SERVICES

TESTOSTERONE OPTIMIZATION

Testosterone Deficiency (TD)

TD or low testosterone can generate a myriad of symptoms that many would just link to "natural aging," however, testosterone's gradual diminishing levels are actually to blame. TD is also known as "male climacteric" or andropause or hypogonadism and concerns an estimated 5 million men in the US. Furthermore, an estimated 25% of men over 30s have below average testosterone levels. There is nothing ordinary about a 50-year-old male having the testosterone level of an 80-year-old; however, due to the ongoing misconception and stigma surrounding testosterone hormone itself, contemporary medicine regards it as someone having "within the normal range." Consequently, nothing is being done because it is thought that these symptoms are something expected, and men just need to "suck it up!". The current aging male population is left with limited means of bettering their total wellness. Yet, in reality, this "low quality of life" syndrome can be easily improved through a properly monitored testosterone optimization therapy. 

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Do you think you have TD?


TD is a well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health, and quality of life. Low T encompass sexual to psychological to physical/metabolic signs and symptoms: Sexual

  • Diminished libido
  • Erectile dysfunction
  • Difficulty achieving orgasm
  • Decreased spontaneous erections
Psychological
  • Diminished energy, sense of vitality, or wellbeing
  • Fatigue
  • Depressed mood
  • Impaired cognition
  • Reduced motivation
Physical
  • Decreased bone mineral density
  • Decreased muscle mass and strength
  • Increased body fat
  • Gynecomastia
  • Anemia
  • Insulin resistance




Who is a candidate?


Here at opTmale, following a physical exam and history, we will check and analyze your comprehensive lab works, including a complete T panel (total, free, SHBG, LH) together with a full metabolic, hematologic, and hormonal profile for a complete picture of your health. If your symptoms and bloodwork are consistent with TD, optimization can begin immediately. Of note, we take into account the "complete picture" and not just lab values. We highly consider your clinical signs and symptoms when considering you for TOT. Studies demonstrate that the testosterone levels being considered by the traditional medical community are somewhat misleading and inaccurate, causing aging men to be misdiagnosed and left untreated. The expected total T level ranges from 300 ng/dl to 1100-1200 ng/dl and differ between various labs and age groups. For instance, a 30-year-old male who has symptoms of low T and with a level of 320ng/dl would be deemed to be "normal." The majority of medical providers would not treat you even though it's the level of an 80-year-old man. Instead, you could just be diagnosed with depression when in reality, the underlying issue is low T, and TOT could be very beneficial in improving his quality of life! TOT Treatment Primer
TOT is personalized to each individual based on presenting symptoms, testosterone levels, desired fertility, estrogen levels, and other factors discussed during your initial and follow-up visits. TOT choices include testosterone therapy, hCG (human chorionic gonadotropin) monotherapy, or clomiphene citrate (Clomid), along with extensive nutritional and exercise counseling. The risks and benefits of each type of TOT modality will be explained in detail before commencing.
Additionally, depending on other factors, adjunct treatment with TOT includes injectable hCG, DHEA, injectable B12, and anastrozole to control your estrogen levels. Goal of Treatment
We target to increase a man's testosterone level to its "therapeutic or optimal level." Different individual has different optimal level, and usually could be at the mid to upper level of the normal range. Signs that one's testosterone level is at the optimal level includes:

  • Improve sexual desire and erectile function (usually the first sign that T is working!)
  • Improve energy, mood, and vitality
  • Increase motivation
  • Increase lean body mass
  • Reduce waist circumference
  • Reduced total body fat mass
  • Increased bone mineral density
  • Increased insulin sensitivity
  • Reduced blood glucose and A1C




How long does it take for TOT to start working?


However, TOT is a process and not an instant drug that would reverse TD symptoms in just a few days. TOT takes about 3 to 6 months before its benefits are fully realized. Other benefits like fat loss, mass muscle development, and bone density improvement will not be apparent until around 6 months of continued treatment. This diagram (adapted from Saad et al., 2011) suggests the timescales of the effects of testosterone therapy on human physiology: Testosterone Therapy
Testosterone is given either through injections (intramuscular or subcutaneous) or topical creams based on patient preference, finances, and desired outcomes. Injections can be performed in the clinic until individuals feel comfortable injecting themselves at home. Our treatment of choice is twice a week subcutaneous injections (but can also be given as once a week injection subcutaneously or intramuscularly). These are typically injected into the abdominal fat. It is effortless and is generally painless! Many men learn how to do this during the first visit. During optimization, clients will have routine lab work to ensure treatment safety and efficiency. We schedule follow-up visits every 3 months until your levels are therapeutic or optimized. We also want to follow up regularly to ensure you have no side effects. For example, estrogen levels can increase in some men during testosterone therapy. We address this type of issue before troublesome symptoms develop to optimize treatment and for you to fully experience testosterone optimization's real potential.





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