@CAPTAIN CARIBE: Thank you very much for your feedback! I am glad you enjoyed it! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed Doc what about tgia i keep hearing about men going on trt after 60 and their chances of dying from a heart attack goung up by 35%. Is it true, and if so, why?

@@goldo1107 The controversy surrounding this started primarily with two separate studies. One was published in JAMA in 2013, and the other on the online journal, PLOS One in 2014. As biased as I may be, I believe both were deeply flawed. Both articles suggested, through retrospective study, that testosterone "use" (the patients were not on what I would call TRT), increased the risk of embolic (blood clot related) events like stroke and heart attacks in men that already had a history of such cardiovascular problems. The entirety of the medical literature on the subject promotes and improvement in cardiovascular health. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed Gotcha. I thought as much myself. Im sure that if the individual is being health at that age they can minimize blood clots and or the thickening of the blood. Im aure that is closely monitored by whatever TRT clinic. I just wanted to hear your opinion. I'm 39 years old. Recently went for a quaterly checkup at the doc and asked for a teatesterone check in my Bloodwork. Comes back 268 and free 6.2. If it wasnt for the fact that I dont have children yet i would go on trt right away. But my fiance and I are not ready for another 2 years. I used to weigh 430 pounds a year ago. Started lifting weights 4 days a week and 30 min of steady cardio 6 days a week. Clean lean meats diet. About 3 months ago i just stoped losing weight even tgo im eating 1900 cal a day. Been very frustrating. I noticed im not as strong as i used to be in my early 30s and 20s thought that was odd too. Ao it led me to think maybe i have very low T. I was having most of the symptoms. Especially bad enxiety that juat came out of no where in the last 7 years. Depression as well. I started looking into reasons why low T and natural ways to bring it up. I asked for a copy of my bloodwork and noticed that i had really low vitamin D levels. Like really low. So ive been taking vitamin D for the last 3 weeks and im now practicing IF. I noticed this last week that my libido has gone up very much. So i thibk its working. I started losing a few pounds as well and im sleeping better. Soon as i have kids im going on TRT. I wanna have a quality life. I just want to do it safely wirh as minimal risks as possible. Hopefully they keep doing reaearch to help minimise the risk even further.

@@goldo1107 Sounds you are evaluating things the right way! Best of luck with everything!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Fully agree

Testosterone Centers of Texas

hello and great video btw.I want to ask only one question.In the case of trt if you take aromatase inhibitors to keep estrogen low isnt a way for the fsh to keep producing?

@Stauros Sotiriou: Thank you for the feedback! Lower estradiol levels may induce "more" pituitary secretion of LH and FSH, but it doesn't completely eliminate hypothalamic/pituitary suppression. Keep in mind that hypothalamic response to estradiol is only one factor that influences GnRH effect on the release of gonadotropins, and this is further modulated by other factors. Therefore LH and FSH secretion does not necessarily respond in lock-step with GnRH secretion. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed thank you very much for your answer :)

@prince prince: Thank you very much for your positive feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you for watching. We really hope the information is helpful to you!

@cap'n sean: Thank you for the feedback! I am glad you found it useful. Practice ownership has definitely broadened my scope in health care. I wish you the best on TRT! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you for taking the time to watch, and we appreciate the feedback!

@Odin Aesthetic: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Lotfi Bouhedjeur: Thank you much, I appreciate the feedback! I hope the information helped. Best of luck to you! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Delboy Trotter, I truly appreciate the feedback. From the beginning, the goal has been to be thorough and informative. There are a lot of ways to do TRT wrong, thank you for staying diligent in you research for how to do it right! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@travisfletcher7334: Hello, and thank you for the question. Based on your numbers, yes. Based on your symptoms, the concomitant need for SSRIs, confirmed by your symptoms...it is ABSOLUTELY worth looking into. Your Free T Calc isn't adjusted for your actual albumin, and to convert it to the range of 9-30 ng/dL that I reference in my videos, you need to move the decimal one place to the left. So, using the website below, calculating your cFT correctly is only 7.34 ng/dL. I consider this well below normal, especially given your age. We chalk up far too many adverse effects to "getting older." Forty-year-olds should not be dealing with Low T. Everyone knows someone with diabetes; everyone knows someone with a thyroid problem. Simply because these problems are pervasive doesn't mean that their presence is normal. That said, if you want your Low T addressed appropriately, you will probably fair better with a provider that you do not need to convince or debate in order for them to initiate treatment. Look for a provider with sound judgment, a balance of monitoring and caution, and a track record of achieving positive outcomes. Calculate your free testosterone at www.issam.ch/freetesto.htm. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@augiegalindo thank you so much for taking the time to respond to my questions and concerns!

@@travisfletcher7334 You're welcome!

@Andrew Sanderson: Thank you for the feedback! I am glad that you found the video to be helpful!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Haha, thank you @Jc Knight! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@crocodilebelfast: Thank you kindly for the feedback! I wish you the best of luck in finding a great TRT provider close to home! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@lidd69: Thank you for the feedback! It is truly appreciated. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Russ Dicono: Thank you for the feedback, I am very glad you liked it! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you for the compliment, Mat. We're glad you found the video helpful!

JohnyfromAustralia, you are most welcome. We appreciate the feedback!

+vern schock Thank you very much, I'm glad it was helpful!

@Kelly Walker: Thank you for the feedback! I appreciate you taking the time to comment, and I am glad you found the content helpful. Merry Christmas! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Joe: I am very glad you found the information helpful! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Jim Provenzale: Thank you so much, your comments are truly appreciated! Best of luck with your therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thanks for taking the time to watch and comment. We're glad it was helpful.

@gozitan5: You're most welcome! I am always glad to see these videos reaching globally! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Vero W: You're very welcome and thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Mr. C: I tend to hear that from time to time. lol Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Penns younger brother

Life’s been tough for Happy ever since Ironman died.

hahahahha, i was like....where did i see this guy before... thanks for clearing this up ! lol

I didn’t see it till I read your comment and now it won’t go away😂

@Bo Christiansen: Thank you, sir! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

f@GREATTECH1: Thank you for the feedback! I am glad you found ithelpfull! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Karuna Sharma: Thank you!

@Hasney Bravim: You're very welcome! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Freddie Greer: Thank you kindly for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Sinasi08: Thank you kindly for the feedback! I am glad you found the information useful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you for the feedback, @Jesse Garcia! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

You're welcome, thank you for watching!

Testosterone Centers of Texas :)

@hanktharipper10: Thank you for the feedback. I wish you continued success with TRT! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@ArchiesBhanushali following

Does TRT makes men infertile?

@Jaang29: You are most welcome, and thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Skye13: You are most welcome! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas I Founding Partner

@pedroucb: Thank you very much! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Kevin St Clair: Thank you so much for the kind feedback! We take pride in helping our patients to enhance their quality of life, and getting back to feeling the way they are supposed to! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Winner of a video, I have been researching "at what age do men's testosterone levels decrease?" for a while now, and I think this has helped. Have you heard people talk about - Peyoraat Rudimentary Preponderance - (Have a quick look on google cant remember the place now ) ? It is a good exclusive product for discovering how to boost testosterone levels minus the hard work. Ive heard some unbelievable things about it and my brother in law got amazing results with it.

Did you notice more energy and less testosterone

@@ashleytaylor994 can you please rephrase the question?

Lol. Fucking RIP bones if you're taking an AI

@Michael David: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@medicineandbrasilianjiujit8511: Thank you for feedback. I am glad you found our content helpful! I also train in Brazilian Jiu Jitsu, and I love that your channel is talking about this!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed God bless!

We appreciate your kind words! We're just hoping to make the information accessible to everyone! We hope it was helpful to you.

@Joel Mcconnell: Thank you so much for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Sam Nammoura: Thank you for the feedback, sir! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@BuLLDoGGn: You're welcome, I am glad you enjoyed it! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

We greatly appreciate your feedback and are so glad it's helpful to you!

+Sam Nammoura And thank you!

@Fredwardo Freddie: Thank you very much! I am glad you found it helpful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@sneekolas: Thank you! I am glad you found it useful. I will be working on new content soon, so please stay on the lookout! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@John Cooper: Thank you very much for your feedback, kind remarks, and suggestions. I will add hyperprolactinemia to the list of future video topics. Pituitary adenomas can induce hypersecretion of pituitary hormones. The most common of these would be a prolactin secreting tumor, but they can also secrete growth hormone (hGH), adrenocorticotropic hormone (ACTH), etc. As the benign, non-malignant tumor grows, it can destroy pituitary function globally, leading to hypopituitarism, and under-functioning or non-functioning pituitary gland. This is why so many systems can be affected, as the pituitary gland is responsible for the secretion of FSH, LH, ACTH, TSH, Prolactin, hGH, MSH, ADH, and Oxytocin. This is also was even small tumors, microadenomas, are followed by neurology/neurosurgery to insure that the potential impact to the pituitary gland and surrounding structures is appropriately monitored. The treatment of the specific adenoma depends on its type, but dopamine agonists, drugs that activate dopaminergic receptors, are the first line treatment for prolcatinomas. I don't manage pituitary tumors, but do have some patients who have a known history of them. Without controlling prolactin levels, the benefit of TRT will likely be reduced, and may skew the risk/benefit ratio in a way that makes TRT an undesirable treatment. CSF rhinorrhea (rhinorrhea alone just being a runny nose) is definitely a serious complication. However, it is also an uncommon one, and is seen with invasive, large adenomas. More common adverse reactions include nausea, headache, dizziness, constipation, asthenia, fatigue, abdominal pain, somnolence, and hypotension, among others. Managing pathology without medication is almost always preferable, but I would just urge you to keep in mind the expected goal of treatment for each approach. I typically recommend the fewest interventions and use of the lowest effective dosing. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed Dear Augie . I am astonished by your comprehensive and detailed response. Thank you so much for your advice and for giving so much of your valuable time to replying to my questions and comments. Since diagnosis of T2 Diabetes and Hypoprolactinemia in 2016 I have carried out much personal research and have received advice from a Consultant Endocrinologist however I have been questioning the advice I have received regarding taking Cabergolin and TRT treatment. Your warnings and advice regarding medication echo my own thoughts on the matter and my feeling is that at the moment as my macroprolactinoma is not causing me any significant health issues and has not changed in size in the past 3 years I will continue to defer any medical intervention . I do not see the potential benefits of medication being worth the potential risk of likely unpleasant side effects . When one has endured decades of ill health due to Hypothyroidism and undiagnosed Prolactinemia and T2 Diabetes ,... any period where one feels relatively well without migraine,headaches, nausea, fatigue, abdominal pain, constipation, brain fog , etc is priceless and very difficult to justify putting at risk by taking medication.

@@johncooper7242, you are most welcome. Issues like these are often complicated, and ultimately, your comfort level with treatment options is all that matters. Even with straightforward TRT, I encourage patients to make sure that the symptoms they suffer with warrant a treatment, that like any other medical intervention, carries potential risk and some level of burden of therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@T Man05: Thank you for the question, I am glad you like the video! Due to its troublesome side effect profile, I do not consider clomiphene (Clomid) an option for treatment in my practice. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@baggahammers2: Thank you for the kind feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

+qfina You're welcome, thanks for commenting!

@Gerald Brienza: Thank you! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@SotoAdvert: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Long overdue response I guess. Short answer yes use HCG with TRT. Also inject once a week not once a month to prevent dips.

@Jeff Saunders: Thank you! I am glad you found it useful. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Lazaro Monteagudo: Thank you for the feedback, I am glad you found the information useful! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Thank you for the feedback, @Trent Alexander! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Thank you for taking the time to watch!

@Damon: Thank you for the feedback! I personally recommend hCG to be used concurrently with TRT when patients wish to protect fertility or prevent testicular atrophy. Aside from those two needs, I don't feel that hCG offers significant benefits. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Big John: Thank you for the feedback, I will add your suggestion to the queue! For now, let me give you a quick answer. The main reason TRT is considered a lifelong commitment is because, in the vast majority of cases, the symptoms of hypogonadism are also lifelong...and progressively so. The more precise characterization would be: TRT need only be continued for as long as you want relief from your symptoms of testosterone deficiency. Additionally, natural production is suppressed while on TRT. This is why it is so important to only intervene in broken systems. TRT should be used for those patients who are deficient and symptomatic. In this scenario, suppression of natural production carries little downside, because level are already so low that they have become disruptive to one's life. Now, within a very short time, pituitary control of testicular production is suppressed by the use of testosterone. So, when TRT is abruptly discontinued after six months to a year as in your proposed scenario, you don't fall to your baseline (pre-treatment) production; you fall further. The rebound to your baseline will take weeks, to even months. Also keep in mind, if you are on therapy for a longer period of time, say 10 years, your baseline would have deteriorated anyway. In this case, your "rebound" will also be limited. Ultimately, TRT is not a lifelong commitment, because you can always choose to live with the symptoms of Low T or with whatever improvement you can achieve through entirely natural means. We don't yet have a reliably safe way to make your body make more testosterone. Perhaps peptide research will change that, but I don't consider this a reliably safe way to treat Low T at its current state of research and advancement. Therefore, as long as you want relief from symptoms of hypogonadism, that's how long you will need to be on TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

I took it for 18 months. The only issue I had when I stopped was my depression levels rising. I had zero issues while taking T. I'd love to explain why I'm not taking it now, but it would take a while. Hopefully I can start again soon.

@@leftie75 why u stopped ?

@@leftie75 did you get back on it?

@@leftie75 hope you’re doing better now brother.

@eyescryont: Thank you for the feedback! I am glad you found the information useful!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

MrBogfrog Clomid won't do this HCG will

@Lee Harley: Thank you for the feedback! Your symptoms and medical history play a profound role in decision-making about TRT. Keep in mind that there is more to account for than just the levels. That said, a total testosterone level of 15.2 nmol/L corresponds with a level of 439 ng/dL on the reference ranges mentioned in the videos. This is on the lower end of normal for most reference ranges, but still normal. Best regards, Augustine Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@ibberman: Thank you for the kind feedback. I have not seen a case like this in my own practice, largely because I do not use finasteride in that manner, but I have come across cases similar to yours. It prompted me to do some digging and I found the following website: www.pfsfoundation.org/ It certainly seems plausible that you issues may have something to do specifically with your use of finasteride. The type of response you describe is highly abnormal in my opinion. I truly hope this helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you for the link, I really appreciate it. I was taking the 1/4 proscar for the hair and had never had side effects before he suggested taking the whole pill. Another problem I found was his inability to get my test levels right. My total level was 450, and by giving me 1cc every 10 days to get my low free test into the normal range, the total test levels went to 2000+. Thank you again for sharing your knowledge.

No problem! I hope it helps. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Apex Predator: Thank you for the feedback! Total testosterone levels can be very misleading. I exclusively use the calculated free testosterone (cFT) level, which uses an algorithmic calculation that takes your SHBG, albumin, and total testosterone levels into account. You can find the formula here: www.issam.ch/freetesto.htm. On this scale, with the reference range for your total testosterone level being roughly between 300-1000 ng/dL, a normal cFT is between 9-30 ng/dL. So, with that said, I definitely would recommend that you at least seek a second opinion. Just make sure you go to a clinic that will be honest with you about your numbers and is willing to tell you that your numbers may not be low enough to take the step of starting TRT. I have many patients who have had totals in the 400-500 range that were still suffering from below normal cFT levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Eyes Open: I'm a PA, so Augie works for me. And, you're most welcome!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Castulo S: Thank you very much for the feedback! I have seen nothing in the literature or in clinical practice that has suggested that therapy needs to be amended for patients who have had a vasectomy remotely or recently. I have many patients who have had this procedure and some who have had it done while already on TRT, and they do very well on therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you very much for the quick response. You just got a new subscriber!!

You are very welcome, I am looking forward to getting more content out there soon. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you for the feedback, @Mind • Muscle • Meditation! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Evolution Daily: You're most welcome. I am glad you found it helpful! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Jaime Locke: Thank you for the positive feedback, I truly appreciate it! As for your questions... 1. There is no significant research that I am aware of that answers this question through formal medical study. That being said, I have not seen a case where TRT has forever compromised the body's ability to produce testosterone naturally, at its baseline level. Now, once stopping TRT abruptly, it will take some time to return to that pre-treatment, baseline production. 2. Yes, it is feasible to use TRT in this way without permanently affecting natural production, but I would not advise it. Keep in mind, with TRT (done the right way) there is no need to "cycle" on and off of therapy. And, your body prefers homeostasis, as opposed to the stop-and-go traffic type strain placed on it with the hormonal roller coaster of cycling. 3. Yes and no. Technically, it would keep your testosterone levels from being lowered, rather than directly increasing them. However, I have found that this effect is minimal to non-discernible both symptomatically and biochemically. I would expect that any positive change here would have less to do with a minimally higher testosterone level and more to do with the fact that there is a stronger androgenic effect when there is less, but normal, estrogenic opposition. I hope that answers your questions, thank you for reaching out! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Testosterone Centers of Texas thank you. -Sam

@Mike Philpot: Thank you for the kind feedback! The role of anastrozole in TRT is to limit the overproduction of estradiol via altering the aromatization of testosterone. So, it can decrease the stimulation of breast tissue by keeping estradiol normal, but misuse may actually contribute to gynecomastia. Maintaining a normal estradiol level is also helpful for mitigating fluid retention. The bad news here is that once you have palpable gyno, your breast tissue is highly unlikely, if not altogether unable, to return to its "dormant" pre-stimulation state. To a degree, it will be irreversible. Think of it as male breast tissue, never being stimulated by abnormal estradiol influence, staying unnoticed and undetectable. However, once it grows, say to a six on a scale from one to ten, the now-disturbed tissue will not retreat back to zero even when you remove the offending stimulants. This is why great care needs to be taken in the management of TRT. If gynecomastia is significant enough, only surgery can improve upon the hypertrophic changes. And, even with such an invasive response, it can remain likely to recur. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@kadir khan: Thank you for the kind words! Check out this link (tctmed.com/genetics-of-male-pattern-baldness/) for the complete answer to your question. Ultimately, whether you will lose hair due to DHT has little to do with your hormone levels and much to do with your genetics. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

+Pendejo: Thank you for the positive feedback! A couple of caveats before I comment: I have to make some assumptions based on what the reference ranges are for these labs, and I am assuming that the free T value is a calculated free T and not a direct/analog free T. That being said, your values definitely see high for a trough level and while you might feel well now, consider that these labs may represent the front side of a building peak. So, you could be exposing yourself to more and more risk going forward, and I don't see evidence that your hematocrit is being monitored. Make sure your provider is keeping up with that as well!

Testosterone Centers of Texas Thank you for taking the time to evaluate and respond to my question. BTW, my hemoglobin is 15.3 g/dL and my hematocrit is 44.1%. I've been on TRT just under a year, how often do you recommend I gets labs done?

+Pendejo: You are most welcome! It looks like your hematocrit is doing great. I evaluate my patients' labs every 90 days.

@sahil sharma: You are most welcome! Costs vary widely, but I can tell you that in our practice, insurance often reduces costs considerably. Our telemedicine services are priced at $200 per month, plus lab fees. Unfortunately, I cannot give out dosing recommendations in this format. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Sabino Humbane: Thank you for the feedback! What I tell patients with this question is that I have seen no evidence that suggests that you will not transition back to your pre-treatment levels if you stop TRT. The only caveat there is that your baseline production will naturally decline over time. So, if you are on treatment for 10 years of more, I would not expect that you would be at exactly the same levels of production after your natural production rebounds. Essentially, I assume your body would more likely settle into whatever your natural production would have been at that time. The hypothalamic/pituitary suppression has not shown to be permanent in my experience. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

A doctor told me you're not likely to stop once you start. That it's practically speaking a life-long decision.

@@mattmarkus4868 that’s why you only take it if you really need it/ having symptoms or lowt .

No, your sh!t plummets

@Garfit Gar: Thank you! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Allkindsofgains: Thank you!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@77ponch77: Injury to the pituitary gland or the infindibular stalk from which it is suspended is a possible cause of secondary hypogonadism, as it can keep the pituitary from commanding testicular activity as it would normally. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

You're most welcome! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Why just 20 yrs ? Living with low T also affect u

I have seen people over 40 years on TRT.

@Chris Muniz: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@DarkVeghetta: Thank you for your reply and feedback! Fertility can be fickle. It could be that with robust sperm production and motility, you may be somewhat protected from severe TRT-related infertility. Still, you could potentially find yourself exquisitely sensitive to exogenous testosterone, too. Make sure to explore the options of sperm banking and the use of supplemental medication like hCG to preserve fertility should you start TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@aad4m I'm also a Brit mate, did you find when you originally had a discussion with your GP, a great deal of downright disinterest from him/her? It took me some 5 months of visits to even get a referral to a specialist endocrinologist? I finally managed to see the specialist, and begin treatment but, not before almost a year had passed!! I'm glad I persisted, my life improvement has been nothing less than amazing!

Delboy Trotter ; has it improved bcos of trt ? Are u on gel or nebido ?

@Sideways23: Actually, in the setting of TRT, it really does very little outside of enhancing fertility and treating testicular atrophy. It won't affect your LH levels, and honestly, your LH should be low while on TRT. The touted benefits of hCG are greatly overstated. Many voices sing its praises, but the effects reported are anecdotal at best. I see no advantage to an improved sense of well-being, weight loss, or HPG axis maintenance with hCG for those patients using it concurrently and those who don't. In our practice, it is used exclusively for promoting fertility and protecting against testicular volume loss in our practice. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@UCIqOF3KtzK-GH_ROXQuoIoQ Thank you for that explanation. My LH is definitely low and the atrophy is what I wanted to reverse. I was under the impression it raised LH levels as well.

@@DanielA23 You're welcome! No, hCG acts like LH in your body, but to raise LH level you'd have to go higher in the production cascade (GnRH).

@David Torres: Yes, what you should be looking at is estradiol levels. As far as the numbers go, it completely depends on you, other symptoms, risk factors. etc. There's no magic number and balancing takes some expertise and creativity. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Hookem Jim: Thank you, sir! Hook 'em! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Excellent idea Darin! We'll add it to the list and let you know if we make the video. Thanks for the suggestion.

Testosterone Centers of Texas TRT LOWERED my blood pressure into the normal range. Had anemia coz low T so heart needed to work harder. I'm so happy now

Texas Boy , but it increases plasma count. One of the reasons you have more aerobic capacity on it.

@Lauren Blanc: Thank you for the feedback! In my opinion, without other underlying problems, yes. Now, it's important to note that there is no study on this and my opinion is based on clinical experience, but I have not personally observed a case where fertility did not return to function with a pause or cessation of TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Thank you for your reply. Highly appreciate it.

@Rocko1290: Great question! The way suppression of the peptide hormone hepcidin works serves to open up export channels from the gut into the bloodstream. So, this increases the availability of iron to the body. In turn, your body makes more red blood cells. Therefore, this is the reason for therapy-related increases in a patient's hematocrit (HCT) or "blood thickness". When this is combined with other processes that increase red blood cell production, like smoking, polycythemia vera, hemochromatosis, or the most frequent culprit, obstructive sleep apnea (OSA), is when we typically experience difficulty in managing a patient's HCT. If such a presentation is treated with therapeutic phlebotomy as the ONLY treatment, patients will invariably end up sapping their iron stores. This iron depletion leads to red blood cells (RBC's) becoming smaller than they should be (microcytosis), and can even lead to frank anemia. The same tunnel-visioned-approach will lead many clinicians to react by supplementing the iron that they are asking the patient to dispense with during too-frequent blood donations/phlebotomies. This isn't inherently "bad" just myopic, and it belies what should be the true focus of intervention. In contrast, the treatment of an elevated HCT while on TRT should be root-cause driven. And dose adjustments, suspension of therapy, referral to outside specialists, and more thorough workups need to all be considered as possible clinical responses to a stubbornly persistent increase in blood thickness. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Francisco Islas: Unfortunately, we do not. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner