Commonly asked questions about Low-T and TRT.

An Ask the Doc Blog Post from our patients.

· What is HCG?

· Should I be taking HCG with Testosterone?

· What are SERMS?

· Will Testosterone help my erections?

· How can I boost my testosterone naturally?

What is HCG and should I be taking it with Testosterone Therapy (TRT)?

HCG stands for Human Chorionic Gonadotropin. It is composed of several amino acids and is identical to the pituitary hormone LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone) in both males and females. HCG is specifically produced in women by the placenta and secreted during the beginning of pregnancy to enrich and nourish the uterus for fetal growth. Because the alpha subunit of HCG is similar to LH and FSH, it can be used to mimic the normal function of LH and FSH in males. LH is secreted in males by the pituitary and acts upon the testes to maintain testicular size and produce testosterone. FSH in males is also secreted by the pituitary and maintains sperm production (spermatogenesis).

Men who take HCG during testosterone replacement therapy (TRT) are doing so to maintain fertility and testicular size. Testosterone given without HCG acts upon the pituitary to shut down FSH and LH production. In effect, the body is telling itself there is too much testosterone, reduce natural production and reduce FSH and LH secretion. This process is termed a “negative feedback loop”. The effect of down-regulation of LH and FSH can be testicular atrophy and a decrease in spermatogenesis. Therefore, it is important to note that testosterone taken alone is an infertility drug for men. Every patient presenting for testosterone therapy should have a discussion about their fertility concerns and desire for children. Testosterone therapy alone will make a man infertile, however, stopping therapy the system will rebound, and spermatogenesis may improve over baseline. The necessity to take HCG for each individual on testosterone replacement is unique and depends on the patient’s desire to maintain fertility. Also, if a patient is experiencing any testicular atrophy while on testosterone therapy alone, HCG administration may alleviate testicular atrophy.

HCG can also be used on its own without taking TRT. For men who want a more natural alternative to taking testosterone therapy, HCG administration will up regulate a body’s own natural secretion of testosterone. HCG mono therapy may achieve similar results to testosterone therapy while maintaining reproductive potential.

What are selective estrogen receptor modulators and how can it improve my Testosterone level?

Selective estrogen receptor blocker or modulators ( SERMs) act upon the hypothalamus to prevent the negative inhibitory effects of estrogen on the hypothalamus. By blocking the negative feedback of estrogen on the hypothalamus, SERMs up-regulate the pituitary secretion of LH and FSH. This, in turn, maintains spermatogenesis and increases testosterone production by the testicles. SERMs were first approved in the United States in 1967 to treat infertility in women. In men, SERM use is off-label, however, many men like to use the medication because testosterone levels increase 2-3x while maintaining fertility. Furthermore, SERMs are an oral medication and is taken every other day. The levels of testosterone that a man achieves may not be as high as administering exogenous testosterone. For many men, SERMs provide the performance, energy and strength building enhancements desired.

Will Testosterone help with my erectile dysfunction?

I advise many patients that testosterone replacement will help increase your desire for sexual activity, and can improve your erectile dysfunction (ED). The primary treatment for ED is not testosterone replacement, however, testosterone does play a pivotal role in maintaining penile tissue health and function. We know some men do see a significant improvement in their erectile function while on testosterone therapy. This may be due to several factors. First, we find many men with hypogonadism to have other associated conditions that can cause ED which includes diabetes, hypertension, elevated lipid profiles, and obesity. Testosterone replacement improves insulin sensitivity, reduces obesity, improves body composition, encourages a healthier lifestyle change and reverses metabolic derangements. This process may assist in improving erectile function. Second, testosterone does have an effect on erectile tissues (cavernosa). Within the cavernosa of the penis are androgen receptors. Testosterone replacement therapy enhances activation of androgen receptors, up regulating nitric oxide synthase (NOS) and promoting new DNA synthesis. NOS is the principal enzyme responsible for penile smooth muscle relaxation and achievement of tumescence (engorgement of blood within the penis to achieve an erection).

Men who are hypogonadal and have erectile dysfunction (ED) may not respond to PDE5 inhibitors such as Viagra and Cialis. Testosterone replacement has been shown in clinical trials to improve the response to oral ED meds. A meta-analysis of the results of testosterone replacement therapy on sexual function as measured by the International Index of erectile function scores (IIEF) found an increase in IIEF scores with a mean difference of 2.31 in men with testosterone therapy replacement. Furthermore, other aspects of the IIEF score domains were also improved including libido, intercourse satisfaction, orgasm, and overall sexual satisfaction. Checking testosterone in men with ED is imperative to optimize and obtain the best results.

The workup for E.D, in short, begins with a history and physical examination to define the cause of the condition and differentiating between a neurogenic, vasculogenic or psychogenic causes of ED. Defining the cause for ED will direct the proper treatment. More often oral medications, termed PDE5 inhibitors are first-line therapy, followed by injection therapy and possibly a penile implant to follow. This algorithm can differ depending on several variables, patient health, medication usage, obesity, and recent pelvic surgery or trauma and psychogenic causes. Men with low testosterone who have ED can benefit from testosterone replacement significantly.

How can I boost my Testosterone Naturally?

The best way to improve your testosterone naturally is with a healthy diet and regular exercise that consists of both resistance training and vigorous aerobic exercise. A study by the American Physiological Society applied a 12-week vigorous exercise program to overweight males. The study looked specifically at the effect of a regular exercise program on testosterone levels. None of the men in the study performed regular daily exercise. The men completed a 40-60-minute jogging or walking exercise one to three days per week. Findings confirmed that all parameters of testosterone levels were increased including total and bioavailable testosterone levels. The takeaway message I advocate to all our patients is a healthy lifestyle accompanied by a well-balanced diet and regular exercise routine will improve your testosterone naturally. Men who are also on TRT will have enhanced results to therapy if they abide by the regimen as well.

Another way exercise can boost testosterone naturally is through a regiment called HIIT workouts. HIIT stands for high-intensity interval workouts. This includes a regiment using moderate and heavy weights during a high intensity burst of exercising. Then during the rest period you say active until again repeating the short burst of high intensity exercise with weights. This training is then repeated. Lightweight with high repetitions will increase endurance and burn fat and enhance metabolism. Workouts that are efficient to boost testosterone levels and increase metabolism are both aerobic in nature and include resistance.