TESTOSTERONE OPTIMIZATION THERAPY
TESTOSTERONE OPTIMIZATION THERAPY
First of all, why do we call it testosterone optimization therapy (TOT) rather than testosterone replacement therapy (TRT)?
Strictly speaking TRT refers to testosterone therapy for men with T levels below the lower end of the laboratory reference range (the lowest 2.5% of their cohort). For instance, this would be men with T less than 280 if the range is 280-1100. The reference range is typically a bell curve encompassing 95% of the patients tested. For testosterone, this is a very broad range. “Normal” testosterone levels are all over the place. I always take time with my patients to explain that there really is a difference between a reference range and “normal” range when it comes to testosterone and will write about this soon. A lot of patients become symptomatic when their T levels decline with age, and become quite discouraged when their doctor tells them that their T level is normal at 290.
TOT is a strategy not only for patients below the reference range, but also for those who are symptomatic from testosterone deficiency but have levels that are within the reference range. For all of these patients our goal is to optimize testosterone levels such that they feel and perform better and note improvements in overall health. In most cases this means getting testosterone levels into the upper half of the reference range.
Bottom line is just because a man’s levels are considered “normal” according to his lab test, it doesn’t mean he would not benefit greatly from OPTIMIZING his testosterone levels. In many cases that just means getting them back to the levels they used to be when he was younger.
Improving the testosterone levels of men is a big part of what we do at The Men’s Center. In appropriate cases, the vast majority of men notice significant improvement in lifestyle and overall health. We find this exceptionally rewarding. This is part of what makes our job fun. Responsible TOT can make lives better and healthier, without question.
Testosterone optimization is not for everybody and is not one-size fits all. We strive to focus on the person and their goals and priorities rather than simply the numbers. In some people TOT is neither necessary nor healthy. We are also NOT in the business of getting testosterone levels to Mark McGwire/Jose Canseco/professional wrestler levels. If a patient wants this, we politely decline. Frankly, there are going to be clinics who oblige, but that’s not our jam. Also to be clear, testosterone optimization should be closely monitored by an actual doctor.
WHAT TYPES OF SYMPTOMS MAY BE SIGNS OF SUBOPTIMAL TESTOSTERONE?
Decreased sex drive, decreased energy, depressed mood or anxiety, loss of muscle mass, fatigue, difficulty sleeping, and in some cases erectile dysfunction (testosterone optimization is generally NOT an appropriate treatment for ED) are some of the more common consequences of suboptimal T. Of course, these symptoms can be caused by a variety of other problems and it is not always easy to establish CAUSALITY. Testosterone is not a cure all. In fact, if you have symptoms consistent with suboptimal testosterone and your labs do indeed demonstrate suboptimal testosterone, the only way to truly know if deficient T is the cause is to try TOT and see if it improves your lifestyle. In our experience it usually does just that. In many cases it is a life changer. In our 4 months at The Men’s Center, we have started a lot of patients on TOT, and so far only 8% have decided that it did not make them feel better enough to continue it. In their cases, their symptoms were likely caused by other issues.
OTHER THAN THE MORE WELL-KNOWN BENEFITS ABOVE, WHAT ARE OTHER POSSIBLE BENEFITS OF TOT?
The following have been shown to be potential benefits of TOT in appropriate patients: Improved memory and cognitive function, decreased cholesterol, improved blood sugar control, increased bone density and reduced fractures, decreased body fat, improved cardiovascular health, and overall longevity.
A lot of people ask about risk of heart attack and stroke with TOT. In fact, the data is massively unclear and varies from significantly decreased to slightly increased risk. It is probably the case that irresponsibly/poorly supervised TOT may increase risk. In particular, testosterone levels that are way too high or untreated polycythemia (elevated red blood cell count due to elevated testosterone) may be risk factors. This is why close monitoring by a physician who has your best interest in mind is critical.
HOW IS TESTOSTERONE ADMINISTERED?
There are a lot of ways to take testosterone. These include oral, topical (rubbed on skin), pellets, intramuscular (IM) injections, or subcutaneous (SQ) injections. At The Men’s Center, we personally prefer twice weekly subcutaneous injections. We like twice weekly because it requires a small volume and levels tend to be more stable than longer intervals. Subcutaneous injections can be done with a very small insulin needle. Most importantly, when compared to the more common IM injections, SQ injections have demonstrated greater safety profiles, with less polycythemia and less conversion to estrogen (guys don’t like that). All this true, we are happy to help our patients use the route of administration that works best for their lifestyles.
Many people fall prey to the philosophy that because it is an expected part of aging we should just accept it—that we should accept loss of energy and initiative, cognitive decline, muscle atrophy, demise of sex life, etc. We just don’t see it that way!
Check out this page for a little more about TRT/TOT at The Men’s Center.