Hormone Replacement Therapy– A Complete Guide

Things you should know about the Hormone Replacement Therapy

  1. Hormone Replacement Therapy is not only science, but it is an art as well, unfortunately, the majority of doctors are not good artists.
  2. When standard reading of testosterone is nearly nothing, it’s considered zero. To get the exact level of testosterone, you should know free testosterone, total testosterone and bioavailable testosterone.
  3. TRT or testosterone therapy should not start by relying on blood tests, but after observing the symptoms. If you observe symptoms like low libido, trouble in putting on muscles, accumulation of fat, no energy and depression, TRT may be required.
  4. Different Hormone Replacement Therapy options are available, like gels, supplements, pellets, creams and injection. These are used to treat low levels of testosterones. But injections are considered the best to return maximum value for your money.
  5. There are not many side effects of TRT. But men already having prostate cancer should not go for it. In some cases, it can cause blood thickness, which is very easy to treat.
  6. We can see some results of TRT very quickly, but others appear after many years. Improvement in libido and depression is observed within a few weeks of the treatment. Muscle building or loss of body fat can take a few months and for complete results, you have to wait for many years.

Testicles: Are they working properly?

When you get your blood test results, you see a chart for your testosterone, which is 420 nanograms per deciliter of blood, ng/dl. The normal range of testosterone is between 200 and 1100 ng/dl. So, if your blood test shows 420ng/dl, it’s satisfying and you will be happy with your testicles doing a fine job. However, it’s important to understand what the meaning of this value is.

“Normal” testosterone means “nothing”

Patients understand that the value 420 ng/dl means nothing. When it comes to testosterone testing it’s an extensive job with a lot of inconsistencies. Testosterone measure in blood can be different on different days and times of a single day. If you get the accurate reading of testosterone, the most reliable way is to check it through urine sample which should be collected over a period of 24 hours. The urine sample should be tested to measure the level of testosterone and related metabolites. Other than that, you can get three samples of blood, but at different times of a day. The lab technician will mix all these samples and measure the level of testosterone.

Unfortunately, tests are not done like this. This method is expensive, time taking and inconvenient for the lab technicians. On the other hand, the doctor would consider you foolish, if you request for this method of your testosterone test. You cannot question your doctor and he thinks you should not be worried about your testosterone level. According to doctors, you should be satisfied with useless readings of your blood and live a contented life, like anyone else around you. Calgary Testosterone Replacement clinics should, ideally do the entire test properly. But a consistent prior to 10am blood test (peak testosterone) will vet out all but the most difficult cases.

You may not be able to get accurate results even If you collect multiple blood samples. If the results show a standard “normal” level of testosterone, they might not be normal for your body.

In your twenties, when you were energetic, your level of testosterone was around 1200. In your 30’s when physical activity is not much, it can be nearly 420 ng/dl. To get the accurate reading of testosterone, a baseline reading should be done, before the age of 32. However, no one cares to do this.

SHBG and Estradiol: Some other reasons

SHBG or Steroid Hormone Binding Globulin is another cause of concern. SHBG is a glycoprotein, which binds sex hormones with itself. It binds nearly 60% testosterone with itself in a young adult and percentage increases with age.

High SHBG is directly related to high quantity of unavailable testosterone, which results in less free hormones to do the positive jobs in our body. Hence, when you have 600ng/dl of testosterone, a large amount of this is not available for your body. It’s really crazy.

That is the reason, when your doctor is testing the level of your T hormone, he should request for the total T level, bioavailable T level and free testosterone level. All these will help to give a clear picture of your hormones. However, very few experienced doctors do this and the majority of them are not interested in this procedure.

We should also keep in mind the estradiol level in men. The level of testosterone will be normal, but if estradiol level is high, it will not let the testosterone do its work properly and you will be a different person.

Now it’s clear that to determine the accurate level of testosterone is not an easy job. So it doesn’t matter what is the result of your lab test, you have to concentrate on the symptoms, it will be more helpful.

Low levels of testosterone: what are the symptoms?

Do you feel less energetic? Has your body fat increased without any reason and you are unable to reduce it? You are losing your muscle mass and workouts are showing no progress at all? Your erection is not proper and decrease quickly? You are more interested in irrelevant things than your sexual parts?

You are experiencing signs of early aging? You find it difficult to memorize things and cannot concentrate properly? Feeling depressed? You feel weak, when it comes to taking decisions? You might feel nervous, or ready to fight with anyone for very small things in daily life. If you feel any of these symptoms, they indicate low levels of testosterone.

If we see back in history, hypogonadism or low testosterone level is associated with middle aged men. A study conducted in 2006 reflected that 39% men exceeding the age of 45 have a low level of T. In the US alone, 13 million men have low levels of testosterone and only 10% go for proper treatment.

That’s just a portion of the large population of sufferers. However, this percentage is of those men, who prove deficient of these hormones in their blood tests. There are other millions of men, who are young and their lab tests show normal level of testosterone, but actually they are deficient.

A large percentage of young men are not included here, who are very young and never go for the lab test of their T levels. They have low levels of T because of pituitary glands, testicle stifling chemicals, estrogens or a modern lifestyle.

It is observed that now a day, the level of T in young man is almost the half, which their grandfathers used to have in the past, at their age.

Consult a good lab

First of all, you have to find an open-minded doctor, or specialist in low testosterone in Calgary. They should not be afraid of the awareness of his patient. Fortunately, now a days, we can find many testosterone treatment clinics in the country. However, the majority of them want to make quick money and they might not have the knowledge and information on this topic. So, you have to decide by yourself, about the treatment.

When you find a good doctor, explain him the symptoms you are experiencing and tell him that you want Hormone Replacement Therapy. You have to request him for the lab work. However, you have to ensure that tests are done, as we have described below. Otherwise, they will do them in an improper way.

  • Testosterone, bioavailable
  • Testosterone, free
  • Testosterone, total
  • Estradiol (sensitive assay)
  • Follicle Stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)

Steroid Hormone Binding Globulin

Blood Chemistry Panel

  • Dihydrotestosterone (DHT)
  • Complete Blood Count (CBC)
  • Prostate Specific Antigen (PSA)
  • Metabolic Panel

These tests will provide a baseline for the reference. You will start the therapy and after three months, you will have a follow-up test. That will show that either you are taking the right dose of hormones or if there are any negative side effects of the therapy.

T replacement: what are the available choices?

If the results of the test suggest that your testosterone levels are low or your symptoms reflect the same, you should do something to avoid the problems. You can find supplements, available in the market. These supplements are very effective. A lot of young men, who do body building use them to build their muscles. However, if your clinical test results show low levels of T, you should not use these supplements.

  1. Testosterone Injection

If we talk about the best available treatment for testosterone, it’s the injections. Gels are more natural in their work, but injections are the best for boosting of libido and building of muscles. However, the important thing in injections is their proper administration.

In the Canada, you have two choices when it comes to injections. One is testosterone cypionate and the other is testosterone enanthate. These are Esters and have slightly different half lives; however, that is not a big problem, particularly if you are getting the right dose and proper method is used according to schedule.

The majority of men need at least 150mg of any of these esters, weekly, for TRT. But depending on the needs, some need more and some others need less. The higher range can be 250mg, per week. If you take more than that, it will start a steroid cycle for body building and testosterone replacement will not be completed.

If you take a weaker dose, at a particular day of the week, you can experience low levels of testosterone as injection the day of next injection approaches. To overcome this problem, many men divide their weekly dose in two halves and take injections twice a week. Keeps the level of testosterone in the blood nearly stable.

Some men try to manage their workouts with the injections. They take the injection, when they have to do heavy workout. It does not make any difference, if you take two injections in a week. Two injections in a week means, your testosterone injections are always at peak values, during the week.

Moreover, some men prefer subcutaneous injections instead of intramuscular ones. You have to pinch your skin from your belly, thigh or arm and inject the needle in it. The angle should be about 90 or 45 degrees. After the injection, you can start your work immediately.

  1. Testosterone Gels

As we have discussed earlier, gels are more natural and body’s natural way should be followed for any therapy. However, they are not the replacement for the injections, which are much more effective.

On the other hand, gels have drawbacks too. Gels should be applied right after taking shower. Swimming and sweating should be avoided for an hour or so after applying gel. Other than that, a child or female, especially who is pregnant, should not come in contact with the gel, until it’s completely dry on the skin.

If you want to use gel, it must be applied daily once or twice. However, you cannot use your hands for the application of gel. Gel sticking to your hands will not be able to enter the blood. You have to squeeze the gel on the arm and rub both arms together, this way no gel will get wasted.

  1. Others

Other than gels and injections we have creams, sublingual drops and pellets, which are not important to discuss. Creams can work, but they create a lot of mess and cannot absorb on the skin like gels. Drops and tablets are not really effective and it’s almost impossible to take their proper dose.

There are some other methods which are considered when it comes to the treatment of secondary hypogonadism. This is the condition when the pituitary gland fails to produce LH and FSH, as hypothalamus cannot send it instructions to do so. LH and FSH affect the testicles for the production of testosterone. For the treatment of this condition, selective estrogen receptor and SERMs are used. Clomid and Nolvadex are commonly used in this regard. They instruct the pituitary to produce LH and after that testicles start their work. The exact working method of these chemicals cannot be explained in this short article.

Testosterone replacement treatment and your testicles

When someone does not go for the testosterone replacement treatment, he is probably afraid of shrinking testicles and infertility. TRT can decrease the sperm count in men and size of testicles can reduce, but HCG can be used for the treatment of this problem, if someone faces it.


This drug acts like LH and makes sure that your testicles keep working. They keep producing the sperms and testosterones, which will keep the size of testicles proper. Moreover, we have receptors for the LH in our body, HCG get attach with these receptors. This is quite helpful during the therapy, and men feel good. The administration of HCG is done subcutaneously, with a typical insulin needle. The needle is available in most pharmacies. 100 IU is the recommended dose for the starters, dose can be increased later. The standard dose is 250 or 500, twice in a week. This is a temporary fix, and will not fix low testosterone overall, over time it will burn out the leydig cells.

TRT: Some side effects are also there

When you start TRT, you can experience some negative effects as well. If you have prostate cancer, before starting the therapy, you can face some issues. No evidence is found about the relation of TRT and prostate cancer, even after a large number of case studies and taking case studies of thousands of patients. However, it is found that TRT can have a negative impact if you already have prostate cancer. The reason of this problem is not understood yet. To avoid the problem, one should have DREs or digital rectal exams once a year and monitoring of PSA or Prostate specific antigens are also very important.

Another negative effect of TRT is the Polycythemia, which reflects that your body is producing more than required red blood cells in response to the TRT. Blood cannot flow freely in your veins and gets thick. It can lead to heart attack and heart strokes, as it can cause blockage in your blood system.

Monitoring of hemoglobin and hematocrit is very important, to avoid these problems. If the level of hemoglobin is more than 18.0 or more than 50.0 is observed for hematocrit, it’s time to take some action. First of all, adjust your dose of testosterone by consulting your doctor and after that donate some blood as well. You can also go for the therapeutic phlebotomy, where the doctor will take your blood in his office.

Heart attack and Gyno in relation to TRT

Gynecomastia is not common in those men, who undergo Hormone Replacement Therapy. This is the abnormal growth of breast tissues in men. It is common in those men, who take high levels of testosterones for body building, i.e. 1,000mg to 3,000 mg per week. Young people can also experience hair loss, however the problem gets settled after 30 years of age. If you have not lost your hair during the therapy, TRT will not do anything wrong with your body.

If you have heard anything else about TRT leading to heart attack or any other major disease, it might not be right. Men having low levels of testosterones are more likely to get diseases like diabetes, dementia and heart problems is purely a myth. A proper Calgary TRT clinic can make you understand all these factors.

Hormone Replacement Therapy: what are the expectations?

Testosterones are beneficial for the proper functioning of the body, but they do not give results quickly. Once you start the therapy, you will start feeling good and energetic, but the benefits will start coming with the passage of time.

  • Depression: improvement in the state of depression is usually seen after 6 weeks, but things keep getting better with time.
  • Sexual advantages: you will see a change in your sexual life after three weeks and the complete advantages will be experienced after 19 weeks.
  • Anxiety and sociability: improvement is observed in creativity and stimulation of the cerebral cortex, the part of the brain which regulates attention, after 3 weeks,. After three months the maximum benefits will be observed.
  • Sensitivity about insulin: It will start increasing after few days of therapy start, but visible effects will be seen during 3 to 12 months. However, it can take years.
  • Increase in muscularity: it depends on many factors like fair level of testosterone, genetics, lifestyle, training and diet. But in general terms, Hormone Replacement Therapy affects muscularity after a month or so, but it will take a year for the complete effect.
  • A healthy life: when you collect all the advantages of TRT, no matter they are psychological or physiological, you experience a healthy life. These advantages cannot be measured, but you have an enjoyable life. However, the important thing is to find a good doctor, who is able to understand the symptoms and starts the treatment accordingly.