A beginners guide to TRT-written by my DR.

[VTX1800]

Just thought I would share this for new members. It's a common basic guide to TRT and how my Dr. Treats her patients.

Low Testosterone
If you are similar to most American men, chances are high you may have experienced at least one of the symptoms featured below. Many of the most persistent symptoms are attributed to hormone imbalance. A customized treatment program can help you achieve harmonious hormones once again.
Andropause , also known as the male menopause, is the result of a gradual drop in testosterone which is an androgen, giving the condition its name. In many cases, bio-identical hormones can be part of the solution. When men get into their early 30s, they begin losing testosterone at a rate of one to two percent a year. According to the US Census Bureau, approximately 4-5 million men have symptoms of low testosterone levels and only 5-10% of these men will seek treatment.
Early Low T
Increasingly, young men in their 20’s are experiencing low testosterone and/or estrogen dominance. This is occurring because of the many endocrine disruptive chemicals in our environment Everything from the plastic bottles we drink from to the hormone-added dairy and meat products we consume, may add to the excess estrogen effect. In males, the excess estrogen leads to belly fat, sexual dysfunction and, even, infertility.
The Importance of Testosterone: Testosterone assists the male body in building protein and is crucial for normal sexual drive and stamina, and in producing erections. Testosterone also contributes to several metabolic functions including bone formation, liver function, prostate gland growth and production of blood cells in bone marrow. Low testosterone contributes to high cholesterol levels. Optimal testosterone levels reduce heart disease, diabetes and prostate cancer.
Andropause Symptoms
The symptoms of male menopause include:
Irritable Male Syndrome
Weight gain
Sleep apnea
Memory loss
Diminished libido
Hair Loss
Erectile dysfunction
Hot Flashes
Fatigue
Night Sweats
Loss of muscle mass
Decreased stamina
Depression
Increased belly fat
Increased perspiration
Gynecomastia (male breasts)
The Treatment: Androgen Replacement Therapy
The risks and benefits of testosterone replacement need to be evaluated by a qualified physician. Men vary in anatomy and physiology, so androgen replacement therapy is not a one-size-fits-all diagnosis. Testosterone replacement therapy is a treatment for men with low testosterone who want to boost their health and overall well-being. Perhaps the best news for men is that hormone losses and imbalances are easily correctible. Proper treatment by a qualified physician can bring about a healthier, younger and more vital you.
Simple testing will measure your current hormone levels, at which point a customized treatment can be created to not only adjust your testosterone levels, but other hormones as well. The treatment is paired with an individualized nutrition, supplement and fitness program that will optimize your hormone replacement therapy. Therapy must include consideration for maintaining testicular function including sperm production. If a man wishes to preserve his options for fathering children, certain stimulating hormones will be added to the regimen. Aromatase inhibitors may be added, on an individual basis, to prevent the conversion of testosterone to estrogen. One of the undesired consequences of testosterone replacement can be breast enlargement. The aromatase inhibitors prevent this. Other undesired effects may be accelerated balding. The use of 5’reductase inhibitors prevents the conversion of testosterone to DHT. This blocking action prevents the hair loss and prostate enlargement which might otherwise be problematic.
A well experienced physician will understand how to monitor and treat all these aspects of testosterone replacement. It is not as simple as prescribing a pharmaceutical gel.
What to expect:
Your first visit will be a complete history and physical exam. Prepare for about one hour. Blood and/or saliva tests will be done to evaluate hormone levels. After all results are in, you will have a consultation (in office or by phone) to establish the custom treatment. The hormones and medications will be picked up at my office. (Most of our patients who compare shop have told us our pricing is lower than their direct purchasing at the pharmacy. That is due to our volume discounts.)
After 45 days, you will need to have the hormone levels retested. This will include the estrogen and testosterone levels. Another phone consultation is made to adjust the treatment protocol, if necessary. After that, visits will be made every 6 months. Hormone testing must be at least once a year.
When will you feel better?
Most men experience significant improvement within a few weeks. Further improvements, such as strength and endurance, will continue to improve over more time.
Here is a patient example:
Here is an example from my clinic: E.M., a 48 yr old gentleman, came to see me for advice about his low testosterone level. His endocrinologist who was treating him for diabetes and hypothyroidism, had told him not to worry-- it wasn’t "that low". However, he had read a list of symptoms which he said described him well. He was feeling less strong and his stamina was down. "I used to enjoy my workouts but now I have less interest. Perhaps I’m just getting old." Upon questioning, he also related less enthusiasm for sexual activity and noted an increase in belly fat which his endocrinologist explained was part of the diabetic metabolic imbalance.
He brought with him the blood tests drawn by his other doctor which did, indeed, indicate a level of free testosterone just under the laboratory range of "normal". I pointed out to him that the range considered to be normal was based on average values for men in his decade of life. If we compared his value to ideal values, his numbers were very sub-optimal. We drew a few other tests and started him on the hypotestosterone program.
He easily mastered the technique of self administering the testosterone by injection into the hip muscle. By dividing the dose into twice weekly amounts, the injections were smaller and less painful. He was given two other prescription tablets to stimulate the testicles to preserve size and function, as well as to prevent conversion to estrogen.
Blood work was rechecked in 45 days. When I called him to tell him the levels were much improved, I was taken aback by his curt response. "You didn’t tell me the side effects!" However, he went on to explain, "My appetite is down and I have lost 16 pounds! My workout at the gym is picking up and my blood sugars are down to normal. I had to cut back my diabetes medicine…. I think it is criminal my endocrinologist was not willing to address my low testosterone."

[austinite]

Forrest is a great doc. A good friend of mine is a patient and has great things to say about her. Small world.

[VTX1800]

That's amazing you know who wrote this without any names mentioned? Hmm I'm impressed. I've been a patient of hers for nearly 4 1/2 months. She saved me from my gel prescribing PCP. She does ALOT for her field, I enjoy my office visits with her. I referred one other member from this board to Forrest...he is now in good hands as well.

[powerlifterty16]

That's amazing you know who wrote this without any names mentioned? Hmm I'm impressed. I've been a patient of hers for nearly 4 1/2 months. She saved me from my gel prescribing PCP. She does ALOT for her field, I enjoy my office visits with her. I referred one other member from this board to Forrest...he is now in good hands as well.

i thought she didnt prescribe hcg or adex?

[VTX1800]

Not sure where you get your info from.

[austinite]

That's amazing you know who wrote this without any names mentioned? Hmm I'm impressed. I've been a patient of hers for nearly 4 1/2 months. She saved me from my gel prescribing PCP. She does ALOT for her field, I enjoy my office visits with her. I referred one other member from this board to Forrest...he is now in good hands as well.

She reminds me of my doc, very 'out of the box' thinking. Certainly not one to throw prescriptions around. Always looking deeper into a cause. I came across that article a short while ago and recognized it. She's probably at ENDO2013 with my doc, she knows her, too!

[VTX1800]

Her staff Is awesome too, the nurse changed the codes to where my insurance would reimburse my office visits. She actually has me on hcg and clomid with my cyp and anastrozole. I've had so many people bash me for taking both but I just can't believe she would prescribe me something that isn't in my best interest. I Let her know how important fertility was ad that My wife and I are trying for our first child so she Prescribed clomid for testicular hypofuction along with 600iu hcg twice a week. I know most do 250 iu mwf but again I trust her knowledge and just do as she asks. I've been on 200mg a week for 5 months and she likes my level above 1000. Only problem is my back acne, I can't get it to clear up. Starting to wonder if I should try 150mg a week to see if it helps. Didnt you have some type of herbal acne protocol? I'm willing to try anything at this point, accutane just doesn't appeal to me.

[powerlifterty16]

what do your lipids look like? that's quite a lot of drugs.

[HRTstudent]

Does this doctor have any recent publications online that are more forward-thinking/not 101-type HRT stuff?

[Keep_It_Moving]

Does this doctor have any recent publications online that are more forward-thinking/not 101-type HRT stuff?

I'd like to know this as well...

[Trific]

VTX try a search on B5 (pantothenic acid) & acne.......

[austinite]

Her staff Is awesome too, the nurse changed the codes to where my insurance would reimburse my office visits. She actually has me on hcg and clomid with my cyp and anastrozole. I've had so many people bash me for taking both but I just can't believe she would prescribe me something that isn't in my best interest. I Let her know how important fertility was ad that My wife and I are trying for our first child so she Prescribed clomid for testicular hypofuction along with 600iu hcg twice a week. I know most do 250 iu mwf but again I trust her knowledge and just do as she asks. I've been on 200mg a week for 5 months and she likes my level above 1000. Only problem is my back acne, I can't get it to clear up. Starting to wonder if I should try 150mg a week to see if it helps. Didnt you have some type of herbal acne protocol? I'm willing to try anything at this point, accutane just doesn't appeal to me.

Just saw this. I see you found the thread

[VTX1800]

Yes I found the thread, started last night! Wal mart didn't carry the vitamin b5 so I got the complex B which has 50mg of B5 in it. Until I can afford the powder from eBay I will have to Get by.
As for my lipids all my BW is posted on my thread "my new protocol" how in the world do you think hcg , anastrozole, cyp and clomid are ALOT of drugs? Look at how many people are on thyroid meds, pain meds, anxiety meds depression meds, blood pressure meds, yada yada yada. It could always be worse...
Recent publications, yes she appeared on the food network recently and has weekly write ups in a4m. If you google Forrest Smith you can locate this info.

[austinite]

Yes I found the thread, started last night! Wal mart didn't carry the vitamin b5 so I got the complex B which has 50mg of B5 in it. Until I can afford the powder from eBay I will have to Get by.

50mg wont do anything, but you can try. Keep me posted!

[VTX1800]

I know we are dragging this out over 2 threads but After further research I see what you mean! I'd have to take like 20 of those complex Bs to get all the vitamin b5 I need. At least I've got it on the way, just waiting for them to ship it.

[powerlifterty16]

Yes I found the thread, started last night! Wal mart didn't carry the vitamin b5 so I got the complex B which has 50mg of B5 in it. Until I can afford the powder from eBay I will have to Get by.
As for my lipids all my BW is posted on my thread "my new protocol" how in the world do you think hcg , anastrozole, cyp and clomid are ALOT of drugs? Look at how many people are on thyroid meds, pain meds, anxiety meds depression meds, blood pressure meds, yada yada yada. It could always be worse...
Recent publications, yes she appeared on the food network recently and has weekly write ups in a4m. If you google Forrest Smith you can locate this info.

just because others are on a lot doesnt mean this isnt. so are your lipids ok?

[VTX1800]

Lipids are fine

[HRTstudent]

some people, like myself, used to consider 1 daily drug "a lot"... I still would prefer to be on nothing, but it's all about weighing the pro's and con's.

[VTX1800]

That's the truth

[powerlifterty16]

I also consider it a lot because I think he would be fine with either hcg or clomid...but he wants to be on the safe side and his doc prescribes it so w/e

[Trific]

I also consider it a lot because I think he would be fine with either hcg or clomid...but he wants to be on the safe side and his doc prescribes it so w/e

Lol....he'd like to be on HMG too....if you buy it, he'll take it...it's not too much for him

[powerlifterty16]

Lol....he'd like to be on HMG too....if you buy it, he'll take it...it's not too much for him

all i want is 100mg test per week and 250iu 3x per week hcg ...and if that gets me to the 750-850 tt range it'd be great

[Trific]

all i want is 100mg test per week and 250iu 3x per week hcg...and if that gets me to the 750-850 tt range it'd be great

You giving up hope on HCG monotherapy so soon?

[powerlifterty16]

You giving up hope on HCG monotherapy so soon?

im only on it for 6 weeks anyway..lol
i asked him about doing it long term when i saw him and he said ''hcg cant be done long term'' lol

besides i feel no different..migraines seem to be much less frequent and workouts better but i may be imagining.

[VTX1800]

I've toured with the Grateful Dead, hell I"ll take anything!! U can mail me your cypionate as well, be glad to dispose of that for you!