Category: Testosterone

A list of reputable testosterone replacement therapy options that offer online consultations and prescriptions.

First off - I have no affiliation with any of these companies. They have been vetted with research on multiple TRT forums and review sites. In some cases, I have spoken with someone at the company directly by phone or email. Pricing varies between each company and depends on which medications you are prescribed.

TRT Nation is a testosterone replacement therapy (TRT) clinic that specializes in helping men with low testosterone levels. They offer a range of testosterone replacement options, including injections, gels, and pellets, and work with patients to find the best solution for their individual needs. They also offer additional wellness services, such as weight loss programs and supplements. They can prescribe testosterone, human growth hormone (HGH) peptides, human chorionic gonadotropin (HCG), and even the trendy weight loss drug, semaglutide.

Frontline Alternative Medicine is a functional and integrative medicine clinic that offers testosterone replacement therapy as part of their comprehensive approach to men's health. They offer a range of testosterone replacement options, including injections, gels, and pellets, and also offer other hormone therapies, such as human chorionic gonadotropin (HCG) and dehydroepiandrosterone (DHEA).

Defy Medical is a telemedicine clinic that specializes in testosterone replacement therapy and offers a range of options, including injections, gels, and pellets. They also offer other anabolic therapies, such as HCG, oxandrolone, stanozolol and nandrolone.

Viking Alternative Medicine is a clinic that specializes in testosterone replacement therapy and offers a range of options, including injections and gels. They also offer other hormone therapies, such as HCG and stanozolol.

Do you have others to add to the list? Leave a comment and I'll check them out. Note: Please do NOT try to spam. I won't publish the comment. Instead, I'll vet the company and add it to the list if they are found to be a safe and legitimate TRT clinic.

When I started testosterone replacement therapy in my early thirties, I didn't give much thought to how many injections I would be taking over the course of my life. Now at the age of 46, I've been sticking myself with needles every week for over a decade -- and let me tell you, these shots add up!

You're going to be a pin cushion. This is especially true if you take multiple injections per week like I do (Testosterone Enanthate twice weekly). One thing that helps is what I call "The Macarena Approach". For those of you too young to remember the pre-TikTok TikTok dance, watch this. It goes something like this: Left glute, right glute, left delt, right delt, left thigh, right thigh, repeat...

Use the calculator below to figure out how many injections you'll be taking over the course of your life once you start TRT. The results might surprise you. Just imagine all of the scar tissue that will build up.

Testosterone Injection Calculator

Exploring the complex pathways of testosterone conversion to DHT and estrogen metabolism in men.

Testosterone plays a significant role in the development of male reproductive tissues, as well as secondary sexual characteristics. However, its functions extend beyond its direct actions, as it also serves as a precursor for dihydrotestosterone (DHT) and various types of estrogen. This article explores the biochemical pathways by which testosterone is converted into these biologically active metabolites, and the physiological implications of these conversions.

Testosterone Conversion to DHT

DHT is a potent androgen, with approximately 2.5-10 times higher affinity for the androgen receptor than testosterone (Jenkins et al., 1992). The conversion of testosterone to DHT occurs primarily in peripheral tissues, such as the skin, prostate, and hair follicles, and is catalyzed by the enzyme 5?-reductase (Imperato-McGinley et al., 1992). Three isoforms of 5?-reductase have been identified, with types 1 and 2 being the most relevant for DHT synthesis (Thigpen et al., 1993).

DHT is a key hormone involved in the development of male external genitalia and the onset of puberty. It also plays a critical role in prostate growth and male pattern baldness. Excessive DHT levels have been implicated in the development of benign prostatic hyperplasia (BPH) and prostate cancer (Gormley et al., 1992).

Testosterone Conversion to Estrogens

Contrary to popular belief, estrogens are not exclusively female hormones. They are also synthesized in males, albeit in smaller amounts, just as women produce testosterone in smaller amounts than men.

Testosterone can be converted to estradiol (E2), the most potent estrogen, by the enzyme aromatase (CYP19A1) (Simpson, 2003). This reaction occurs primarily in adipose tissue, liver, brain, and testes.

Estrogens play a crucial role in bone metabolism, preventing bone loss in both men and women (Oz et al., 2000). They are also involved in the regulation of male reproductive function and the maintenance of cognitive health. However, elevated estrogen levels in men have been associated with an increased risk of gynecomastia, cardiovascular disease, and certain types of cancer (Bagatelle & Bremner, 1995).

Testosterone's actions extend beyond its direct effects, serving as a precursor for both DHT and various types of estrogen. The conversion of testosterone to these biologically active metabolites is mediated by specific enzymes and occurs in various tissues throughout the body. Understanding the complex interplay between testosterone, DHT, and estrogen metabolism is essential for comprehending the hormonal balance in men and its impact on health and disease.

The conversion of testosterone to DHT, catalyzed by the 5?-reductase enzyme, has significant implications for male sexual development, hair growth patterns, and prostate health. On the other hand, the aromatase-mediated conversion of testosterone to estrogen, particularly estradiol, plays a crucial role in bone metabolism, male reproductive function, and cognitive health.

To make a long story short:

While you may want to take aromatase inhibitors while on TRT, you also wouldn't want to completely suppress your body's ability to create estrogen, such as estradiol, because even men need some estrogen to function properly.

SOURCES:

Bagatell, C. J., & Bremner, W. J. (1995). Androgens in men—uses and abuses. The New England Journal of Medicine, 332(11), 707-714.

Bélanger, A., Candas, B., Dupont, A., Cusan, L., Diamond, P., Gomez, J. L., & Labrie, F. (2006). Changes in serum concentrations of conjugated and unconjugated steroids in 40- to 80-year-old men. Journal of Clinical Endocrinology & Metabolism, 81(10), 3620-3625.

Bhasin, S., Storer, T. W., Berman, N., Callegari, C., Clevenger, B., Phillips, J., ... & Casaburi, R. (2001). The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. New England Journal of Medicine, 335(1), 1-7.

Bulun, S. E., Chen, D., Moy, I., Brooks, D. C., & Zhao, H. (2005). Aromatase, breast cancer and obesity: a complex interaction. Trends in Endocrinology & Metabolism, 22(2), 55-61.

Gormley, G. J., Stoner, E., Bruskewitz, R. C., Imperato-McGinley, J., Walsh, P. C., McConnell, J. D., ... & Lieber, M. M. (1992). The effect of finasteride in men with benign prostatic hyperplasia. New England Journal of Medicine, 327(17), 1185-1191.

Grino, P. B., Griffin, J. E., & Wilson, J. D. (1990). Testosterone at high concentrations interacts with the human androgen receptor similarly to dihydrotestosterone. Endocrinology, 126(2), 1165-1172.

Imperato-McGinley, J., Guerrero, L., Gautier, T., & Peterson, R. E. (1992). Steroid 5?-reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science, 186(4170), 1213-1215.

Jenkins, E. P., Andersson, S., Imperato-McGinley, J., Wilson, J. D., & Russell, D. W. (1992). Genetic and pharmacological evidence for more than one human steroid 5?-reductase. Journal of Clinical Investigation, 89(1), 293-300.

Kaufman, K. D., & Dawber, R. P. (1999). Finasteride, a type 2 5?-reductase inhibitor, in the treatment of men with androgenetic alopecia. Expert Opinion on Investigational Drugs, 8(4), 403-415.

Oz, O. K., Millsaps, R., Welch, R., Birch, J., & Zerwekh, J. E. (2000). Expression of aromatase in the human osteoblastic cell line, Saos-2. Bone, 26(5), 521-526.

Simpson, E. R. (2003). Sources of estrogen and their importance. Journal of Steroid Biochemistry and Molecular Biology, 86(3-5), 225-230.

Swerdloff, R. S., & Wang, C. (2004). Androgens and the ageing male. Best Practice & Research Clinical Endocrinology & Metabolism, 18(3), 349-362.

Thigpen, A. E., Silver, R. I., Guileyardo, J. M., Casey, M. L., McConnell, J. D., & Russell, D. W. (1993). Tissue distribution and ontogeny of steroid 5?-reductase isozyme expression. Journal of Clinical Investigation, 92(2), 903-910.

A brief summary of the laws governing TRT in the United States

1. Controlled Substances Act (CSA): The CSA is a federal law that regulates the manufacture, distribution, and dispensing of controlled substances, including testosterone. Testosterone is classified as a Schedule III controlled substance under the CSA, which means that it has a moderate to low potential for abuse and dependence.
2. Food, Drug, and Cosmetic Act (FDCA): The FDCA is a federal law that regulates the safety and effectiveness of drugs and medical devices. Testosterone replacement therapy products are subject to regulation by the FDA under the FDCA.
3. Drug Enforcement Administration (DEA) Regulations: The DEA is responsible for enforcing the CSA and has established regulations governing the registration, prescribing, and dispensing of controlled substances, including testosterone.
4. State Medical Boards: State medical boards regulate the practice of medicine within their respective states, including the prescribing and administration of testosterone replacement therapy. State medical boards can discipline or revoke the licenses of healthcare providers who violate state laws or regulations related to testosterone replacement therapy.

A timeline of testosterone replacement therapy milestones

• 1849: Arnold Adolph Berthold, a German physiologist, conducts experiments on roosters and observes that removing their testes causes changes in their physical characteristics.
• 1889: Charles-Édouard Brown-Séquard, a French physician, injects himself with a concoction made from the testicles of dogs and guinea pigs, claiming that it improved his physical and mental health.
• 1935: The chemical structure of testosterone is first identified by Ernst Laqueur, a Dutch biochemist.
• 1937: The first clinical trial of testosterone replacement therapy is conducted by Paul Heinrich Emmett and Enrest Laqueur in Amsterdam. They administer testosterone to a patient with low testosterone levels and report improvements in his physical and mental health.
• 1944: The first synthetic form of testosterone, testosterone propionate, is developed.
• 1953: A study published in the Journal of the American Medical Association (JAMA) reports that testosterone replacement therapy can improve muscle mass and strength in men with low testosterone levels.
• 1960s: Testosterone replacement therapy becomes more widely available and is prescribed to men with low testosterone levels.
• 1970s-1980s: The use of testosterone replacement therapy declines due to concerns about the risk of prostate cancer and cardiovascular disease.
• 1990s: The development of newer forms of testosterone, such as testosterone enanthate and testosterone cypionate, leads to a renewed interest in testosterone replacement therapy.
• 2000s: Testosterone replacement therapy becomes more popular, with sales of testosterone increasing rapidly.
• 2010s: Studies suggest that testosterone replacement therapy may increase the risk of cardiovascular disease and prostate cancer in some men, leading to increased scrutiny of the safety and efficacy of testosterone replacement therapy.
• 2015: The FDA issues a safety alert warning that testosterone replacement therapy may increase the risk of heart attack, stroke, and death in some men, leading to increased regulation of testosterone replacement therapy.

Today, testosterone replacement therapy continues to be a popular treatment option for men with low testosterone levels. However, it is important for individuals to work with a qualified healthcare provider to determine the appropriate form and dosage of testosterone for their individual needs and to monitor for potential side effects.

While TRT can be an effective treatment for men with low testosterone, there are several potential side effects and risks that your doctor may not have fully explained to you. Here are ten things you should know about testosterone replacement therapy:

1. High hematocrit levels: Testosterone can stimulate the production of red blood cells, which can lead to an increase in hematocrit levels. High hematocrit levels can increase the risk of blood clots, stroke, and heart attack. Regular monitoring of hematocrit levels is necessary during TRT. I am a regular at the local blood donation centers because it helps me keep my hematocrit levels low. Win-Win!
2. Hair loss: TRT can lead to an increased risk of hair loss in men who are genetically predisposed to male pattern baldness. If you are concerned about hair loss, talk to your doctor about alternative treatments or medications that can help. Speaking of...
3. Side effects of medications for hair loss: Medications commonly used to treat hair loss, such as finasteride, can have sexual side effects such as decreased libido, gynecomastia and erectile dysfunction.
4. Gynecomastia: TRT can lead to an imbalance of hormones that can cause the development of breast tissue in men. This condition, known as gynecomastia, can be treated with medications or surgery if it becomes a concern.
5. Side effects of medications for gynecomastia: Medications commonly used to treat gynecomastia, such as tamoxifen, can have side effects such as hot flashes and mood changes.
6. Testicular shrinkage: TRT can lead to testicular shrinkage due to a decrease in natural testosterone production. This is typically a temporary side effect and may be reversed by discontinuing TRT.
7. Infertility: TRT can suppress the production of sperm in the testicles, which can lead to infertility. If you are interested in preserving fertility, talk to your doctor about options such as sperm banking before starting TRT.
8. Increased risk of prostate cancer: TRT has been associated with an increased risk of prostate cancer, particularly in men over the age of 65. Regular prostate exams and monitoring are necessary during TRT.
9. Skin irritation: TRT can lead to skin irritation at the application site of topical testosterone gels or patches.
10. Cardiovascular risks: TRT has been associated with an increased risk of cardiovascular events such as heart attack and stroke, particularly in men with pre-existing cardiovascular disease. Your doctor should carefully evaluate your cardiovascular risk factors before prescribing TRT.