Testosterone Replacement Therapy (TRT)
How common is low testosterone?
What are the symptoms of low testosterone?
How is low testosterone diagnosed?
What does the treatment process look like?
Is there anything besides testosterone to elevate my testosterone?
How does being overweight affect testosterone levels?
Click on links to learn more
Benefits of Testosterone
Improvements in mood, energy, and quality of life
Improvement in red blood cell count
Increased bone strength
Improvement in sexual desire
Improvement in erectile function
Improvement in muscle mass and fat loss
$85 per month
Book a free consult and begin your journey.
We will draw your blood in office or direct you to a lab near you for the lab work needed.
Your doctor will discuss your results and provide a treatment plan and prescription you need to start your new life!
What is the goal of TRT?
The goal of testosterone replacement therapy (TRT) is to improve symptoms and signs of testosterone deficiency including decreased libido, erectile dysfunction, depressed mood, anemia, loss of muscle and bone mass, by increasing blood testosterone levels to normal range.
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How common is low testosterone?
Testosterone levels naturally decrease 1% to 2% each year beginning at 30 years of age. One study showed that 39% of men over 45 years of age were deficient in testosterone.
1) Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. 2) Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769.
What are the symptoms of low testosterone?
Signs and symptoms suggestive of testosterone deficiency in men include:
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Decreased energy, motivation, initiative, and self-confidence
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Feelings of sadness or being “blue”, depressed mood, dysthymia
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Poor concentration and memory
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Sleep disturbances, increased sleepiness
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Low red blood cell count
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Reduce muscle bulk and strength
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Increased body fat and body mass index
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Reduced sexual desire and activity
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Decreased spontaneous erections
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Male breast discomfort or enlargement
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Low to zero sperm count and infertility
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Height loss, low bone strength, increased risk for broken bones.
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Hot flashes, sweats
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Loss of male pattern body hair
1) Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
How is low testosterone diagnosed?
The Endocrine Society recommends making a diagnosis of low testosterone when there are symptoms of testosterone deficiency as well as low serum testosterone.
We inquire about symptoms of testosterone using the nationally recognized Androgen Deficiency in Aging Males (ADAM) questionnaire and the Aging Males' Symptoms (AMS) scale.
We will then check your blood testosterone levels.
1) Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. 2) Morley JE, Charlton E, Patrick P, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000;49(9):1239-1242.
What are the benefits of testosterone?
Potential benefits of testosterone replacement therapy include:
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Improvement in sexual desire
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Improvement in erectile function
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Increased bone strength
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Improvements in mood, energy, and quality of life
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Improvement in muscle mass and fat loss
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Improvement in red blood cell count
1) Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
How do I take testosterone?
Treatment options include testosterone supplementation through daily oral medication, weekly or monthly injections, skin gels or patches, and implantable pellets that last 3 months. We will carefully discuss the pros and cons of each type of testosterone administration to help you decide on which type best fits your lifestyle.
What does the treatment process look like?
1) Book a free consult
2) We will first draw your blood to determine your testosterone levels and establish a baseline for red blood cell level and prostate markers (if 40 or older). We will recheck your levels of testosterone, red blood cells, and prostate markers between months three and six and then annually.
3) You receive your prescription.
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Are there any side effects?
1) Mulhall JP, Trost LW, Brannigan RE et al: Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018; 200: 423. 2) Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. 3) Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Therapeutics Clin Risk Manage. 2009;5:427-448. 3) Osterberg, E. C., Bernie, A. M., & Ramasamy, R. (2014). Risks of testosterone replacement therapy in men. Indian journal of urology: IJU: journal of the Urological Society of India, 30(1), 2.
Testosterone replacement therapy is generally well tolerated. There are some side effects that we carefully monitor for throughout treatment. These include benign enlargement of prostate and elevated red blood cell count. Throughout testosterone therapy we will monitor your red blood cell count as well as check for markers of prostate enlargement (PSA) if you are 40 or older.
Temporary low sperm count is frequently seen so testosterone is not recommended if you are interested in fertility.
Testosterone may accelerate hair loss If you are genetically predisposed to male pattern baldness (follow link for male hair restoration). Certain testosterone formulations lead to higher levels of DHT which is responsible for male pattern baldness in genetically prone individuals. These formulations are avoided if you suspect that you are prone to hair loss.
"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." (American Urological Association Guidelines, 2018)1
How much does it cost?
For testosterone therapy, we charge $85 per month.
You are responsible to pay for the costs of medication from the pharmacy. The cost varies by pharmacy. CVS and Target charge $23.42 for a one month supply (April 2024). Check prices at GoodRx.
Laboratory analysis is performed by Intermountain Lab Services at an approximate cost of:
Total Testosterone ........................... $50.00
Hematocrit ........................................ $11.50
Prostate (PSA) screen ....................... $35.00
Is there anything besides testosterone to elevate my testosterone?
1) Cooke, P. S., Nanjappa, M. K., Ko, C., Prins, G. S., & Hess, R. A. (2017). Estrogens in male physiology. Physiological reviews, 97(3), 995-1043. 2) Hess, R. A. (2003). Estrogen in the adult male reproductive tract: a review. Reproductive Biology and Endocrinology, 1, 1-14. 3) Hayes, F. J., Seminara, S. B., Decruz, S., Boepple, P. A., & Crowley, W. F., Jr (2000). Aromatase inhibition in the human male reveals a hypothalamic site of estrogen feedback. The Journal of clinical endocrinology and metabolism, 85(9), 3027–3035. 4) Scovell, J. M., & Khera, M. (2018). Testosterone replacement therapy versus clomiphene citrate in the young hypogonadal male. European urology focus, 4(3), 321-323. 5) Herzog, B. J., Nguyen, H. M. T., Soubra, A., & Hellstrom, W. J. (2020). Clomiphene citrate for male hypogonadism and infertility: an updated review. Androgens: Clinical Research and Therapeutics, 1(1), 62-69.
Direct testosterone replacement is not the only way to increase your body’s testosterone level. The drug clomiphene is an effective way to increase testosterone.
Testosterone is made in the testes in response to hormones released from the hypothalamus and pituitary gland, specifically GnRH and LH. A portion of circulating testosterone is converted to estrogen by the enzyme aromatase in fat, skin, brain, and bone cells.1,2 As testosterone is produced and increases, so does the level of estrogen. That estrogen sends a signal to the hypothalamus and pituitary gland to stop releasing GnRH and LH, halting the production of testosterone.3 In this way the body keeps testosterone at an appropriate level.
Clomiphene blocks the activity of estrogen at the hypothalamus and pituitary gland. The testes therefore continue to produce testosterone unimpeded.4
"[Clomiphene] is generally considered a safe drug, and the majority of [clomiphene] studies do not report any significant side effects.”5 The benefit of clomiphene over pure testosterone is fewer side effects. Clomiphene will not result in loss of testicular size or function and subsequent infertility. There is also less risk of prostate symptoms, acne, breast enlargement, and clot formation.
Clomiphene is not the best option for those whose testosterone is low because of testicular injury, absent testes, or advanced age where the testes just can’t produce sufficient testosterone for the body’s needs.
Clomiphene remains a great option for younger and middle aged individuals with low testosterone, those who want to elevate their testosterone and preserve their fertility and sperm production, and overweight individuals in whom testosterone deficiency may be a result of high levels of circulating estrogen.
How does being overweight affect testosterone?
1) Diaz-Arjonilla, M., Schwarcz, M., Swerdloff, R. S., & Wang, C. (2009). Obesity, low testosterone levels and erectile dysfunction. International journal of impotence research, 21(2), 89-98. 2) Cooke, P. S., Nanjappa, M. K., Ko, C., Prins, G. S., & Hess, R. A. (2017). Estrogens in male physiology. Physiological reviews, 97(3), 995-1043. 3) Cohen, P. G. (2008). Obesity in men: the hypogonadal–estrogen receptor relationship and its effect on glucose homeostasis. Medical hypotheses, 70(2), 358-360. 2) Cohen, P. G. (2008). Obesity in men: the hypogonadal–estrogen receptor relationship and its effect on glucose homeostasis. Medical hypotheses, 70(2), 358-360.
"It is known that BMI is inversely proportional to serum total testosterone concentrations".1 Excess body fat can result in elevated levels of estrogen in males. This estrogen sends a signal to the brain (hypothalamus and pituitary gland) to stop producing testosterone.
Yes, men produce estrogen. About 20% of a male's estrogen is produced in the testes. The remaining 80% is produced as the testosterone is converted to estrogen by the enzyme aromatase in fat, skin, brain, and bone cells.2
"In males with increasing obesity there is increased aromatase activity, which irreversibly converts testosterone to [estrogen] resulting in decreased testosterone and elevated estrogen levels."3
Low testosterone and high estrogen levels in men account for symptoms of male breast enlargement, reduction in the size of testes and penis, and loss of male pattern body hair.
The solution that best addresses the problem of low testosterone in overweight individuals is weight loss.
Clomiphene is an effective option that stimulates testosterone production by blocking the negative effects of estrogen on testosterone production as well as other areas like breast and gonadal tissue.