Testosterone Replacement Therapy or Hormone Replacement Therapy?

If you have a confirmed testosterone deficiency, it’s important to identify if there are any reversible causes that can be addressed before committing to, what should be considered a lifelong therapy.  Testosterone Replacement Therapy (TRT) is an involved process. In my professional opinion, the most effective method of replacement is daily Testosterone Cypionate and Human Chorionic Gonadotropin (HCG) injections. Your dose is carefully titrated to normalise your male androgen levels. 

TRT is an involved process, it’s a financial commitment and it’s a time-consuming process. Two daily subcutaneous injections, admittedly with a tiny 29-gauge insulin needle, preparation of your multi-dose vial, every 3 months for Testosterone Cypionate and monthly for HCG, regular blood tests, additional blood tests after a protocol change. We have patients from all over the UK, Europe and further afield, they all have an initial face to face consultation and yearly thereafter, the rest can be managed remotely.  Some of my patients travel thousands of miles, Denmark, Norway, Spain, Portugal, Dubai, the Philippines to ensure they receive Gold Standard care. Londoners often complain a trip to Poole is too far, little do they know.

TRT has traditionally been thought of as simply replacing the testosterone. It makes sense, replace the testosterone that is deficient. The issue lies with the subsequent negative effect on other important parameters administration of exogenous testosterone has on the body.  Injecting testosterone shuts down the Hypo-pituitary Gonadal (HPG) axis, you know longer produce Lutenising Hormone (LH) and Follicle Stimulating Hormone (FSH) from the pituitary gland in the brain. LH stimulates the Leydig cells of the testes to produce testosterone, the FSH stimulates the Sertoli cells to produce sperm through a process called spermatogenesis. 

HCG mimics LH, it is used in the treatment of male infertility. Intra-testicular testosterone is partly converted to oestradiol by the aromatase enzyme, this helps facilitate spermatogenesis. The Men’s Health Clinic now has 20 pregnancies with the concurrent use of HCG alongside testosterone.  It’s important to appreciate that there are LH receptors all over the body, most noticeably the brain. HCG is clearly important to help maintain fertility and testicular size, but its effects are more wide ranging. Men report an improved sense of well-being and libido using HCG alongside testosterone.

I am uncomfortable with allowing an organ, in this case your testicles, to atrophy with testosterone monotherapy.  It seems illogical to me that this should be accepted. I believe that irrespective of whether you want to conceive or not, you should replace this hormone.  TRT should be considered hormone replacement therapy (HRT), we should be maintaining function with HCG and supplementing with testosterone to ensure your male androgen levels are normalised. 

I am rather shocked and appalled that the medical community has such a simplistic approach to TRT, as one NHS Endocrinologist recently said to me “either the patient wants to retain fertility in which case you offer HCG or they do not want to retain fertility in which case you treat with testosterone”. This regressive and outdated attitude and approach to TRT is one of the reasons men are willing to travel from all over the world to The Men’s Health Clinic, Gold Standard care.

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