Hormone Replacement

Male Hormone Replacement Therapy

(HRT) for Men Suffering from Low Testosterone:

You’ve probably been hearing and reading more and more about Low Testosterone (also known as Male Menopause or Andropause). You may also be wondering if “Low T” has affected you. If so, you are not alone. Approximately 40% of men over the age of 45 have Low Testosterone. Bottom line … if you have Low T, you need to take care of it.

You can start by taking the following test, called the ADAM questionnaire (Androgen Deficiency in the Aging Male), to help determine if Low Testosterone is affecting you.

If you answer “Yes” to question number 1 or 7, or if you answer “Yes” to more than 3 questions, you may have low testosterone:

1. Do you have a decrease in libido (sex drive)?

2. Do you have a lack of energy?

3. Do you have a decrease in strength and/or endurance?

4. Have you lost height?

5. Have you noticed a decreased “enjoyment of life”?

6. Are you sad and/or grumpy?

7. Are your erections less strong?

8. Have you noticed a recent deterioration in your ability to play sports?

9. Are you falling asleep after dinner?

10. Has there been a recent deterioration in your work performance?

Testosterone Replacement for Men

This is a summary of the International Society for the Study of the Aging Male.  The participants for these resolutions were from a broad range of specialties from 11 countries and 4 continents.

Fundamental Concepts Regarding Testosterone Deficiency and Treatment:  International Expert Consensus Resolutions. Mayo Clinic Proceedings July 2016;91(7):881-896

Summary of Resolutions:

1: Testosterone deficiency is a well-established, significant medical condition which negatively affects male sexuality, reproduction, general health, and quality of life.

Low testosterone can predict an increased risk of obesity or metabolic syndrome.  Low testosterone is associated with increased death rate and more cardiovascular events and deaths.   It is also associated with lower quality of life and poor general health.

2:  The symptoms and signs of testosterone deficiency occur as a result of low levels of testosterone and may benefit from treatment regardless of whether there is an identified underlying etiology.

This means that, regardless of the cause of low testosterone, men benefit from testosterone replacement.  They additionally point out that it is inappropriate to withhold testosterone replacement when a cause cannot be identified, which is usually the case.

3:  Testosterone deficiency is a global health problem.

In the study they explain the enormous costs (in the hundreds of billions of dollars in the US alone) associated with untreated low testosterone.

4:  Testosterone therapy for men with testosterone deficiency is an effective, rational, and evidence based.

Testosterone replacement definitively benefits sexual desire as well as erectile and orgasmic function.

Testosterone improves bone mineral density, mood, and energy.

5:  There is no testosterone concentration threshold that reliably distinguishes those who will respond to treatment from those who will not.

In this resolution, the consensus agreed unanimously that the absolute value of testosterone on a blood test is not a predictor or an accurate way to diagnose testosterone deficiency.  Symptoms of testosterone deficiency, as well as the overall clinical picture are combined with laboratory evaluation to assist in decision making for testosterone replacement.

6:  There is no scientific basis for any age-specific recommendations against the use of testosterone therapy in men.

Men, regardless of age, responded to testosterone therapy when they were deficient.   Age is not a predictor of testosterone deficiency, and other factors such as genetics, overall health and obesity play roles in testosterone deficiency.

Avoiding testosterone replacement in elderly men is as illogical as avoiding the treatment of other conditions such as high blood pressure, heart disease, arthritis and cancer because they occur more frequently as men age.

7:  The evidence does not support increased risks of cardiovascular events with testosterone therapy.

Numerous clinical studies have shown benefits in replacing testosterone in men with heart diseases, such as greater exercise capacity and less chest pain.

Low testosterone is known to be associated with increased heart disease, obesity, and mortality.

There were two recent reports of testosterone replacement possibly having a negative impact on cardiovascular health.  These reports were flawed, and were not supported in numerous other positive studies on testosterone replacement.

8:  The evidence does not support increased risk of prostate cancer with testosterone therapy.

Testosterone therapy does not increase the risk of prostate cancer.   Men previously treated for prostate cancer, and in remission, can safely use testosterone replacement.

9:  The evidence supports major research initiative to explore possible benefits of testosterone therapy for cardiometabolic disease, including diabetes.

Men with low testosterone who receive testosterone therapy have ½ the mortality rate of untreated men.

Men treated with testosterone therapy have less cardiovascular events and death than men not treated.

Testosterone therapy reliably increases lean body mass and decreases fat mass.

Higher levels of testosterone are protective to the heart and cardiovascular system.


What Allure Can Offer

As with any modern medical treatment breakthroughs, there are guardians of the past.  Many people, including doctors, will suggest “just age naturally.”  Does that mean you should ignore heart disease, diabetes, cancer or arthritis (as noted in the consensus)?   Of course not.  If these conditions occurred, you and your doctor would address it.  Yet, there remains some degree of bias toward treating low testosterone.

One cited reason for withholding testosterone treatment in aging men is that a side effect can sometimes occur where the body makes excess red blood cells.  This can require a blood donation to resolve.  However it is generally not serious, can be monitored.   Modern testosterone replacement more or less addresses this and makes it for the most part a non-issue.  The elevated blood count (as well as other less significant minor side effects) is largely related to what we call medication peaks and valleys.

If a medicine is taken twice daily (as in the case with testosterone cream), there are two medication peaks (each occurring about 30 minutes after the cream is applied) and two valleys (occurring right before reapplying the cream).  It is the frequency of peaks and valleys felt that to lead to some of the infrequent minor side effects of testosterone therapy.

For injections, the peaks and valley are less frequent.  At one time, men were given testosterone injections once a month.   This was far too infrequent as massive doses are needed to get sufficient levels weeks later.  As a result, the peaks and valleys were less frequent, but the highs were very high and the lows were very low.  This led to more side effects that are reduced when the injections are given weekly.  With weekly injections there are basically one peak and one valley a week.

The most effective dosing that is very consistent has the fewest peaks and valleys, and is proven to reduce the risk of elevated blood counts is pellet injections.  These are tiny pellets of testosterone about the size of a grain of rice that are placed under the skin and dissolve slowly over several months.  They do not need to be removed and are generally inserted 2-3 times per year.

During your visit, you will answer a questionnaire and have blood work done.  An appointment will be scheduled in two weeks to review the laboratory results and go over a plan.  When the pellets are inserted, you will have a small bandage that can be removed in a couple of days.  Pellets are generally placed in the buttocks but can go anywhere.  Symptom improvement generally takes 2-3 weeks.  Additional lab monitoring is fairly infrequent.  As noted, the absolute level of testosterone is not an accurate predictor of deficiency or excess, it is more symptom based.



A blood test to measure your testosterone, as well as your other related hormones, is most frequently done as a simple blood test. If your testosterone is low, you can be prescribed Testosterone Replacement Therapy (TRT).

Usually, you can sense something has changed, and you don’t know what it is. A simple blood test will tell you if you have Low T.

Fortunately, it is very simple. First, we do a blood test. If the test reveals that you have Low T, we advise you take Testosterone replacement. You are replacing what nature took away from you.

There are numerous medical conditions that may cause low testosterone. However the most common causes remain normal aging and your own personal genetics. For example, if you have a family history of adult onset diabetes, you are at personal risk for developing low testosterone at a younger age. In some cases, the onset of low testosterone can be delayed by diet and exercise, and you should do that. And if your testosterone is borderline low, and you are overweight and do not exercise, changing your lifestyle can boost your levels at least for a period of time.

If you have low testosterone you are more at risk for prostate cancer, premature heart disease, diabetes, obesity, Alzheimer’s, erectile dysfunction, poor sex drive, minor depression, and loss of muscle mass.

Since your body is supposed to make testosterone in the first place, the risks are limited, and can be reviewed at your office visit. Most side effects of TRT are from taking too much, or not enough, so this is monitored with a blood test. It is not safe if you have active prostate cancer. Men with preexisting heart disease need to be carefully monitored when starting TRT.

This is a very important question. Low T is a disease; just as much as heart disease, diabetes, Parkinsonism, depression, obesity, erectile dysfunction, and other “age” related diseases are diseases. Yet, they all have this in common: Men with Low T have an increase in heart disease, diabetes, Parkinsonism, depression, obesity, erectile dysfunction, and other “age” related diseases.

There are side effects with too much Testosterone, but too little Testosterone is much more dangerous.

Men with the lowest Testosterone have the most prostate cancer. We cannot say that restoring Testosterone can prevent cancer. But Testosterone does not cause cancer. Men get prostate cancer. Period. It happens. Men with the Lowest T get the most aggressive prostate cancers. Men with normal T get the least cancers.

More energy, less depression, less fat, more sex drive, harder erections, more edge, less tiredness. Are other side effects possible? Yes. But with monitoring of your T level, it is generally not an issue. If you cannot commit to communicating with our practitioners 1-2 times per year, you are not a candidate.

Testosterone replacement has been shown to improve men’s energy, libido, erectile firmness, and decrease body fat. It is also known to help combat minor depression, elevate mood, increase bone density (resulting in less broken bones) and improve muscle mass. It has also been shown to be beneficial for memory, cardiac (heart) performance, and may be preventative of heart disease and can be helpful for reversing early stages of adult onset diabetes. (There is some recent controversy over heart disease and testosterone replacement for men with existing heart disease).

At Allure Medical Spa, we prefer replacing testosterone using pellet injections.  Tiny pellets containing the hormone are inserted underneath the skin, which enables a slow, steady and consistent release of testosterone.  This method requires little work on the part of the patient – just show up for twice yearly appointments for a simple insertion.

Usually about 2-4 weeks. Your blood will be tested to see how much testosterone is needed to get your body to healthy, youthful levels of testosterone.

Most men will take it forever. If you have low testosterone, in most cases it is permanent. So the solution is permanent as well.

Allure Medical Spa’s hormone replacement therapy services are cash-based.  Initial consultations are complimentary.  Prices start at $800 per insertion for hormone replacement therapy utilizing pellets.

In the early stages of low testosterone, exercise and healthy diet can give some benefit. So that is step one. Additionally, there are some medical conditions and drugs that lower testosterone, so your doctor will evaluate you for that. Some success may be seen with using testosterone boosters (such as HCG or Human Chorionic Gonadotropin), but these generally are not as effective as just simply replacing your diminished testosterone.

It is optimal to restore not just to a “normal” lab value, but an ideal level. Typically, most men will feel their best with a testosterone level in the range of 600-900 ng/dl. The range a laboratory will report as normal is generally 280-1000 ng/dl. Men with a testosterone level of 290-400 would be “normal” based on a doctor lab report, but that would be physiologically low for most middle aged men. In other words, the testosterone level that is average for an 80 year old man may make a 45 year old man feel … old. But it would be reported as “normal” for a man. So, it needs to be reviewed with respect to age and symptoms.

TRT, or Testosterone Replacement Therapy is restoring your testosterone to normal levels. Steroid Abuse is when men take drugs that are designed to copy the effect of testosterone’s actions (or just massive doses of testosterone) on muscle development in order to create large, unnatural muscles. Steroid abuse is unsafe, leads to serious side effects (including premature death) and is illegal.

Well, this is a medical website, so we have to say the typical answer of “it depends”. But it can happen at any age. Most Male Menopause, Andropause, or Low Testosterone occurs in men ages 38-60. It can occur earlier or later. It is not universal at a young age; however it is almost universal as men age.

To find out if you have Low Testosterone, or if you would benefit from Testosterone Replacement Therapy (TRT) call us at 586-992-8300 or email us at hrt@alluremedicalspa.com to set up an appointment and testing.