What treatments are available?

Lifestyle advice:

Decreasing your weight when appropriate and increasing your level of exercise will increase your levels of testosterone.

There are many different treatments available. In the younger man where fertility is important, The Leger Clinic will generally suggest Clomiphene (Clomid) as first choice because this does not reduce sperm production or cause any shrinkage of the testicles. It is also a cheap option for treatment.

How does Clomid work?

Clomid is a weak oestrogen receptor antagonist, it blocks the normal negative feedback mechanism of circulating oestrodiol on the hypothalamus, preventing oestrogen from limiting the production of GnRH. The increase GnRH level then stimulates the pituitary gland to release more FSH and LH, resulting in an increase in sperm and testosterone production by the testes.

Results: there is generally a good response to the treatment. A recent study from Brazil showed a response rate of 68% with the only side effect being nipple tenderness in 5% of patients. The use of Clomid in men is unlicensed but is used worldwide by Andrologists.

Testosterone

Testosterone can be given by oral, skin gels or injection.

Injections can be short acting injections or long acting injections.

HCG injection can be given alongside testosterone to reduce testicular shrinkage and effects on sperm count/fertility.

Oral Testosterone – Testocaps

Very rarely prescribed as the Testosterone is very poorly absorbed from the stomach.

There are 3 Gel products available:

  1. Testogel Pump 16.2mg
  2. Tostran 2% Gel
  3. Testavan – this has become recently available and your Doctor will discuss this option with you at your Consultation.

They are very similar in effectiveness and cost but some patients complain that Tostran Gel can cause skin irritation so the Leger Clinic’s first choice is Testogel.

Testogel is easy to apply without the use and worry of a needle. It is just applied by spreading onto the skin of the shoulder and arm and takes only a few seconds once a day in the morning. Patients may wish to visit: www.testogelpump.co.uk/patient.

Cost: Approximately £40 per month.

Dr. Savage or one of his medical team, will give you a private prescription which you can use at any pharmacy allowing you to shop on price between pharmacies.

Injections can be either short acting such as Sustanon or Testosterone Enanthathe. Or long acting Nebido.

The short acting injections are self-administered, generally weekly into the front of the thigh. The Doctor will give you instructions on how to do this.

The long acting Nebido is given into the buttock but needs to be given by a Nurse approximately every 10 weeks.

Dr. Savage, with your permission, will write to your GP practice to arrange this.

HCG injections these can be given alongside Testosterone to reduce testicular shrinkage and preserve fertility. The commonest dose used is 500 iu subcutaneously (just under the skin) 3 times a week.

The advantages and disadvantages of each treatment will be discussed at your appointment.

“I have heard that testosterone treatment can cause cancer of the Prostate, is this true?”

NO, this is a myth and indeed has been a medical myth for some years. Bizarrely, the very latest evidence suggests that men with very low levels of testosterone are more likely to get a more aggressive form of Prostate Cancer if untreated for their testosterone deficiency.

Are there any fringe benefits to taking TRT apart from the sexual ones?

Yes, apart from improving you sexually there are a number of benefits which are now beginning to emerge from men who have been taking TRT long term. Among these are:

  • Improvements to your cardiovascular system
  • Improvements to your cognitive function and memory
  • Increased mineral bone density to help prevent fractures.
  • Increased muscle mass and decreased body fat

All that said it is a mistake to expect miracles. The benefits from TRT are often subtle and mild and TAKE TIME!

Not necessarily life transforming but rather life enhancing.

The Leger Clinic