Testosterone: A Man's Guide PDF Free Download. As a physician who treats testosterone deficient male patients I have found Nelson's book so informatively. A MAN'S GUIDE TO TESTOSTERONE REPLACEMENT THERAPY PhysioAge Medical Group. Who We Are Ronald V. Livesey, MD and Joseph M. Raffaele, MD . How to Optimize Your Testosterone - Free download as PDF File .pdf), Text File ( .txt) or read online for free. This book full of 5- And much more Written by Nelson Vergel, author of Testosterone: A Man's Guide and founder of ExcelMale. com.
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This book summarizes over 20 years of literature research and personal experiences about the clinical use of testosterone replacement therapy to treat hypogonadism in men. Testosterone Replacement Therapy. Testosterone replacement therapy in hypogonadal men. What causes low testosterone? While testosterone levels in the body can decline as a man ages, general health and medical conditions can also affect. Editorial Reviews. Review. This book provides the bare knuckles' how-to tips on the treatment The Definitive Testosterone Replacement Therapy MANual: How to Optimize Your Testosterone for Lifelong Health and. The Definitive.
You may be subject to an annual deductible and a co-pay. As previously mentioned, aging and illness increase SHBG. Then your physician will spend 2 hours discussing the principles of bioidentical hormones. Bosaeus I. Because of this we screen for breast cancer with a mammogram and a breast exam prior to starting therapy.
Herein lies the crux of the controversy. To see if the decline in bioavailable testosterone correlates with some of the signs and symptoms of aging. At sometime during his life a man will begin to experience a decline in testosterone levels. So much for the prevailing wisdom. How do I start TRT? The first step is to get your levels of total testosterone. We think that the dose of testosterone used in this study was too low and that if higher dose had been used even more impressive results would have been demonstrated.
Then start with a cream or gel based transdermal TRT that closely mimics the natural physiological pattern of testosterone levels in your blood.
If one does have an occult as yet undetected cancer. The tendency to lose scalp hair can be exacerbated as well. This has been studied extensively and there is a greater incidence of heart disease in men with low testosterone levels than those with high levels.
The main concern that men have with regard to long term TRT is whether it will increase the risk of prostate cancer. The accumulating evidence shows that whenever you raise the testosterone level—no matter what the starting level—you get benefits in body composition.
The concern about a link between testosterone and heart disease comes from the following line of reasoning: The concern about TRT increasing the risk of prostate cancer stems from the well documented fact that prostate cancers shrink if you deprive them of testosterone. At physiologic replacement levels—the range we keep our patients within—there is no evidence of any increase risk of prostate cancer or enlargement of the prostate to the point of symptoms.
Because two conditions are found in the same population. This is another example of the fallacious reasoning that plagues the field of hormone replacement therapy.
Other studies have looked at the effect of TRT on cholesterol levels and have universally found a decrease in total cholesterol. More dramatic evidence comes from the fact that giving testosterone intravenously during angina results in improvement in symptoms. This can be treated with topical or oral medications quite effectively.
If a man had a propensity to develop acne as a teenager. For these two conditions— testosterone levels and heart disease—we. What are the risks of TRT? What about that free lunch question? Short term risks. The next step is to come in for a complete history and physical exam so that the treatment can be started in the context of your overall medical condition. Many other studies have been done documenting the beneficial effect of bringing the DHEAS level back to younger adult levels in lupus.
We also make sure that you have adequate zinc levels and that your conversion of testosterone to estradiol is not too high.
The only side effects of DHEA in the doses we use are a slight increase in acne in patients predisposed to it and in some women increased hair growth. There is no evidence that its use causes an increased risk of breast or prostate cancer. The truth is that it is just one of the important hormones in an overall hormone replacement therapy program.
With close monitoring. Human studies in which the level of DHEAS the form found circulating in the blood was replaced back to the levels of a 20 year old have shown impressive results in older adults and in various disease states in which the level is lower than expected for the age group.
Because of this we screen for breast cancer with a mammogram and a breast exam prior to starting therapy. Much is true. The next few months will be a time of monitoring and adjusting your dose depending on how you feel and your laboratory test results.
These patients experienced an increase in lean muscle mass and a decrease in fat mass. To keep the conversion of testosterone to DHT low within the prostate.
Yen and Morales administered 50 mg of DHEA for six months to 13 men and 17 women aged 40 to 70 years. These same researchers did a similar study to assess the effect of DHEA on immune function and found that there was an increase in natural killer cell function. Lack of hGH causes dwarfism or short-stature in children. Melatonin is produced in the pineal gland at the center of the brain.
Because it is released in spurts. The blood level of IGF-I. Walter Pierpaoli. Melatonin is also a strong anti- oxidant and cancer fighter it has been shown that solid tumors partially regress with melatonin treatment. We routinely check blood levels of thyroid hormones in all our patients and treat as necessary. Treatment consists of a combination of T3 and T4.
By age Thyroid hormone replacement therapy is one of the unabashed successes of modern clinical medicine. It is well documented that humans produce less and less melatonin as they age. T3 and T4 stimulate and maintain metabolic processes by modulating the synthesis and degradation of proteins and fatty acids in many tissues.
When he did the reverse experiment. Because of these benefits and its safety in even very high doses. Growth Hormone Before we discuss the story of human growth hormone hGH as an anti-aging therapy.
Under the influence of the hypothalamus the part of the brain concerned with the more primitive bodily functions. This is a very common disorder you probably know someone with it. It is standard medical therapy to replace thyroid hormone in anyone exhibiting fatigue. As it circulates through the blood. Melatonin is released in spurts at night to initiate sleep. In This gland receives direct input from the eyes so that it knows what the day and night cycles are.
At about the same time. When researchers looked back at records of adults who had been treated with hGH as children or those who had become growth hormone deficient as a result of trauma or tumors.
They had two times the rate of death from cardiovascular disease compared with age-matched controls. These latter hormones routinely have been replaced because their deficiencies can be immediately life threatening or at least decrease the quality of life in the short term.
Daniel Rudman. In the conclusion. After six months of therapy. He found that virtually all of these aspects of premature aging were reversed with one year of treatment. Bengt Bengtsson. If it occurs when he is past adolescence. The other cause of hGH deficiency occurs when a person has had damage to his pituitary gland.
These patients appeared to be suffering from premature aging. This development set in motion renewed interest in the other physiologic roles of hGH because of its availability for clinical research.
If this occurs when he is young. He had documented the continuous decline in growth hormone secretion beginning in the third decade of life and wondered if it was responsible for the well-known body composition changes associated with aging such as decreased muscle tone. MD and his group in Sweden decided to study the effect of the now more available recombinant hGH on these patients.
Bengtsson has said. Once on therapy. During our discussions with the principal investigators of the studies. If you have a higher level. The studies began in and ended in June of Many studies have been done on GHDAs and it is now known that the subcutaneous hGH injections must be given once or twice a day at a 50 to 25 percent lower dose. Its only effective route of administration is subcutaneous injection under- the-skin.
These men were given hGH in much higher doses than necessary to get the body composition changes expected and it was given only three times a week. There are virtually no significant side effects at this dose.
Growth Hormone is not for everybody. Abnormally high levels of this amino acid are as much a risk factor for heart disease as are smoking and high cholesterol. This promotes enhanced effects of the hormones and possibly to decreased doses necessary to achieve optimal effects. We encourage our patients to exercise regularly. In addition to restoring your key hormone levels to a youthful level.
For example. If you should decide for some reason not to start a program with us. Much research shows a link between diet and key hormones such as insulin and anti-oxidants such as glutathione. For these reasons.. Our on-staff nutritionist is available for an in-depth consultation at your request. We will provide you with a graduated exercise program and a free consultation with our on-staff personal trainer to help you carry through our recommendations. The Rust of Mother Nature Free radicals are very reactive by-products of normal metabolism that are constantly being produced by your cells.
For instance. We now offer our proprietary line of high-potency vitamins and supplements online through our site at www. A major cause of age-related decline. It is also well- documented that weight-bearing exercise helps to maintain good bone density.
Laboratory evaluation Before you visit our offices. We have developed an advanced biomarker testing system that uses scientific measurements and sophisticated algorithms to determine your true biological age. PhysioAgeR Systems consists of a battery of tests that measure validated biomarkers of aging. Advanced Biomarker Testing Before meeting with your physician for your initial consultation. High density lipoprotein HDL. This methodology requires lab tests and subsequent follow-up visits times during the first year.
Walk-in blood draws in our Manhattan office. Consultation Fees Precision Medicine involves frequent assessment and adjustment of hormone levels until a stable regimen is achieved. You will consult with your physician times in the first year. You will discuss the expected benefits and risks of your program as well as its administration. The HCG Program: Precision hormone replacement therapy for men.
Office visits are generally covered by indemnity insurance plans according to your out-of-network provider schedule. Custom-compounded medications will be shipped to your door the next day and every 28 days thereafter. This balanced. For patients who are not able to visit New York this frequently.
The TRT Program: Whereas we do not accept insurance for payment. Follow-up consultations. We will optimize your levels of testosterone. Management of your lab follow-up requirements and treatment program. Your choice will depend on your physiological age. Your laboratory results. Initial Consultation Before your 2-hour initial consultation you will fill out a questionnaire designed to detect any underlying conditions that need to be addressed.
This will also establish a baseline of aging against which to compare your progress. You will then meet with your physician to discuss your medical history and undergo a physical exam. STEP 3: The laboratory tests can be submitted directly to your insurance company by the lab and may be covered by your indemnity insurance plan. They do not correlate to office visits or shipments. We will send you a lab requisition that you can take to any Quest Lab.
What does the program involve? STEP 1: Contact Us Contact our office on to schedule an appointment. If you wish to determine coverage before your initial consultation.
Contact your insurance company for more details on coverage. No appointment is necessary for your lab test.
One complimentary nutritionist consultation late cancellation fees are not covered. Most labs open before 8AM. Then your physician will spend 2 hours discussing the principles of bioidentical hormones. The results will be sent to our office days later.
Our technicians will conduct 7 advanced biomarker tests here in our office. Labcorp charges more for the same tests.
Depending on your program. You must be fasting for hours before the test is performed. They will provide you with properly coded receipts that you may submit to your insurance company for reimbursement. Annual DEXA bone density scan These fees apply to every day period as long as your physician is responsible for monitoring blood levels. STEP 4: Medications Compounded medications are made-to-order and shipped to your door every 28 days from MedQuest Pharmacy.
STEP 2: Blood Test You are required to get a blood test before your visit. Take all medications on the day of your test. MedQuest is one of only a handful of compounding pharmacies that not only makes bioidentical transdermal hormonal cream. They use only the highest-quality USP-grade pharmaceutical ingredients.
We will be glad to provide you with properly coded invoices that you may submit for reimbursement. Many insurance plans will cover the cost of office visits according to their out-of-network provider schedule.
You will need to get a follow-up blood test 10 days before your consultation. Custom-compounded medications will be shipped to you the next day and every 28 days thereafter from MedQuest Pharmacy. Will my insurance cover the cost of prescriptions? Most insurance companies do not cover the cost of compounded medications.
You may be subject to an annual deductible and a co-pay. Depending on the type of FSA. MedQuest Pharmacy does not accept insurance for direct payment. The list of tests we perform can be found on p. Our office does not accept insurance for payment. New patients will need two or three follow-ups during the first year of treatment while the proper dosages are determined.
Average medication costs for a day supply are as follows: Will my FSA cover your treatment? These arrangements permit the employee to stow a portion of their pre-tax earnings in a special account for use on health-related expenses NOT covered by primary health insurance. STEP 5: Follow-Up After 6 weeks of treatment. What are the costs involved? You will repeat this process after months and again every 6 months thereafter. Speak with your insurance carrier for more details.
Your physician will discuss the effects of the program and adjust your dosages accordingly. Please contact your provider for more details on coverage. Will my insurance cover the cost of lab tests? Insurance plans will sometimes cover the cost of lab tests. Medications will be shipped to your door every 28 days from MedQuest Pharmacy. For this reason. The Program Maintenance Fee covers the cost of all follow- up care and more see previous page. Can I use my own pharmacy? We are better able to manage your hormone levels with precise accuracy if all medications come from the same pharmacy.
None of our more than 1. Injections are relatively painless when using ultra-fine 31 gauge. The molecules are then modified to exact replicas of the hormones currently in your body. For more information. If you prefer to consult with a physician experienced in bioidentical hormone replacement therapy in your immediate area. Do you test cortisol levels? We do not test cortisol levels because currently there is no significant data on the value unless you are looking for the specific disease states of hypercortisolism Cushing's syndrome or hypocortisolism Addison's disease.
Bioidentical hormone modulation is very different from prescribing "one-size-fits-all" drugs like Premarin. By standardizing with one pharmacy. There are many variables such as the absorption level of the cream base or the particle size of the powder. What are the hormones made from? In every case.
Every treatment regimen is custom-tailored to the individual based on the results of blood tests. If a patient obtains their hormones or supplements elsewhere. Do I have to come to New York? How can I find a doctor in my area? For your initial consultation. Measuring just the total testosterone in the blood may not provide the whole picture and let you know how much active or usable testosterone you have.
Levels will vary with age and individual factors. It is useful to also measure the level of free testosterone as this may be more indicative of how hormone therapy is progressing. Levels of free testosterone can range between 0. Higher than normal testosterone i. Like everything in life, balance is key.
Too much of a good thing can be detrimental. Proper monitoring by an experienced physician is extremely important to ensure optimal levels of testosterone, to maximize benefits and to minimize side effects.
As mentioned previously, hypogonadism is the medical term for the con- dition in males that is caused when the body is not producing sufficient amounts of testosterone. What most people dont realize is that in addition to sexual desire, testosterone also affects lean body mass, strength, bone density, mental focus, mood, fat loss, and other important factors in both males and females.
Common complaints for men with hypogonadism include: Normalizing testosterone in people who have lower than normal levels has dramatic benefits, among which are increased sexual desire, lean body mass, bone density, strength, mood, motivation, mental focus, and stamina. However, these benefits can be erased if proper monitoring, dose adjustment, and appropriate choice of testosterone replacement option are not accomplished.
Louis University to aid in the diagnosis of hypogonadism. Do you have a decrease in sex drive? Do you lack energy? Do you feel shorter? Have you lost height? Lower bone density can decrease height.
Have you noticed a decreased enjoyment of life? Are your erections less strong or gone? Has it been more difficult to maintain your erection throughout sexual intercourse? Has your work performance deteriorated recently? If you answered Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low testosterone. Other questions that are usually not asked by doctors, but which Ive found to be important are the following: Are you relating well with people around you?
Are you loving to your lover or life partner? Are you able to pay attention when someone talks to you? In my life low testosterone caused problems that went far beyond sex and my body. It affected the way that I related to people and my ability to handle stress at work and in life.
Note that several of the above-mentioned problems can be caused by many other issues unrelated to low testosterone. This questionnaire is not a perfect predictor of low testosterone and should not replace tests for testosterone blood levels. The benefit of this questionnaire is that it may encourage some men to seek medical advice. Then they can get their testosterone checked and have a physical examination to help determine whether they are indeed hypogonadal.
Causes of Testosterone Deficiency As discussed before, hypogonadism is caused when the testicles fail to pro- duce normal levels of testosterone. In another, there is not enough secretion of LH and FSH needed to tell the testicles to produce needed testosterone. Furthermore,high prolactin hormone levels may suggest a pituitary tumor that may be causing a decrease in testosterone production.
It is important that your doctor measure hormones in the HPGA cascade to diagnose what kind of hypogonadism you have. The most common kind of hypogonadism presents low testosterone with normal or elevated FSH and LH levels, which indicates that your testicles are not responding to the signals of both LH and FSH.
This is what is called primary hypogonadism. There are several reasons that testosterone levels may be low: This could be caused by heavy alcohol intake or the effect of some medications on estrogen clearance in the liver. Too much free testosterone is being bound by SHBG.
This would be especially apparent if a males total testosterone level is in the high reference range but his free testosterone unbound level is low. As previously mentioned, aging and illness increase SHBG. The pituitary gland, which controls testosterone production through the production of LH, is not secreting enough LH to stimulate production of testosterone by the testicles. In this case, total testosterone would be low. The hypothalamus is not functioning properly. The testicles have lost their ability to produce testosterone, despite adequate amounts of LH.
Disease or infections. Street drugs, prescription or over-the-counter medications more on this later. High prolactin levels, which may indicate the presence of a pituitary tumor that impairs production of hormones that tell your testicles to produce testosterone rare condition but worth mentioning! Defects in genes that affect LH and FSH production caused by genetic mutations Low or high thyroid hormones Obesity and sleep apnea Diagnosis of Testosterone Deficiency Lab work will play an important role in diagnosing hypogonadism.
Your doctor will likely check your total testosterone and your free testosterone levels. There are some things you should know about these tests, including what they represent and when they should be done.
For more information on required blood work, click here: The normal range from most laboratories for free testosterone usually is between 3. Table 2 shows the reference ranges for free testosterone according to age in men.
As mentioned earlier, free testosterone is not bound to blood carrier proteins, so it is free to diffuse readily into cells where it signals them to adjust their activity.
Some studies report that free testosterone may be a better indicator for quality of life and lean body mass, but there are some conflicting studies on this issue. Since aging and illness can increase SHBG, which can attach to testosterone to impair its effectiveness, it becomes more important to test for free testosterone if you are older or being challenged by illness. Measures of free testosterone are controversial. Other measures of free testosterone are less accurate.
So, make sure your doctor is using either one of these methods. Testosterone decreases as we age. This decline is due to many factors that get in the way of retaining a healthy testosterone blood level.
Among them are inflammatory states caused by being overweight, diet, medications, alcohol and street drug abuse, stress, lack of adequate sleep, and problems with how the body uses carbohydrates for energy due to impaired function of the blood sugar controlling hormone insulin. Some experts also think that our own bodies are slowly turning down their engines to get ready for a slower pace and eventual death.
However, many physicians in the aging field have now begun to believe that we can grow older while keeping our strength, sexual function, lean tissue, and cognitive function so that we have more disability-free years. Testosterone levels can vary throughout the day.
Young and adult men tend to have higher testosterone levels in the morning than in the evening. This variation is less evident as men age, however. This fact may explain why its not uncommon for men to have morning erections. Some physicians recommend doing hormone testing in the morning on an empty stomach, as many things can affect free testosterone measurements, including diet. Elevated insulin caused by eating carbohydrates, for instance, can increase free testosterone levels by reducing plasma levels of SHBG.
Some doctors tend to test this hormone in the late afternoon since the levels may be lower then. In my opinion, it is not practical to restrict testing of this hormone to early morning times and in a fasting state since intraday fluctuations are not that great in men over 30 and it may be equal to laboratory variability.
Normal values may vary from lab to lab depending on what reference range they use. Your doctor will have your test results in one to two days. Depending on the country, ranges are in nanograms per deciliter usually in the United States or nanomoles per liter Europe and other countries.
The conversion factor is: The degree of this increase has not been clearly quantified, but there is evidence that the following can help. T Sleep well. At least 7 -8 hours and keeping proper sleeping hours. Reference Moderate alcohol consumption to no more than 2 drinks a day.
Reference Exercise for an hour, times a week. Do not over train since this can decrease testosterone. Reference Lower stress. Learn breathing exercises and set your phone up for alerts every 2 hours to remind you to take a deep breath. Reference Some men may be deficient in zinc.
Zinc is needed for proper testosterone production. Reference Do not wear tight underwear. Let your testicles hang and cool off since high temperatures can affect sperm quality. Sleep in boxers or naked if you can to allow nocturnal blood flow and erections to your penis.
It is nature's way to feed and regenerate your penis' tissues. Reference Lose weight if overweight. Probably the most effective way to increase testosterone. Reference Avoid pesticide exposure and do not heat up your food in plastic containers. Toxins can increase the conversion of testosterone to estradiol, a female based hormone. Reference Have sex or masturbate. People who do tend to have higher testosterone. Even the use of Viagra has been associated with increased testosterone.