What is testosterone?

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Testosterone is a hormone that is primarily produced in men in the testicles. Healthy levels of testosterone contribute to the maintenance of male bone density and fat distribution, red blood cell production, facial and body hair, libido (sex drive), and sperm production.

Endogenous androgens, including testosterone, are responsible for normal growth and development of the male sex organs as well as for the maintenance of secondary sex characteristics.

Androgens have several physiological effects on the body, including:

• Retention of nitrogen, sodium, potassium, and phosphorous
• Decreased urinary excretion of calcium
• Increased protein anabolism
• Decreased protein catabolism
• Improved nitrogen balance (only when the intake of calories and protein is sufficient)

Androgens are responsible for the growth spurt of adolescence and for eventual termination of linear growth, brought about by fusion of the epiphyseal growth centers. In children, exogenous androgens accelerate linear growth rates, but may cause disproportionate advancement in bone maturation.

The physiological effects of androgens can result in a variety of development and changes in men over time, including:

• Growth and maturation of the prostate, seminal vesicles, penis, and scrotum
• Development of male hair distribution, such as beard, pubic, chest, and axillary hair
• Laryngeal enlargement
• Vocal cord thickening
• Alterations in body musculature and fat distribution

Androgen use over long periods may result in fusion of the epiphyseal growth centers and termination of the growth process. Androgens have been reported to stimulate production of red blood cells by enhancing production of erythropoietic stimulation factor (EPO).

During exogenous (external or intentional) administration of androgens, endogenous (internal or naturally occurring) testosterone release is inhibited due to the decrease of pituitary luteinizing hormone (LH). Men taking large doses of exogenous androgens may also experience a suppression or cessation of spermatogenesis due to the decrease in the pituitary follicle stimulating hormone (FSH).

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Why is testosterone used?

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As men age, testosterone levels tend slowly decline approximately one percent per year after the age of 30. The decline in testosterone levels can have a negative impact on several physiological factors. Your physician will help you determine whether your low testosterone levels are due to the normal aging process or to a specific condition.

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What is hypogonadism?

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Hypogonadism is a condition in which the male body is no longer able to produce normal levels of testosterone. Typically, this is due to a lack of testosterone production by the testicles or lack of signaling from the pituitary gland to the testicles to make testosterone.

Before any man undergoes testosterone replacement therapy (TRT), it is imperative first to ascertain the cause of low testosterone, and only then to treat a low testosterone level. A good urologist who is an expert in TRT will not only your replace testosterone levels, but investigate why your levels are low.

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What’s the difference between Low-T, low testosterone, androgen deficiency, andropause & hypogonadism?

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Low testosterone, Low-T, androgen deficiency, hypogonadism, and andropause are all terms that refer to having a low testosterone level.

Medical terminology that refers to low testosterone primarily uses the terms “hypogonadism” or “androgen deficiency”. Less formal terms like “Low-T” and “andropause” have been adopted both to normalize the condition and to market treatments for the condition.

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What causes Low-T?

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Male hypogonadism is caused by a variety of conditions. These conditions also determine whether a man has primary or secondary hypogonadism.

• Primary hypogonadism is the result of a lack of testosterone production by the testicle. It is most often associated with an increase in FSH/LH secretion by the pituitary.
• Secondary hypogonadism is a result of a lack of signaling from the pituitary to the testicle. It is associated with a decrease in FSH/LH and low testosterone levels.

First, your physician should determine the cause of low testosterone before designing and beginning therapy. Common causes of low testosterone in men include:

• Primary hypogonadism (also known as hypergonadotropic hypogonadism and primary testicular failure):
  • Klinefelter Syndrome
  • Noonan Syndrome
  • Absent testes
  • Poorly functioning testes
• Secondary hypogonadism aka hypogonadotropic hypogonadism and secondary testicular failure):
  • High prolactin level
  • Iron overload
  • Medications
  • Pituitary damage or tumor
  • Kalman’s Syndrome
  • Prader Willi Syndrome

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What testosterone value is considered low?

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Consensus on low testosterone values varies across different medical treatment guidelines. In addition, many labs have different testosterone threshold that determine a low value. It is

important to have your testosterone value reviewed by a board-certified urologic physician to most accurately diagnose and understand your testosterone value and if treatment is indicated. Most often, the decision to treat for low testosterone is at the discretion of your physician.

In accordance with many clinical trial reports, most physicians use a testosterone cut-off of anything below 250-300ng/dl.

• According to the American Urologic Association (AUA), a total testosterone value below 300ng/dl is considered a reasonable value for which to diagnose low testosterone.
• The Endocrine Clinical Practice Guideline recommends diagnosing hypogonadism in men with symptoms and signs of testosterone deficiency as well as unequivocally and consistently low serum total testosterone and/or free testosterone concentrations (when indicated).

While some clinical guidelines such as the AUA provide a succinct number at which to diagnose hypogonadism, the Endocrine Society does not. Because testosterone levels vary throughout the day, your health provider will discuss the importance of drawing blood levels before 11:00AM when measuring testosterone. Visit with a REGENX Health provider today to get a better understanding of your testosterone level and whether you’re a candidate for therapy.

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How is low testosterone diagnosed and measured?

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Diagnosing low testosterone typically includes two factors:

• Blood tests to measure testosterone levels (typically anything less than 300ng/dl)
• The presence of particular signs or symptoms

Testosterone is measured from blood samples. Blood samples taken in the early morning, before 11:00 AM, ensure the most specific and accurate results. Two common tests are used to measure testosterone levels in blood:

• Mass Spectrometry Liquid Chromatography is the gold standard method. This method isolates the steroid hormones in blood using chromatographic separation then a detection of massto-charge ratio. This testosterone measuring method is the most accurate and specific, so it can take about three (3) days to perform.
• Rapid automated immunoassay is the most commonly used method. This test is faster, typically taking one (1) day.

Additionally, surveys are sometimes used to assist in diagnosing low testosterone. The most popular and validated survey is the Androgen Deficiency in Aging Male (ADAM) questionnaire. The ADAM survey has widely been used a screening tool to detect men at risk for androgen deficiency (Low-T). The standard ADAM questionnaire consists of 10 yes-or-no questions that relate to symptoms of androgen deficiency. A man who responds positives to questions #1 or #7 or a total of 3 other questions typically has a positive Low-T diagnosis.

1. Do you have a decrease in libido (sex drive)?
2. Do you have lack of energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased “enjoyment for life”?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Have you noted a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?

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What are common symptoms of low testosterone?

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Men experiencing hypogonadism (low testosterone) may experience the following symptoms, divided into physical, cognitive and sexual areas:

• Physical signs & symptoms:
  • Reduced energy and endurance
  • Diminished work performance
  • Diminished physical performance
  • Loss of body hair
  • Reduced beard growth
  • Fatigue
  • Reduced lean muscle mass
  • Weight gain and/or obesity
  • Infertility
  • Gynecomastia (breast enlargement)

• Cognitive signs & symptoms:
  • Depressive symptoms
  • Reduced motivation to complete tasks
  • Poor concentration
  • Forgetfulness
  • Irritability personality

• Sexual signs & symptoms:
  • Reduced sex drive and desire
  • Erectile dysfunction (ED)
  • Lack of morning erection

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What are the benefits of testosterone therapy?

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The primary treatment for hypogonadism is testosterone replacement therapy (TRT). Testosterone therapy can include the use of injections, gels, patches, or pellets, though injections and gels are most common.

Testosterone therapy can improve the symptoms of low testosterone, including the following:

• Correcting insulin resistance
• Increasing bone and muscle mass
• Decreasing subcutaneous fat
• Lowering lowdensity lipoprotein cholesterol, triglycerides, blood glucose, HbA1c, and blood pressure
• Increasing highdensity lipoprotein cholesterol
• Improving erectile function and life parameters (such as increased energy and friendliness, decreased anger and anxiety, etc.)
• Improve energy & performance
• Reduce daytime fatigue

This improvement in physiologic factors is itself enough to warrant therapy. However, patients cite the improvements in physical and mental symptoms as key to their satisfaction. One recent study evaluated the patient satisfaction of men treated with different formulations of testosterone therapy (52.5% injection, 30.6% gels, and 16.9% pellets), with overall satisfaction rates ranging from 62.8% with less than 6 months of therapy to higher than 79% at 25-36 months.

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What treatment options are available for Low-T?

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At REGENX Health, our board-certified urologic physicians will prescribe one of two treatments:

• Injectable testosterone formulation (testosterone cypionate or testosterone ethanoate)
• Testosterone topical gel

Both options are effective in increasing male testosterone levels. For members who desire a way to raise their testosterone levels without utilizing exogenous testosterone, our physicians can prescribe other medications and lifestyle changes that will raise testosterone levels in accordance with your expectations.

If you desire, testosterone pellets, please contact REGENX Health to learn more.

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Will testosterone therapy cause my testicles to atrophy (shrink)?

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Testicular atrophy can occur in some men who are undergoing testosterone replacement therapy. Testicular atrophy can result from a decrease in pituitary signaling of LH and FSH to the testicles to maintain spermatogenesis and intratesticular testosterone production. Administering HCG (human chorionic gonadotropin) during testosterone replacement may negate this effect, resulting in a maintenance in testicular size and a potential maintenance in spermatogenesis (sperm production) during testosterone replacement therapy.

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Will testosterone replacement therapy improve my erectile dysfunction?

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Testosterone plays a key role in the central and peripheral modulation of erectile physiology. Though testosterone replacement therapy is not a primary treatment for erectile dysfunction (ED), many hypogonadal men who receive testosterone therapy report improvement in their erectile function and their sexual activity.

Several clinical trials indicate that testosterone replacement therapy can improve erectile function in several ways:

• Enhancing nitric oxide synthase (NOS)
• Improving penile nerve functions
• Enhancing response to PDE5 inhibitors, particularly Viagra (Sildenafil), among others
• Improving venoocclusive erectile function

Clinical trials have shown that testosterone therapy can rapidly increase levels of testosterone and improve sexual function and mood in men with hypogonadism. Testosterone gel in combination with the PDE-5 inhibitor Viagra (Sildenafil) has been demonstrated to significantly improve erectile function and orgasmic function in patients with ED and hypogonadism who had previously not responded to sildenafil monotherapy. Therefore, testosterone therapy may be considered for the treatment of ED in men with low to low–normal total testosterone levels who have failed previous treatment with PDE-5 inhibitors.

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Does testosterone replacement cause infertility?

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Testosterone is a crucial hormone in the development of male reproductive organs and male fertility. Elevated levels of testosterone in the testicles secreted by Leydig cells are necessary for spermatogenesis (sperm production). The administration of exogenous testosterone results in suppression and shutdown of the hypothalamic pituitary-gonadal (HGP) axis. This results in a decrease in LH and FSH secretion and subsequent lack of signaling to Leydig Cells and Sertoli cells in the testicles to make testosterone and promote spermatogenesis.

Many clinicians and patients are unaware of the effects of testosterone on male fertility. A review of the current literature suggests that most cases of testosterone-induced male factor-induced oligospermia (low sperm concentration) or azoospermia (absence of motile sperm) will likely resolve within 4-12 months after cessation of exogenous testosterone administration. Factors that can hinder the return of sperm production include age and duration of testosterone usage.

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What medications can improve my testosterone levels without causing infertility?

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Men can utilize a variety of medication options as well as lifestyle changes in order to raise testosterone levels without administering exogenous testosterone directly.

Medications that can raise testosterone indirectly include:

• Human Chorionic Gonadotropin (HCG)
• Clomiphene Citrate (Clomid)
• Anastrozole (Arimidex)

Men can utilize a variety of medication options as well as lifestyle changes in order to raise testosterone levels without administering exogenous testosterone directly.

Medications that can raise testosterone indirectly include:

• Human Chorionic Gonadotropin (HCG)
• Clomiphene Citrate (Clomid)
• Anastrozole (Arimidex)

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Can I increase my testosterone naturally?

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It is possible to increase a man’s testosterone naturally by improving your daily routine. First, look at the root cause of low testosterone in a man, which may include poor diet, weight gain, lack of sleep, or stress. (Stress linked to multiple jobs, many work-related deadlines, and long daily commutes contribute to low testosterone levels.) Improving these four factors in your daily routine will likely improve your testosterone levels.

• Studies indicate that a loss of more than 10% of a male body’s weight can improve testosterone levels significantly, up to 85ng/dl. A 15% weight loss can increase testosterone levels up to 180ng/dl.
• Other studies show that sleep restriction (lack of sleep) can decrease testosterone levels by as much at 15%. Quality, restful sleep between the hours of 4:00 – 8:00 AM have the highest correlation to improve testosterone levels.

Other factors contribute to low testosterone levels including hypertension (high blood pressure), tobacco use, and sleep apnea.

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Is estrogen management important during testosterone therapy?

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Estrogens in humans are found in several forms: estrone (E1), estradiol (E2) and estriol (E3). Of these, estradiol (E2) has the highest affinity for the estrogen receptors and is most biologically active. Estradiol is produced in men by the aromatization of testosterone in fat cells predominately and to a lesser extent in the adrenal glands and testicles.

Men on testosterone therapy can often find an increase in estradiol levels. Elevated estradiol levels in men on testosterone therapy can lead to decreased libido, breast tenderness and growth (gynecomastia).

The use of anastrozole in men on testosterone therapy is considered off-label, but can be used during testosterone replacement therapy to optimize results and reduce elevated estradiol levels that may result. Studies have shown improved libido in men on testosterone therapy combined with an aromatase inhibitor over testosterone alone.

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How does testosterone affect my hemoglobin and hematocrit levels?

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Erythrocytosis (an increase in red blood cells and blood viscosity) is the most frequent dose-limiting adverse effect of testosterone replacement therapy.

• Clinically, erythrocytosis is defined as either:
  • an Hb (hemoglobin) level higher than 18.5 g/dL, or
  • an Hct (Hematocrit) higher than 52% in men (this definition can vary)
• Physiologically, erythrocytosis is defined by an erythrocyte mass that exceeds 125% of that predicted for sex and body mass.

Much of the concern on increased blood viscosity resulting from increased red blood cell mass centers on the potential increased risk for venous thromboembolism, myocardial infarction, and cerebrovascular accidents. However, little evidence supports an increased risk of these negative sequelae (consequence) in men on testosterone replacement therapy.

Erythrocytosis occurs more significantly and earlier in men on injectable testosterone versus topical testosterone gel formulations. Erythrocytosis is monitored during testosterone therapy by measuring and monitoring hematocrit and hemoglobin blood levels periodically. If the hematocrit increases above 54% your healthcare provider can advise you to stop testosterone therapy until the hematocrit decreases to a safe level or perform periodic phlebotomy while still receiving testosterone therapy.

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What is gynecomastia (male breast enlargement) and how is it treated?

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Gynecomastia is the painful enlargement of the breast tissue in men. It can occur in some men who are using testosterone therapy, although other causes of breast enlargement can include:

• Certain medications
• Liver disease
• Starvation
• Renal failure
• Prolactin secreting pituitary adenomas
• Hyperthyroidism
• Aromatase excess syndrome
• Ectopic HCG production
• Diabetes mellitus
• Stressful conditions

The development of gynecomastia is partly due to an imbalance of estradiol (estrogen) to testosterone signaling in breast tissue. Though treatment depends on the root cause, the off-label use of Tamoxifen and Arimidex have shown benefits in alleviating the condition in men.

Symptom duration of gynecomania tends to correlate with response to therapy. The longer a man experiences gynecomastia, the longer scar tissue builds up around the nipple and typical response to medical therapy may not be effective. In such instances, surgical intervention and removal of such tissue may be necessary.

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Is testosterone approved by the FDA?

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Testosterone injection is approved by the FDA for replacement therapy in the male conditions specifically associated with symptoms of hypogonadism (deficiency or absence of endogenous testosterone).

There are two types of low or absent endogenous (internal or naturally occurring) testosterone:

• Primary hypogonadism (congenital or acquired): testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome; or orchidectomy.
• Secondary/Hypogonadotropic hypogonadism (congenital or acquired): gonadotropin or LHRH deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.

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Is testosterone approved for other uses?

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The FDA has not specifically approved testosterone (cypionate) in men with hypogonadism due to aging (late-onset hypogonadism) because the safety and efficacy have not been established.

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Why is there an FDA label warning about hypogonadism (low testosterone)?

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The U.S. Food and Drug Administration (FDA) cautions that prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions. The FDA recommends that health care professionals prescribe testosterone therapy only for men with low testosterone levels caused by certain medical conditions and confirmed by laboratory tests. The benefit and safety of such medications have not been established for treating low testosterone levels due to aging, even if a man’s symptoms seem related to low testosterone.

As such, the FDA requires the manufacturers of all approved prescription testosterone products to change their labeling to clarify the approved uses of these medications and to add information on the labeling about a possible increased risk of heart attacks and strokes in patients taking testosterone.

The FDA approves testosterone for replacement therapy only for men who have low testosterone levels due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism. Examples of these disorders include failure of the testicles to produce testosterone because of genetic problems, or damage from chemotherapy or infection.

In addition, based on the available evidence from published studies and expert input from an Advisory Committee FDA has concluded that there is a possible increased cardiovascular risk associated with testosterone use. These studies included aging men treated with testosterone. Some studies reported an increased risk of heart attack, stroke, or death associated with testosterone treatment, while others did not.

The FDA recommends that health care professionals make patients aware of this possible risk when deciding whether to start or continue a patient on testosterone therapy.

Patients using testosterone should seek medical attention immediately if symptoms of a heart attack or stroke are present, such as:

• Chest pain
• Shortness of breath or trouble breathing
• Weakness in one part or one side of the body
• Slurred speech

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What does off-label use mean?

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Off-label use refers to the practice of prescribing a medication for a condition other than the medication is intended or approved to treat. A healthcare provider may prescribe a medication for a different condition or a different dosage other than what’s approved by the U.S. Food & Drug Administration (FDA), if medically appropriate for the patient.

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Does testosterone cause any drug reactions?

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Androgens, including testosterone, can increase sensitivity to oral anticoagulants (blood thinners). You may need to reduce your dosage of anticoagulant in order to maintain satisfactory improvement in your hypoprothrombinemia.

The metabolic effects of androgens in diabetic patients may decreased blood glucose, resulting in a change in insulin requirements.

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What warnings are associated with taking testosterone?

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The use of androgens, including testosterone, can increase hypercalcemia in immobilized patients. If this occurs, stop taking the drug immediately.

Prolonged use of high doses of androgens has been associated with life-threatening complications including the development of:

• Hepatic adenomas
• Hepatocellular carcinoma
• Peliosis hepatis

If you experience pain, edema, or warmth and erythema in your lower extremities, or acute shortness of breath, seek medical help immediately.

Edema, with or without congestive heart failure, may be a serious complication in patients with pre-existing cardiac, renal or hepatic disease.

Long term clinical safety trials have not been conducted to assess the cardiovascular outcomes of testosterone replacement therapy in men. To date, epidemiologic studies and randomized controlled trials have been inconclusive for determining the risk of major adverse cardiovascular events (MACE), such as: non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death, with the use of testosterone compared to non-use.

Some studies, but not all, have reported an increased risk of MACE in association with use of testosterone replacement therapy in men. Patients should be informed of this possible risk when deciding whether to use or to continue to use DEPO-Testosterone (testosterone cypionate).

Testosterone has been subject to abuse, typically at doses higher than recommended for the approved indication and in combination with other anabolic androgenic steroids.

This drug has not been shown to be safe and effective for the enhancement of athletic performance. Because of the potential risk of serious adverse health effects, this drug should not be used for such purpose.

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What are the side effects of testosterone?

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Common and uncommon side effects of testosterone and other androgens may include, but are not limited to, the following:

• Endocrine and urogenital conditions such as gynecomastia, excessive frequency and duration of penile erections, and oligospermia (low sperm count)
• Skin and appendages conditions such as hirsutism, male pattern of baldness, seborrhea, and acne
• Cardiovascular disorders such as myocardial infarction and stroke.
• Fluid and electrolyte disturbances such as retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates
• Gastrointestinal conditions such as nausea, cholestatic jaundice, alterations in liver function tests, rarely hepatocellular neoplasms, and peliosis hepatis
• Hematologic conditions such as the suppression of clotting factors II, V, VII, and X, bleeding in patients on concomitant anticoagulant therapy, and polycythemia
• Nervous system conditions such as an increased or decreased libido, headache, anxiety, depression, and generalized paresthesia
• Allergic reactions or hypersensitivity, including skin manifestations and anaphylactoid reactions
• Vascular disorders including venous thromboembolism
• Special conditions such as rare cases of central serous chorioretinopathy (CSCR)
• Miscellaneous conditions such as inflammation and pain at the site of intramuscular injection

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How long does testosterone stay active in my body?

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The half-life of testosterone cypionate when injected intramuscularly is approximately eight days.

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How often should I take testosterone?

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Testosterone esters are less polar than free testosterone. Testosterone esters in oil injected intramuscularly are absorbed slowly from the lipid phase; thus, testosterone cypionate can be given at intervals of 2-4 weeks. Your REGENX Health physician will determine your custom regimen based on your health goals and therapy expectations.

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What medications interfere with (are contraindicated with) testosterone?

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Do not take testosterone if any of the following conditions apply to you:

• A known hypersensitivity to testosterone
• Current carcinoma of the breast
• Current or suspected carcinoma of the prostate gland
• Serious cardiac, hepatic, or renal disease

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What does my healthcare provider need to know before I take testosterone?

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Testosterone is not right for everyone. Only your healthcare provider and you can decide if testosterone is right for you. Your physician or healthcare provider must know all medications and non-prescription drugs or medicines you are currently taking.

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Is testosterone a controlled substance?

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Testosterone is a Schedule III controlled substance per the Controlled Substances Act.

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Is it possible to abuse or misuse testosterone?

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Abuse and misuse of testosterone has been seen in both male and female adults and children. Drug abuse is defined as the intentional and non-therapeutic use of any drug in order to feel the rewarding psychological and physiological effects. Drug abuse can occur once or over repeated use over any length of time.

Testosterone may be abused by athletes and bodybuilders in particularly, often in combination with other anabolic androgen steroids (AAS) and/or obtained by methods other than by prescription from a pharmacy. There are reported of misuse by men taking higher doses of legally obtained testosterone than prescribed and/or continuing testosterone despite adverse events or against medical advice.

Individuals who abuse testosterone or other AAS have reported serious adverse reactions including:

• Cardiac arrest
• Myocardial infarction
• Hypertrophic cardiomyopathy
• Congestive heart failure
• Cerebrovascular accident
• Hepatotoxicity
• Serious psychiatric manifestations, including major depression, mania, paranoia, psychosis, delusions, hallucinations, hostility, and aggression

Men in particular have reported:

• Transient ischemic attacks
• Convulsions
• Hypomania
• Irritability
• Dyslipidemias
• Testicular atrophy
• Subfertility
• Infertility

Women have reported:

• Hirsutism
• Virilization
• Deepening of voice
• Clitoral enlargement
• Breast atrophy
• Malepattern baldness
• Menstrual irregularities

Male and female adolescents have reported the premature closure of bony epiphyses with termination of growth, and precocious (early onset) puberty.

Note that these reactions are reported voluntarily from a population of uncertain size and may include abuse of other agents. As such, it is not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

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Who should I contact if I have a reaction to testosterone?

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If you experience serious side effects such as fainting, heart attack, or significant allergic reaction, seek immediate medical help by calling 911.

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Who should not take testosterone?

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Testosterone is not right for everyone. Only your healthcare provider and you can decide if testosterone is right for you. Only those who have specifically been prescribed testosterone should take it. Never share testosterone with others, even if their symptoms are similar, as it may cause serious harm.

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How does the Low-T treatment at REGENX Health work?

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At REGENX Health, we aim to provide a comprehensive, affordable, and convenient online experience that gets you performing better.

Receiving treatment for low testosterone is easy, convenient, and provided by experts in men’s health. Your treatment is provided, guided, and monitored by a board-certified urologist and specialist. You will meet the doctor during every online visit, ensuring you’re a receiving expert attention to detail alongside leading, cutting-edge testosterone replacement therapy.

New REGENX Health members can expect to follow this timeline when getting started:

1. Fill out an online medical assessment, which will be reviewed by our urologic physicians. This assessment helps our REGENX Health physicians better understand your medical history, symptoms, and therapy expectations, which will drive our customized treatment protocols and optimize your results.
2. Schedule an online visit with a REGENX Health urologic physician. After our physicians review your assessment, a REGENX Health liaison will schedule your online visit with us as well as help you obtain comprehensive lab work and make an appointment for a physical examination where you live.
   • Members can obtain lab work from several locations local to their home or office. Our staff provide you instructions and help guide you through, ensuring an easy, timely process.
   • Members who have had recent lab work (from the last three months) may be able to proceed to the online physician visit sooner.
3. Attend your online physician visit. During your initial consultation, you and a REGENX Health physician will review your lab work, medical history, and physical examination via our REGENX Health telemedicine platform.
   • We utilize a HIPPAcompliant telemedicine online platform that allows our members to “meet” face-to-face with a board-certified urologist during every visit.
   • Our platform is accessible by smartphone or computer, without downloading any software or apps. Only an internet connection is needed.
   • During your consultation, if your physician confirms your candidacy for therapy, medication with all necessary supplies are mailed discreetly.
4. Begin your customized testosterone treatment. Your health and safety are our priority, which is why we include in your treatment an additional virtual session with the physician to show you how to mix the medication, utilize sterile injection or application technique, and store your supplies correctly for no additional charge.
5. Schedule a follow-up online visit. Follow-up online visits with your REGENX Health physician include lab work every 3-6 months. Our goal is to enhance your performance and health so you can achieve your goals.

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How is REGENX Health different from other online service providers?

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REGENX Health is different from other online and Low-T clinics. We take pride in educating you about the therapy you are undergoing. In our experience, the more you know about your health and testosterone levels, the better results you will obtain.

Here’s what makes REGENX Health stand out:

• Your healthcare is always expert. That’s because every virtual meeting you’ll have is with a boardcertified urologist who specializes in testosterone replacement therapy and men’s health. Other online or Low-T clinics rely on mid-level health providers, nurse practitioners, or non-urologic physicians.
• Your health and treatment are always physicianguided, in order to ensure your health and optimize your performance results. Each visit with a physician, scheduled every three months via video teleconference, provides a personable and convenient experience for our members, so we get to know you and you get to know us. (This timing is significantly more frequent than other providers.) Know that your testosterone therapy, management, and concerns will always be fully addressed.
• Our pricing is always inclusive. Unlike other online or LowT clinics, there are no hidden fees or surprise prices. Your low, monthly investment includes everything you’ll need during your testosterone therapy:
  • Online physician visits
  • Medications
  • Supplies
  • Delivery
  • Comprehensive lab work

As always, there are no long-term commitment requirements, so you can cancel anytime. All medication and supplies are mailed discreetly to your home or office. Unlike other providers, you’ll never have to visit a clinic weekly to get an injection. Instead, your labs are performed on your time at a location most convenient to you and you’ll handle your personalized treatment in your own time and privacy.

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What supplies are included in the testosterone service?

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REGENX Health provides all necessary care, therapy monitoring, and supplies you will need in order to undergo successful testosterone replacement therapy. The following are supplies included in your testosterone therapy:

• Testosterone medication
• Supplies
• Alcohol prep pads
• Band aids

For men who are also on Human Chorionic Gonadotropic (HCG) treatment, sterile bacteriostatic water and mixing supplies are also included with your necessary testosterone supplies.

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How much does testosterone replacement therapy cost?

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Your initial consultation with a REGENX Health physician is only $299. This consultation includes:

• A physician review of your medical history and current conditions
• A virtual video meeting with the physician
• Review of your comprehensive lab work and physical (performed locally)
• Discussion about testosterone, including benefits, drawbacks, and whether you’re a good candidate for the therapy
• A personalized testosterone replacement regimen

Should you qualify as a good candidate and move forward with testosterone replacement therapy, the cost of the program is $350 per month, which includes:

• All testosterone therapy medications
• All necessary supplies
• Delivery of medication and supplies
• Comprehensive lab work every 3 months (or sooner, per physician discretion)
• Virtual video meeting with your REGENX Health physician every three months
• Estrogen management
• HCG management (if needed)

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What do I need to know before starting testosterone therapy?

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Before undergoing testosterone therapy, your physician should make sure you’re aware of the following information:

• Low testosterone is a risk factor for cardiovascular disease.
• Testosterone therapy may result in improvements in erectile function, low sex drive, anemia, bone mineral density, lean body mass, and depressive symptoms.
• Evidence is inconclusive on whether testosterone therapy improves cognitive functions, diabetic control, fatigue, lipid parameters, and quality of life measures.
• The longterm use of testosterone therapy can impact spermatogenesis (sperm production).
• No current evidence links testosterone therapy to the development of prostate cancer.
• A man with testosterone deficiency and a history of prostate cancer should know there is a lack of quality evidence to quantify the riskbenefit ratio of receiving testosterone.
• No definitive evidence links testosterone therapy to a higher incidence of VTE (venothrombolic events).
• At this time, it is uncertain whether testosterone therapy increases or decreases the risk of cardiovascular events, such as myocardial infarction, stroke, cardiovascularrelated death, or all-cause mortality.
• Positive lifestyle changes are an effective treatment strategy to raise testosterone levels. Reducing stress, eating healthy, losing weight, and getting adequate quality sleep can significantly improve a man’s testosterone levels naturally.

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How should I take testosterone?

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Take testosterone exactly as prescribed by your physician or healthcare professional. Never share testosterone with others, even if their symptoms are similar, as it may cause serious harm.

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How do I inject testosterone safely?

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See REGENX Health testosterone injection page.

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What is the best way to store testosterone?

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Keep testosterone at room temperature, between 59°F and 85°F (15-30°C). Always store testosterone and all medications out of reach from children.

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