The foundation of successful testosterone replacement therapy is the prescription of testosterone, management of estrogen levels, and preservation of testicular function.
Testosterone - We prescribe testosterone at doses specific to the patient's needs so they can feel their best while keeping levels at their ideal, healthy range. We require blood work to initiate treatment and our in-office initial lab panel is extensive and thorough and includes Free and Total Testosterone, Sex Hormone Binding Globulin, FSH and LH, Estradiol, and more. We then repeat labs 3 months after initiating therapy, then every 3 or 6 months if stable.
Anastrozole - There are many reasons why men will have elevated estrogen including normal aging, abdominal fat, medications, environmental exposures, chronic stress, alcohol consumption, and testosterone replacement therapy. Unfortunately, once estrogen levels rise this may cause a further drop in testosterone levels. When men are not prescribed anastrozole with their TRT, an overwhelming amount of estrogen is converted from testosterone and men will experience many unwanted side effects including enlarged breast tissue, or gynecomastia. We prescribe anastrozole as part of the Trifecta of TRT.
Enclomiphene citrate is a non-injection option that stimulates the testes to produce testosterone and sperm without any significant conversion to estrogen.
HCG is prescribed in cases of pituitary dysfunction and bypasses the pituitary to stimulate the testes. As of March 2020, per decree by the US Food and Drug Administration (FDA), pharmacies can no longer legally compound human chorionic gonadotropin (HCG). Regulatory authorities in Florida and across the US had long sought a ban on HCG, with the recent ruling by the FDA signaling a victory. It may be found under its brand name Pregnyl but much more expensive.