Sy Syms (1926-2009)

Testosterone Q & A

The Center For Men's Health (C4MH) believes that men need to know the facts on Testosterone Replacement Therapy (TRT) therefore we present the answers to the most common questions about Testosterone and Testosterone Replacement Therapy.
We are confident that what you read here could lead to a better more fulfilling life.

For answers just click on the question or just scroll down and read all questions and answers.

What is Testosterone?
What is a Hormone?
Where is Testosterone made?
How does Testosterone affect men?
What happens to your Testosterone level as you age?
How does low Testosterone happen? (andropause, injury, disease & fatherhood)
What are the symptoms of low Testosterone?
Must I have all symptoms to have low Testosterone?
Does Testosterone effect erections?
What exactly is low libido?
Does low Testosterone cause other health problems?
What about Testosterone and Type II diabetes?
What is Total Testosterone & Free Testosterone?
How does C4MH test for Testosterone levels?
How does the Center for Men's Health treat low Testosterone?
What age must I be to get an appointment?
What is the process for becoming a patient?
Why is treatment required every two weeks?
How long will it take to see improvements?
What happens if I stop treatments?
Can Testosterone be taken in pill form?
What about Testosterone gels and creams?
Is Testosterone replacement therapy safe?
What are the known side effects of Testosterone replacement therapy?
Can Testosterone replacement therapy cause prostate cancer?
Will my voice deepen if I undergo Testosterone Replacement therapy?
Will I grow more hair if I undergo Testosterone Replacement therapy?
What about that crazy stuff involving athletes & body builders?
Will you increase my dosage if I want to gain size?
Will my muscles grow if I undergo Testosterone Replacement therapy?
Will Testosterone replacement therapy improve my golf game?
Is Testosterone replacement therapy "cheating"?
Will you respect my privacy?
Will C4MH be my primary healthcare provider?
Will C4MH refill my regular prescriptions?
Will C4MH bill my Insurance or Medicare?
How does C4MH assure that its supply of Testosterone is of the highest quality?

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What is Testosterone?
Testosterone is a basic fundamental, hormone found in all mammals. It is the principal androgen, or male sex hormone, although it appears in both genders.

What is a Hormone?
The U.S. National Institute of Health (NIH) defines Hormones (such as Testosterone) as powerful chemicals that help keep our bodies working normally. The term hormone is derived from the Greek word, hormo, which means to set in motion. And that's precisely what hormones do. They stimulate, regulate, and control the function of various tissues and organs.
Made by specialized groups of cells within structures called glands, hormones are involved in almost every biological process, including sexual reproduction, growth, metabolism, and immune function.

Where is Testosterone made?
Most of the Testosterone in a man's body is produced in the testicles

How does Testosterone affect men?

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What happens to your Testosterone level as you age?
Your body's Testosterone level peaks during adolescence and early adulthood. Starting around age 40, sometimes younger, your body produces less Testosterone. For some men, Testosterone levels decline slowly, but for many the decline in Testosterone levels is more rapid or severe. This process is known as ANDROPAUSE (also known as "Man-o-pause").

How does low Testosterone happen?

Four possible ways:

1) Andropause: Andropause as detailed above is the transition period in a man's life when his body produces less of the hormone Testosterone. Until recently, the accepted medical treatment was to tell the man "you're just getting old."

2) Injury: An injury to the testicles.

3) Disease: Primary hypogonadism is the failure of the body to produce sufficient Testosterone to meet its needs. Secondary hypogonadism (rare) occurs when the brain fails to tell the testicles to make Testosterone.

4) Fatherhood: A just released medical study (see below) clearly indicates that men who became fathers had a Testosterone decline more than double that of childless men.

Dr. Lee Gettler at Northwestern University checked the Testosterone levels of 624 men at age 21 and brimming. Five years after becoming fathers, their Testosterone levels had dipped as much as 34 percent. The steepest decreases occurred among men who reported that they acted as the primary caregivers of their children.
Published study in "Proceedings of the National Academy of Sciences" September 2011

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What are the symptoms of low Testosterone?
Lack of interest in sex (low libido)
Decreased endurance
Erectile dysfunction
Fatigue
Anxiety
Depression
Weakness
Weight gain
Lack of self-esteem
Lack of motivation
Confused thinking
Decreased erectile rigidity
Decreased muscle mass

Must I have all symptoms to have low Testosterone?
No. Low T may mean having only one symptom or many. Men will say "my sex drive (libido) is great" and yet they have low T. After therapy begins, they come to realize what they were missing.

Does Testosterone affect erections?
Yes. Testosterone acts directly on the penis by assisting in blood flow in the erectile chambers. Many older men can still get erections, but have trouble maintaining or achieving the rigidity they had in their 20's. Think back to those days of full Testosterone – an erection was automatic. You can be there again.

What exactly is low libido?
1) A reduce overall desire for sex
2) Infrequent desire….
3) Absence of desire…..

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Does low Testosterone cause other health problems?
Yes.

"….. numerous studies have documented that chronic low Testosterone levels increase men's risk of cardiovascular disease, increase overall mortality rate and decrease libido, muscle mass and quality of life."
Natan Bar-Chama, MD
New York Times, Sept. 13, 2011
Dr. Bar-Chama is the Director of Male Reproductive Medicine and Surgery at The Mount Sinai Hospital (NYC) and is on faculty in both the Department of Urology and the Department of Obstetrics, Gynecology, and Reproductive Science at Mount Sinai School of Medicine. Dr. Bar-Chama was awarded the New York Academy of Medicine F.C. Valentine Fellowship.

What about Testosterone and Type II diabetes?
Low T is frequently found in men with diabetes. Testosterone therapy increases insulin sensitivity in diabetic men and decreases their daily insulin or medication requirement. Increasing lean muscle mass and decreasing total body fat also contributes to a lower blood sugar.
There is a growing body of evidence that indicates low T is associated with an increased risk for diabetes.

What is Total Testosterone & Free Testosterone?
A. Guys love to talk about Total Testosterone as if it’s the only thing that counts and nothing could be further from the truth; Total T is the total level of testosterone (both free and total) in your blood BUT here’s the kicker: only about 2% (or less) of the total testosterone in your blood is Free T and Free T is the only testosterone that can enter the body’s cells and do the needed work that leads to the improvements you seek. The other 98% of testosterone in your blood is bound, unavailable and unable to enter your body’s cells. Free T is the level that you should care about and the level that C4MH treats.

TREATING TESTOSTERONE WITHOUT FREE T TESTING DOES NOT MEET THE STANDARD OF CARE AND CAN CAUSE FREE T TO REACH UNHEALTHY LEVELS.

How does C4MH test for Testosterone levels?
A. C4MH exclusively utilizes serum (blood) testing provided by Quest Diagnostics, the world's leading provider of diagnostic testing services. C4MH insists on “equilibrium dialysis” method as it is the “gold standard” for serum (blood) testosterone testing; no other test can match the accuracy. At C4MH we find it sad that many other clinics say that “equilibrium dialysis” testosterone testing is impractical for routine use, to us that sounds like an excuse to save money.  At C4MH cutting corners is not an option when it comes to your care. Lastly, beware of those that use saliva tests. 

How does the Center for Men's Health treat low Testosterone?
C4MH uses Intramuscular (IM) injections for Testosterone replacement
therapy (TRT).

What age must I be to get an appointment?
If you believe that you are suffering from the symptoms of low T, then an appointment is yours for the making. Generally we find that most low T patients are over 40, but that does not mean younger men cannot be afflicted with low T, especially if they are fathers.

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What is the process for becoming a patient?
If you have some or all of the stated symptoms and are concerned that you might have Low Testosterone, then the next step is making an appointment for an initial visit. C4MH offers two ways to become a patient:

1) Your Initial Visit Using The C4MH "Express Treatment Plan" (ETP):
The ETP initial visit will include a physician consultation and examination and because your lab appointment is already completed Testosterone Replacement Therapy (TRT) may begin immediately if the physician determines you are suffering from low testosterone.
To participate in the ETP program click on the Express Treatment Plan menu tab or click here.

2) Your Initial Visit not utilizing ETP:
Your initial visit will include a consultation with a physician and an examination along with a prescription for a simple blood test. This test will be performed by a local lab at a special low rate. The test will supply the physician with a Testosterone reference level needed to calculate a safe and effective treatment program designed exclusively for you. TRT treatment may not begin until you have completed your lab appointment.

Ongoing Treatment:
To maintain the optimum levels of Testosterone you will be required to return every two weeks (a quick 10 minute visit) for the administration of the required Testosterone replacement dosage. We'll quickly, easily and safely adjust your Testosterone levels back to where they should be so that you can enjoy a full life again.

Why is treatment required every two weeks?
When your body was producing normal levels of Testosterone it was doing so around the clock. Injections of Testosterone will last approximately 15-17 days and after that there will be a dramatic drop. The 14 day treatment schedule keeps that dramatic drop from occurring.

How long will it take to see improvements?
Improvements will generally begin to be seen after 3 months of continuous therapy (6 treatments) but remember results do vary as does the timeframe.

What happens if I stop treatments?
Your Testosterone level will return to pre-therapy levels.

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Can Testosterone be taken in pill form?
Yes, but oral Testosterone has been shown to cause liver damage. This problem is avoided by using the injectable form.

What about Testosterone gels and creams?
These applications are effective to some degree, but the amount of Testosterone absorbed is erratic and depends on skin type, area of application, amount of sweating, etc. Injections every two weeks deliver 100% of the prescribed amount 100% of the time.

Is Testosterone replacement therapy safe?
Yes! Testosterone replacement therapy (TRT) has been used for decades and studied just as long. To date no controlled clinical study has shown any adverse health risks associated with the therapy although those with pre-existing conditions such as blood clots or coronary disease would be advised to discuss TRT with their primary physician and/or cardiologist before proceeding. The truth is that men with higher levels of Testosterone live longer with less heart disease compared to men with lower levels of Testosterone (and enjoy the extra years much more).

Unfortunately Testosterone replacement therapy (TRT) has been the victim of massive misinformation (old wives' tales) such as increased T will cause prostate cancer; much of that misinformation comes from physicians who were taught this in medical school……..decades ago. Ask them for the supporting science; there is none! In fact recent studies now show that Low T is more of an issue in the possible cause of prostate cancer (see “Low T Research” page).

Remember: Testosterone replacement therapy (TRT) is safe when done under the care of a physician.

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What are the known side effects of Testosterone replacement therapy?

a) Increase in red blood cells: This can be beneficial if you have anemia (low blood counts). However, it can be a potential health problem if your hemoglobin and or hematocrit gets too high. C4MH recommends that TRT patients donate blood at least twice annually during therapy which usually eliminates the problem. C4MH will monitor your initial red cell count (hematocrit / hemoglobin) at the beginning of therapy then again at 12 weeks and every 6 to 12 months thereafter or more frequently as determine by treating physician. (See Dr. Morgentalers comments below which further explain the hemoglobin / hemocrit issue.)

 b) Infertility: This is not uncommon, particularly in young men, but normally reversible after stopping Testosterone therapy.

For those that wish to proceed with TRT and have significant concerns about future fertility we recommend sperm storage (sperm banks).

c) Testicular Atrophy / Testicular Shrinkage:  When undergoing TRT the human body will see the increase in Testosterone as its own and slow or cease production in the testicles causing testicular atrophy which presents itself as a reduction is testicle size. Medication can be prescribed to limit the effects of this condition.

d) Sleep apnea: This is a condition that disrupts breathing during sleep. Testosterone does not cause sleep apnea, but can possibly make it worse. This has not yet been statistically proven.

e) Other: Mild fluid retention, Acne, oily skin, increased body hair, injection site pain and flushing have also been reported in a small minority of patients (<6%).

f) Tender Breasts or Enlargement of Breasts: This may occur in some older men.

Click here for a complete list of potential side effects.

Putting Side effects into perspective:

Below From Harvard Medical School web site;

Harvard Clinical Professor and Board Certified Urologist Abraham Morgentaler, M.D.

"When patients ask about risks, I remind them that they already have testosterone in their system and that the goal of testosterone treatment is to restore its concentration back to what it was 10 or 15 years previously. And the molecule itself that we give is identical to the one that their bodies make naturally, so in theory, everything should be hunky-dory. But in practice, there are always some curveballs.

For example, testosterone can increase the hematocrit, the percentage of red blood cells in the bloodstream. If the hematocrit goes up too high, we worry about the blood becoming too viscous or thick, possibly predisposing someone to stroke or clotting events. Although, frankly, in a review that I wrote in the New England Journal of Medicine* where we reviewed as much of this as we could, we found no cases of stroke or severe clotting related to testosterone therapy. Nevertheless, the risk exists, so we want to be careful about giving testosterone to men who already have a high hematocrit, such as those with chronic obstructive pulmonary disease, or those who have a red-blood-cell disorder.

Although it’s rare to see swelling caused by fluid retention, physicians need to be careful when prescribing testosterone to men with compromised kidney or liver function, or some degree of congestive heart failure. It can also increase the oiliness of the skin, so that some men get acne or pimples, but that’s quite uncommon, as are sleep apnea and gynecomastia (breast enlargement)."

*Source: New England Journal of Medicine 2004;350:482–92. PMID: 14749457

Can Testosterone replacement therapy cause prostate cancer?
No. Concerns about Testosterone and prostate cancer were based on 1940’s study that has been thoroughly debunked (many doctors are still unaware of this). It is simply not true, as modern studies have shown. Read more about the theoretical prostate cancer myths at http://www.center4menshealth.com/GMTmyth.html

Will my voice deepen if I undergo Testosterone replacement therapy?
No.

Will I grow more hair if I take Testosterone replacement therapy?
No.

What about that crazy stuff involving athletes & body builders?
Years ago certain body builders and athletes began to use Testosterone not as a replacement but for an overall increase so as to gain a competitive advantage BUT these individuals were injecting themselves with massive amounts far beyond any medically approved level as used in Testosterone replacement therapy (TRT).

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Will C4MH increase my dosage if I want to gain size?
No. C4MH will only administer clinically indicated dosages as determined by your individual hormone levels and response to therapy. At the Center for Men's Health we treat within the known standard of care and will not tolerate the abuse of any medication we administer or prescribe.

Will my muscles grow if I undergo Testosterone replacement therapy?
Yes. Without adequate Testosterone levels, your body will not see the expected gains with exercise. Restoring normal Testosterone levels will, in conjunction with a good diet and exercise, result in significant gains in strength, endurance and energy but understand you can't undergo TRT and sit on the couch and expect six-pack abs and 20" biceps to appear. You will also recover faster after exercise.

I used to drive the ball 250 yards when I was younger. Will Testosterone replacement therapy improve my golf game?
Look, Testosterone replacement therapy will not make you a scratch golfer or give you a serve like Roger Federer, but it will make you stronger and happier, and this will add immensely to your enjoyment of any sport.

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Is Testosterone replacement therapy "cheating"?
No, C4MH is merely restoring normal levels of a naturally occurring hormone. If you are a member of an organized sports activity, you may want to check the rules and regulations of your governing body first.

Will C4MH protect my privacy?
Yes. The C4MH is a medical office, and, as such, is bound by HIPPA regulations. Your privacy will be protected.

Will C4MH be my primary healthcare provider?
No. We provide care to those that suffer with conditions that are directly related to low Testosterone only. If we discover, through our exams or lab tests, that you have other health issues, you will then be referred to a primary physician for treatment.

Will C4MH refill prescriptions written by other physicians?
No. Please re-read the response to the previous question.

Will C4MH bill my Insurance or Medicare?
No. We do not send out bills of any kind. Payment is required at the time of service in the form of cash or credit/debit cards.

How does C4MH assure that its supply of Testosterone is of the highest quality?

Medication Quality

TESTOSTERONE USED AT THE CENTER FOR MEN’S HEALTH IS PRODUCEDBY TWO OF THE WORLDS LARGEST PHARMACEUTICAL COMPANIES* ANDALL SHIPMENTS HAVE PEDIGREE PAPERS AS REQUIRED BY FL LAW**. 

* Pfizer Pharmaceuticals               http://www.pfizer.com/home/
   Watson Pharmaceuticals           http://www.watson.com/ 

**FL Pharma Pedigree Statute:  http://www.flsenate.gov/Laws/Statutes/2012/499.01212

This video clearly shows why C4MH does not use any “compounded”injectable Testosterone:

Click to watch video.