT at youtube. there are some other but they dont cover all essential things.
@prince prince: Thank you very much for your positive feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Thank you for the video. I have been researching for a while now and have read about all the elements that you mentioned but you put them together so that they can be understood the pro's and con's of each step. Very informative. Much appreciated. I only wish that we had similar clinics to yours here in the UK.
@crocodilebelfast: Thank you kindly for the feedback! I wish you the best of luck in finding a great TRT provider close to home!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
I didn’t realize Jon Favreau was so smart!
@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
Penns younger brother
Life’s been tough for Happy ever since Ironman died.
hahahahha, i was like....where did i see this guy before... thanks for clearing this up ! lol
I didn’t see it till I read your comment and now it won’t go away😂
One f the best videos on TRT.. well detailed explanation.. Thank you doctor
Best video I've seen on this subject. Thank you so much for breaking it down and explaining.👍👍👍
Thank you for the compliment, Mat. We're glad you found the video helpful!
Amazing, thorough explanation! Thank you so much for taking the time. Your response to Jamie Locke was superb.
@Russ Dicono: Thank you for the feedback, I am very glad you liked it!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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.
@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
Best video I’ve seen on this , and I’ve been watching many. Great job. Super helpful and simply described.
@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
Very good layman breakdown of process-great video;) very informative -thanks
+vern schock Thank you very much, I'm glad it was helpful!
Great practical easy to understand explanations....thanks from UK !
@gozitan5: You're most welcome! I am always glad to see these videos reaching globally!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Very detailed information !great!!
@Karuna Sharma: Thank you!
Hands down THE best video on TRT on UA-cam.
Thanks for taking the time to watch and comment. We're glad it was helpful.
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.
JohnyfromAustralia, you are most welcome. We appreciate the feedback!
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.
@lidd69: Thank you for the feedback! It is truly appreciated.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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!
@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
Best video I seen about TRT...thank you
@Vero W: You're very welcome and thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Thank you and I learn more there than I ever did from four doctors that I had for TRT
@Joe: I am very glad you found the information helpful!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Wonderful explanation. Thank you!!!!
@Hasney Bravim: You're very welcome!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Fantastic presentation, with great lessons learned.
@Freddie Greer: Thank you kindly for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Great video. Very well explained. Thank you 😊
@Sinasi08: Thank you kindly for the feedback! I am glad you found the information useful.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Very informative video, well done and beyond easy to understand
Thank you for the feedback, @Jesse Garcia!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Best explanation! Thank you.
Skye13: You are most welcome!
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas I Founding Partner
Greta video thanks for giving us your time to do this video for the world to see thanks
You're welcome, thank you for watching!
Testosterone Centers of Texas :)
I agree. I learned a lot from this video. I'll watch it again. I hope he has or makes more videos.❤
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
Excellent explanation
Woouuww the best understandsble video about these issues on youtube , super 🙌🏻🙌🏻🙌🏻
@Bo Christiansen: Thank you, sir!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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!
@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
Awesome explanation! Thanks
@BuLLDoGGn: You're welcome, I am glad you enjoyed it!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
awesome video, very informative, and well presented..
@Fredwardo Freddie: Thank you very much! I am glad you found it helpful.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
ow what an amazing well explained easy to understand video. Congrats doc
@pedroucb: Thank you very much!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Super informative. Sincerely thank you.
@Michael David: Thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
thank you for the simplicity sir
@Jaang29: You are most welcome, and thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Excellent explanation!
@baggahammers2: Thank you for the kind feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
This is phenomenal, Doc.
Great stuff.
Cheers
@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
@@TCTmed
God bless!
Excellent video !!
@Jeff Saunders: Thank you! I am glad you found it useful.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Excellent presentation.
@Gerald Brienza: Thank you!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Great Video. Thank you very much .
+Sam Nammoura And thank you!
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...
@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
@@ArchiesBhanushali following
Does TRT makes men infertile?
This is by far the best presentation on TRT I've come across on UA-cam. Thank you for this video.
We greatly appreciate your feedback and are so glad it's helpful to you!
What a great video. Well done
@sneekolas: Thank you! I am glad you found it useful. I will be working on new content soon, so please stay on the lookout!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Very good video, thank you
+qfina You're welcome, thanks for commenting!
Oh wow. So informative . Thank you.
@Sam Nammoura: Thank you for the feedback, sir!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Thanks for the video
Thank you for taking the time to watch!
Very informative and well done presentation !
Is clomid a solution as well ?
@T Man05: Thank you for the question, I am glad you like the video! Due to its troublesome side effect profile, I do not consider clomiphene (Clomid) an option for treatment in my practice.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Best explanation on this subject I have ever seen! More men need to see this video......
@Joel Mcconnell: Thank you so much for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Well explained for once this is. actually the best video.
@SotoAdvert: Thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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
Great breakdown of the male system!
Thank you for the feedback, @Trent Alexander!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Well done! 👏
Thank you for the feedback, @Mind • Muscle • Meditation!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
You know your stuff doc, more than others.
@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
I just graduated 🎓 I wish this guy was my Doc / coach ..
@Chris Muniz: Thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Thank you for this
You're most welcome!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Thank you Doctor!
@Eyes Open: I'm a PA, so Augie works for me. And, you're most welcome!!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Superior teaching skills, very informative & well presented. Like'd & sub'd instantly.
@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
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?
Long overdue response I guess. Short answer yes use HCG with TRT. Also inject once a week not once a month to prevent dips.
Great video
@Allkindsofgains: Thank you!!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Great info
@Garfit Gar: Thank you!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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
@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
@@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.
@@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
Very informative video. What are your thoughts on taking TRT alongside or without HCG?
@Damon: Thank you for the feedback! I personally recommend hCG to be used concurrently with TRT when patients wish to protect fertility or prevent testicular atrophy. Aside from those two needs, I don't feel that hCG offers significant benefits.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
amazing. thank you
@Evolution Daily: You're most welcome. I am glad you found it helpful!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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.
@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
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.
No problem! I hope it helps.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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?
@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
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.
@@leftie75 why u stopped ?
@@leftie75 did you get back on it?
@@leftie75 hope you’re doing better now brother.
Wow great video
@Hookem Jim: Thank you, sir!
Hook 'em!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
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.
@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
Thanks for the reply
Mr. Galindo, how often should your Test levels be checked? And how often should the other levels you spoke of be checked? My Dr. Said my next set of labs won't be until 2 weeks after my 3rd dose of Testosterone which currently I'm scheduled to get once a month. Please advise. Thank you!
Great Video on TRT. Very detailed and very well presented. My question is if a Vasectomy can in any way hinder the TRT treatment plan and or cause any kind on problems once they are started on TRT. Just a general question and one many men reading this would like to know an answer to. Thank you for your time. And keep up the great work
@Castulo S: Thank you very much for the feedback! I have seen nothing in the literature or in clinical practice that has suggested that therapy needs to be amended for patients who have had a vasectomy remotely or recently. I have many patients who have had this procedure and some who have had it done while already on TRT, and they do very well on therapy.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Thank you very much for the quick response. You just got a new subscriber!!
You are very welcome, I am looking forward to getting more content out there soon.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
What a wonderful and informative video; thank you for taking to time to produce this!
I'm currently on TRT/HCG, and I would like to get your opinion on my regimen. I recently had my labs done (the day prior to my injection) to include a lipid panel:
1) my T is at 1448 ng/dL, my free T is at 29.5 pg/mL and E2 is 37.5 pg/mL.
2) all my other labs are within normal range, and I have no acne or other negative side effects.
Do you believe I should reduce my dosage, because I currently feel fine. Thank you!
+Pendejo: Thank you for the positive feedback! A couple of caveats before I comment: I have to make some assumptions based on what the reference ranges are for these labs, and I am assuming that the free T value is a calculated free T and not a direct/analog free T.
That being said, your values definitely see high for a trough level and while you might feel well now, consider that these labs may represent the front side of a building peak. So, you could be exposing yourself to more and more risk going forward, and I don't see evidence that your hematocrit is being monitored. Make sure your provider is keeping up with that as well!
Testosterone Centers of Texas Thank you for taking the time to evaluate and respond to my question. BTW, my hemoglobin is 15.3 g/dL and my hematocrit is 44.1%.
I've been on TRT just under a year, how often do you recommend I gets labs done?
+Pendejo: You are most welcome! It looks like your hematocrit is doing great. I evaluate my patients' labs every 90 days.
Great video. Does your clinic have any position on the use of Clomiphene (Clomid) to help maintain fertility while on TRT? Some clinics are claiming that it can keep the feedback loop partially active and possibly help lower the risk of long term fertility problems.
MrBogfrog Clomid won't do this HCG will
Thank you, this was excellent and easy to understand. I'm 38 and have experienced low T symptoms since I was 20. My test however is in normal range of 454 total Testosterone and 75 free. Should I consider TRT?
@Apex Predator: Thank you for the feedback! Total testosterone levels can be very misleading. I exclusively use the calculated free testosterone (cFT) level, which uses an algorithmic calculation that takes your SHBG, albumin, and total testosterone levels into account. You can find the formula here: www.issam.ch/freetesto.htm. On this scale, with the reference range for your total testosterone level being roughly between 300-1000 ng/dL, a normal cFT is between 9-30 ng/dL.
So, with that said, I definitely would recommend that you at least seek a second opinion. Just make sure you go to a clinic that will be honest with you about your numbers and is willing to tell you that your numbers may not be low enough to take the step of starting TRT. I have many patients who have had totals in the 400-500 range that were still suffering from below normal cFT levels.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I'm starting my trt therapy today. I'm 34 and my testosterone level came back at 300. However I have testosterone enanthate/anastrozole. I'm a bit concerned because some people react different to the AI. I dont have the choice of lowering my dose if needed. How do you feel or what's your opinion on that?
Great info bro am 24yrs diagnosed low t and high estradiol if I go for TRT will last long 20 years
Why just 20 yrs ?
Living with low T also affect u
I have seen people over 40 years on TRT.
I have my test results total testosterone 155. Estrogen 29 and the paper work says the estrogen levels are low. Can you help explain I have a doctors appointment in 10 days and I have impressions the they dont have the knowledge and that's the reason why I appreciate this videos thank you
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 😊
@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
I started on TRT a year ago without HCG. They did however monitor my Blood as well as my Estrogen levels. The test Cyp I take is mixed with Anastrozole and I also take 1mg tablet per week the day after I inject. I recently added HCG on my own since they don't offer it and am awaiting my next lab to check my LH levels. They fell to pretty much nothing on TRT alone. Have no desire for kids but don't want some shriveled raisins wither. Its my understanding that HCG does a lot more than just stimulate LHG as well which makes you feel better overall than when just on TRT by itself.
@Sideways23: Actually, in the setting of TRT, it really does very little outside of enhancing fertility and treating testicular atrophy. It won't affect your LH levels, and honestly, your LH should be low while on TRT. The touted benefits of hCG are greatly overstated. Many voices sing its praises, but the effects reported are anecdotal at best. I see no advantage to an improved sense of well-being, weight loss, or HPG axis maintenance with hCG for those patients using it concurrently and those who don't. In our practice, it is used exclusively for promoting fertility and protecting against testicular volume loss in our practice.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@UCIqOF3KtzK-GH_ROXQuoIoQ Thank you for that explanation. My LH is definitely low and the atrophy is what I wanted to reverse. I was under the impression it raised LH levels as well.
@@DanielA23 You're welcome! No, hCG acts like LH in your body, but to raise LH level you'd have to go higher in the production cascade (GnRH).
can you give some cost estimate and how much dosage will be there? BTW thank you so much for such an informative video.
@sahil sharma: You are most welcome! Costs vary widely, but I can tell you that in our practice, insurance often reduces costs considerably. Our telemedicine services are priced at $200 per month, plus lab fees. Unfortunately, I cannot give out dosing recommendations in this format.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Hcg + Clomid this option , is it appropriate for primary or secondary hypogonadism ?
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?
@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
Testosterone Centers of Texas thank you. -Sam
@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. .
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
@@TCTmed thank you so much.. I needed this information. I feel so much better now.
No problem!
Where do you like to keep the E2 numbers?
excellent video and a big thank you from uk.
I wish I had you as my endocrinologist or doctor.
is there any medication to stimulate the fsh since wer covering testosterone and lh unless supplementing hcg will mimic both lh and fsh.
@aad4m
I'm also a Brit mate, did you find when you originally had a discussion with your GP, a great deal of downright disinterest from him/her? It took me some 5 months of visits to even get a referral to a specialist endocrinologist?
I finally managed to see the specialist, and begin treatment but, not before almost a year had passed!!
I'm glad I persisted, my life improvement has been nothing less than amazing!
Delboy Trotter ; has it improved bcos of trt ?
Are u on gel or nebido ?
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. 🤙🏻
@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
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
@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
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!
@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
A doctor told me you're not likely to stop once you start. That it's practically speaking a life-long decision.
@@mattmarkus4868 that’s why you only take it if you really need it/ having symptoms or lowt .
No, your sh!t plummets
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.
@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
yh that was well explained cool guy
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
@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
Very nice
@El Clavo: Thank you!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
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.
@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