Mr. Galindo 40 year old male who doesn’t feel like he used to. Several life changes over the past 5-7 years have occurred. Two kids and new job promotion with a lot more responsibilities has taken place in that time frame. When I tell people I feel tired, unmotivated, lethargic, etc., they respond with “that’s part of getting older…. You’re 40 now”. A friend of mine, who’s also PA, suggested getting bloodwork done to check my testosterone levels. So I finally did. My results: Albumin 4.7 HCT 49.1 Total T 333 ng/L SHBG 25 nmol/L Free T Calc 77.2 pg/mL FSH 5 LH 7.6 The APRN says I’m within range but on the low side. I know how I feel. Been on SSRIs for the past 7 years. Based on the numbers you see, should I look into TRT as a possibility? Thank you
@travisfletcher7334: Hello, and thank you for the question. Based on your numbers, yes. Based on your symptoms, the concomitant need for SSRIs, confirmed by your symptoms...it is ABSOLUTELY worth looking into. Your Free T Calc isn't adjusted for your actual albumin, and to convert it to the range of 9-30 ng/dL that I reference in my videos, you need to move the decimal one place to the left. So, using the website below, calculating your cFT correctly is only 7.34 ng/dL. I consider this well below normal, especially given your age. We chalk up far too many adverse effects to "getting older." Forty-year-olds should not be dealing with Low T. Everyone knows someone with diabetes; everyone knows someone with a thyroid problem. Simply because these problems are pervasive doesn't mean that their presence is normal. That said, if you want your Low T addressed appropriately, you will probably fair better with a provider that you do not need to convince or debate in order for them to initiate treatment. Look for a provider with sound judgment, a balance of monitoring and caution, and a track record of achieving positive outcomes. Calculate your free testosterone at www.issam.ch/freetesto.htm. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Probably one of the best lectures I've seen on the testosterone puzzle not overly complicated and Simple enough for the Layman to understand Thank you very much. 👍
@CAPTAIN CARIBE: Thank you very much for your feedback! I am glad you enjoyed it! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed Doc what about tgia i keep hearing about men going on trt after 60 and their chances of dying from a heart attack goung up by 35%. Is it true, and if so, why?
@@goldo1107 The controversy surrounding this started primarily with two separate studies. One was published in JAMA in 2013, and the other on the online journal, PLOS One in 2014. As biased as I may be, I believe both were deeply flawed. Both articles suggested, through retrospective study, that testosterone "use" (the patients were not on what I would call TRT), increased the risk of embolic (blood clot related) events like stroke and heart attacks in men that already had a history of such cardiovascular problems. The entirety of the medical literature on the subject promotes and improvement in cardiovascular health. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed Gotcha. I thought as much myself. Im sure that if the individual is being health at that age they can minimize blood clots and or the thickening of the blood. Im aure that is closely monitored by whatever TRT clinic. I just wanted to hear your opinion. I'm 39 years old. Recently went for a quaterly checkup at the doc and asked for a teatesterone check in my Bloodwork. Comes back 268 and free 6.2. If it wasnt for the fact that I dont have children yet i would go on trt right away. But my fiance and I are not ready for another 2 years. I used to weigh 430 pounds a year ago. Started lifting weights 4 days a week and 30 min of steady cardio 6 days a week. Clean lean meats diet. About 3 months ago i just stoped losing weight even tgo im eating 1900 cal a day. Been very frustrating. I noticed im not as strong as i used to be in my early 30s and 20s thought that was odd too. Ao it led me to think maybe i have very low T. I was having most of the symptoms. Especially bad enxiety that juat came out of no where in the last 7 years. Depression as well. I started looking into reasons why low T and natural ways to bring it up. I asked for a copy of my bloodwork and noticed that i had really low vitamin D levels. Like really low. So ive been taking vitamin D for the last 3 weeks and im now practicing IF. I noticed this last week that my libido has gone up very much. So i thibk its working. I started losing a few pounds as well and im sleeping better. Soon as i have kids im going on TRT. I wanna have a quality life. I just want to do it safely wirh as minimal risks as possible. Hopefully they keep doing reaearch to help minimise the risk even further.
@@goldo1107 Sounds you are evaluating things the right way! Best of luck with everything!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
hello and great video btw.I want to ask only one question.In the case of trt if you take aromatase inhibitors to keep estrogen low isnt a way for the fsh to keep producing?
@Stauros Sotiriou: Thank you for the feedback! Lower estradiol levels may induce "more" pituitary secretion of LH and FSH, but it doesn't completely eliminate hypothalamic/pituitary suppression. Keep in mind that hypothalamic response to estradiol is only one factor that influences GnRH effect on the release of gonadotropins, and this is further modulated by other factors. Therefore LH and FSH secretion does not necessarily respond in lock-step with GnRH secretion. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@Lotfi Bouhedjeur: Thank you much, I appreciate the feedback! I hope the information helped. Best of luck to you! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
This guy started me on TRT at 46 years of age after giving me a full, blood test. He’s got this entire Science of hormones completely dialed-in. I thank him for increasing my quality of life in a big way. Highly recommend subscribing to his channel. He’s the best. 💪🏼🙏🏼
@Kevin St Clair: Thank you so much for the kind feedback! We take pride in helping our patients to enhance their quality of life, and getting back to feeling the way they are supposed to! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Winner of a video, I have been researching "at what age do men's testosterone levels decrease?" for a while now, and I think this has helped. Have you heard people talk about - Peyoraat Rudimentary Preponderance - (Have a quick look on google cant remember the place now ) ? It is a good exclusive product for discovering how to boost testosterone levels minus the hard work. Ive heard some unbelievable things about it and my brother in law got amazing results with it.
@prince prince: Thank you very much for your positive feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
I do so wish I had found this very much earlier! I'm sure your presentation will sound a little 'heavy' for some but, anyone who is receiving TRT will find much to understand and relate to! Many thanks for broaching a difficult subject with undoubted, well-presented and a common sense approach. Many thanks!
@Delboy Trotter, I truly appreciate the feedback. From the beginning, the goal has been to be thorough and informative. There are a lot of ways to do TRT wrong, thank you for staying diligent in you research for how to do it right! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
This is the best video I have seen on trt. Very well done to you. I have done so much research on this and you know what you are talking about and can deliver it in a straightforward way.
@Andrew Sanderson: Thank you for the feedback! I am glad that you found the video to be helpful!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
f@GREATTECH1: Thank you for the feedback! I am glad you found ithelpfull! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Good info. Im 38 years old and been on trt for a year now and its been grate for me. Before I started it i been losing weight i went from 210 to 190 and going to the gym. I would recommend it to any man thats older to get checked for low t. Before I got on trt my levels were 371 now I have them around any 600 to 1500 and I feel good. Just stay on top of my blood work...
@hanktharipper10: Thank you for the feedback. I wish you continued success with TRT! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Great explanation! I can't understand why there are any dislikes... I'm using this exact regimen at a different facility and it was explained to me just like this - actually this might be a little better having the visuals! Thank you!
@Jim Provenzale: Thank you so much, your comments are truly appreciated! Best of luck with your therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Augie - another PA-C here... thank you for your excellent work on this presentation. I am seeking as much insight into TRT before I commit to starting and found your vid helpful. As an aside, great to see you propelling our profession farther with practice ownership/leadership.
@cap'n sean: Thank you for the feedback! I am glad you found it useful. Practice ownership has definitely broadened my scope in health care. I wish you the best on TRT! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Awsome explanation of TRT, I’m Sure your knowledge on this subject and breakdown in this video will help men understand this treatment and not to be afraid or worried about treatment.
This is about the best explanation of the hormonal pathophysiology on You Tube. I have questions though: 1. After commencing testosterone replacement therapy, is the body's ability to produce its own testosterone forever effected? 2. Is it feasible to have short bursts of TRT to regain sex drive without effecting the body's own production permanently? 3. If I take a Estradiol inhibitor, would this be effective in raising my Testosterone levels?
@Jaime Locke: Thank you for the positive feedback, I truly appreciate it! As for your questions... 1. There is no significant research that I am aware of that answers this question through formal medical study. That being said, I have not seen a case where TRT has forever compromised the body's ability to produce testosterone naturally, at its baseline level. Now, once stopping TRT abruptly, it will take some time to return to that pre-treatment, baseline production. 2. Yes, it is feasible to use TRT in this way without permanently affecting natural production, but I would not advise it. Keep in mind, with TRT (done the right way) there is no need to "cycle" on and off of therapy. And, your body prefers homeostasis, as opposed to the stop-and-go traffic type strain placed on it with the hormonal roller coaster of cycling. 3. Yes and no. Technically, it would keep your testosterone levels from being lowered, rather than directly increasing them. However, I have found that this effect is minimal to non-discernible both symptomatically and biochemically. I would expect that any positive change here would have less to do with a minimally higher testosterone level and more to do with the fact that there is a stronger androgenic effect when there is less, but normal, estrogenic opposition. I hope that answers your questions, thank you for reaching out! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
This is still without question the best tutorial on Testosterone on the web. I'd like to request an update with the addition of information about Prolactin and Pituitary issues like Prolactinemia . I am a 67 year old male with a T level of 2-3nmol/L due to a macro prolactinoma . I have been in a dilemma about whether to accept treatment or not for the past 3 years. I am not inclined to take Cabergolin due to both the unpleasant side effects and the risk of rhinorrhea (leaking of CSF cerebral spinal fluid . I have been offered oral testosterone by my Endocrinologist but am concerned that T treatment might exacerbate my current symptoms as I also suffer with T2 Diabetes, Hypothyroidism, NAFL, HypoGonadism low GFH etc. I am managing my T2 and other chronic conditions with a Keto diet
@John Cooper: Thank you very much for your feedback, kind remarks, and suggestions. I will add hyperprolactinemia to the list of future video topics. Pituitary adenomas can induce hypersecretion of pituitary hormones. The most common of these would be a prolactin secreting tumor, but they can also secrete growth hormone (hGH), adrenocorticotropic hormone (ACTH), etc. As the benign, non-malignant tumor grows, it can destroy pituitary function globally, leading to hypopituitarism, and under-functioning or non-functioning pituitary gland. This is why so many systems can be affected, as the pituitary gland is responsible for the secretion of FSH, LH, ACTH, TSH, Prolactin, hGH, MSH, ADH, and Oxytocin. This is also was even small tumors, microadenomas, are followed by neurology/neurosurgery to insure that the potential impact to the pituitary gland and surrounding structures is appropriately monitored. The treatment of the specific adenoma depends on its type, but dopamine agonists, drugs that activate dopaminergic receptors, are the first line treatment for prolcatinomas. I don't manage pituitary tumors, but do have some patients who have a known history of them. Without controlling prolactin levels, the benefit of TRT will likely be reduced, and may skew the risk/benefit ratio in a way that makes TRT an undesirable treatment. CSF rhinorrhea (rhinorrhea alone just being a runny nose) is definitely a serious complication. However, it is also an uncommon one, and is seen with invasive, large adenomas. More common adverse reactions include nausea, headache, dizziness, constipation, asthenia, fatigue, abdominal pain, somnolence, and hypotension, among others. Managing pathology without medication is almost always preferable, but I would just urge you to keep in mind the expected goal of treatment for each approach. I typically recommend the fewest interventions and use of the lowest effective dosing. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed Dear Augie . I am astonished by your comprehensive and detailed response. Thank you so much for your advice and for giving so much of your valuable time to replying to my questions and comments. Since diagnosis of T2 Diabetes and Hypoprolactinemia in 2016 I have carried out much personal research and have received advice from a Consultant Endocrinologist however I have been questioning the advice I have received regarding taking Cabergolin and TRT treatment. Your warnings and advice regarding medication echo my own thoughts on the matter and my feeling is that at the moment as my macroprolactinoma is not causing me any significant health issues and has not changed in size in the past 3 years I will continue to defer any medical intervention . I do not see the potential benefits of medication being worth the potential risk of likely unpleasant side effects . When one has endured decades of ill health due to Hypothyroidism and undiagnosed Prolactinemia and T2 Diabetes ,... any period where one feels relatively well without migraine,headaches, nausea, fatigue, abdominal pain, constipation, brain fog , etc is priceless and very difficult to justify putting at risk by taking medication.
@@johncooper7242, you are most welcome. Issues like these are often complicated, and ultimately, your comfort level with treatment options is all that matters. Even with straightforward TRT, I encourage patients to make sure that the symptoms they suffer with warrant a treatment, that like any other medical intervention, carries potential risk and some level of burden of therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Very informative and actually useful videos! I would have liked to hear "why" its a lifelong commitment and what would happen if someone stopped TRT after 6 months to a year. Maybe another video?
@Big John: Thank you for the feedback, I will add your suggestion to the queue! For now, let me give you a quick answer. The main reason TRT is considered a lifelong commitment is because, in the vast majority of cases, the symptoms of hypogonadism are also lifelong...and progressively so. The more precise characterization would be: TRT need only be continued for as long as you want relief from your symptoms of testosterone deficiency. Additionally, natural production is suppressed while on TRT. This is why it is so important to only intervene in broken systems. TRT should be used for those patients who are deficient and symptomatic. In this scenario, suppression of natural production carries little downside, because level are already so low that they have become disruptive to one's life. Now, within a very short time, pituitary control of testicular production is suppressed by the use of testosterone. So, when TRT is abruptly discontinued after six months to a year as in your proposed scenario, you don't fall to your baseline (pre-treatment) production; you fall further. The rebound to your baseline will take weeks, to even months. Also keep in mind, if you are on therapy for a longer period of time, say 10 years, your baseline would have deteriorated anyway. In this case, your "rebound" will also be limited. Ultimately, TRT is not a lifelong commitment, because you can always choose to live with the symptoms of Low T or with whatever improvement you can achieve through entirely natural means. We don't yet have a reliably safe way to make your body make more testosterone. Perhaps peptide research will change that, but I don't consider this a reliably safe way to treat Low T at its current state of research and advancement. Therefore, as long as you want relief from symptoms of hypogonadism, that's how long you will need to be on TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
I took it for 18 months. The only issue I had when I stopped was my depression levels rising. I had zero issues while taking T. I'd love to explain why I'm not taking it now, but it would take a while. Hopefully I can start again soon.
Does the body ever resume normal level production of Testosterone on its own after using TRT or would I have to take TRT forever once I begin treatment? This was very educational by the way. Thank you for making this video!
@Sabino Humbane: Thank you for the feedback! What I tell patients with this question is that I have seen no evidence that suggests that you will not transition back to your pre-treatment levels if you stop TRT. The only caveat there is that your baseline production will naturally decline over time. So, if you are on treatment for 10 years of more, I would not expect that you would be at exactly the same levels of production after your natural production rebounds. Essentially, I assume your body would more likely settle into whatever your natural production would have been at that time. The hypothalamic/pituitary suppression has not shown to be permanent in my experience. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Hey TCT! I know this video is over 3 yrs old but I have been researching TRT the past couple of months! A little background of me, I'm a retired Army veteran, 53 yrs old and I have been seeing a Urologist for about 2 years about low T. So for the last 2 yrs, once a month I have been going in Dr office and been getting 1 injection of 200mg cypionate, 400mg. Now, been doing this for 2 yrs. Feel good probably the 1st week after shot then after that just start going down again. Around 1st week of Mar I was due for blood work, had that done then I got a message that my labs was on a my patients portal so I pulled them up and noticed that my Total Testosterone was 230.8, with the range being 300.0-800.0. So I contacted the nurse and she told me the reason it was low that I was due for a shot that month. But, I also ask her was a estrogen level taken for my labs and she said no so I requested that, but haven't gone in to do that. But fast forward to today. I found a place that specializes in TRT, it is called Hormone Therapuetics out of Dallas, Texas. I received my shipment to day but haven't been home to look at it. I've also been doing research on HCG and there's a lot of people that are taking trt and hcg therapy. If I'm on TRT shouldn't I be taking HCG also? I talked to another consultant from Prime Body and he said that they put their patients on TRT and HCG Therapy. So I emailed my consultant and ask about HCG, he said that they needed to see how I'm going to react to taking 1 shot every 7 days of 200mg cypionate, then If we need to we could add it. Whats your thought on taking TRT with or without HCG?
@Kelly Walker: Thank you for the feedback! I appreciate you taking the time to comment, and I am glad you found the content helpful. Merry Christmas! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Great vid. Wonderful to see support from a company. Every thing very clear and concise. After having done a lot of investigation on the net, your summary and teaching underlines so much in a short vid. Thank you so much.
@Jaang29: You are most welcome, and thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Lazaro Monteagudo: Thank you for the feedback, I am glad you found the information useful! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I listen to testosterone replacement doctors say TRT is safe and urologists say it’s unsafe. Being almost 60 my prostate is enlarged like everyone else my age and my PSA is elevated (I don’t recall the numbers). I got TRT and the PSA jumped up. I had another test for a more sensitive PSA and it also showed elevated and the urologist said my numbers in that test indicated a 25% likelihood that I had cancer. I got a 12 point biopsy and it was clean but the urologist said my numbers made it very unsafe to ever get TRT again.
@crosisofborg5524: “While up to a third of men who are placed on testosterone therapy do not meet the criteria to be diagnosed as testosterone deficient,2, 3 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.” (Mulhall JP, Trost LW, Brannigan RE, et al.: Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018; 200: 423) The above quote is from the American Urological Association’s (the national association for urologists in the US) position paper on the management of TRT. Many urologists treat testosterone deficiency, and in fact, there is a subspecialty of andrology within the field of urology hyperfocused on male hormonal issues. Our diagnosis and ongoing evaluation standards are more stringent than those advocated by the AUA and The Endocrine Society. We recommend treatment for roughly only 60% of the new patients we evaluate, and we never put “the bottom line” ahead of patient safety and sound medical ethics. A healthy amount of skepticism is good, but one must be careful not to let it persuade you into a hasty generalization fallacy. Our patients are well-informed and undergo a thorough introduction to the pros and cons, risks and benefits, and the rationale behind how we approach TRT. If, after that sort of detailed study, a patient is not comfortable with the associated risks, even free therapy would be wrong for them. Guiding values and foundational philosophies matter more than whether or not an advocate of a given treatment is also a practitioner of the same. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Thank you for the video. I have been researching for a while now and have read about all the elements that you mentioned but you put them together so that they can be understood the pro's and con's of each step. Very informative. Much appreciated. I only wish that we had similar clinics to yours here in the UK.
@crocodilebelfast: Thank you kindly for the feedback! I wish you the best of luck in finding a great TRT provider close to home! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@Testosterone Centers of Texas I'm 25 and just found out today I have low testosterone (133ng/dl) And it explains alot. I'm constantly depressed, anxious, have trouble sleeping, and I'm overweight. My doctor said it's really low and we are hopefully starting TRT next week. Can anyone fill me in on what I should expect? Like side effects, pros & cons, and how long I will be doing this? I'm excited and I hope this is the beginning of a new chapter in my life. Is there anyone out there my age who is suffering from this? I'm a former drug user so that may be a big reason for the low t. I'm currently in treatment for drug abuse and I take suboxone for opioid use disorder. I'm scared to take the testosterone. Also I had one doctor basically tell me I'll be miserable later in life because I won't be able to make my own testosterone if for some reason I dont have access to more. He said I'm too young and said it's because I'm fat and a former drug addict. But I feel these symptoms even when not using drugs for very long periods of time. Sorry for rambling. I eagerly await your response. .
I am glad you are on your way to being treated. The advice you were given about being too young, that you would be miserable later in life, and that it would destroy your ability to produce naturally is categorically wrong. Go through all of my videos and then head to our blog at tctmed.com. You will find all the information you are looking for there. Suboxone is one of the reasons you are producing so little testosterone right now, but it may not be the only reason. Recent studies show that many younger men (20-39) with normal BMIs and therefore not overweight and without risk factors such as opioid use are experiencing hypogonadism at alarming rates. Testosterone production is on the decline, almost across the board. Yes, behaviors influence it, but not as much as genetic and environmental factors. You may be able to rebound to normal production once you're off Suboxone, but it is also very plausible that you will need TRT life-long to avoid those symptoms. Your level crosses a threshold into the range of "severe" hypogonadism. It certainly appears that TRT is right for you; just make sure that you are managed by an experienced provider. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Unless you have a doc NOT paying attention to your blood work, your hemo goes too high for too long and you get knocked down with systolic congestive heart failure.. yes it CAN happen if you are not vigilant about your treatment, do NOT fully trust your doc.
@Teufelhund Odinic Rite: Agreed! With the PROPER management of potential side effects, TRT can be both effective AND low risk! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@snailnslug3 im 57 at 56 3x bypass 6 yrs cycles differnt compounds im currently on blood thinners and cholesterol meds blood pressure meds could be combination steriods and gentics but still want to do trt
@@TCTmed I have been going to low t center for low t treatment. They checked my blood when I first started and I have currently done 6 treatments without doing blood work. Should I be concerned?
@Russ Dicono: Thank you for the feedback, I am very glad you liked it! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
What other hormones or natural functions will be turned off or reduced by exogenous testosterone? I have heard that progesterone and DHEA will be lowered, which could have effects on memory Etc
@W H: Progesterone and DHEA are both precursors to testosterone. Their levels don't change directly due to testosterone administration, but there can be variance. Via the Cytochrome P450 system, cholesterol is converted to pregnenolone, and both progesterone and DHEA are derived from this steroid. Vitamin D levels can affect progesterone levels, and progesterone can impact thyroid and metabolic functions. However, the most notable effects of progesterone deficiency are noticed further down the cascade. So, low progesterone may reduce your quality of sleep or your fat metabolism directly, or it may change due to the downstream drop in testosterone levels or resultant estrogen dominance. I have not found the need to treat progesterone deficiency in males when the other more impactful hormones are appropriately balanced. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@carlorocky: That depends; while 1500 ng/dL is definitely elevated, many factors are considered. If your blood was drawn near the peak (~48 hours after injection), that would obviously lead to higher readings. Also, if your SHBG is elevated, you could still have a normal calculated free testosterone, which is more indicative of what is influencing your body. Generally speaking, though, if you are at 1500, you would likely be able to reduce your dose and still have an optimal response. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
What a great video, one of the best I have seen. If I may, I would like to ask if you ever encountered an experience like the one I had. About 6 years ago my then Md. suggested I try TRT, due to my low free test. It was below the normal range. I was taking 1/4 of a Proscar pill every day as well, and my sex-drive was to the moon with the extra test I was getting. After 3-4 months, asking for a refill of Proscar, the Md. suggested I take the whole 5mg pill instead of just a 1/4, so I did. My sex-drive totally disappeared after that, even though I was still getting the shots for several more months. Then my hair started to shed, so I quit the treatment. Sex drive never came back, and I was 55 at the time.
@ibberman: Thank you for the kind feedback. I have not seen a case like this in my own practice, largely because I do not use finasteride in that manner, but I have come across cases similar to yours. It prompted me to do some digging and I found the following website: www.pfsfoundation.org/ It certainly seems plausible that you issues may have something to do specifically with your use of finasteride. The type of response you describe is highly abnormal in my opinion. I truly hope this helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Thank you for the link, I really appreciate it. I was taking the 1/4 proscar for the hair and had never had side effects before he suggested taking the whole pill. Another problem I found was his inability to get my test levels right. My total level was 450, and by giving me 1cc every 10 days to get my low free test into the normal range, the total test levels went to 2000+. Thank you again for sharing your knowledge.
I've heard traumatic brain injury can cause problems with the pituitary and hypothalamus. I believe this is my root cause of my low t. I hit my head on the dashboard in a car accident at 7 years old in the 80's when TBI wasn't even known about I think so they didn't see anything but my broken jaw.
@77ponch77: Injury to the pituitary gland or the infindibular stalk from which it is suspended is a possible cause of secondary hypogonadism, as it can keep the pituitary from commanding testicular activity as it would normally. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
I'm on TRT 200ml every 3 weeks. Just a month and a half in. Noticing some gyno and fluid retention. Would the anastrozole counter act that and get rid of the gyno and fluid retention? Outstanding presentation doc. 🤙🏻
@Mike Philpot: Thank you for the kind feedback! The role of anastrozole in TRT is to limit the overproduction of estradiol via altering the aromatization of testosterone. So, it can decrease the stimulation of breast tissue by keeping estradiol normal, but misuse may actually contribute to gynecomastia. Maintaining a normal estradiol level is also helpful for mitigating fluid retention. The bad news here is that once you have palpable gyno, your breast tissue is highly unlikely, if not altogether unable, to return to its "dormant" pre-stimulation state. To a degree, it will be irreversible. Think of it as male breast tissue, never being stimulated by abnormal estradiol influence, staying unnoticed and undetectable. However, once it grows, say to a six on a scale from one to ten, the now-disturbed tissue will not retreat back to zero even when you remove the offending stimulants. This is why great care needs to be taken in the management of TRT. If gynecomastia is significant enough, only surgery can improve upon the hypertrophic changes. And, even with such an invasive response, it can remain likely to recur. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I have huge respect you doctor , your information helping millions of people around the world ,, great job 😆 I have low T symptoms but testerstone is normal so my doctor advised TRT maybe in future but not yet . I need a hair transplant now and my question is : Shall I wait or TRT and do the hair transplant or shall I wait ?? If my future is TRT what will happen to my hairs ?? Thanks in advance
@kadir khan: Thank you for the kind words! Check out this link (tctmed.com/genetics-of-male-pattern-baldness/) for the complete answer to your question. Ultimately, whether you will lose hair due to DHT has little to do with your hormone levels and much to do with your genetics. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Seems like the one thing we should have done for our 16 year old children is have a full work up done on all there hormone levels, this way they have the numbers they need to stay young there whole life. Or repair their counts when they get old as stale bread in the head.
@ginger bread: Great point! Even a little more sobering, however, is the trend of younger and younger people suffering with confirmed testosterone deficiency. The standard itself (a healthy late teen to late twenties patient) is under the same assault. Studies show a progressive decline in testosterone production decade over decade. This isn't just an old person's problem. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Do you believe that natural production of T could be increased with heavy lifting in the gym, maintaining a healthy body fat % and eating a good diet? Also cutting out toxic substances like cigarettes, drugs and alcohol? Great presentation by the way, the best I’ve seen. It was great to watch.
@Vivid Joey: I absolutely DO believe that. The question becomes, will such efforts increase testosterone levels enough to control symptoms and improve health in the desired manner. That being said, I always urge patients to do everything they can naturally, before resorting to TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed once i started gym my test fell even more so they got me on trt 200 wk test e. That castor oil sucks... but where i come from in order to find smoother transporter oils u have go go underground... What can i do to lessen the injection pain.
@@moralrevulsionLive Proper injection techniques should keep it from being anything more that a small, short-lived annoyance. Whether cottonseed oil, grape seed oil, or any other sterile base, I have not seen consistent complaints when injections are given carefully and properly. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed you sir is awesome. I told a senior sister today as it was my trt 200 day. I feel the pimp but nowhere near like last 2 times. I didnt even feel it the time she inject me. And i starting to feel the effectd after 3 weeks x200 test e weekly. That alpha male flare is back
@medicineandbrasilianjiujit8511: Thank you for feedback. I am glad you found our content helpful! I also train in Brazilian Jiu Jitsu, and I love that your channel is talking about this!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I stopped trt because of side effects, I told my doctor he didn't really care,I have learned to live without this substance for my entire life so it's not a problem at all
Hello there ...Great video btw ...I had my test levels done they have come back as 15.2 nmol ... could you advise if this is sufficiently low enough to start a low dose trt course every other day ... many thanks 😊
@Lee Harley: Thank you for the feedback! Your symptoms and medical history play a profound role in decision-making about TRT. Keep in mind that there is more to account for than just the levels. That said, a total testosterone level of 15.2 nmol/L corresponds with a level of 439 ng/dL on the reference ranges mentioned in the videos. This is on the lower end of normal for most reference ranges, but still normal. Best regards, Augustine Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Great Video on TRT. Very detailed and very well presented. My question is if a Vasectomy can in any way hinder the TRT treatment plan and or cause any kind on problems once they are started on TRT. Just a general question and one many men reading this would like to know an answer to. Thank you for your time. And keep up the great work
@Castulo S: Thank you very much for the feedback! I have seen nothing in the literature or in clinical practice that has suggested that therapy needs to be amended for patients who have had a vasectomy remotely or recently. I have many patients who have had this procedure and some who have had it done while already on TRT, and they do very well on therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
You are very welcome, I am looking forward to getting more content out there soon. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Is there a way to balance testosterone and HCL so it stays at about 50, to avoid clots while getting as much of testosterone as that allows? Thanks, wonderful presentation.
@johnmontana18: Thank you for the feedback! The risk of "cardiovascular events" and/or clotting due solely to TRT has been largely overstated. Two studies from 2013 and 2014 that received much attention have since been redacted, amended, and essentially debunked. Testosterone will cause most people to have some increase in hematocrit (HCT) levels, but this increase is typically minimal. People with difficulty maintaining a normal HCT level typically have other underlying concomitant conditions such as obstructive sleep apnea (OSA), polycythemia vera, or hemochromatosis. By far, OSA is the usual suspect. This includes disordered breathing that may not actually progress to frank apneic episodes. So, if you remove OSA from the equation, HCT levels are not a rate-limiting step in optimizing testosterone levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed Thank you for the response. My HCT was 56.2 at the time I had PE. My PCP blames it on the HCT and says it should be kept below 55. I live at 7000 feet, if that affects HCT. I had to stop T but will restart when permitted because I am very low T without it.
@@johnmontana18 You're welcome. Normal reference ranges are, to a degree, geographically specific. My elevation in North Texas is less than 700 feet above sea level. And, yes, an elevation of 7000 ft. would impact what is considered normal in your area. Still, even if your HCT was to blame, the portion of an elevated HCT due to the use of testosterone is minimal. If you haven't already, consider seeing a cardiologist and hematologist. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
2 Doctors told me there are definitely pros & cons on TRT. You can get heart problems from thickened blood and you can go bald! These are Major side effects for sure!! I need TRT but cannot risk my life for it. Plus it’s something u need to stay on for life they said. Once u get off TRT, your test levels will be much lower than when u started. Can also cause gynomastia (women like breasts).
@Jeff Swope: I would encourage you to look past all bias; mine, theirs, perhaps any you may have developed over time. If you look for medical studies to support the claim that TRT causes heart problems, you will have to go back to 2013 and 2014 to find any substantial allegation in that regard. The first was done by a resident physician in the Dallas area who mined VA data to identify people who already had heart conditions that were "on TRT." Some of these people she tallied never actually received testosterone, many never made a follow-up appointment, and none of them were closely monitored. The study was supposed to be on only men, but women were accidentally included. Using an anomalous statistical model, the study authors counted each "cardiovascular event" as more than one event, purposefully. The study was published in JAMA and revised several times over due to its many flaws. The second study, from 2014, was from an online journal, PLOS ONE. It was also deeply flawed and was a retrospective study. The drug sildenafil (Viagra) is used for erectile dysfunction but is also used to reduce the workload for the heart by reducing pressure in the vessels the heart pumps blood to and from the lungs through. Despite this cardioprotective effect, it was used as the medication of the "control" group of individuals who, like in the first study, also had a history of cardiovascular events. Look at the studies from the last decade, and you will see that TRT has been shown to improve cardiac health. Testosterone can make you make more red blood cells by suppressing hepcidin, but if you aren't a smoker, don't have untreated sleep apnea (common and very treatable), polycythemia vera (rare), or hemochromatosis (also rare), the likelihood of you ever having an above-normal blood thickness (hematocrit) solely because of well-managed TRT is very low. You would have to have a significantly elevated, even neglected, hematocrit for it to be high enough to actually cause a "heart problem." I've never seen such a state develop in any patient under the care of our practice since its inception in 2013 or the 2 years before that when my fellow owners and I were working with another company. We administer more than 5,000 injections monthly. Check out the links below. Yes, TRT could make you bald -- but only if you were genetically programmed to go bald already. Theoretically, if you "would" have gone bald with normal or optimized T levels but your testosterone production drops earlier and harder than it should have, that lower T production could save you from balding, and starting TRT could pull the trigger of the gun that nature loaded. However, keep in mind that the trade-off is all the symptoms of Low T vs. an untouched head of hair. The claim that you must stay on it for life is wrong. However, no provider would recommend a patient who doesn't produce enough insulin or thyroid hormone to stop taking that hormone. Your natural production is suppressed while on therapy and will likely remain low for several weeks as you rebound to your baseline, should you stop. If you were on TRT for 3 months, your baseline would not have changed much, if at all. If you were on TRT for ten years and then stopped, your new baseline would be commensurate with what it would have been had you never started TRT. You can stop any time, but if you want your symptoms treated, yes, you need to stay on therapy to experience therapy benefits. Gynecomastia can occur, but this happens in a high-estrogen or "estrogen dominant" state. We monitor and maintain normal estrogen levels for our patients, so while this is a risk, we don't see this develop in well-managed care settings. Until a provider has seen the enormous benefit that properly managed TRT offers, until they realize that it can profoundly improve the life in their patients' years, they will be inclined to inflate and overestimate the potential risks. Every medical intervention comes with risks, but providers are prescribing antidepressants and a host of other treatment options for symptoms consistent with Low T, and never bat an eye at the laundry list of risks and side effects associated with those "mainstream" therapies. Scrutiny, temperance, and discernment should always be employed when evaluating whether a treatment is right for you, but it appears that you have been lead to believe that you have to choose TRT or death. That assessment doesn't hold up against the evidence. tctmed.com/trt-heart-attack/ tctmed.com/trt-cardiovascular-disease/ tctmed.com/trt-blood-clots/ Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner
I'm a little confused by this video. The title says "why you shouldn't be worried about side effects", then the last side effect... in my opinion, probably the scariest of all of them...low fertility and inhibited ability to father children, he says there's no reliable study that has shown that hcg can keep your sperm levels normal. Basically...saying if you go on TRT, that yes you will have reduced fertility and something you should be aware of, and hcg is not guaranteed to work and has no real studies behind it. I'm not supposed to be worried with this side effect?
@Eugene Nayvelt: How this affects you depends primarily on your stage of life, I suppose. Keep in mind that the suppression of fertility is only temporary. I have many patients, who want to maintain fertility, that are on testosterone and hCG concurrently. More specifically, I took this same approach and my wife and I had zero difficulty achieving her third pregnancy, and my third is now about to turn 4. Furthermore, I have a gentleman who had low sperm counts and motility prior to TRT, and hCG monotherapy was not addressing his symptoms. After length discussion with he and his wife, we decided on concurrent therapy. At his next semen analysis, his counts were slightly lower, but his motility was significantly improved. They conceived shortly after. Now, I do not manage the fertility side of things, and these are bits of anecdotal information only. However, I feel very confident in placing patients who wish to maintain fertility on testosterone with hCG concurrently. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Great videos , thanks Latest blood test , Total Test 234 Free Test 216 Pmol /L SHBG 15 Nmol /L FSH 7.5 U/L LH 3.0 UL Labs say Free Test is in ( range ) so no TRT Have plenty symptoms , what's your valuable opinion , Thanking you in advance
@Lex paterson: Thank you for the positive feedback! I had to do some conversions to the units of measure I am accustomed to working with, but I show that a calculated free testosterone of less than 300 Pmol/L is low. The criteria I use for diagnosis is a total testosterone OR a free testosterone that is low on two separate occasions, before 10 AM in the morning, confirms the presence of hypogonadism in a symptomatic patient. Based on your levels and stated symptoms, you may want to seek a second opinion. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Founding Partner
Is an aromatase inhibitor necessary if the dose is normal? My reasoning is ... If you are giving an aging male only the levels of a Genetically gifted 18 or 25 year old, wouldn't the body keep the estrogen levels exactly where it should be? Also, about blood thickening....or balding with too much dht or iron absorption increasing...wouldn't all this be out of question if the dose is kept natural...also what would be the dose to have a man at a genetically gifted 25 year old's levels of testosterone .
@Varun Kamal: This is a common question we get. Unfortunately, even when normal levels are targeted, the use of an exogenous hormone (one that is not originally made by the body) will elicit changes that would not have happened in the setting of natural production, even to the exact same level. Increased iron absorption is what leads to "blood thickening" or an increased hematocrit, and is linked to the effect of exogenous testosterone on hepcidin. Balding occurs in those who are genetically predisposed to it, and not because DHT goes too high specifically. However, DHT is what "pulls the trigger" of the genetically "loaded gun". So, if testosterone levels are low, DHT will be relatively low, and any increase in testosterone will lead to an increase in DHT. Even just normalizing DHT is someone who is genetically predestined to experience balding can accelerate hair loss. Dosing is not cookie-cutter, so there is no single perfect dose that would recreate the internal environment of a genetically gifted 25 year old, and I fully expect any patient targeting high-normal levels to have at least some degree of side effects. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@@TCTmed thank you so much for answering.... Do you have reason to believe that this is due to a weekly once shot peaking and lowering through the week in spite of a slow acting cypionate ester.... Unlike endogenous hormone which is released multiple times a day.... Without peaking unnaturally
@@varunkamal91: That undoubtedly has some impact, but it doesn't explain all of it. That, of course, is largely dependent on how high the peak is and where the trough is maintained. I have many patients who have requested twice weekly injections, and those who have tried it have not exhibited a 50% decrease in side effects. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
Fantastic explainer, Dr. Galindo. Much appreciated. Personally, while my testosterone levels are roughly 11 times lower than normal for my age (I'm 37), my spermatozoa count is quite high - about 4 times of what would be considered normal, with motility being double the minimum normal levels. I want to father multiple children, so that's the aspect that I worry about the most. Considering the way in which the chain reaction leading to the production of both testosterone and sperm was explained here, I do wonder if, given the huge disparity between my testosterone deficiency and my sperm production abundance, TRT would likely lead to lower-than-now but still normal levels of fertility overall. I fully intend to seek an experienced medical opinion on the matter before making any decisions, but it certainly seems like the most logical outcome, given my particular test results. Best wishes from Romania.
@DarkVeghetta: Thank you for your reply and feedback! Fertility can be fickle. It could be that with robust sperm production and motility, you may be somewhat protected from severe TRT-related infertility. Still, you could potentially find yourself exquisitely sensitive to exogenous testosterone, too. Make sure to explore the options of sperm banking and the use of supplemental medication like hCG to preserve fertility should you start TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Great information. Thank you. I’m naturally ripped now and my veins pop up. Some people where I work out have been asking me if I’m doing steroids or trt but it’s all diet and work outs. Thinking what would happen if I try it
@gozitan5: You're most welcome! I am always glad to see these videos reaching globally! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
I wonder how this treatment could potentially affect men with supernumerary nipples (given the estrogen changes and due to the increase in probability of developing breast cancer of this group). We need to also consider a family history of breast cancer as well.
@Orty Rod: Correct! Noting the presence of a family history of breast cancer, particularly BRCA+ family history, is important to assess when contemplating TRT. Not all patients with supernumerary nipples have associated breast tissue, but risk stratification may differ in those cases. Maintaining normal estradiol levels is always an important piece of therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I'm only in my 3rd injection, my highest blood test came in at 324 and 7.7 free. I'm 30 years old, my provider didn't explain if that's extremely low or if I'm just on the low end of the spectrum
@White Jodeci: For most reference laboratories, your total testosterone would be considered to be "low-normal." However, because of your age, I would consider this a more marked deficiency. If the free testosterone level you provided is a calculated free testosterone (www.issam.ch/freetesto.htm), then I would characterize it as frankly low. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Testosterone Centers of Texas TRT LOWERED my blood pressure into the normal range. Had anemia coz low T so heart needed to work harder. I'm so happy now
@T Man05: Thank you for the question, I am glad you like the video! Due to its troublesome side effect profile, I do not consider clomiphene (Clomid) an option for treatment in my practice. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
I’d like to know if someone doesn’t suffer from low test, but wants to cycle trt in order to maximise his progression inside the gym. Are the fertility side effects limited? So on for 6 -8 weeks then off for 6 - 8 weeks ?
@S C: All the same side effects would be in play. When you cycle to boost normal levels in a TRT-related asymptomatic patient, that wouldn't be considered TRT. So, explicitly gearing testosterone to bolster anabolic gains would create a more deleterious environment than we seek to maintain with TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Brad Phuck: Great question! Unfortunately, no exogenous hormone or biochemical is going to be able to be introduced to the body and still have all the EXACT same effects as it would if it is produced naturally, through its proper pathway. The balance created by negative feeback loops is delicate and is altered once any part of it is circumvented. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
What a wonderful and informative video; thank you for taking to time to produce this! I'm currently on TRT/HCG, and I would like to get your opinion on my regimen. I recently had my labs done (the day prior to my injection) to include a lipid panel: 1) my T is at 1448 ng/dL, my free T is at 29.5 pg/mL and E2 is 37.5 pg/mL. 2) all my other labs are within normal range, and I have no acne or other negative side effects. Do you believe I should reduce my dosage, because I currently feel fine. Thank you!
+Pendejo: Thank you for the positive feedback! A couple of caveats before I comment: I have to make some assumptions based on what the reference ranges are for these labs, and I am assuming that the free T value is a calculated free T and not a direct/analog free T. That being said, your values definitely see high for a trough level and while you might feel well now, consider that these labs may represent the front side of a building peak. So, you could be exposing yourself to more and more risk going forward, and I don't see evidence that your hematocrit is being monitored. Make sure your provider is keeping up with that as well!
Testosterone Centers of Texas Thank you for taking the time to evaluate and respond to my question. BTW, my hemoglobin is 15.3 g/dL and my hematocrit is 44.1%. I've been on TRT just under a year, how often do you recommend I gets labs done?
@sneekolas: Thank you! I am glad you found it useful. I will be working on new content soon, so please stay on the lookout! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@sahil sharma: You are most welcome! Costs vary widely, but I can tell you that in our practice, insurance often reduces costs considerably. Our telemedicine services are priced at $200 per month, plus lab fees. Unfortunately, I cannot give out dosing recommendations in this format. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@eyescryont: Thank you for the feedback! I am glad you found the information useful!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
I just started trt last week. Testosterone level was 276 and they only prescribed me 100ml every 2 weeks. Doesn't seem like near enough considering everyone I know that's on trt takes more than twice that amount. (I'm 6'5" 287lbs)
@Adam Thomas: I am glad to hear you started therapy, but almost undoubtedly, that dose will not improve symptoms of testosterone deficiency. Dosing isn't really weight-based, but there can be a great deal of variance in the speed with which people break down the medication. I have some taller, heavier patients on lower doses than smaller ones, with both achieving the same level of optimization. I believe weekly dosing is the best overall method. That said, I would advise you to not take it upon yourself to re-educate the provider you are currently with. You should seek out a practice that is better equipped to safely help you. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
By taking HCG won't your body continue to produce testosterone even while on TRT? If HCG is treated like LH by the body then your testes would continue to produce testosterone regardless of the TRT right? So would you need a smaller dose of TRT to maintain a proper range?
@smjastrzebski: The short answer is, no. The effect of hCG on testosterone production is scant when it is dosed for reduction of fertility suppression or reversal of testicular atrophy. You need much larger, and more frequent dosing of hCG to achieve even mediocre improvement of testosterone production. Concurrent use of hCG does not significantly reduce the dosing needs for testosterone. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
@GREATTECH1: We have a wealth of material on our website, but be on the lookout for some updates coming this year! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Sinasi08: Thank you kindly for the feedback! I am glad you found the information useful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner
If someone had total Test in the 700, but high SHBG (81) and low Free T (80 pg/mL), everything else is normal including liver enzymes, LH, and estrodial, would you treat them assuming they had symptoms?
@thefinder808: We have treated patients with patterns like this. In my opinion, the calculated free testosterone value is the focal point of the laboratory evidence for the medical necessity of therapy. If there is a way to solve the SHBG dysfunction, namely isolated hyperestrogenism, then that may be the first option ahead of TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@TCTmed Thank you very much for your response. One follow-up, since my estrodial numbers are normal, I'm assuming TRT would be a valid next step at least for a 3 month trial?
I really hope ull answer my question as it was an amazing video , trust me on this ive done almost everything to cure my low trt symptoms and very carefully did a TRT with A lot of hope but dont know why even after keeping everything in check it just made my symptoms worse and i was heart broken , i have low testosterone please help me what else can i do ive reseached a lot and lot i know what to keep in check like dht, blood pressure, estrogen everything but still my trt back fired raising my anxiety and even depression low energy which were main reasons i went on trt 😢
@mancheapterunited5125: Thank you for the kind feedback! Unfortunately, some cases can get complicated. The best way to figure it out is to apply diligence to specific monitoring of symptoms, side effects, and dosing simultaneously. You may also need to have other potential issues investigated further. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Damon: Thank you for the feedback! I personally recommend hCG to be used concurrently with TRT when patients wish to protect fertility or prevent testicular atrophy. Aside from those two needs, I don't feel that hCG offers significant benefits. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Is trt safe for somebody with mild kidney damage? Such as efgr at 65? Or is there a big risk of increasing damage from the use of testosterone? Thanks for any help
@p062161r: I haven't seen any evidence of negative impacts on the renal system with properly managed TRT. Testosterone is metabolized by the liver, so improper use or abuse of the medication (particularly in the oral form) can be injuries to the hepatic system. We routinely monitor kidney and liver function in our patients and have not seen a correlation between the use of TRT and harm to the kidneys in a decade of treating low T. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@p062161r No problem at all! I know we have a handful of patients with renal insufficiency, but I do not recall treating any patients who were in frank renal failure (dialysis). Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@AlaWarteg Ketofast: That depends. It is not helpful to exogenously raise the testosterone levels of a patient whose labs indicate a deficiency, but history reveals no evidence of related symptoms. On the other hand, we routinely see total serum testosterone levels "normal" in patients with significant symptoms. This could be because other processes are causing a similar symptom pattern as hypogonadism (Low T) does. A "normal" total testosterone level often fails to support a normal calculated free testosterone level. So, if you are significantly symptomatic with a low-normal total T level but still have a low calculated free T, you may still be a candidate for therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Can pregnenolone be use instead of HCG to prevent testicular atrophy? Are injections a better method than creams for physiology? Can Calcium D-glucarate mitigate excessive estrogen instead of an AI? I've heard from another health professional that estrogen may play a major role in male pattern baldness and PSA enlargement opposed to DHT being the primary culprit.
@Gif24 GT: There are proponents of pregnenolone for the treatment of atrophy, but many of them rely on studies from the 1940s. Given that there are multiple pathways for the metabolism of PG5, it would be difficult to isolate which byproduct was actually helping, if it does at all. I prefer injections to topicals. CDG can help estradiol metabolize down to more preferable metabolites, but it is not suitable for AIs. I have not found any evidence to show that estrogen is a key factor in male pattern balding or BPH. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
Thank you, this was excellent and easy to understand. I'm 38 and have experienced low T symptoms since I was 20. My test however is in normal range of 454 total Testosterone and 75 free. Should I consider TRT?
@Apex Predator: Thank you for the feedback! Total testosterone levels can be very misleading. I exclusively use the calculated free testosterone (cFT) level, which uses an algorithmic calculation that takes your SHBG, albumin, and total testosterone levels into account. You can find the formula here: www.issam.ch/freetesto.htm. On this scale, with the reference range for your total testosterone level being roughly between 300-1000 ng/dL, a normal cFT is between 9-30 ng/dL. So, with that said, I definitely would recommend that you at least seek a second opinion. Just make sure you go to a clinic that will be honest with you about your numbers and is willing to tell you that your numbers may not be low enough to take the step of starting TRT. I have many patients who have had totals in the 400-500 range that were still suffering from below normal cFT levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
is hcg an alternative to trt due to acne and concerns over potential hairloss? or it it better to just lower the dose to 50mg to keep some in the system instead of stopping altogether?
Hello, @p! Monotherapy with hCG only for testosterone deficiency is a thing, but in my opinion, it's not at all optimal. Hair loss is directly related to your genetic predisposition for it. Limiting or avoiding testosterone may save someone who is genetically prone to male-pattern balding from loss. Still, it will be at the cost of all the symptoms of testosterone deficiency. On the other hand, if you are NOT genetically primed for balding, going on TRT will not make you bald. Acne will be stimulated by a rise in DHT, and again, will predominately affect those with a propensity for acne. I primarily prescribe hCG for one of two reasons: promoting fertility while on TRT or counteracting TRT-related testicular atrophy. I have not found it to be a good alternative to TRT altogether. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@@user-we4mr3uc7m Finasteride is very good at blocking the conversion of testosterone to DHT, but remember that there are beneficial effects of DHT that you don't want to block. Also, it can mask prostate changes by making PSA tests less reliable. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
@Marcus Vickers, peptide research may be bringing us close to this. There are drugs like clomiphene that do affect pituitary stimulation for testosterone production. Still, it also leads to stimulation of sperm production (originally a female fertility drug), and it can lead to gonadal hyperstimulation and vision disturbance. I think we will get there eventually. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner
As far as I know testosterone produce in the morning,, - I wake up every day 6 o clock in the morning and have two questions 1- is my body missing the morning sleep to produce testosterone till 10 am ?? 2 - I do exercise on empty stomach in the morning before I have breakfast - as cortisol rise in the morning am I doing any harm to me for my testosterone production?
Mr. Galindo
40 year old male who doesn’t feel like he used to. Several life changes over the past 5-7 years have occurred. Two kids and new job promotion with a lot more responsibilities has taken place in that time frame. When I tell people I feel tired, unmotivated, lethargic, etc., they respond with “that’s part of getting older…. You’re 40 now”.
A friend of mine, who’s also PA, suggested getting bloodwork done to check my testosterone levels. So I finally did. My results:
Albumin 4.7
HCT 49.1
Total T 333 ng/L
SHBG 25 nmol/L
Free T Calc 77.2 pg/mL
FSH 5
LH 7.6
The APRN says I’m within range but on the low side. I know how I feel. Been on SSRIs for the past 7 years. Based on the numbers you see, should I look into TRT as a possibility?
Thank you
@travisfletcher7334: Hello, and thank you for the question. Based on your numbers, yes. Based on your symptoms, the concomitant need for SSRIs, confirmed by your symptoms...it is ABSOLUTELY worth looking into. Your Free T Calc isn't adjusted for your actual albumin, and to convert it to the range of 9-30 ng/dL that I reference in my videos, you need to move the decimal one place to the left. So, using the website below, calculating your cFT correctly is only 7.34 ng/dL. I consider this well below normal, especially given your age.
We chalk up far too many adverse effects to "getting older." Forty-year-olds should not be dealing with Low T. Everyone knows someone with diabetes; everyone knows someone with a thyroid problem. Simply because these problems are pervasive doesn't mean that their presence is normal. That said, if you want your Low T addressed appropriately, you will probably fair better with a provider that you do not need to convince or debate in order for them to initiate treatment. Look for a provider with sound judgment, a balance of monitoring and caution, and a track record of achieving positive outcomes.
Calculate your free testosterone at www.issam.ch/freetesto.htm.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@augiegalindo thank you so much for taking the time to respond to my questions and concerns!
@@travisfletcher7334 You're welcome!
Probably one of the best lectures I've seen on the testosterone puzzle not
overly complicated and
Simple enough for the
Layman to understand
Thank you very much. 👍
@CAPTAIN CARIBE: Thank you very much for your feedback! I am glad you enjoyed it!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed Doc what about tgia i keep hearing about men going on trt after 60 and their chances of dying from a heart attack goung up by 35%. Is it true, and if so, why?
@@goldo1107 The controversy surrounding this started primarily with two separate studies. One was published in JAMA in 2013, and the other on the online journal, PLOS One in 2014. As biased as I may be, I believe both were deeply flawed. Both articles suggested, through retrospective study, that testosterone "use" (the patients were not on what I would call TRT), increased the risk of embolic (blood clot related) events like stroke and heart attacks in men that already had a history of such cardiovascular problems. The entirety of the medical literature on the subject promotes and improvement in cardiovascular health.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed Gotcha. I thought as much myself. Im sure that if the individual is being health at that age they can minimize blood clots and or the thickening of the blood. Im aure that is closely monitored by whatever TRT clinic. I just wanted to hear your opinion. I'm 39 years old. Recently went for a quaterly checkup at the doc and asked for a teatesterone check in my Bloodwork. Comes back 268 and free 6.2. If it wasnt for the fact that I dont have children yet i would go on trt right away. But my fiance and I are not ready for another 2 years. I used to weigh 430 pounds a year ago. Started lifting weights 4 days a week and 30 min of steady cardio 6 days a week. Clean lean meats diet. About 3 months ago i just stoped losing weight even tgo im eating 1900 cal a day. Been very frustrating. I noticed im not as strong as i used to be in my early 30s and 20s thought that was odd too. Ao it led me to think maybe i have very low T. I was having most of the symptoms. Especially bad enxiety that juat came out of no where in the last 7 years. Depression as well. I started looking into reasons why low T and natural ways to bring it up. I asked for a copy of my bloodwork and noticed that i had really low vitamin D levels. Like really low. So ive been taking vitamin D for the last 3 weeks and im now practicing IF. I noticed this last week that my libido has gone up very much. So i thibk its working. I started losing a few pounds as well and im sleeping better. Soon as i have kids im going on TRT. I wanna have a quality life. I just want to do it safely wirh as minimal risks as possible. Hopefully they keep doing reaearch to help minimise the risk even further.
@@goldo1107 Sounds you are evaluating things the right way! Best of luck with everything!!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
You are very welcome, and thank you for taking the time to watch and comment, Sam!
Testosterone Centers of Texas
hello and great video btw.I want to ask only one question.In the case of trt if you take aromatase inhibitors to keep estrogen low isnt a way for the fsh to keep producing?
@Stauros Sotiriou: Thank you for the feedback! Lower estradiol levels may induce "more" pituitary secretion of LH and FSH, but it doesn't completely eliminate hypothalamic/pituitary suppression. Keep in mind that hypothalamic response to estradiol is only one factor that influences GnRH effect on the release of gonadotropins, and this is further modulated by other factors. Therefore LH and FSH secretion does not necessarily respond in lock-step with GnRH secretion.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed thank you very much for your answer :)
Wow, even i could be a doctor if i had a teacher like that. Really good!
Fully agree
I love this guy. So eloquent. No fluff. Kudos.
@Lotfi Bouhedjeur: Thank you much, I appreciate the feedback! I hope the information helped. Best of luck to you!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
This guy started me on TRT at 46 years of age after giving me a full, blood test.
He’s got this entire Science of hormones completely dialed-in.
I thank him for increasing my quality of life in a big way.
Highly recommend subscribing to his channel. He’s the best. 💪🏼🙏🏼
@Kevin St Clair: Thank you so much for the kind feedback! We take pride in helping our patients to enhance their quality of life, and getting back to feeling the way they are supposed to!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Winner of a video, I have been researching "at what age do men's testosterone levels decrease?" for a while now, and I think this has helped. Have you heard people talk about - Peyoraat Rudimentary Preponderance - (Have a quick look on google cant remember the place now ) ? It is a good exclusive product for discovering how to boost testosterone levels minus the hard work. Ive heard some unbelievable things about it and my brother in law got amazing results with it.
Did you notice more energy and less testosterone
@@ashleytaylor994 can you please rephrase the question?
Lol. Fucking RIP bones if you're taking an AI
The only thing more impressive than his medical knowledge is his sterling penmanship!
Haha, thank you @Jc Knight!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
One of the best, most informative, non bs video on trt. And I've seen them all.
@Odin Aesthetic: Thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
This is the best explanation I have found on TRT at youtube. there are some other but they dont cover all essential things.
@prince prince: Thank you very much for your positive feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
I didn’t realize Jon Favreau was so smart!
@Mr. C: I tend to hear that from time to time. lol
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Penns younger brother
Life’s been tough for Happy ever since Ironman died.
hahahahha, i was like....where did i see this guy before... thanks for clearing this up ! lol
I didn’t see it till I read your comment and now it won’t go away😂
I do so wish I had found this very much earlier! I'm sure your presentation will sound a little 'heavy' for some but, anyone who is receiving TRT will find much to understand and relate to! Many thanks for broaching a difficult subject with undoubted, well-presented and a common sense approach. Many thanks!
@Delboy Trotter, I truly appreciate the feedback. From the beginning, the goal has been to be thorough and informative. There are a lot of ways to do TRT wrong, thank you for staying diligent in you research for how to do it right!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
This is the best video I have seen on trt. Very well done to you. I have done so much research on this and you know what you are talking about and can deliver it in a straightforward way.
@Andrew Sanderson: Thank you for the feedback! I am glad that you found the video to be helpful!!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I agree. I learned a lot from this video. I'll watch it again. I hope he has or makes more videos.❤
f@GREATTECH1: Thank you for the feedback! I am glad you found ithelpfull!
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
this doctor is a godlike at explaining medicine to average people
We appreciate your kind words! We're just hoping to make the information accessible to everyone! We hope it was helpful to you.
Good info. Im 38 years old and been on trt for a year now and its been grate for me. Before I started it i been losing weight i went from 210 to 190 and going to the gym. I would recommend it to any man thats older to get checked for low t. Before I got on trt my levels were 371 now I have them around any 600 to 1500 and I feel good. Just stay on top of my blood work...
@hanktharipper10: Thank you for the feedback. I wish you continued success with TRT!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@ArchiesBhanushali following
Does TRT makes men infertile?
Great explanation! I can't understand why there are any dislikes... I'm using this exact regimen at a different facility and it was explained to me just like this - actually this might be a little better having the visuals! Thank you!
@Jim Provenzale: Thank you so much, your comments are truly appreciated! Best of luck with your therapy.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
This is by far the best presentation on TRT I've come across on RUclips. Thank you for this video.
We greatly appreciate your feedback and are so glad it's helpful to you!
Augie - another PA-C here... thank you for your excellent work on this presentation. I am seeking as much insight into TRT before I commit to starting and found your vid helpful. As an aside, great to see you propelling our profession farther with practice ownership/leadership.
@cap'n sean: Thank you for the feedback! I am glad you found it useful. Practice ownership has definitely broadened my scope in health care. I wish you the best on TRT!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Surely the most informative piece of information on TRT I have found on RUclips.. Highly recommended!
Thank you for taking the time to watch, and we appreciate the feedback!
Man that was the best info I’ve heard so far. Thank you for taking the time to explain.
Thank you for watching. We really hope the information is helpful to you!
Awsome explanation of TRT, I’m
Sure your knowledge on this subject and breakdown in this video will help men understand this treatment and not to be afraid or worried about treatment.
@lidd69: Thank you for the feedback! It is truly appreciated.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Hands down THE best video on TRT on RUclips.
Thanks for taking the time to watch and comment. We're glad it was helpful.
This is about the best explanation of the hormonal pathophysiology on You Tube. I have questions though:
1. After commencing testosterone replacement therapy, is the body's ability to produce its own testosterone forever effected?
2. Is it feasible to have short bursts of TRT to regain sex drive without effecting the body's own production permanently?
3. If I take a Estradiol inhibitor, would this be effective in raising my Testosterone levels?
@Jaime Locke: Thank you for the positive feedback, I truly appreciate it! As for your questions...
1. There is no significant research that I am aware of that answers this question through formal medical study. That being said, I have not seen a case where TRT has forever compromised the body's ability to produce testosterone naturally, at its baseline level. Now, once stopping TRT abruptly, it will take some time to return to that pre-treatment, baseline production.
2. Yes, it is feasible to use TRT in this way without permanently affecting natural production, but I would not advise it. Keep in mind, with TRT (done the right way) there is no need to "cycle" on and off of therapy. And, your body prefers homeostasis, as opposed to the stop-and-go traffic type strain placed on it with the hormonal roller coaster of cycling.
3. Yes and no. Technically, it would keep your testosterone levels from being lowered, rather than directly increasing them. However, I have found that this effect is minimal to non-discernible both symptomatically and biochemically. I would expect that any positive change here would have less to do with a minimally higher testosterone level and more to do with the fact that there is a stronger androgenic effect when there is less, but normal, estrogenic opposition.
I hope that answers your questions, thank you for reaching out!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Testosterone Centers of Texas thank you. -Sam
Best explanation on this subject I have ever seen! More men need to see this video......
@Joel Mcconnell: Thank you so much for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
This is still without question the best tutorial on Testosterone on the web.
I'd like to request an update with the addition of information about Prolactin and Pituitary issues like Prolactinemia . I am a 67 year old male with a T level of 2-3nmol/L due to a macro prolactinoma .
I have been in a dilemma about whether to accept treatment or not for the past 3 years.
I am not inclined to take Cabergolin due to both the unpleasant side effects and the risk of rhinorrhea (leaking of CSF cerebral spinal fluid . I have been offered oral testosterone by my Endocrinologist but am concerned that T treatment might exacerbate my current symptoms as I also suffer with T2 Diabetes, Hypothyroidism, NAFL, HypoGonadism low GFH etc. I am managing my T2 and other chronic conditions with a Keto diet
@John Cooper: Thank you very much for your feedback, kind remarks, and suggestions. I will add hyperprolactinemia to the list of future video topics.
Pituitary adenomas can induce hypersecretion of pituitary hormones. The most common of these would be a prolactin secreting tumor, but they can also secrete growth hormone (hGH), adrenocorticotropic hormone (ACTH), etc. As the benign, non-malignant tumor grows, it can destroy pituitary function globally, leading to hypopituitarism, and under-functioning or non-functioning pituitary gland. This is why so many systems can be affected, as the pituitary gland is responsible for the secretion of FSH, LH, ACTH, TSH, Prolactin, hGH, MSH, ADH, and Oxytocin. This is also was even small tumors, microadenomas, are followed by neurology/neurosurgery to insure that the potential impact to the pituitary gland and surrounding structures is appropriately monitored.
The treatment of the specific adenoma depends on its type, but dopamine agonists, drugs that activate dopaminergic receptors, are the first line treatment for prolcatinomas. I don't manage pituitary tumors, but do have some patients who have a known history of them. Without controlling prolactin levels, the benefit of TRT will likely be reduced, and may skew the risk/benefit ratio in a way that makes TRT an undesirable treatment. CSF rhinorrhea (rhinorrhea alone just being a runny nose) is definitely a serious complication. However, it is also an uncommon one, and is seen with invasive, large adenomas. More common adverse reactions include nausea, headache, dizziness, constipation, asthenia, fatigue, abdominal pain, somnolence, and hypotension, among others. Managing pathology without medication is almost always preferable, but I would just urge you to keep in mind the expected goal of treatment for each approach. I typically recommend the fewest interventions and use of the lowest effective dosing. I hope that helps!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed Dear Augie . I am astonished by your comprehensive and detailed response. Thank you so much for your advice and for giving so much of your valuable time to replying to my questions and comments.
Since diagnosis of T2 Diabetes and Hypoprolactinemia in 2016 I have carried out much personal research and have received advice from a Consultant Endocrinologist however I have been questioning the advice I have received regarding taking Cabergolin and TRT treatment.
Your warnings and advice regarding medication echo my own thoughts on the matter and my feeling is that at the moment as my macroprolactinoma is not causing me any significant health issues and has not changed in size in the past 3 years I will continue to defer any medical intervention . I do not see the potential benefits of medication being worth the potential risk of likely unpleasant side effects .
When one has endured decades of ill health due to Hypothyroidism and undiagnosed Prolactinemia and T2 Diabetes ,... any period where one feels relatively well without migraine,headaches, nausea, fatigue, abdominal pain, constipation, brain fog , etc is priceless and very difficult to justify putting at risk by taking medication.
@@johncooper7242, you are most welcome. Issues like these are often complicated, and ultimately, your comfort level with treatment options is all that matters. Even with straightforward TRT, I encourage patients to make sure that the symptoms they suffer with warrant a treatment, that like any other medical intervention, carries potential risk and some level of burden of therapy.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Very informative and actually useful videos! I would have liked to hear "why" its a lifelong commitment and what would happen if someone stopped TRT after 6 months to a year. Maybe another video?
@Big John: Thank you for the feedback, I will add your suggestion to the queue! For now, let me give you a quick answer. The main reason TRT is considered a lifelong commitment is because, in the vast majority of cases, the symptoms of hypogonadism are also lifelong...and progressively so. The more precise characterization would be: TRT need only be continued for as long as you want relief from your symptoms of testosterone deficiency.
Additionally, natural production is suppressed while on TRT. This is why it is so important to only intervene in broken systems. TRT should be used for those patients who are deficient and symptomatic. In this scenario, suppression of natural production carries little downside, because level are already so low that they have become disruptive to one's life. Now, within a very short time, pituitary control of testicular production is suppressed by the use of testosterone. So, when TRT is abruptly discontinued after six months to a year as in your proposed scenario, you don't fall to your baseline (pre-treatment) production; you fall further. The rebound to your baseline will take weeks, to even months. Also keep in mind, if you are on therapy for a longer period of time, say 10 years, your baseline would have deteriorated anyway. In this case, your "rebound" will also be limited.
Ultimately, TRT is not a lifelong commitment, because you can always choose to live with the symptoms of Low T or with whatever improvement you can achieve through entirely natural means. We don't yet have a reliably safe way to make your body make more testosterone. Perhaps peptide research will change that, but I don't consider this a reliably safe way to treat Low T at its current state of research and advancement. Therefore, as long as you want relief from symptoms of hypogonadism, that's how long you will need to be on TRT.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
I took it for 18 months. The only issue I had when I stopped was my depression levels rising. I had zero issues while taking T.
I'd love to explain why I'm not taking it now, but it would take a while. Hopefully I can start again soon.
@@leftie75 why u stopped ?
@@leftie75 did you get back on it?
@@leftie75 hope you’re doing better now brother.
Does the body ever resume normal level production of Testosterone on its own after using TRT or would I have to take TRT forever once I begin treatment?
This was very educational by the way. Thank you for making this video!
@Sabino Humbane: Thank you for the feedback! What I tell patients with this question is that I have seen no evidence that suggests that you will not transition back to your pre-treatment levels if you stop TRT. The only caveat there is that your baseline production will naturally decline over time. So, if you are on treatment for 10 years of more, I would not expect that you would be at exactly the same levels of production after your natural production rebounds. Essentially, I assume your body would more likely settle into whatever your natural production would have been at that time. The hypothalamic/pituitary suppression has not shown to be permanent in my experience.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
A doctor told me you're not likely to stop once you start. That it's practically speaking a life-long decision.
@@mattmarkus4868 that’s why you only take it if you really need it/ having symptoms or lowt .
No, your sh!t plummets
Hey TCT! I know this video is over 3 yrs old but I have been researching TRT the past couple of months! A little background of me, I'm a retired Army veteran, 53 yrs old and I have been seeing a Urologist for about 2 years about low T. So for the last 2 yrs, once a month I have been going in Dr office and been getting 1 injection of 200mg cypionate, 400mg. Now, been doing this for 2 yrs. Feel good probably the 1st week after shot then after that just start going down again. Around 1st week of Mar I was due for blood work, had that done then I got a message that my labs was on a my patients portal so I pulled them up and noticed that my Total Testosterone was 230.8, with the range being 300.0-800.0. So I contacted the nurse and she told me the reason it was low that I was due for a shot that month. But, I also ask her was a estrogen level taken for my labs and she said no so I requested that, but haven't gone in to do that. But fast forward to today. I found a place that specializes in TRT, it is called Hormone Therapuetics out of Dallas, Texas. I received my shipment to day but haven't been home to look at it. I've also been doing research on HCG and there's a lot of people that are taking trt and hcg therapy. If I'm on TRT shouldn't I be taking HCG also? I talked to another consultant from Prime Body and he said that they put their patients on TRT and HCG Therapy. So I emailed my consultant and ask about HCG, he said that they needed to see how I'm going to react to taking 1 shot every 7 days of 200mg cypionate, then If we need to we could add it. Whats your thought on taking TRT with or without HCG?
Best video I’ve seen on this , and I’ve been watching many. Great job. Super helpful and simply described.
@Kelly Walker: Thank you for the feedback! I appreciate you taking the time to comment, and I am glad you found the content helpful. Merry Christmas!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Great vid. Wonderful to see support from a company. Every thing very clear and concise. After having done a lot of investigation on the net, your summary and teaching underlines so much in a short vid. Thank you so much.
JohnyfromAustralia, you are most welcome. We appreciate the feedback!
thank you for the simplicity sir
@Jaang29: You are most welcome, and thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I just graduated 🎓 I wish this guy was my Doc / coach ..
@Chris Muniz: Thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
You know your stuff doc, more than others.
@Lazaro Monteagudo: Thank you for the feedback, I am glad you found the information useful!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I listen to testosterone replacement doctors say TRT is safe and urologists say it’s unsafe. Being almost 60 my prostate is enlarged like everyone else my age and my PSA is elevated (I don’t recall the numbers). I got TRT and the PSA jumped up. I had another test for a more sensitive PSA and it also showed elevated and the urologist said my numbers in that test indicated a 25% likelihood that I had cancer. I got a 12 point biopsy and it was clean but the urologist said my numbers made it very unsafe to ever get TRT again.
@crosisofborg5524: “While up to a third of men who are placed on testosterone therapy do not meet the criteria to be diagnosed as testosterone deficient,2, 3 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.” (Mulhall JP, Trost LW, Brannigan RE, et al.: Evaluation and management of testosterone deficiency: AUA guideline. J Urol 2018; 200: 423)
The above quote is from the American Urological Association’s (the national association for urologists in the US) position paper on the management of TRT. Many urologists treat testosterone deficiency, and in fact, there is a subspecialty of andrology within the field of urology hyperfocused on male hormonal issues.
Our diagnosis and ongoing evaluation standards are more stringent than those advocated by the AUA and The Endocrine Society. We recommend treatment for roughly only 60% of the new patients we evaluate, and we never put “the bottom line” ahead of patient safety and sound medical ethics.
A healthy amount of skepticism is good, but one must be careful not to let it persuade you into a hasty generalization fallacy. Our patients are well-informed and undergo a thorough introduction to the pros and cons, risks and benefits, and the rationale behind how we approach TRT. If, after that sort of detailed study, a patient is not comfortable with the associated risks, even free therapy would be wrong for them.
Guiding values and foundational philosophies matter more than whether or not an advocate of a given treatment is also a practitioner of the same.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Thanks for the reply
Thank you for the video. I have been researching for a while now and have read about all the elements that you mentioned but you put them together so that they can be understood the pro's and con's of each step. Very informative. Much appreciated. I only wish that we had similar clinics to yours here in the UK.
@crocodilebelfast: Thank you kindly for the feedback! I wish you the best of luck in finding a great TRT provider close to home!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
One f the best videos on TRT.. well detailed explanation.. Thank you doctor
@Testosterone Centers of Texas I'm 25 and just found out today I have low testosterone (133ng/dl) And it explains alot. I'm constantly depressed, anxious, have trouble sleeping, and I'm overweight. My doctor said it's really low and we are hopefully starting TRT next week. Can anyone fill me in on what I should expect? Like side effects, pros & cons, and how long I will be doing this? I'm excited and I hope this is the beginning of a new chapter in my life. Is there anyone out there my age who is suffering from this? I'm a former drug user so that may be a big reason for the low t. I'm currently in treatment for drug abuse and I take suboxone for opioid use disorder. I'm scared to take the testosterone. Also I had one doctor basically tell me I'll be miserable later in life because I won't be able to make my own testosterone if for some reason I dont have access to more. He said I'm too young and said it's because I'm fat and a former drug addict. But I feel these symptoms even when not using drugs for very long periods of time. Sorry for rambling. I eagerly await your response. .
I am glad you are on your way to being treated. The advice you were given about being too young, that you would be miserable later in life, and that it would destroy your ability to produce naturally is categorically wrong. Go through all of my videos and then head to our blog at tctmed.com. You will find all the information you are looking for there.
Suboxone is one of the reasons you are producing so little testosterone right now, but it may not be the only reason. Recent studies show that many younger men (20-39) with normal BMIs and therefore not overweight and without risk factors such as opioid use are experiencing hypogonadism at alarming rates. Testosterone production is on the decline, almost across the board. Yes, behaviors influence it, but not as much as genetic and environmental factors.
You may be able to rebound to normal production once you're off Suboxone, but it is also very plausible that you will need TRT life-long to avoid those symptoms. Your level crosses a threshold into the range of "severe" hypogonadism. It certainly appears that TRT is right for you; just make sure that you are managed by an experienced provider.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thank you so much.. I needed this information. I feel so much better now.
No problem!
Best video I've seen on this subject. Thank you so much for breaking it down and explaining.👍👍👍
Thank you for the compliment, Mat. We're glad you found the video helpful!
Thank you and I learn more there than I ever did from four doctors that I had for TRT
@Joe: I am very glad you found the information helpful!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Unless you have a doc NOT paying attention to your blood work, your hemo goes too high for too long and you get knocked down with systolic congestive heart failure.. yes it CAN happen if you are not vigilant about your treatment, do NOT fully trust your doc.
@Teufelhund Odinic Rite: Agreed! With the PROPER management of potential side effects, TRT can be both effective AND low risk!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Teufelhund Odinic Rite just donate blood every six months
Mike Mcneill I do every other month
@@snailnslug3 im 57 at 56 3x bypass 6 yrs cycles differnt compounds im currently on blood thinners and cholesterol meds blood pressure meds could be combination steriods and gentics but still want to do trt
@@TCTmed I have been going to low t center for low t treatment. They checked my blood when I first started and I have currently done 6 treatments without doing blood work. Should I be concerned?
Amazing, thorough explanation! Thank you so much for taking the time. Your response to Jamie Locke was superb.
@Russ Dicono: Thank you for the feedback, I am very glad you liked it!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
What other hormones or natural functions will be turned off or reduced by exogenous testosterone?
I have heard that progesterone and DHEA will be lowered, which could have effects on memory Etc
@W H: Progesterone and DHEA are both precursors to testosterone. Their levels don't change directly due to testosterone administration, but there can be variance. Via the Cytochrome P450 system, cholesterol is converted to pregnenolone, and both progesterone and DHEA are derived from this steroid. Vitamin D levels can affect progesterone levels, and progesterone can impact thyroid and metabolic functions. However, the most notable effects of progesterone deficiency are noticed further down the cascade. So, low progesterone may reduce your quality of sleep or your fat metabolism directly, or it may change due to the downstream drop in testosterone levels or resultant estrogen dominance.
I have not found the need to treat progesterone deficiency in males when the other more impactful hormones are appropriately balanced.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I’m a 48 year old man and have been on TRT for ten years. The results of my blood test today was a testosterone level of 1500! Should I be worried?
@carlorocky: That depends; while 1500 ng/dL is definitely elevated, many factors are considered. If your blood was drawn near the peak (~48 hours after injection), that would obviously lead to higher readings. Also, if your SHBG is elevated, you could still have a normal calculated free testosterone, which is more indicative of what is influencing your body. Generally speaking, though, if you are at 1500, you would likely be able to reduce your dose and still have an optimal response.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Greta video thanks for giving us your time to do this video for the world to see thanks
You're welcome, thank you for watching!
Testosterone Centers of Texas :)
What a great video, one of the best I have seen.
If I may, I would like to ask if you ever encountered an experience like the one I had.
About 6 years ago my then Md. suggested I try TRT, due to my low free test. It was below the normal range.
I was taking 1/4 of a Proscar pill every day as well, and my sex-drive was to the moon with the extra test I was getting.
After 3-4 months, asking for a refill of Proscar, the Md. suggested I take the whole 5mg pill instead of just a 1/4, so I did.
My sex-drive totally disappeared after that, even though I was still getting the shots for several more months.
Then my hair started to shed, so I quit the treatment.
Sex drive never came back, and I was 55 at the time.
@ibberman: Thank you for the kind feedback. I have not seen a case like this in my own practice, largely because I do not use finasteride in that manner, but I have come across cases similar to yours. It prompted me to do some digging and I found the following website: www.pfsfoundation.org/
It certainly seems plausible that you issues may have something to do specifically with your use of finasteride. The type of response you describe is highly abnormal in my opinion. I truly hope this helps!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Thank you for the link, I really appreciate it.
I was taking the 1/4 proscar for the hair and had never had side effects before he suggested taking the whole pill.
Another problem I found was his inability to get my test levels right.
My total level was 450, and by giving me 1cc every 10 days to get my low free test into the normal range, the total test levels went to 2000+.
Thank you again for sharing your knowledge.
No problem! I hope it helps.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Oh wow. So informative . Thank you.
@Sam Nammoura: Thank you for the feedback, sir!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I've heard traumatic brain injury can cause problems with the pituitary and hypothalamus. I believe this is my root cause of my low t. I hit my head on the dashboard in a car accident at 7 years old in the 80's when TBI wasn't even known about I think so they didn't see anything but my broken jaw.
@77ponch77: Injury to the pituitary gland or the infindibular stalk from which it is suspended is a possible cause of secondary hypogonadism, as it can keep the pituitary from commanding testicular activity as it would normally.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
I'm on TRT 200ml every 3 weeks. Just a month and a half in. Noticing some gyno and fluid retention. Would the anastrozole counter act that and get rid of the gyno and fluid retention? Outstanding presentation doc. 🤙🏻
@Mike Philpot: Thank you for the kind feedback! The role of anastrozole in TRT is to limit the overproduction of estradiol via altering the aromatization of testosterone. So, it can decrease the stimulation of breast tissue by keeping estradiol normal, but misuse may actually contribute to gynecomastia. Maintaining a normal estradiol level is also helpful for mitigating fluid retention.
The bad news here is that once you have palpable gyno, your breast tissue is highly unlikely, if not altogether unable, to return to its "dormant" pre-stimulation state. To a degree, it will be irreversible. Think of it as male breast tissue, never being stimulated by abnormal estradiol influence, staying unnoticed and undetectable. However, once it grows, say to a six on a scale from one to ten, the now-disturbed tissue will not retreat back to zero even when you remove the offending stimulants.
This is why great care needs to be taken in the management of TRT. If gynecomastia is significant enough, only surgery can improve upon the hypertrophic changes. And, even with such an invasive response, it can remain likely to recur.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I have huge respect you doctor , your information helping millions of people around the world ,, great job 😆
I have low T symptoms but testerstone is normal so my doctor advised TRT maybe in future but not yet .
I need a hair transplant now and my question is :
Shall I wait or TRT and do the hair transplant or shall I wait ??
If my future is TRT what will happen to my hairs ??
Thanks in advance
@kadir khan: Thank you for the kind words! Check out this link (tctmed.com/genetics-of-male-pattern-baldness/) for the complete answer to your question.
Ultimately, whether you will lose hair due to DHT has little to do with your hormone levels and much to do with your genetics.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Very good layman breakdown of process-great video;) very informative -thanks
+vern schock Thank you very much, I'm glad it was helpful!
Seems like the one thing we should have done for our 16 year old children is have a full work up done on all there hormone levels, this way they have the numbers they need to stay young there whole life. Or repair their counts when they get old as stale bread in the head.
@ginger bread: Great point! Even a little more sobering, however, is the trend of younger and younger people suffering with confirmed testosterone deficiency. The standard itself (a healthy late teen to late twenties patient) is under the same assault. Studies show a progressive decline in testosterone production decade over decade. This isn't just an old person's problem.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Do you believe that natural production of T could be increased with heavy lifting in the gym, maintaining a healthy body fat % and eating a good diet? Also cutting out toxic substances like cigarettes, drugs and alcohol?
Great presentation by the way, the best I’ve seen. It was great to watch.
@Vivid Joey: I absolutely DO believe that. The question becomes, will such efforts increase testosterone levels enough to control symptoms and improve health in the desired manner. That being said, I always urge patients to do everything they can naturally, before resorting to TRT.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed once i started gym my test fell even more so they got me on trt 200 wk test e. That castor oil sucks... but where i come from in order to find smoother transporter oils u have go go underground...
What can i do to lessen the injection pain.
@@moralrevulsionLive Proper injection techniques should keep it from being anything more that a small, short-lived annoyance. Whether cottonseed oil, grape seed oil, or any other sterile base, I have not seen consistent complaints when injections are given carefully and properly.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed guess nurse was in a hurry... i will ask for a sister next time. Thank u for ur kind reply.
@@TCTmed you sir is awesome.
I told a senior sister today as it was my trt 200 day.
I feel the pimp but nowhere near like last 2 times. I didnt even feel it the time she inject me.
And i starting to feel the effectd after 3 weeks x200 test e weekly. That alpha male flare is back
This is phenomenal, Doc.
Great stuff.
Cheers
@medicineandbrasilianjiujit8511: Thank you for feedback. I am glad you found our content helpful! I also train in Brazilian Jiu Jitsu, and I love that your channel is talking about this!!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed
God bless!
I stopped trt because of side effects, I told my doctor he didn't really care,I have learned to live without this substance for my entire life so it's not a problem at all
Hello there ...Great video btw ...I had my test levels done they have come back as 15.2 nmol ... could you advise if this is sufficiently low enough to start a low dose trt course every other day ... many thanks 😊
@Lee Harley: Thank you for the feedback! Your symptoms and medical history play a profound role in decision-making about TRT. Keep in mind that there is more to account for than just the levels. That said, a total testosterone level of 15.2 nmol/L corresponds with a level of 439 ng/dL on the reference ranges mentioned in the videos. This is on the lower end of normal for most reference ranges, but still normal.
Best regards,
Augustine Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Great Video on TRT. Very detailed and very well presented. My question is if a Vasectomy can in any way hinder the TRT treatment plan and or cause any kind on problems once they are started on TRT. Just a general question and one many men reading this would like to know an answer to. Thank you for your time. And keep up the great work
@Castulo S: Thank you very much for the feedback! I have seen nothing in the literature or in clinical practice that has suggested that therapy needs to be amended for patients who have had a vasectomy remotely or recently. I have many patients who have had this procedure and some who have had it done while already on TRT, and they do very well on therapy.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Thank you very much for the quick response. You just got a new subscriber!!
You are very welcome, I am looking forward to getting more content out there soon.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Is there a way to balance testosterone and HCL so it stays at about 50, to avoid clots while getting as much of testosterone as that allows? Thanks, wonderful presentation.
@johnmontana18: Thank you for the feedback! The risk of "cardiovascular events" and/or clotting due solely to TRT has been largely overstated. Two studies from 2013 and 2014 that received much attention have since been redacted, amended, and essentially debunked. Testosterone will cause most people to have some increase in hematocrit (HCT) levels, but this increase is typically minimal.
People with difficulty maintaining a normal HCT level typically have other underlying concomitant conditions such as obstructive sleep apnea (OSA), polycythemia vera, or hemochromatosis. By far, OSA is the usual suspect. This includes disordered breathing that may not actually progress to frank apneic episodes. So, if you remove OSA from the equation, HCT levels are not a rate-limiting step in optimizing testosterone levels.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed Thank you for the response. My HCT was 56.2 at the time I had PE. My PCP blames it on the HCT and says it should be kept below 55. I live at 7000 feet, if that affects HCT. I had to stop T but will restart when permitted because I am very low T without it.
@@johnmontana18 You're welcome. Normal reference ranges are, to a degree, geographically specific. My elevation in North Texas is less than 700 feet above sea level. And, yes, an elevation of 7000 ft. would impact what is considered normal in your area. Still, even if your HCT was to blame, the portion of an elevated HCT due to the use of testosterone is minimal. If you haven't already, consider seeing a cardiologist and hematologist.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Woouuww the best understandsble video about these issues on youtube , super 🙌🏻🙌🏻🙌🏻
@Bo Christiansen: Thank you, sir!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Very informative video, well done and beyond easy to understand
Thank you for the feedback, @Jesse Garcia!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
2 Doctors told me there are definitely pros & cons on TRT. You can get heart problems from thickened blood and you can go bald! These are Major side effects for sure!! I need TRT but cannot risk my life for it. Plus it’s something u need to stay on for life they said. Once u get off TRT, your test levels will be much lower than when u started. Can also cause gynomastia (women like breasts).
@Jeff Swope: I would encourage you to look past all bias; mine, theirs, perhaps any you may have developed over time. If you look for medical studies to support the claim that TRT causes heart problems, you will have to go back to 2013 and 2014 to find any substantial allegation in that regard. The first was done by a resident physician in the Dallas area who mined VA data to identify people who already had heart conditions that were "on TRT." Some of these people she tallied never actually received testosterone, many never made a follow-up appointment, and none of them were closely monitored. The study was supposed to be on only men, but women were accidentally included. Using an anomalous statistical model, the study authors counted each "cardiovascular event" as more than one event, purposefully. The study was published in JAMA and revised several times over due to its many flaws.
The second study, from 2014, was from an online journal, PLOS ONE. It was also deeply flawed and was a retrospective study. The drug sildenafil (Viagra) is used for erectile dysfunction but is also used to reduce the workload for the heart by reducing pressure in the vessels the heart pumps blood to and from the lungs through. Despite this cardioprotective effect, it was used as the medication of the "control" group of individuals who, like in the first study, also had a history of cardiovascular events.
Look at the studies from the last decade, and you will see that TRT has been shown to improve cardiac health. Testosterone can make you make more red blood cells by suppressing hepcidin, but if you aren't a smoker, don't have untreated sleep apnea (common and very treatable), polycythemia vera (rare), or hemochromatosis (also rare), the likelihood of you ever having an above-normal blood thickness (hematocrit) solely because of well-managed TRT is very low. You would have to have a significantly elevated, even neglected, hematocrit for it to be high enough to actually cause a "heart problem." I've never seen such a state develop in any patient under the care of our practice since its inception in 2013 or the 2 years before that when my fellow owners and I were working with another company. We administer more than 5,000 injections monthly. Check out the links below.
Yes, TRT could make you bald -- but only if you were genetically programmed to go bald already. Theoretically, if you "would" have gone bald with normal or optimized T levels but your testosterone production drops earlier and harder than it should have, that lower T production could save you from balding, and starting TRT could pull the trigger of the gun that nature loaded. However, keep in mind that the trade-off is all the symptoms of Low T vs. an untouched head of hair.
The claim that you must stay on it for life is wrong. However, no provider would recommend a patient who doesn't produce enough insulin or thyroid hormone to stop taking that hormone. Your natural production is suppressed while on therapy and will likely remain low for several weeks as you rebound to your baseline, should you stop. If you were on TRT for 3 months, your baseline would not have changed much, if at all. If you were on TRT for ten years and then stopped, your new baseline would be commensurate with what it would have been had you never started TRT. You can stop any time, but if you want your symptoms treated, yes, you need to stay on therapy to experience therapy benefits.
Gynecomastia can occur, but this happens in a high-estrogen or "estrogen dominant" state. We monitor and maintain normal estrogen levels for our patients, so while this is a risk, we don't see this develop in well-managed care settings.
Until a provider has seen the enormous benefit that properly managed TRT offers, until they realize that it can profoundly improve the life in their patients' years, they will be inclined to inflate and overestimate the potential risks. Every medical intervention comes with risks, but providers are prescribing antidepressants and a host of other treatment options for symptoms consistent with Low T, and never bat an eye at the laundry list of risks and side effects associated with those "mainstream" therapies. Scrutiny, temperance, and discernment should always be employed when evaluating whether a treatment is right for you, but it appears that you have been lead to believe that you have to choose TRT or death. That assessment doesn't hold up against the evidence.
tctmed.com/trt-heart-attack/
tctmed.com/trt-cardiovascular-disease/
tctmed.com/trt-blood-clots/
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Managing Partner
I'm a little confused by this video. The title says "why you shouldn't be worried about side effects", then the last side effect... in my opinion, probably the scariest of all of them...low fertility and inhibited ability to father children, he says there's no reliable study that has shown that hcg can keep your sperm levels normal. Basically...saying if you go on TRT, that yes you will have reduced fertility and something you should be aware of, and hcg is not guaranteed to work and has no real studies behind it. I'm not supposed to be worried with this side effect?
Eugene Nayvelt - For most of us older users of TRT, infertility is an added bonus.
@Eugene Nayvelt: How this affects you depends primarily on your stage of life, I suppose. Keep in mind that the suppression of fertility is only temporary. I have many patients, who want to maintain fertility, that are on testosterone and hCG concurrently. More specifically, I took this same approach and my wife and I had zero difficulty achieving her third pregnancy, and my third is now about to turn 4. Furthermore, I have a gentleman who had low sperm counts and motility prior to TRT, and hCG monotherapy was not addressing his symptoms. After length discussion with he and his wife, we decided on concurrent therapy. At his next semen analysis, his counts were slightly lower, but his motility was significantly improved. They conceived shortly after. Now, I do not manage the fertility side of things, and these are bits of anecdotal information only. However, I feel very confident in placing patients who wish to maintain fertility on testosterone with hCG concurrently.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Great videos , thanks
Latest blood test ,
Total Test 234
Free Test 216 Pmol /L
SHBG 15 Nmol /L
FSH 7.5 U/L
LH 3.0 UL
Labs say Free Test is in ( range ) so no TRT
Have plenty symptoms , what's your valuable opinion ,
Thanking you in advance
@Lex paterson: Thank you for the positive feedback! I had to do some conversions to the units of measure I am accustomed to working with, but I show that a calculated free testosterone of less than 300 Pmol/L is low. The criteria I use for diagnosis is a total testosterone OR a free testosterone that is low on two separate occasions, before 10 AM in the morning, confirms the presence of hypogonadism in a symptomatic patient.
Based on your levels and stated symptoms, you may want to seek a second opinion.
Best regards,
Augie Galindo, PA-C
Testosterone Centers of Texas | Founding Partner
Great info bro am 24yrs diagnosed low t and high estradiol if I go for TRT will last long 20 years
Why just 20 yrs ?
Living with low T also affect u
I have seen people over 40 years on TRT.
Is an aromatase inhibitor necessary if the dose is normal? My reasoning is ... If you are giving an aging male only the levels of a Genetically gifted 18 or 25 year old, wouldn't the body keep the estrogen levels exactly where it should be? Also, about blood thickening....or balding with too much dht or iron absorption increasing...wouldn't all this be out of question if the dose is kept natural...also what would be the dose to have a man at a genetically gifted 25 year old's levels of testosterone .
@Varun Kamal: This is a common question we get. Unfortunately, even when normal levels are targeted, the use of an exogenous hormone (one that is not originally made by the body) will elicit changes that would not have happened in the setting of natural production, even to the exact same level. Increased iron absorption is what leads to "blood thickening" or an increased hematocrit, and is linked to the effect of exogenous testosterone on hepcidin. Balding occurs in those who are genetically predisposed to it, and not because DHT goes too high specifically. However, DHT is what "pulls the trigger" of the genetically "loaded gun". So, if testosterone levels are low, DHT will be relatively low, and any increase in testosterone will lead to an increase in DHT. Even just normalizing DHT is someone who is genetically predestined to experience balding can accelerate hair loss. Dosing is not cookie-cutter, so there is no single perfect dose that would recreate the internal environment of a genetically gifted 25 year old, and I fully expect any patient targeting high-normal levels to have at least some degree of side effects.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
@@TCTmed thank you so much for answering.... Do you have reason to believe that this is due to a weekly once shot peaking and lowering through the week in spite of a slow acting cypionate ester.... Unlike endogenous hormone which is released multiple times a day.... Without peaking unnaturally
@@varunkamal91: That undoubtedly has some impact, but it doesn't explain all of it. That, of course, is largely dependent on how high the peak is and where the trough is maintained. I have many patients who have requested twice weekly injections, and those who have tried it have not exhibited a 50% decrease in side effects.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Best video I seen about TRT...thank you
@Vero W: You're very welcome and thank you for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Fantastic explainer, Dr. Galindo. Much appreciated.
Personally, while my testosterone levels are roughly 11 times lower than normal for my age (I'm 37), my spermatozoa count is quite high - about 4 times of what would be considered normal, with motility being double the minimum normal levels. I want to father multiple children, so that's the aspect that I worry about the most.
Considering the way in which the chain reaction leading to the production of both testosterone and sperm was explained here, I do wonder if, given the huge disparity between my testosterone deficiency and my sperm production abundance, TRT would likely lead to lower-than-now but still normal levels of fertility overall.
I fully intend to seek an experienced medical opinion on the matter before making any decisions, but it certainly seems like the most logical outcome, given my particular test results.
Best wishes from Romania.
@DarkVeghetta: Thank you for your reply and feedback! Fertility can be fickle. It could be that with robust sperm production and motility, you may be somewhat protected from severe TRT-related infertility. Still, you could potentially find yourself exquisitely sensitive to exogenous testosterone, too. Make sure to explore the options of sperm banking and the use of supplemental medication like hCG to preserve fertility should you start TRT.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Great information. Thank you. I’m naturally ripped now and my veins pop up. Some people where I work out have been asking me if I’m doing steroids or trt but it’s all diet and work outs. Thinking what would happen if I try it
Great practical easy to understand explanations....thanks from UK !
@gozitan5: You're most welcome! I am always glad to see these videos reaching globally!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
I wonder how this treatment could potentially affect men with supernumerary nipples (given the estrogen changes and due to the increase in probability of developing breast cancer of this group). We need to also consider a family history of breast cancer as well.
@Orty Rod: Correct! Noting the presence of a family history of breast cancer, particularly BRCA+ family history, is important to assess when contemplating TRT. Not all patients with supernumerary nipples have associated breast tissue, but risk stratification may differ in those cases. Maintaining normal estradiol levels is always an important piece of therapy.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thank you!
I'm only in my 3rd injection, my highest blood test came in at 324 and 7.7 free. I'm 30 years old, my provider didn't explain if that's extremely low or if I'm just on the low end of the spectrum
@White Jodeci: For most reference laboratories, your total testosterone would be considered to be "low-normal." However, because of your age, I would consider this a more marked deficiency. If the free testosterone level you provided is a calculated free testosterone (www.issam.ch/freetesto.htm), then I would characterize it as frankly low.
I hope that helps!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
TRT and heart decease. I've seen research saying it's helpful or its bad for you. can you do a video on this?
Excellent idea Darin! We'll add it to the list and let you know if we make the video. Thanks for the suggestion.
Testosterone Centers of Texas TRT LOWERED my blood pressure into the normal range. Had anemia coz low T so heart needed to work harder. I'm so happy now
Texas Boy , but it increases plasma count. One of the reasons you have more aerobic capacity on it.
Great breakdown of the male system!
Thank you for the feedback, @Trent Alexander!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Fantastic presentation, with great lessons learned.
@Freddie Greer: Thank you kindly for the feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Wonderful explanation. Thank you!!!!
@Hasney Bravim: You're very welcome!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Very informative and well done presentation !
Is clomid a solution as well ?
@T Man05: Thank you for the question, I am glad you like the video! Due to its troublesome side effect profile, I do not consider clomiphene (Clomid) an option for treatment in my practice.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
Excellent explanation!
@baggahammers2: Thank you for the kind feedback!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I’d like to know if someone doesn’t suffer from low test, but wants to cycle trt in order to maximise his progression inside the gym. Are the fertility side effects limited? So on for 6 -8 weeks then off for 6 - 8 weeks ?
@S C: All the same side effects would be in play. When you cycle to boost normal levels in a TRT-related asymptomatic patient, that wouldn't be considered TRT. So, explicitly gearing testosterone to bolster anabolic gains would create a more deleterious environment than we seek to maintain with TRT.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Why does TRT have side effects when its a normal chemical in your body?
@Brad Phuck: Great question! Unfortunately, no exogenous hormone or biochemical is going to be able to be introduced to the body and still have all the EXACT same effects as it would if it is produced naturally, through its proper pathway. The balance created by negative feeback loops is delicate and is altered once any part of it is circumvented.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
What a wonderful and informative video; thank you for taking to time to produce this!
I'm currently on TRT/HCG, and I would like to get your opinion on my regimen. I recently had my labs done (the day prior to my injection) to include a lipid panel:
1) my T is at 1448 ng/dL, my free T is at 29.5 pg/mL and E2 is 37.5 pg/mL.
2) all my other labs are within normal range, and I have no acne or other negative side effects.
Do you believe I should reduce my dosage, because I currently feel fine. Thank you!
+Pendejo: Thank you for the positive feedback! A couple of caveats before I comment: I have to make some assumptions based on what the reference ranges are for these labs, and I am assuming that the free T value is a calculated free T and not a direct/analog free T.
That being said, your values definitely see high for a trough level and while you might feel well now, consider that these labs may represent the front side of a building peak. So, you could be exposing yourself to more and more risk going forward, and I don't see evidence that your hematocrit is being monitored. Make sure your provider is keeping up with that as well!
Testosterone Centers of Texas Thank you for taking the time to evaluate and respond to my question. BTW, my hemoglobin is 15.3 g/dL and my hematocrit is 44.1%.
I've been on TRT just under a year, how often do you recommend I gets labs done?
+Pendejo: You are most welcome! It looks like your hematocrit is doing great. I evaluate my patients' labs every 90 days.
What a great video. Well done
@sneekolas: Thank you! I am glad you found it useful. I will be working on new content soon, so please stay on the lookout!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I'm 43 and I'm taking 1ml a week. I feel fine.
Im 36 n im taken 1ml every week alson n im fine..
@@anthonygutierrez9375 im 53 and i am taking 1ml pw 250mg and im feeling GRATE !!!
Someone is fine , someone is great, why i am still waiting ?
can you give some cost estimate and how much dosage will be there? BTW thank you so much for such an informative video.
@sahil sharma: You are most welcome! Costs vary widely, but I can tell you that in our practice, insurance often reduces costs considerably. Our telemedicine services are priced at $200 per month, plus lab fees. Unfortunately, I cannot give out dosing recommendations in this format.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Superior teaching skills, very informative & well presented. Like'd & sub'd instantly.
@eyescryont: Thank you for the feedback! I am glad you found the information useful!!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Very detailed information !great!!
@Karuna Sharma: Thank you!
I just started trt last week. Testosterone level was 276 and they only prescribed me 100ml every 2 weeks. Doesn't seem like near enough considering everyone I know that's on trt takes more than twice that amount. (I'm 6'5" 287lbs)
@Adam Thomas: I am glad to hear you started therapy, but almost undoubtedly, that dose will not improve symptoms of testosterone deficiency. Dosing isn't really weight-based, but there can be a great deal of variance in the speed with which people break down the medication. I have some taller, heavier patients on lower doses than smaller ones, with both achieving the same level of optimization. I believe weekly dosing is the best overall method.
That said, I would advise you to not take it upon yourself to re-educate the provider you are currently with. You should seek out a practice that is better equipped to safely help you.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
By taking HCG won't your body continue to produce testosterone even while on TRT? If HCG is treated like LH by the body then your testes would continue to produce testosterone regardless of the TRT right? So would you need a smaller dose of TRT to maintain a proper range?
@smjastrzebski: The short answer is, no. The effect of hCG on testosterone production is scant when it is dosed for reduction of fertility suppression or reversal of testicular atrophy. You need much larger, and more frequent dosing of hCG to achieve even mediocre improvement of testosterone production. Concurrent use of hCG does not significantly reduce the dosing needs for testosterone.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
ow what an amazing well explained easy to understand video. Congrats doc
@pedroucb: Thank you very much!
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
I Just realized how old this video is. Is there an update?
@GREATTECH1: We have a wealth of material on our website, but be on the lookout for some updates coming this year!
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Great video. Very well explained. Thank you 😊
@Sinasi08: Thank you kindly for the feedback! I am glad you found the information useful.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Founding Partner
If someone had total Test in the 700, but high SHBG (81) and low Free T (80 pg/mL), everything else is normal including liver enzymes, LH, and estrodial, would you treat them assuming they had symptoms?
@thefinder808: We have treated patients with patterns like this. In my opinion, the calculated free testosterone value is the focal point of the laboratory evidence for the medical necessity of therapy. If there is a way to solve the SHBG dysfunction, namely isolated hyperestrogenism, then that may be the first option ahead of TRT.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed Thank you very much for your response. One follow-up, since my estrodial numbers are normal, I'm assuming TRT would be a valid next step at least for a 3 month trial?
@@thefinder8087 You are most welcome! Yes, it does seem appropriate at this time.
I really hope ull answer my question as it was an amazing video , trust me on this ive done almost everything to cure my low trt symptoms and very carefully did a TRT with A lot of hope but dont know why even after keeping everything in check it just made my symptoms worse and i was heart broken , i have low testosterone please help me what else can i do ive reseached a lot and lot i know what to keep in check like dht, blood pressure, estrogen everything but still my trt back fired raising my anxiety and even depression low energy which were main reasons i went on trt 😢
@mancheapterunited5125: Thank you for the kind feedback! Unfortunately, some cases can get complicated. The best way to figure it out is to apply diligence to specific monitoring of symptoms, side effects, and dosing simultaneously. You may also need to have other potential issues investigated further.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Very informative video. What are your thoughts on taking TRT alongside or without HCG?
@Damon: Thank you for the feedback! I personally recommend hCG to be used concurrently with TRT when patients wish to protect fertility or prevent testicular atrophy. Aside from those two needs, I don't feel that hCG offers significant benefits.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Is trt safe for somebody with mild kidney damage? Such as efgr at 65? Or is there a big risk of increasing damage from the use of testosterone? Thanks for any help
@p062161r: I haven't seen any evidence of negative impacts on the renal system with properly managed TRT. Testosterone is metabolized by the liver, so improper use or abuse of the medication (particularly in the oral form) can be injuries to the hepatic system. We routinely monitor kidney and liver function in our patients and have not seen a correlation between the use of TRT and harm to the kidneys in a decade of treating low T.
Best regards,
Augie Galindo, MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Thw you very much for the info. Have your patients included people with kidney damage/renal problems? I appreciate your time helping me
@@p062161r No problem at all! I know we have a handful of patients with renal insufficiency, but I do not recall treating any patients who were in frank renal failure (dialysis).
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
I have symptoms of low testosterone, but the results of my laboratory tests are normal testosterone levels. I am 57 years old, do I need TRT HRT?
@AlaWarteg Ketofast: That depends. It is not helpful to exogenously raise the testosterone levels of a patient whose labs indicate a deficiency, but history reveals no evidence of related symptoms. On the other hand, we routinely see total serum testosterone levels "normal" in patients with significant symptoms. This could be because other processes are causing a similar symptom pattern as hypogonadism (Low T) does.
A "normal" total testosterone level often fails to support a normal calculated free testosterone level. So, if you are significantly symptomatic with a low-normal total T level but still have a low calculated free T, you may still be a candidate for therapy.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
Can pregnenolone be use instead of HCG to prevent testicular atrophy?
Are injections a better method than creams for physiology?
Can Calcium D-glucarate mitigate excessive estrogen instead of an AI?
I've heard from another health professional that estrogen may play a major role in male pattern baldness and PSA enlargement opposed to DHT being the primary culprit.
@Gif24 GT: There are proponents of pregnenolone for the treatment of atrophy, but many of them rely on studies from the 1940s. Given that there are multiple pathways for the metabolism of PG5, it would be difficult to isolate which byproduct was actually helping, if it does at all. I prefer injections to topicals. CDG can help estradiol metabolize down to more preferable metabolites, but it is not suitable for AIs. I have not found any evidence to show that estrogen is a key factor in male pattern balding or BPH.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thanks for such comprehensive explanations!
Side effects of TRT: Feeling Great!
@Kilju Pullo: Love it!
Thank you, this was excellent and easy to understand. I'm 38 and have experienced low T symptoms since I was 20. My test however is in normal range of 454 total Testosterone and 75 free. Should I consider TRT?
@Apex Predator: Thank you for the feedback! Total testosterone levels can be very misleading. I exclusively use the calculated free testosterone (cFT) level, which uses an algorithmic calculation that takes your SHBG, albumin, and total testosterone levels into account. You can find the formula here: www.issam.ch/freetesto.htm. On this scale, with the reference range for your total testosterone level being roughly between 300-1000 ng/dL, a normal cFT is between 9-30 ng/dL.
So, with that said, I definitely would recommend that you at least seek a second opinion. Just make sure you go to a clinic that will be honest with you about your numbers and is willing to tell you that your numbers may not be low enough to take the step of starting TRT. I have many patients who have had totals in the 400-500 range that were still suffering from below normal cFT levels.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
is hcg an alternative to trt due to acne and concerns over potential hairloss? or it it better to just lower the dose to 50mg to keep some in the system instead of stopping altogether?
Hello, @p!
Monotherapy with hCG only for testosterone deficiency is a thing, but in my opinion, it's not at all optimal. Hair loss is directly related to your genetic predisposition for it. Limiting or avoiding testosterone may save someone who is genetically prone to male-pattern balding from loss. Still, it will be at the cost of all the symptoms of testosterone deficiency. On the other hand, if you are NOT genetically primed for balding, going on TRT will not make you bald. Acne will be stimulated by a rise in DHT, and again, will predominately affect those with a propensity for acne.
I primarily prescribe hCG for one of two reasons: promoting fertility while on TRT or counteracting TRT-related testicular atrophy. I have not found it to be a good alternative to TRT altogether.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
@@TCTmed thankyou. can taking finasteride while on trt offset the side effects or is trt strong enough to push through that medication
@@user-we4mr3uc7m Finasteride is very good at blocking the conversion of testosterone to DHT, but remember that there are beneficial effects of DHT that you don't want to block. Also, it can mask prostate changes by making PSA tests less reliable.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
If we could find a way to communicate to the brain to produce more testosterone, that would be nice.
@Marcus Vickers, peptide research may be bringing us close to this. There are drugs like clomiphene that do affect pituitary stimulation for testosterone production. Still, it also leads to stimulation of sperm production (originally a female fertility drug), and it can lead to gonadal hyperstimulation and vision disturbance. I think we will get there eventually.
Best regards,
Augie Galindo MPAS, PA-C
Testosterone Centers of Texas | Managing Partner
As far as I know testosterone produce in the morning,, - I wake up every day 6 o clock in the morning and have two questions
1- is my body missing the morning sleep to produce testosterone till 10 am ??
2 - I do exercise on empty stomach in the morning before I have breakfast - as cortisol rise in the morning am I doing any harm to me for my testosterone production?