FAQ

TRT stands for Testosterone Replacement Therapy, which is a treatment used to supplement or replace naturally occurring testosterone in the body.

TRT is typically prescribed for men who have low testosterone levels, which can lead to symptoms such as low libido, fatigue, lack of motivation, poor sleep, brain fog or cognitive decline, irritability and reduced muscle mass and strength.

Benefits of TRT may include increased energy, improved mood, enhanced libido, reduction in erectile dysfunction, increased muscle mass, decreased fat, increased motivation, and improvement in bone density.

Risks of TRT can include acne, fluid retention, increased red blood cell count, risk for clotting issues based on past medical history, testicular atrophy, reduction in fertility while on TRT, increased PSA and increased lower urinary tract symptoms.

TRT can be administered through injections, patches, gels, pellets, or oral medications, depending on the patient's preference and the doctor's recommendation. We prefer injections at Vanguard Genetix because of the ability to better control the doses so patients have tailored therapy and to reduce side effects.

Some men may start to notice improvements in symptoms within a few weeks of starting TRT, while others may take several months to experience significant changes. At Vanguard Genetix we typically tell patients to wait at least 6-8 weeks to start seeing changes. Most patients will notice an improvement in energy and libido first.

TRT is generally safe when prescribed and monitored by a qualified healthcare provider. However, like any medication, it carries potential risks and side effects. Hormones should always be balanced and high testosterone just like low testosterone is not good. Some of the side effects if levels are not balanced may include include acne, fluid retention, increased red blood cell count, risk for clotting issues based on past medical history, testicular atrophy, reduction in fertility while on TRT, increased PSA and increased lower urinary tract symptoms.

The main types of TRT include testosterone injections, patches, gels, pellets, and oral medications.

In many cases, TRT is not covered by insurance. Insurance typically requires two separate AM labs with levels below the lab reference range. They will not usually cover ancillary medications if they are needed to preserve testicular function and control estrogen. At Vanguard Genetix we do not take insurance, but it allows us to be much more flexible with optimal doses and dosing regimen that our patients may need to be optimal. It also allows us to avoid long unnecessary prior authorizations which allows us to spend more time with the patient, as well as not allowing someone with no medical training to dictate what is best for our patients.

The frequency of TRT administration depends on the type of treatment prescribed. For example, injections may be given weekly, while patches or gels may be applied daily. At Vanguard Genetix we are a proponent of injectable testosterone. We encourage smaller more frequent injections as it avoids the peaks and troughs or highs and lows of rising and falling testosterone levels. If the levels are more consistent with minimal fluctuation this translates to the benefits such as energy or libido being consistent throughout the entire week.

TRT may improve erectile function in men with low testosterone levels, but it's not always effective for everyone. Other treatments for erectile dysfunction may be recommended in combination with TRT such as the PED5 inhibitors like Cialis (tadalafil) Viagra (Sildenafil) PT-141. Many of our patients take a small daily dose of tadalafil and love the vasodilatory effects.

TRT can help increase muscle mass and strength in men with low testosterone levels, especially when combined with exercise and proper nutrition. Our primary focus at Vanguard Genetix is not prescribing testosterone to solely increase muscle mass, but the retention of lean mass later in life reduces many potential injuries and chronic diseases as well as helps burn more fat.

TRT can suppress sperm production and fertility in some men. When the body is getting supplemental testosterone it sends a signal back to the pituitary gland in the brain telling it to slow down the production of luteinizing hormone (LH) and follicular stimulating hormone (FSH.) LH stimulates the Leydig cells in the testes to produce testosterone and FSH stimulates the Sertoli cells which produce sperm. So both natural testosterone production and sperm production can be reduce while on testosterone. Vanguard Genetix can prescribe several medications in conjunction with TRT to help preserve some of this natural function. For those concerned about fertility, alternative treatments or strategies may be recommended, or our clinicians may advise waiting to initiate TRT until after someone successfully conceives.

There are typically no specific dietary restrictions while on TRT, but maintaining a healthy diet and lifestyle can enhance the benefits of treatment. We recommend lean protein meals balanced with whole food including vegetables, fruits, healthy fats and complex carbohydrates.

The relationship between TRT and prostate cancer is complex and was muddied by Dr. Huggins research on testosterone and prostate cancer from his study in 1941. He found that if patients were castrated and sex hormone levels were zero that it bought patients with aggressive prostate cancers more time. There was further research by Dr. Morgentaler where he biopsied men with low testosterone and men with elevated prostate specific antigens (PSA) and found a similar incidence of prostate cancer which contradicted Dr. Huggins findings that low testosterone reduced the risk of prostate cancer and high testosterone must promote it. Currently, most of the urology does not believe that TRT causes prostate cancer. There have been recent findings that showed men with prostate cancer and normal testosterone levels (even if on TRT) after having their prostate removed or having radiation, had a much lower incidence of prostate cancer returning than men with very low levels of testosterone. It seems that at certain levels testosterone can be protective for the prostate. The prostate has a very low threshold for androgens (sex hormones) where once it is saturated the risk or prostate cancer is not increased. The use of testosterone with prostate cancer depends on the type and severity of the cancer. There are some lower grade cancers that are not propagated by testosterone replacement and other high grade cancers where androgen deprivation therapy is employed. Despite these findings we will always monitor PSA levels and if we see a deviation from baseline, we will address it to keep our patients safe. We also would not start someone on TRT that had a history of prostate cancer or an elevated PSA without further testing and consulting with their urologist. Our patient’s safety is our number one priority.

Hair loss is not a common side effect of TRT, but it may occur in some men, especially if they are genetically predisposed to male pattern baldness. If testosterone levels remain therapeutic dihydrotestosterone (DHT) levels rarely become elevated which is the theory behind hair loss (elevated DHT levels.)

TRT has been shown to improve mood and overall well-being in men with low testosterone levels, potentially reducing symptoms of depression and anxiety. Another common symptom that we hear reported more often by wives, girlfriends or children is irritability. We have seen many of our patients dramatically reduce irritability levels and their children report dad is more fun to be around or spouses say it is more pleasant to spend time with their significant other.

TRT can help increase muscle mass and metabolism, which may contribute to weight loss in some men. However, it's not a primary treatment for obesity and should be used in conjunction with diet and exercise. TRT can also reduce fatigue, increase energy and improve motivation which often leads to patients being much more active and in turn losing weight or causing body re-composition.

TRT can improve cognitive function. We often hear our patients report that they have less brain fog and are less forgetful.

TRT may affect cholesterol levels, some studies have shown a decrease in LDL and total cholesterol but also a decrease in HDL cholesterol. Despite this decrease in HDL cholesterol, the TRAVERSE study concluded that men at high risk for cardiac events or that had already pre-existing cardiovascular disease who were on testosterone replacement therapy were not at an increased risk of cardiac events (stroke, heart attack.)

TRT may cause fluid retention and increase red blood cell production, which can contribute to changes in blood pressure. Monitoring blood pressure regularly is

important for men on TRT. Correcting underlying issues that may cause an increase in red blood cell production is also important such as stopping smoking or reducing sleep apnea.

TRT may improve sleep quality in men with low testosterone levels, reducing symptoms of insomnia and sleep disturbances. It is not appropriate for men with uncontrolled sleep apnea.

TRT is more likely to stabilize mood rather than cause mood swings. However, individual responses to TRT can vary, and some men may experience mood changes as their hormone levels adjust. It is important to work with a qualified clinic that regularly monitors patient symptoms accompanied by routine lab work.

TRT can increase energy levels and reduce fatigue in men with low testosterone levels, leading to improved overall vitality and well-being.

Acne is a potential side effect of TRT, especially with testosterone injections, due to increased sebum production in the skin. Proper skincare can help manage acne while on TRT. Testosterone levels should be kept below supratherapeutic levels to avoid increasing DHT levels and increasing the chance of acne.

The TRAVERSE study from 2023 found that men with a high risk or pre-existing cardiovascular disease on testosterone replacement therapy were not at an increased risk of cardiac events. Hormones are a harmonious balance, and low levels seem to be linked with an increased risk of cardiovascular disease. Levels that are too high have been shown to thicken heart walls.

TRT can increase libido and sexual desire in men with low testosterone levels, leading to improved sexual function and satisfaction.

TRT can suppress natural testosterone production in the testes, which may lead to testicular shrinkage in some men. However, this is usually reversible upon discontinuation of TRT or reduced by using medications that preserve some level of gonadotropin stimulation or testicular stimulation such as clomiphene, enclomiphene or Pregnyl (human chorionic gonadotropin(HCG).)

TRT increase testosterone which via aromatization will cause an increase in estrogen. By maintaining levels that are not supraphysiologic it will help control aromatization and keep estrogen levels balanced. Patients that have more adipose tissue or higher body fat percentages tend to aromatize more and have a greater chance of breast tissue stimulation. We do a very good job of controlling testosterone levels to control aromatization and encouraging our patients to decrease body fat percentages. Not every patient gets an aromatase inhibitor(AI) (estrogen blocker) and we aim to control aromatization through an improved body habitus, the dose of testosterone we prescribe, type of injections…. subcutaneous over intramuscular and smaller more frequent injections. We prefer not to prescribe aromatase inhibitors and find if we control testosterone levels AI’s are the exception.

TRT can be stopped once started, but it's important to do so under the guidance of a healthcare provider. Abruptly stopping TRT can lead to mood changes, muscle loss, decreased quality of sleep and hormonal imbalances with hormonal levels below patient’s original baselines. Most men continue testosterone replacement longer term, but there are some men that use the testosterone as an impetus to gain better lifestyle habits (increased activity levels leading to weight loss, improved diet, improved quality of sleep, improved mood and stress reduction.) All of these modifiable factors may increase baseline testosterone levels and in rare cases men have used TRT as a tool and went off of it after changing their lifestyle and increasing testosterone levels. (This would be the exception not the norm.)