Men's Weight Loss and Health

Testosterone Replacement Therapy (TRT)

Basic information, thoughts, trends, and considerations.

In some ways, testosterone is what makes men, men.  It gives them their deeper voices, large muscles, and facial and body hair.  It stimulates the growth of the genitals at puberty, plays a role in sperm production, fuels libido, and contributes to normal erections.  It also aids in the production of red blood cells, boosts mood, and aids in cognition.

Over time, the testicular “machinery” that produces testosterone gradually becomes less effective, and testosterone levels start to fall – about 1% per year, beginning in the 40s (sometimes much earlier).  As men get into their 50s, 60s, and older, they may start to have signs and symptoms of low testosterone (“Low T”); such as lower sex drive and vitality, dysfunction, decreased energy, reduced muscle mass and bone density, and anemia.  Researchers estimate that the condition affects anywhere from two to six million men in the United States.  Yet, it is an underdiagnosed problem, with only about 5% of those affected receiving treatment.

What is HCG?

HCG stands for Human Chorionic Gonadotropin.  It is used medically to induce ovulation in females and to stimulate testosterone production in males.  HCG requires a prescription and is injected into the subcutaneous fat or in the muscle tissue.

overweight to healthy

How does HCG work?

For this discussion, we will be focusing on the action in males.  HCG mimics luteinizing hormone (LH).  LH stimulates the Leydig cells in the testicles to produce testosterone.  This action also causes the testes to return to normal size and function if they were suppressed due to exogenous (from the outside) testosterone.

How to take HCG

The dose and frequency vary by individual.  Many patients will take an HCG injection once or twice per week (between 500 IU and 1000 IU).  It is injected using a very small insulin syringe (with a tiny needle) in the subcutaneous tissue of the lower abdomen.  Some studies and some doctors recommend 500IU three times a week, one week on, three weeks off.  Usually, these patients inject the HCG during the first week of each month.  It is injected just like a diabetic would inject insulin.  The level peaks in about 6 hours and remains at this level for 36 hours.  After about 72 hours, the level is back to baseline.

Using HCG while taking testosterone is important to maintain testicular size and function, help balance the other hormones needed in the body and increases a man’s sense of well-being and libido.  As time goes on and research continues, we are learning more and more about how to properly use this wonderful hormone.

Man Standing On Scale

Will HCG stimulate my own testosterone production?

Yes, but by how much varies in studies, and there may be other potential disadvantages as well.  Using HCG regularly over time will desensitize the Leydig cells so when you stop the HCG, your testicles will not recognize the LH signal from your brain…not good.  HCG will increase your own testosterone for about five days after you inject it.

Will HCG stimulate estrogen production?

Yes.  When testosterone rises sharply, your body will aromatize some of the testosterone into estrogen.  Exogenous testosterone (TRT) can and does this as well. This can be prevented with drugs that are “estrogen blockers” (Anastrozole).  Many of our patients take Anastrozole anyway while on testosterone therapy to “counter-act” this process, and to keep your Testosterone and Estrogen levels where they should be.

Low Testosterone concerns

Indications that you may have low testosterone.

Am I a candidate for Testosterone Replacement Therapy?

The primary hallmark of low testosterone (“low T”) is low sexual desire or libido, but another somewhat common issue can be dysfunction, and anyone who is experiencing dysfunction should have their testosterone level checked.  Men may also experience other symptoms, such as more difficulty achieving an orgasm, or less-intense orgasms.  The more of these symptoms a man has, the more likely it is that he has low testosterone.  Many physicians may dismiss these symptoms as a normal part of aging, but they are often treatable by normalizing testosterone levels.

Other common signs and symptoms that we see in our clinics are:

  • Low Energy/Vitality
  • Loss of muscle mass
  • Increased belly fat
  • Loss of sex drive

So, how low is “too low” when considering testosterone levels?

We typically consider both the biochemical numbers (total testosterone and free testosterone), that are determined by a simple blood test, and the characteristic symptoms and signs of low testosterone.  The Endocrine Society considers low testosterone to be a “Total Testosterone” level of less than 300 ng/dl, and in our clinics, we believe this is a reasonable guide.  However, if a gentleman is having several symptoms of Low T (mentioned above), but their blood levels are a bit higher than this, we still often have good reason to treat, and the patients benefit.  The biologically available part of total testosterone is called free testosterone, and it is readily available to the cells.  Almost any lab has a blood test to measure free testosterone. Even though it’s only a small fraction of the total, the free testosterone level is a good indicator of low testosterone.  It’s not perfect, but the correlation is greater than with Total Testosterone.

Endocrine Society recommendations summarized

Testosterone therapy is recommended for men who have both:

  • Low levels of testosterone in the blood (less than 300 ng/dl)
  • Symptoms of low testosterone

Testosterone replacement therapy may offer a wide range of benefits for men with hypogonadism (low testosterone and/or the signs and symptoms of Low T), including improved libido (sex drive), mood, cognition, muscle mass, bone density, and red blood cell production.  However, little consensus exists on what constitutes low testosterone, or what risks patients face.  Much of the current debate focuses on the long-held belief that testosterone may stimulate prostate cancer.  This “idea” is because when treating prostate cancer, lowering testosterone sometimes improves the condition – so, the thinking follows that raising testosterone must make prostate cancer grow.  But, even though it has been a widely held belief for about 60 years – no one has found any additional evidence to support the theory.

Therapy is not recommended for men who have:

  • Prostate or breast cancer
  • A nodule on the prostate that can be felt
  • A PSA greater than 3 ng/ml without further evaluation
  • A hematocrit greater 50% or thick, viscous blood
  • Untreated obstructive sleep apnea
  • Severe lower urinary tract symptoms
  • Class III or IV heart failure

Give us a call today if you have questions about testosterone, the benefits, the risks associated with treatment, costs involved or anything else that we can help to answer.

Different items for fitness

Who should use HCG?

Men who currently are on testosterone therapy should generally use HCG.  If a man is older (over 40), is not bothered at all by a decrease in the size of the testicles, and is NOT concerned about maintaining fertility – then, HCG may not be used.  However, there are other good reasons to consider the use of HCG during TRT; we work with each patient individually to determine the best approach.

What happens if I’m on testosterone and I don’t use HCG?

When your body has enough testosterone, the brain does not send the LH signal to your testicles.  Therefore, you will not make any testosterone until your levels drop to below normal and the signal returns, stimulating production.  Since you are getting testosterone from an outside source, your brain is most likely not sending that signal to your testicles.  Over time, the adage of “use it or lose it” comes into play and your testicles will shrink in size. The time is different for every man and the amount of “shrinkage” is different for every man. Fortunately, the HCG will quickly restore the size and function.

Is there anything else I should know?

When you are on testosterone therapy, it is inevitable that your cholesterol level will go up.  Cholesterol is the beginning chemical structure for many of our hormones.  The enzyme that begins the changes of cholesterol into other hormones is stimulated by LH.  When taking testosterone, LH is suppressed. When you inject the HCG, the enzyme is stimulated, and the pathway flows normally.

Contact us for more information or book an appointment