Male Testosterone Therapy
Frequently Asked Questions For Men
How do you diagnose low Testosterone in men?
Low Testosterone can be diagnosed if you have 3 or more of the following symptoms:
- decreased sex drive
- erectile dysfunction (ED)
- loss of stamina
- fatigue, weakness or low energy
- mental fogginess or forgetfulness
- irritability or mood swings
- depression, or lack of motivation
- sleep disturbances
- muscle loss or wasting
- increase in body fat, especially waistline
- arthritis or joint pains
- loss of skin tone
- loss of body hair
Along with the symptoms, we look for a low total testosterone blood level or a low free testosterone blood level. A man must have both symptoms and a low blood level of testosterone to qualify for treatment.
What Symptoms Do Testosterone Pellets Treat?
When men age, testosterone production normally declines which causes them to lose their ability to have sex without ED medications, experience aging of their body losing muscle and gaining belly fat, developing diseases of aging including heart disease, diabetes, obesity, osteoporosis, joint damage and autoimmune diseases.
Where are the Pellets inserted in men?
There are two places that pellets are placed in men: upper outer hip and love handles.
How long will it take for my pellets to work?
It takes about 3-5 weeks to get the full effect. Pellets must be re-inserted every four to six months to prevent symptoms from recurring.
Does testosterone cause prostate cancer?
No. The metabolites of testosterone, dihydrotestosterone and estrone, cause prostate enlargement but an expert in prostate cancer, Dr. Abraham Morgantaler, has proven that low testosterone and not normal young healthy levels contribute to prostate cancer.
Do present and former athletes need testosterone replacement earlier than other men?
In general, that is what we have determined through experience, however the physiology behind this is not clear. Pellets tend to improve the joint function, cartilage thickness and muscle tone necessary to relieve the pain from damage to the joints from years of sports. It also replaces the testosterone that decreases because of head injuries in contact sports.
What if I have prostate enlargement already?
Bio-identical Testosterone Pellets will usually shrink the prostate. There are exceptions to this rule, but this is our experience.
Can a man who has had prostate cancer take bioidentical Testosterone pellets?
No. Once prostate cancer has been diagnosed, the cancer cells in the prostate are completely different from the benign prostate cells that were there before, and it is recommended that men refrain from replacing testosterone if there is prostate cancer present. However, if a man has had prostate cancer that is completely removed surgically, and has negative lymph nodes (does not have any more prostate cancer cells), Dr. Morgantaler of Harvard feels that it is then a choice to be made by the patient and his doctor. If cancer is metastasized, we do not advise replacement of testosterone in any form.
Why are pellets better than testosterone patches, shots and pills?
Bio-identical Testosterone Pellets contain the pure hormone, testosterone, that is dissolved and absorbed directly from the pellet into the blood stream. The testosterone is not immediately converted to the byproducts (Estrone/DHT), which can cause prostate swelling, hair loss, belly fat and a requirement for more and more testosterone. Other forms of testosterone are delivered in a form that causes blood levels to rise and fall drastically between dosing. Pellets are dosed two to three times a year which allows blood levels to remain quite stable.
If I have a genetic reason that causes me to convert testosterone to dihydrotestosterone (DHT) and estrone, how is that monitored and managed?
We follow blood levels of your estrone and DHT, before and after treatment, and then periodically. If they are elevated, we treat with medications and/or herbal supplements to decrease DHT and Estrone. DHT is lowered by using Saw Palmetto, or the medications Avodart, Propecia or Proscar. We treat too much estrone with the supplement DIM or the drug Arimidex.
Will my testicles shrink while I take the testosterone pellets?
Yes, they will to some extent. Testicles shrink normally with age, as they provide less and less testosterone. As the pellets take over the supply of testosterone, testicles are not producing as much as usual, so they get smaller. This is not a permanent change, and there are medical methods to stimulate the testicular size, but it is cosmetic and not necessary to be healthy.
How long will it take for my body to get back to my lean normal self?
That depends on how heavy you are at the beginning of treatment as well as how much you exercise, your diet, and how often you work out with weights. Without testosterone replacement, this transformation would not be possible even with a perfect diet and exercise.
If I have used alcohol or drugs like marijuana, will my effect be the same as other men?
No. You will use up the testosterone more quickly because your liver is activated and it metabolizes testosterone with the same enzymes that metabolize alcohol and drugs. Marijuana increases prolactin, the hormone that increases breast size in men and women. Prolactin not only decreases your testosterone level but decreases your sex drive, ejaculatory function and sexual stamina. It is expected that if you take testosterone, you should stop using marijuana altogether and decrease or stop alcohol consumption.
Can testosterone improve depression and anxiety?
Yes. It often can replace the need for antidepressants which also can decrease libido.
If I have diabetes will testosterone help me with my sexual response?
Yes, in most cases it will. It also increases insulin sensitivity which can decrease triglycerides and stabilize blood glucose. It can improve the overall status of your diabetes. In men who have had many years of diabetes—especially without good control—the blood vessels in the pelvis are affected and might not provide enough blood to the penis for an effective erection. In these cases, other medication designed to improve penile blood flow might be required.
How do cholesterol-lowering drugs affect testosterone?
Testosterone is made of cholesterol. When you take cholesterol-lowering drugs, you decrease the primary ingredient that testosterone is made of which can lead to lower testosterone production.
Why are Testosterone pellets better than Viagra?
Testosterone fixes the real problem—lack of testosterone that decreases libido and sexual response. Viagra does not fix the sexual desire issues, it just improves blood flow to the penis. This is only treating the symptom of ED, not the other symptoms of low testosterone, and it has many side effects.
Can I receive Testosterone pellets if I have normal testosterone levels and want to increase my testosterone for the purposes of body building or athletic advantage?
No. We cannot honor these requests. Our purpose is to replace testosterone for symptomatic men who have low levels because of age, genetic problems, head injuries, or other causes.
What treatment will I need if I want to receive testosterone pellets because I have andropause, and I also have high levels of red blood cells?
This is a concern for men who take testosterone, because the addition of testosterone can increase the red blood count in anyone. If there is an underlying condition that also elevates the red blood count, it is important to diagnose and treat that condition early while being treated with testosterone. The reason it is important is that increased concentrations of red blood cells can lead to sludging of the blood and could cause blood clots (an embolism) to form.
It is important that this condition (called polycythemia) is diagnosed and treated prior to, or early during a course of testosterone replacement. Evaluation of elevated hematocrit determines whether you have Hemochromatosis, a benign elevation of red blood cells, or a Jak 2 genetic defect which has other far-reaching consequences with or without testosterone replacement. We can also determine whether your situation requires a specialist such as a hematologist/oncologist.
Do Testosterone Pellets increase my risk of blood clots?
No, because we evaluate and treat men with an increase in blood count, discussed above. They do not increase the risk of clotting for other reasons either.
Should I try another form of testosterone before I come in for testosterone pellets?
There is no reason for you to try a method that will not bring you back to health completely before you come here for testosterone pellet therapy.
Will I still need my E.D. medicine after I get pellets?
Maybe. Most men find that they do not. However, if there is vascular compromise from arteriosclerosis or diabetes, then it is still possible that ED medicine in one form or another may be needed. We often find that a patient’s blood pressure medicine is contributing to the problem and we advise our patients to switch to a blood pressure medication that is least likely to cause ED. In any case, if ED meds are needed, they are also generally used at a lower dose than before.