Welcome to the Ultimate Testosterone Optimization Guidebook! In this comprehensive resource, we delve into the intricacies of testosterone health and its pivotal role in your overall well-being. Whether you're looking to enhance your physical performance, boost your mental clarity, or improve your vitality, this guidebook offers a wealth of knowledge and practical strategies to help you achieve optimal hormone balance. From understanding the science behind testosterone to exploring natural, supplemental, and medical approaches, we're here to empower you with the tools and insights needed to take control of your health and elevate your life to new heights. Let's embark on this journey towards peak performance and unmatched vitality toge
GOALS&OBJECTIVES
Provide clear, evidence-based information to empower men in optimizing their hormonal health
Clarify the many facets of testosterone's role in the body.
Address misunderstandings about TRT
Highlight the importance of natural optimization strategies
Promote a deeper understanding of how maintaining optimal testosterone levels can significantly enhance physical health, mental well-being, professional performance, and family life
ProvideTriedandTrueResources
Evidence-Based Information
Practical Strategies
Reliable Sources
Comprehensive Education
Actionable Steps
Committment and Accountability
A sense of community
Tools & guidance to improve mood
Improve emotional resilience
Improve mental clarity
Testosterone:NotaPanacea
Testosterone, while beneficial for many aspects of health, is not a cure-all solution. Its effectiveness is greatly enhanced when complemented by a comprehensive approach to wellness. Testosterone therapy can provide significant rewards, but these benefits are maximized when met halfway with consistent effort in areas such as diet, exercise, and mindfulness. A balanced diet rich in essential nutrients supports hormonal health, while regular physical activity enhances muscle mass, energy levels, and overall vitality. Additionally, practices like mindfulness and stress management are crucial for maintaining mental well-being and hormonal balance. Thus, while testosterone can be a powerful tool in improving health, its true potential is realized only when combined with a holistic lifestyle approach that prioritizes overall wellness.
MentalFocus
Enhanced productivity with more efficient task completion with better time management.
Improved Decision-Making
Reduced Stress from a clear and focused mind
Better memory and enhanced concentration
Higher Quality work with focused attention and fewer mistakes.
Confidence/ImprovedMood
Increased motivation and positive mindset to pursue goals and pursue new challenges. Better and stronger relationships.
Enhanced cognitive performance.
Greater resilience and self confidence. Overall well being improved.
SexualHealth/ErectionQuality
Improved intimacy and partner satisfaction. Increased confidence with good erection quality and sexual performance. Better mental health from satisfying sexual experiences.
Enhanced physical health as regular sexual activity promoves heart health, better immune function and overall physical fitness
IncreasedMuscleMass
Enhanced strength and endurance allowing for more effective performance
Improved metabolic rate with more muscle tissue
Better bone health as increased muscle mass supports stronger bones
Improved Body composition as more muscle leads to a leaner physique and appearance
Reduced risk of chronic disease.
Muscle = Freedom
HealthyHeart
Helps aid in reducing risk of cardiovascular disease like stroke and heart attack.
Improved blood circulation to vital organs and tissues including the penis.
Enhanced physical stamina for overall endurance.
Increased longevity
Hearth Health supports brain function and mental health.
DecreasedBodyFat
Improved cardiovascular health
Enhanced mobility and physical performance.
Better metabolic health
Reduced Inflammation
Enhanced Self-Esteem and body image.
Improved sleep quality.
Look good naked!
WHATISTESTOSTERONE?
Testosterone is a crucial hormone predominantly produced in the testes in men and in smaller amounts by the adrenal glands. It plays a vital role in developing male reproductive tissues, including the testes and prostate, and promoting secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair. Beyond its impact on physical traits, testosterone is essential for overall health and well-being. It influences mood, energy levels, and cognitive function, and supports the maintenance of muscle strength and bone density. Adequate levels of testosterone are linked to better cardiovascular health, reduced body fat, and improved libido. Thus, maintaining optimal testosterone levels is fundamental for men to lead a healthy, active, and fulfilling life.
ISTESTOSTERONEASTEROID?
Testosterone is indeed a steroid hormone naturally produced in the body, playing a vital role in male development, muscle mass, bone density, and overall health. There is a difference between the use of testosterone and the abuse of testosterone for its anabolic qualities.Medical use of testosterone, such as in testosterone replacement therapy (TRT), aims to restore normal hormone levels in individuals with deficiencies, thereby improving their quality of life. However, the abuse of testosterone, particularly in higher doses for its anabolic properties, can lead to serious health risks, including cardiovascular issues, liver damage, and hormonal imbalances. Understanding this distinction is crucial for recognizing the legitimate therapeutic benefits of testosterone while being aware of the potential dangers of its misuse.
PATHOPHYSIOLOGYLESSON101
HYPOTHALAMUS
Secretes GnRH (Gonadotropin Releasing Hormone) in a pulsatile manner.
PITUITARY GLAND
GnRH travels to the anterior pituitary gland & releases LH (Luteinizing Hormone) & FSH (Follicle-Stimulating Hormone).
TESTICLES
LH targets the Leydig cells in the testes where it stimulates the production of testosterone.
FSH targets the Sertoli cells, which are essential for spermatogenesis. Sertoli cells support and nourish developing sperm cells and facilitates their maturation.
FEEDBACK MECHANISM
High levels of testosterone exert negative feedback on the hypothalamus and pituitary, reducing the GnRH, LH and FSH. Sertoli cells produce inhibin in response to FSH.
SEXHORMONECASCADE
The sex hormone cascade refers to the series of biochemical reactions that convert cholesterol into various sex hormones, including testosterone, estrogen and dihydrotestosterone (DHT). The cascade is quite complex but to keep the process digestable here is the basic sequance of events:
1.
Cholesterol converted to Pregnanolone, often referred to as the “Mother Hormone”.
Pregnanolone is then mainly converted to Progesterone. 2.
Progesterone is then converted into androstenedione. 3.
Androstenedione is then converted to Testosterone. 4.
Testosterone is further converted into DiHyrdrotestosterone (DHT) via teh 5-alpha reducatase enzyme. 5.
Testosterone can also be aromatized into estradiol by the aromatase enzyme. 6.
ESTROGEN...
NOTJUSTAFEMALEHORMONE
Estrogen, though often associated with female physiology, plays a crucial role in male health as well. It is important for maintaining bone density, as estrogen helps regulate the bone remodeling process and prevents bone loss.
Additionally, estrogen influences libido, erectile function, and spermatogenesis, contributing to overall reproductive health.
Estrogen also helps modulate cholesterol levels, promoting cardiovascular health by supporting the maintenance of healthy blood vessels. Proper estrogen balance is vital for cognitive function, mood regulation, and preventing conditions such as osteoporosis and cardiovascular diseases in men.
Testosteroneiswhatmakesmen,MEN!
WHYTHEDECLINE?
In recent years, testosterone levels among men have been declining at an unprecedented rate, a trend attributed to several interrelated factors Modern lifestyles, characterized by increased stress, poor diet, and sedentary behavior, play a significant role. High levels of stress elevate cortisol, a hormone that can negatively impact testosterone production. Additionally, the widespread consumption of processed foods, high in unhealthy fats and sugars, disrupts hormone balance and contributes to weight gain, which is associated with lower testosterone levels Environmental factors, such as exposure to endocrine-disrupting chemicals found in plastics, pesticides, and personal care products, further exacerbate this decline. These chemicals can interfere with the body's hormonal systems, reducing testosterone production. Furthermore, the rise in obesity rates, increased screen time, and decreased physical activity compound the issue, leading to a concerning drop in testosterone levels across the population. Addressing these factors through lifestyle modifications and increased awareness is crucial to reversing this trend and promoting hormonal health.
MENAREUNDERDIAGNOSED
Dx: Hypogonadism- a medical condition characterized by the body’s inability to produce adequate levels of sex hormones, particularly testosterone in men.
Primary: Results from issues within the testes
Secondary: Problems with the hypothalamus or pituitary gland
Why the underdiagnosis?
Men don’t report it to their doctors because they are embarrassed of their symptoms.
No standard model for appropriate treatment of low T.
The Endocrine Society classifies low T as two fasted AM readings that are below average, preventing many men who are suffering from symptoms to be accurately diagnosed.
SO,WHATTODO??
Make no mistake, there is much more that can be done other than committing to exogenous testosterone supplementation to optimize your testosterone. Testosterone replacement therapy is not a “last resort” but there are several areas that should be addressed prior to administration to not only improve your bodies ability to handle an increase in testosterone but also find ways to relieve your symptoms without it.
You have already taken the first step in optimizing your testosterone and that is by gaining KNOWLEDGE and INSIGHT into the importance of testosterone through this Ebook.
If you haven’t already, share this with a male friend, relative or co-worker who would benefit from understanding more about testosterone.
THEADAMQUESTIONNAIRE
Androgen Deficiency in Aging Males
The ADAM (Androgen Deficiency in Aging Males) questionnaire is a widely recognized screening tool designed to identify older men who might have symptoms of hypogonadism, a condition characterized by low testosterone levels. It consists of a series of questions related to the common symptoms of hypogonadism. Men answer ‘yes’ or ‘no’ to each question.
The ADAM questionnaire consists of a series of questions related to the common symptoms of hypogonadism. Men answer 'yes' or 'no' to each question. A positive answer to question 1 or 7 or any three other questions suggests that the individual may have androgen deficiency.
The ADAM questionnaire includes the following questions: Do you have a decrease in libido (sex drive)?
Do you have a decrease in strength and/or endurance?
Has there been a recent deterioration in your work performance?
A positive answer to question 1 or 7 or any three other questions suggests that the individual may have androgen deficiency.
HYPOGONADALSYMPTOMS
Suboptimal Total and/or Free Testosterone Levels on AM labs.
Clinical Symptoms:
Lack of Motivation
Mental Brain Fog
Anxiety/Depression
Decreased Strength or Endurance
Decreased Muscle Size or Endurance
Bone Loss
Increased Body Fat %
Decreased Enjoyment in Life
Decreased Sex Drive (libido)
Lack of Energy
Lack of or Decreased frequency of Morning Erections
Inability to obtain or maintain an erection.
Low Sperm Count
Sleep Difficulties
TREATMENT:NATURAL/BEFORETRT
Lifestyle
Building a strong foundation of lifestyle modifications is crucial for optimizing testosterone levels long-term. This includes a balanced diet rich in nutrients, regular exercise, adequate sleep, and stress management These factors support testosterone production and overall well-being. Resistance training can boost testosterone levels and improve muscle mass, while reducing stress through mindfulness can lower cortisol, which can inhibit testosterone REFER TO LIV1 PILLARS
SUPPLEMENTS
Supplementation can play a significant role in improving testosterone levels, particularly when lifestyle modifications alone are insufficient By complementing lifestyle changes with targeted supplementation, individuals can more effectively optimize their testosterone levels and enhance their overall health and well-being
Prescriptive options can effectively optimize testosterone levels by stimulating the body's natural hormone production Medications like enclomiphene work by blocking estrogen receptors in the brain, leading to increased production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which in turn stimulate the testes to produce more testosterone. These options can be beneficial for individuals seeking to enhance testosterone levels without directly supplementing with the hormone, helping to maintain fertility and natural hormonal b
BORON
SUPPLEMENT OPTIONS
LIV1 Member discount available on Fullscript. .
Boron supports calcium, phosphorous, and magnesium metabolism, and reduces the loss of these minerals through the urine.
Boron plays a role in the synthesis of estrogen, vitamin D, and other steroidal hormones and protects these hormones from rapid breakdown. In addition, boron strengthens the connective structure in bone matrix.
Reduces production of SHBG in the liver to allow for more free testosterone availability.
GORILLA MODE SIGMA
This formula hits various vectors to address suboptimal nutrient and mineral intake, insufficient gonadotropin output, androgen biosynthesis in the testis, binding protein interactions, and even stress management to support a more conducive state to maxed out natural Testosterone output.
Code: ATLAS for discount.
MAGNESIUM GLYCINATE
Magnesium plays a crucial role in boosting testosterone levels by influencing the hormone's bioavailability. One of the ways magnesium achieves this is by interacting with sex hormone-binding globulin (SHBG), a protein that binds to testosterone, making it unavailable for the body's use. Magnesium has a higher affinity for SHBG, which means it can effectively bind to this protein, thereby reducing the amount of SHBG available to bind with testosterone. This action increases the levels of free testosterone in the bloodstream, enhancing its availability and activity within the body. As a result, adequate magnesium intake can support hormonal balance and improve testosterone levels, contributing to overall health and vitality.
L. CARNITINE Injections
Available to LIV1 members.
Aids in increasing Androgen Receptor site density to upregulate additional free testosterone.
Decreases inflammation, aids in fat mobilization and improves metabolic health. Preferred over oral forms as oral L.Carnitine is more easily converted to TMAO which has been associated with colon cancer, cardiovascular disease and kidney disease.
TADALAFIL Troches
Tadalafil is low dose Cialis which is a vasodilator. This helps with blood flow to muscle, aids in erection quality and libido.
Contact provider if any vision changes occur It's reported that 2% of tadalafil users can experience blurred vision, eye pain, seeing blue tinge to objects and color blindness (rare).
ENCLOMIPHENE Citrate
Enclomiphene is a nonsteroidal Selective Estrogen Receptor Modulator (SERM) and acts by increasing the gonadal production of testosterone while stimulating FSH and LH. Enclomiphene has been shown to increase testosterone levels while stimulating FSH and LH production.
Studies have demonstrated that Enclomiphene maintains the androgenic benefit of clomiphene citrate without the undesirable effects attributable to zuclomiphene. Potential side effects include increased risk of blood clots (more associated with clomid and is reported as rare and <1%), GI discomfort, visual disturbances (blurred vision or flashes of light), mood changes, skin reactions, gynecomastia.
Contact us if you experience oily skin, acne, breast tenderness, excess water retention, difficulty sleeping, or high blood pressure In some patient's brain fog, reduced libido and anxiety can occur, if these symptoms occur, please contact us.
BEFORESTARTINGTRT...
On the next few pages are important considerations to review to aid in your decision to move forward with testosterone therapy. This is not an exhaustive list but include the most well known topics discussed when it comes to initiating TRT. Review them carefully and bring any questions or concerns you may have to your provider’s attention.
IMPORTANTFACTORS TOCONSIDERWHEN INITIATINGTRT
Fertility
The negative feedback effects on FSH and LH production will result in potential reduction of fertility. This is because decreased FSH production will cause decreased spermatogenesis (creation of sperm).
While TRT does impact fertility, TRT alone does not make one infertile. Testosterone is not considered a male contraception and pregnancy can still occur while on exogenous testosterone.
A key factor in the misunderstanding of TRT causing infertility is that many men are infertile prior to going on TRT (low testosterone and infertility occur concurrently) and then don’t realize it until afterwards and then believe the exogenous testosterone was the cause. T
here is always a potential risk of significant and/or permanent fertility impact. Given this potential, prior to initiation of TOT it is recommended that patient freeze and store sperm and/or obtain a sperm analysis if fertility is of utmost importance.
LIV1 recommends Give Legacy or YO at home semen analysis kit.
Fertility will be discussed at your consult.
Measures to potentially preserve fertility are available.
IMPORTANTFACTORS TOCONSIDERWHEN INITIATINGTRT
ProstateCancer
Prostate cancer (PCa) is the most common cancer and the second leading cause of cancer mortality among American men. While the biological mechanisms behind the development and progression of prostate cancer are not fully understood, the prostate is known to be an androgen-regulated organ, leading to significant interest in the role of androgens, such as testosterone, in prostate cancer. Current research suggests that testosterone does not cause prostate cancer; however, it may enhance the growth of an existing cancer. This potential risk underscores the importance of monitoring prostate health. [3]
It is recommended that men begin regular prostate-specific antigen (PSA) testing and Digital Rectal Exams starting at age 50 for those at average risk, age 45 for those at high risk (including African Americans and men with a first-degree relative diagnosed before age 65), and age 40 for those at even higher risk (men with multiple first-degree relatives diagnosed at an early age). These proactive measures help in the early detection and management of prostate cancer, emphasizing the importance of vigilant health monitoring in potentially high-risk populations.
IMPORTANTFACTORS TOCONSIDERWHEN INITIATINGTRT
HairLoss
If you are predisposed to male pattern baldness, then testosterone replacement therapy (TRT) may result in hair loss. Male pattern baldness is primarily due to the activation of androgen receptors in the scalp by dihydrotestosterone (DHT), a potent derivative of testosterone. Individuals with a genetic predisposition to male pattern baldness have hair follicles that are more sensitive to DHT, leading to hair loss. When testosterone levels are increased through TRT, more testosterone can be converted into DHT, potentially accelerating the hair loss process for those who are genetically susceptible.
The term "accelerated" is used because, for those genetically prone to hair loss, this process is likely to occur eventually; however, TRT could cause it to happen more rapidly due to the increased levels of circulating testosterone and DHT. Conversely, if you do not carry the genetic markers for male pattern baldness, TRT should not cause hair loss, as the androgen receptors in your scalp are not as sensitive to DHT. Therefore, while TRT can offer many benefits, such as improved energy, mood, and muscle mass, it's important for individuals considering this therapy to be aware of their genetic predisposition to hair loss and discuss any concerns with a healthcare professional.
IMPORTANTFACTORS TOCONSIDERWHEN INITIATINGTRT
CardiovascularRisk
The Testosterone in Older Men with Mobility Limitations (TOM) trial conducted between 2005 and 2009 was an initial study setting off concern about CVD and testosterone A cohort of 209 elderly men with a mean age of 74 who could not walk or move on their own efficiently and had a high prevelance of hypertension, diabetes, hyperlipidemia and obesity, were given topical testosterone gel to apply daily for six months The goal of the study was to see if increased muscle mass, strength and leg power would improve the participants poor mobility. The testosterone group compared to the placebo had significantly greater improvements in leg-press and chest-press strength and in stair climbing while carrying a load, however 23 subjects in the testosterone group as compared to 5 in the placebo group had a cardiovascular-related adverse event The study concluded with stating, “Caution is also warranted in interpreting this finding, because of the small number of events and because of the limitations with respect to the ascertainment of the adverse events ” [1]
More recently in June 2023, the TRAVERSE trial was published. The TRAVERSE trial investigated the cardiovascular safety of testosterone-replacement therapy in men. They enrolled 5246 men between the ages of 45-80 years old with preexisting or high risk of cardiovascular disease Led by A Michael Lincoff and Shalender Bhasin, the study included a diverse team of researchers and involved a thorough examination of the effects of testosterone therapy on cardiovascular health The findings indicated that testosterone-replacement therapy does not significantly increase the risk of major adverse cardiovascular events, such as heart attacks and strokes, compared to a placebo. [2]
IMPORTANTFACTORS TOCONSIDERWHEN INITIATINGTRT
LifelongTherapy
Starting TRT should be considered a significant, lifelong commitment, requiring regular injections every few weeks, ongoing lab work, and follow-up visits at least every six months, even if through telemedicine. The decision to begin TRT should not be taken lightly, given its implications on the body’s natural hormone production. Exogenous testosterone suppresses the body's natural testosterone production by inhibiting the pituitary gland from releasing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) through a negative feedback loop. While it is possible to discontinue TRT and potentially return testosterone levels to their pre-therapy state, this process can be challenging and may not yield the same benefits or quality of life improvements seen during therapy.
For individuals truly experiencing hypogonadal symptoms, such as low energy, decreased libido, and muscle weakness, TRT can offer significant rewards by alleviating these symptoms and improving overall quality of life. However, it is crucial to weigh these benefits against the potential risks, such as cardiovascular issues, prostate health concerns, and the permanent impact on natural testosterone production Additionally, the need for continuous monitoring and medical oversight can be a demanding aspect of TRT, both in terms of time and financial commitment.
Before starting TRT, it is essential to thoroughly evaluate the risk-reward ratio in consultation with a healthcare professional. This evaluation should consider the severity of hypogonadal symptoms, overall health status, lifestyle, and personal goals. Understanding the lifelong nature of the therapy and its potential impact on health is vital for making an informed decision that aligns with one's longterm well-being and quality of life.
POTENTIALSIDEEFFECTS
Side effects of TRT are minimal and typically easy to spot and treat. Your primary goal is to achieve a balance (defined as feeling good without side effects) between your levels of testosterone (both free and total) and estrogen. This is monitored through our lab work and open communication to mitigate risk earl on.
POTENTIALSIDEEFFECTS
EstrogenicSymptoms
Managing estrogen is just as important to male brain and sexual function as managing testosterone levels Estrogen plays a crucial role in modulating libido, erectile function, and mood. It is essential to maintain estrogen within a narrow therapeutic range, which can vary among individuals. High levels of body fat, particularly above 20%, can lead to increased aromatization, where testosterone is converted to estrogen, potentially resulting in estrogenic side effects. Therefore, losing excess body fat should be a priority when undergoing testosterone replacement therapy (TRT) to minimize these effects.
High estrogenic side effects can significantly impact quality of life and sexual health. Symptoms may include sexual dysfunction, poor erectile strength, decreased libido and arousal, disrupted sleep patterns, and reduced insulin sensitivity, which can lead to weight gain and increased risk of metabolic disorders. One of the initial signs of elevated estrogen levels is decreased erectile strength, often accompanied by water retention, leading to bloating and swelling.
Conversely, low estrogen levels can also have detrimental effects, such as reduced interest in sexual activity and difficulty achieving or maintaining an erection. Low estrogen can affect bone health, leading to a risk of osteoporosis, and can contribute to mood swings and fatigue
Maintaining balanced estrogen levels is crucial for optimizing the benefits of TRT and ensuring overall health and well-being. Regular monitoring of hormone levels through blood tests and working closely with a healthcare professional can help achieve the right balance Additionally, lifestyle modifications such as maintaining a healthy diet, engaging in regular physical activity, and managing stress can further support hormonal balance and enhance the effectiveness of TRT
POTENTIALSIDEEFFECTS
Dihydrotestosterone(DHT)Effects
Dihydrotestosterone (DHT) is a key hormone in the body's hormonal system, acting as a potent messenger that influences various physiological processes. While testosterone is the main androgen produced by the testes, DHT, formed from testosterone by the enzyme 5-alpha-reductase (5-AR), is more potent due to its stronger binding affinity to androgen receptors. This makes DHT more effective in promoting muscle growth and affecting tissues like the brain, nervous system, skin, and genitals.
However, DHT is also a major contributor to male pattern baldness. The conversion of testosterone to DHT can accelerate hair loss in genetically predisposed individuals Thus, there is a risk-reward consideration between experiencing hair loss and benefiting from optimized testosterone levels. For hair loss, topical treatments targeting the hair follicles and scalp are recommended, while oral 5-AR inhibitors like finasteride are discouraged due to potential negative sexual side effects and reduced fertility from decreased motile sperm count.
DHT can also cause benign prostate growth, which may result in a temporary rise in PSA and DHT levels, especially when starting testosterone therapy This typically stabilizes as testosterone and estrogen reach optimal balance. PSA levels are monitored annually, and levels above 4 ng/dl warrant a referral to a primary care physician or urologist
Additionally, DHT increases oil production in the skin's sebaceous glands, often leading to acne. Diet can also play a role in skin health. Reducing refined and processed food intake while consuming a diet rich in essential fatty acids can help improve skin condition and reduce acne
POTENTIALSIDEEFFECTS Erythrocytosis/BloodClots
Increase in RBC, Hemoglobin and Hematocrit. Testosterone promotes the release of erythropoietin (EPO), a hormone that regulates RBC production from the bone marrow. Hemoglobin is an iron-rich protein found in RBC that carry oxygen throughout the body. Hematocrit is the percentage of total blood volume occupied by RBCs. This is not to be confused with polycythemia vera (all blood cells are elevated including platelets), which causes “thicker blood” and potential for heart attacks and stroke.
Other contributing factors: living at high elevations, sleep apnea, COPD, and dehydration can all attribute to the increase in RBC, hemoglobin and hematocrit.
Risk mitigation: Frequent monitoring twice per year with a goal of keeping the hematocrit less than 52-54%. Evaluating for sleep apnea.
Treatment: keeping testosterone levels within the optimal ranges. Option of donating blood (phlebotomy) may be discussed.
In the Traverse Trial, it was noted that the incidence of pulmonary embolism (PE) was higher with testosterone than with placebo. However, most reported cases of thrombosis associated with testosterone therapy have been in men with underlying thrombophilia, a meta-analysis of randomized trials did not show an association between venous thromboembolic events and testosterone use in wider populations. Testosterone should be used with caution in men who have had previous thromboembolic events. [2]
WHATTOEXPECTONTRT
Some clients will report a “honeymoon” period of 1-2 weeks or even a bit longer, after commencing TRT. While some put this purely down to placebo effect (always a factor), it may not just be a placebo effect solely at play. This is likely an increased transmission of dopamine from testosterone as well as enhanced activation of the androgen receptor in the brain, resulting in an “enhanced” response to treatment. Some find these first two weeks euphoric; others may find it over stimulating or anxiety provoking. Others might not notice anything at first. All these outcomes are normal. Testosterone optimization therapy takes time to achieve its goal, results are not instant.
Your body will be adjusting as your entire biology has been forged and expressed in a low testosterone environment and there are drastic changes at play. This is similar to when a child first enters puberty. You may have to deal with a less agreeable temper or more labile mood you have to regulate. Your appetite may increase, and you may experience other side effects noted above. All of this is very normal and part of your body adjusting to the new level of testosterone. Do not be reactive in this period. Trust the process and review your blood work at the advised follow up (6-8 weeks) and during this time start doing the activities that you have been neglecting. Engaging in exercise and applying yourself to your work and passions is primary. Start adjusting your routine to the person you have been wanting to be by improving your physical and mental well-being. Hint: Exercise- resistance training/cardio, learn martial arts, learn meditation, practice cold/heat exposure, listen to audiobooks and podcasts.
YOURPROTOCOL
There is no "one size fits all" protocol for testosterone replacement therapy (TRT). The dose, frequency, and additional treatments should be tailored to each individual based on their goals, objective markers, symptoms, and risk tolerance. TRT is not an anabolic cycle designed to push testosterone levels into supraphysiological ranges Instead, it focuses on unlocking your genetic potential by providing the foundation needed to achieve your personal and professional goals. In a low testosterone state, men often have reduced resilience and are more susceptible to stress. Optimizing testosterone can help men face challenges with greater drive and passion. However, TRT alone won't change your lifestyle; you must actively work on becoming the person you want to be.
TRT will not solve all problems but can provide the potential for growth and improvement. A significant factor in the success of TRT is diet and lifestyle. There is no magic dose of testosterone that will make you feel great if you are consuming a diet of processed foods and leading a sedentary lifestyle. There are no shortcuts. The most significant influences on your health are the calories you consume and the physical activity you engage in You can't solve all health problems by perfecting your testosterone dose alone. It's essential to evaluate other hormones and monitor metabolic and cardiovascular markers to achieve overall health and well-being.
DOSING
Your individual dosing and adjustments will always be discussed with your provider. If more clarification is needed, please reach out prior to initiating injections.
DO NOT ADJUST DOSING ON YOUR OWN!
How to draw and inject testosterone.
How to determine mg and units.
FREQUENTLYASKEDQUESTIONS
ShouldImakedoseadjustments?
The temptation to experiment with your TRT dosage is common. However, it's crucial to avoid adjusting the dose without follow-up lab work and a discussion with your healthcare provider. Trust the process and remember that it takes 6-8 weeks for the cypionate ester to stabilize in your body.
Willmytesticlesdecreaseinsize?
Yes, testicular shrinkage is a normal occurrence and typically not a concern for most men. It's usually mild, a reported average reduction of 20%. However, if it bothers you, there are options such as HCG or Taurine that can help restore testicular size and volume.
WillTRTnegativelyimpactfertility?
If you desire to maintain fertility while on TRT, treatments like HCG and/or FSH might be recommended. Please note that TRT should not be relied upon as a birth control method, as many men on TRT are still able to impregnate their partners. It just takes one sperm.
FREQUENTLYASKEDQUESTIONS
WhatifIneedtodiscontinueTRT?
Generally, testosterone replacement therapy is a lifelong commitment. However, if you need to stop TRT, it's advisable to consult with LIV1 who can suggest a post-cycle therapy (PCT) protocol. This typically involves the use of HCG and a Selective Estrogen Receptor Modulator (SERM) like Enclomiphene to help restore the body's natural testosterone production.
The responsibility lies with you to shape yourself into the person you aspire to be. Start your day with a cold shower, engage in vigorous exercise, practice mindfulness, consume fresh and nutrient-rich foods, engage in weightlifting, explore martial arts, read, and write down your goals, pursuing them relentlessly. Remember, TRT is not a magical solution, but it provides the foundation for you to reach your potential as the person you strive to become.
It's important to carry your testosterone in its original prescription packaging, along with a copy of the prescription or a note from your doctor, to avoid any issues with security or customs. When flying, pack your medication in your carry-on bag to prevent exposure to extreme temperatures in the cargo hold.
TRTCOMMONADD-ONS
TadalafilTroche
Low-dose tadalafil, commonly used for treating erectile dysfunction, offers benefits beyond its primary purpose. By inhibiting the enzyme phosphodiesterase type 5 (PDE5), tadalafil increases blood flow, which can enhance both physical performance and cognitive function. Improved circulation supports brain health by delivering more oxygen and nutrients, potentially boosting cognitive performance, focus, and mental clarity Additionally, low-dose tadalafil has been shown to improve exercise endurance and recovery, benefiting those looking to enhance both physical and cognitive performance
L-CarnitineInjections
L-Carnitine is an essential amino acid necessary for fatty acid oxidation, which assists in reducing body fat and enhancing energy levels and endurance. It also contributes to the increase in androgen receptor density, which are the receptors responsible for binding and exerting the effects of testosterone and other androgens Furthermore, L-Carnitine facilitates the movement of cholesterol into the inner mitochondrial membrane, where it can be transformed into beneficial neurosteroids
HairProducts
Shampoos and conditioners formulated with biotin, caffeine, and saw palmetto can help strengthen hair and promote growth Products containing ketoconazole, an antifungal agent, may reduce inflammation and improve scalp health, potentially benefiting hair growth. Medical options like topical dutasteride, minoxidil, tretinoin and others are available.
Resources: (Basaria, Shehzad, Andrea D. Coviello, Thomas G. Travison, Thomas W. Storer, Wildon R. Farwell, Alan M. Jette, Richard Eder, et al. "Adverse Events Associated with Testosterone Administration." New England Journal of Medicine, vol. 363, no. 2, 2010, pp. 109-122. DOI: 10.1056/NEJMoa1000485.)
1. Lincoff, A. Michael, Shalender Bhasin, Panagiotis Flevaris, Lisa M. Mitchell, Shehzad Basaria, William E. Boden, Glenn R. Cunningham, et al. "Cardiovascular Safety of Testosterone-Replacement Therapy." New England Journal of Medicine, vol 389, no 2, 2023, pp 107-117 DOI: 10 1056/NEJMoa2215025
3
2. Xu, X , Chen, X , Hu, H , Dailey, A B , & Taylor, B D (2015) Current opinion on the role of testosterone in the development of prostate cancer: a dynamic model BMC Cancer, 15(806) https://doi org/10 1186/s12885-0151833-5
