Frequently Asked Questions
How soon will it be before I feel/see anything from testosterone replacement therapy?
Testosterone replacement therapy can have dramatic effects on your appearance, especially if you do it in conjunction with an exercise program and a healthy diet.
• Body Fat — Body fat levels begin to decrease in 1 or 2 months, but this loss may take 2 to 3 years to plateau.
• Waist Size — Just as with body fat in general, you should expect your waist size to start to decrease in 1 or 2 months. Expect to lose approximately 3.5 inches in the first year after starting therapy.
• Muscularity — The amount of muscle you gain is dependent on genetics, exercise, age, and diet, but you should start to see more muscle in as little as a month.
2. Sexual Benefits
Testosterone replacement therapy does a lot more than just increase your sex drive. TRT patients generally report stronger and more frequent erections and ejaculations, in addition to a more satisfying sex life in general.
• Sexual Desire, Thoughts, and Fantasies — You could feel an increase in libido in as little as a week, but generally, it takes about three weeks for things to really start to percolate, generally plateauing at about the 9th week.
3. Psychological Effects
A lot of people don’t realize it, but psychological problems like depression and anxiety might have their roots in low testosterone levels. Also, positive psychological traits like sociability and “appropriate aggressiveness” might be associated with higher testosterone levels. (“Appropriate aggressiveness” refers to asserting yourself or acting confidently, such as mustering up the courage to ask the boss for a raise or asking a woman out to dinner.)
Anxiety Levels, Appropriate Aggressiveness, Sociability, Mental Wakefulness, and Creativity — All of these areas should start to improve by week 3 of TRT and continue to improve for the first 9 weeks or so, eventually plateauing after about 3 months.
Depression –– Depression, or even increased levels of sadness, should start to decrease by about week 6, but maximum effects take longer and vary widely from individual to individual.
4. Health Benefits
TRT is one of the best things you can do to improve your overall health as testosterone plays a big part in heart health, insulin sensitivity, bone density, reduced inflammation, and improved blood chemistry.
• Insulin Sensitivity — Without good insulin sensitivity, a good portion of the food you eat gets transported to fat storage instead of being used to build muscle. The more insulin sensitive you are, the better, and TRT starts to increase insulin sensitivity in just a few days, but often continues for several years.
• Bone Density — While osteoporosis is more often a problem with aging women, men with low testosterone levels can also have signs of diminishing bone density. However, restoring testosterone levels to normal or high normal can show positive effects on bone density in about 6 months and continue for at least 3 years.
• Inflammation — Inflammation plays a big role in just about every human disease, especially heart disease, and TRT generally starts to calm inflammation in 3 to 12 weeks.
• Blood Chemistry — Total cholesterol and LDL (but not HDL, i.e., “good” cholesterol) generally start to decrease by about week 4 and continue to improve for 6 to 12 months.
What's the difference between testosterone and steroids?
Testosterone is actually a steroid, but the term steroid is just a chemical classification of certain fat-soluble organic compounds, many of which are found naturally in the human body. They’re responsible for having a whole slew of physiological effects ranging from tissue growth, reproductive development, inflammation, immune response, and even salt and water balance. Examples include estrogen and, of course, testosterone.
Testosterone is responsible for the development of secondary sex characteristics like broader shoulders, a deeper voice, development of sexual organs, facial hair, and most of the physical characteristics that distinguish men from women. When men get older and their testosterone levels drop, testosterone replacement therapy is often prescribed to reverse many of the effects of aging and to restore confidence, libido, and a more youthful, energetic feeling.
Of course, when most non-medical people refer to steroids, they’re referring to anabolic steroids, which are typically used for cosmetic performance or physical performance reasons (like building muscle, burning fat, or enhancing athletic ability). It’s true that all anabolic steroids are synthetic variations of naturally occurring testosterone, but as mentioned, they’re used for non-health reasons and aren’t suitable for testosterone replacement therapy. Many have unpredictable side effects and they’re almost always used in extremely large, potentially dangerous doses.
So yes, testosterone is a steroid, but it‘s a naturally occurring one that’s vital to a healthy, functioning body.
Does Optimal Health Medical Group accept medical insurance?
Sorry, we don’t accept medical insurance of any kind, but it’s out of necessity. Insurance companies have simply become profit-minded to the point where they seek to dictate which treatments and products physicians can prescribe.
For instance, many companies would require us to treat testosterone deficiency with a largely ineffective drug like Androgel, or prescribe orally delivered, static-dosed horse estrogens for women.
More often, insurance companies decline coverage for any kind of hormone replacement therapy altogether. In a nutshell, insurance companies have just become too adversarial, unreasonable, intransigent, and burdensome to work with.
However, we won’t hesitate to provide you with the proper documentation and support you need in submitting your bills to your insurance company for reimbursement.
What's the difference between total testosterone, free testosterone, and bioavailable testosterone?
When doctors order blood work to determine testosterone levels in your body (which is something they rarely do in the first place), they generally ask the lab to test for “total testosterone.” The results will generally reveal a number somewhere between 300 nanograms per deciliter (ng/dl) and 1100 ng/dl.
If the number is somewhere above 400 ng/dl, the physician will probably tell you your testosterone levels are fine. Unfortunately, despite getting a “normal” reading, your true testosterone level might be anything but normal.
Here’s the problem. Testosterone pretty much exists in three different states. First, you have free testosterone. This is the testosterone that’s unencumbered and free to do all the good things that testosterone is supposed to do. However, the vast majority of the remaining testosterone is non-free, or bound to other chemicals, making it pretty much unavailable to the body.
About two-thirds of this bound or non-free testosterone has formed a tight, chemical bond to something called Sex Hormone Binding Globulin (SHBG). For all intents and purposes, it’s locked up and put away. The other third of this bound testosterone is loosely bonded to a protein called albumin. While bound, this albumin-bonded testosterone can still work to improve your brain, muscles, blood, heart, sex life, and all the other things we count on testosterone to do.
Bioavailable Testosterone = Albumin-Bonded Testosterone + Free Testosterone
This is why, when testing your blood, Optimal Health Medical Group focuses on your free testosterone and your bioavailable testosterone. That’s the only way to get a realistic and effective idea of what testosterone is doing in your body.
What can I expect when I come in for an appointment?
Here’s how it works: When you make an appointment with OHMG, we’ll make arrangements for you to get your free lab work done at the Lab Corp office nearest your home (there are hundreds of offices in California).
That way, we’ll have your lab results when you walk in the door for your appointment. The initial consultation takes about an hour and is free of charge. We’ll teach you how to do an intramuscular injection and you can start testosterone replacement therapy that day.
Meanwhile, we’ll call in your prescription and a 90-day supply of testosterone, including all supplies, will be shipped to your door for a cost of $250 per month.
However, if you don’t live within reasonable driving distance of our offices, we’re set up to do consultations via telemedicine. That way, you won’t even have to come to the office to start receiving testosterone replacement therapy.
How do I do an intramuscular (IM) injection?
- Testosterone vial
- 1 ml syringe with 1-inch, 25-gauge needle
- Extra 18-gauge needle (for drawing testosterone out of the vial)
- 3 alcohol swabs
How to Inject:
- Wash your hands thoroughly with soap and hot water.
- Arrange all of your materials (listed above) on a clean surface.
- Remove the needle from the wrapper then twist on the 18-gauge needle. Set the capped 25-gauge needle aside. You’ll need it later.
- Loosen the cap from the 18-gauge needle. Leave it on, though, until you’re ready to draw up the testosterone. (Make sure not to touch the needle!)
- Wipe off the rubber seal on the testosterone vial with an alcohol swab and then put the vial down momentarily.
- Remove the loosened cap from the needle and draw about 1 cc of air into the syringe by pulling back on the plunger.
- Pick up the vial of testosterone and turn it upside down, being careful not to touch the rubber seal.
- While keeping the vial upside down, insert the needle through the rubber seal on the vial.
- Making sure the needle is in the fluid, gently depress the plunger to push all the air into the vial.
- After you’ve expelled all the air, slowly pull back on the plunger and withdraw the required amount of testosterone into the syringe.
- If you don’t manage to withdraw the proper amount, you can inject some of the oil back into the vial and repeat the process. As long as you don’t pull the needle out of the vial, you can “pump” the oil back in and out as much as you need to until you’ve withdrawn the required amount.
- When you’re sure you’ve drawn up the proper amount of testosterone, withdraw the needle (and syringe) out of the vial and put the vial down.
- Put the cap back on the needle and replace the needle with the other 25-gauge needle.
- Choose an injection site on either your thigh or glute. If you prefer the thigh, divide it up into three sections from the hip to the knee. Pretty much any spot in the middle section will work. Now draw an imaginary line going straight down your thigh. You’ll want to inject anywhere towards the outer part of the thigh, but not too far to the outside or underside.Injecting in the glute is a little trickier, but it’s the preferred location. To find the proper injection spot, use an alcohol swab to draw a line from the top of the crack of your butt to the side of the body. Find the approximate middle of that line and go up 3 inches. From that point, draw another line straight down so that it intersects the first line and makes a cross.What you’ve done is divide the area into four quadrants. Your target is in the upper outer square. Locate the curved hipbone in this square. You should inject below this curved bone. (Make sure you keep track of which side you injected, and then switch to the other side the next time.)
- Take an alcohol wipe and use a circular motion to wipe the injection site to a circumference of about three inches. Allow the skin to dry to prevent any alcohol from entering the injection site, which could cause a burning sensation.
- Remove the cap from the needle. Make sure the air bubble is near the plunger end of the syringe (and make sure not to touch the needle or injection site so that they stay sterile).
- Using a 90-degree angle, stick the needle all the way into your glute (or thigh). The speed doesn’t matter; just proceed however you feel most comfortable.
- Given that there’s generally so much “meat” in the glute area, most people don’t have to aspirate (draw back on the syringe to see if the needle hit a blood vessel). However, if you’re exceptionally lean, or if you’re injecting into the thigh, you’ll want to aspirate by holding the barrel of the syringe steady with your non-dominant hand while using your dominant hand to pull back slightly on the plunger. Look for any appearance of blood in the syringe. If you don’t see any blood (just air bubbles and clear fluid), then it’s okay to carry on.If there’s blood, pull the needle out and pick another nearby location and start over.
- Hold the syringe steady and begin to depress the plunger slowly but deliberately until all the testosterone is injected.
- Remove the needle. There may be a little blood at the injection site, so keep a tissue handy and apply some steady pressure. If it continues to bleed, apply a bandage.
- Place the needle back into the cap and dispose of it into a sharps container (a plastic needle disposal container).
- Start to feel awesome.
What's a "normal" testosterone level?
There’s a clinical answer to this question, and a practical, real-life-way-things-work answer. The clinical answer is that testosterone levels, with some variability depending on the lab used, are roughly between 200 and 1100 nanograms per deciliter of blood.
Blood tests are typically taken in the morning, when testosterone levels are typically the highest.
Now to the practical answer. Your blood test might indicate that your testosterone level is 400 ng/dL, which, by most standards, is “normal.” However, that number might not be normal for you. Your normal level, the one you had in your twenties, might have been 600, or 800, or even 1,000, but there’s no way of knowing. Almost no one, unfortunately, has a baseline testosterone level blood test taken during their twenties, thirties, or even their forties.
As such, it’s more important to gauge your symptoms rather than your blood levels. True, blood levels are an important adjunct in determining whether testosterone replacement therapy is for you, but it’s only part of the whole picture.
What are the symptoms of low testosterone?
Oftentimes, the main symptom of low testosterone is a mental one rather than a physical one. Men with low testosterone often present as depressed or irritable and take little (or less) joy in things they used to be passionate about.
They simply don’t have that spark, or what the French refer to as Joie de vivre, which translates to a cheerful enjoyment of life, an exultation of spirit.
Of course, there are plenty of physical manifestations of low testosterone, too. Afflicted men often complain of weight gain, loss of muscle, less interest in sex or diminished sexual performance, infertility, diminished mental capacities, or a lack of motivation in general.
Any and all of these symptoms could be alleviated by testosterone replacement therapy.
At what age is someone eligible for testosterone replacement therapy?
While low testosterone is more common in older men (50 and over), it often afflicts younger men, too. Because of genetics, environment, or lifestyle habits, men as young as 25 can sometimes suffer from low testosterone levels. However, anyone younger than 25 who suffers from low testosterone should consult an endocrinologist to determine the exact cause.
Can women receive testosterone?
Absolutely. While women are considered to be purely estrogenic creatures, the testosterone levels of healthy women are 10 times greater than their estrogen levels.
Testosterone deficiencies, however, are quite common in females, causing women to suffer some of the same symptoms as men, including low energy, loss of muscle, loss of bone mass, loss of energy, weight gain, and sexual dysfunction. In fact, a few studies report that the percentage of women between the ages of 18 and 59 that suffer from “sexual dysfunction” is somewhere around 50%.
Oftentimes, this dysfunction is commonly misdiagnosed as underlying depression with referrals to psychotherapy or counseling, but many doctors are starting to suspect testosterone deficiency because the hormone plays as big a part in female sexuality as it does male sexuality.
Clearly, testosterone is very important to the health of women and it’s quite common for women to receive carefully monitored testosterone replacement therapy at Optimal Health Medical Group.
How is low testosterone treated?
While some doctors treat low testosterone with gels, creams, or patches, these treatments are often problematical. If you use a testosterone gel or cream on your body, you’re restricted from having bodily contact with anyone, particularly women and children, as some of it might rub off on their skin and give them an unwarranted and undesired dose of testosterone.
Additionally, gels, creams, or even patches must be applied to clean skin and they can be affected by excess perspiration. Lastly, skin permeability varies from person to person, so much so that creams, gels, and patches are sometimes ineffectual (or have minor effects) on certain patients.
The preferred mode of treatments at the Optimal Health Medical Group is weekly self-administered injections of testosterone cypionate. Regular injections have by far the best, most satisfying results.
However, in the event that you’re uncomfortable with doing injections, you can make arrangements to come into the office and have a nurse administer the injections every week (preferred) or two, depending on your schedule.
Can testosterone be used to treat any diseases or conditions?
Testosterone is used primarily to treat conditions like sexual dysfunction in men and women, hot flashes in women, pernicious anemia, muscle wasting (from disease), or low testosterone levels in general. However, testosterone was once thought to be a potential treatment for a host of diseases. Back in the 1950’s and 60’s, scientists all over the country conducted studies on testosterone and disease, many with promising results.
Unfortunately, testosterone research pretty much shut down because of a couple of primarily sociological reasons. For one, puritanical doctors frowned on the notion of restoring sexual vitality to “old” men. Secondly, the use of testosterone and steroids (synthetic versions of testosterone) by athletes gave the hormone a bad name. Consequently, most research literally dried up.
However, it’s logical to think that testosterone could be used to treat a variety of medical conditions, especially those involving the muscular system.
While using testosterone to treat such conditions is considered an “off label” use, afflicted patients might have low levels of testosterone in general and thus qualify to receive testosterone, which might have a therapeutic carryover effect.