STEP 8. If natural methods and restarts have not worked, how can your doctor help your raise your testosterone?
The previous couple of steps have helped you look at natural ways to get your testosterone back. One step even threw out the possibility that you could restart your testosterone, i.e. that it needed a "reboot." But, much more often than not from what I have seen, these methods simply do not work. For example, I tried everything under the sun in my pre-HRT days and nothing budged my testosterone. However, I am almost positive that I have had low testosterone since puberty.
So, if you fall into that category, and you just cannot increase your testosterone by any other rmeans, then you really have just a few ways you can go:
Let's go over some of the major points with each of these to, hopefully, get you up to speed where you can discuss the subject intelligently with a knowledgeable physician:
1. Do Nothing and Live with Low Testosterone. I see quite a few men go this route on the Peak Testosterone Forum. Often these men are either afraid of HRT (TRT) or they are doing research to better understand their options. And this makes complete sense, unless you happen to one of the men with actual medical issues stemming from the low testosterone, i.e. Anemia from Low Testosterone or Bone Loss from Low Testosterone. In that case, you need to discuss with your physician asap how to proceed.
2. Clomid. Clomid is a pill given to both men and women for fertility reasons. In men, Clomid can improve fertility and raise testosterone, although not for all guys. It does, however, often have side effects and more often than not does nothing for libido or even lowers it. It is incredibly convenient of course. For more information, read my page on Clomid and Testosterone.
3. HCG Monotherapy. HCG is a Luteininzing Hormone mimic that will directly stimulate your testes to produce more testosterone. Many men wishing to preserve fertility and keep "the boys" in working order use this option. For reasons that are not completely understood, this option generally does not make men feel as good as they would through standard HRT (TRT) from what I have seen. One of the reasons is that it seems to disproportionately raise estradiol levels. However, even if men use Arimidex to lower estradiol, men using HRT Monotherapy still do not have the increases in libido, energy and mood that men on HRT typically get. Nevertheless, it is a popular option as you can see on this Peak Testosterone Forum Poll. You can read more about on the page: HCG Monotherapy.
4. Arimidex (or Aromatase Inhibitor) Monotherapy. This is rarely used and rarely successful from what I have seen, but some men take Armidex to boost their testosterone. It has certain risks and rewards, For example, it is very convenient as Arimidex (anastrozole) is cheap and available. However, if your estradiol is low already, this could be risky (and potentially result in bone loss). In addition, Arimidex is known for interfering negatively with the clotting cascade.
5. Standard HRT (TRT). The most common solution to hypogonadism is exogenous testosterone, i.e. testosterone applied to the body. HRT has been a miracle-worker for me and many other men on Peak Testosterone Forum. However, it is not always that way and some men even have negative reactions, side effects and so on. I will discuss some of these issues in ensuing steps. Here I wish to cover some of the basic delivery systems:
a) Gels / Topicals / Transdermals. Androgel, which comes in packets or bottles that you pump in a metered dose and rub into your chest and upper body. Generally, you'll receive a box of two bottles which, depending on if you are receiving four, six or eight pumps/day, can last up to a couple of weeks. Testim, another patented gel, followed shortly thereafter. These are very convenient and provide a nice metered dose with few highs or lows. The primary issue is that some guys simply can't get enough testosterone from these gels for whatever reason, i.e. it is poorly absorbed topically. After a while, you just "shellac" or "wax" any more into your system. Some doctors will try to get around this poor absorption with Testim, a much more expensive form of HRT. However, as far as I know, no study shows that Testim is more absorbable, so this is of debatable value.
NOTE: If you are having trouble with Androgel or Testim, you may want to consider a Compounding Pharmacy, which can often deliver the testosterone at a higher does and lower cost.
b) Injections (Cypionate and Enanthate). Testosterone cypionate and enanthate are two esters of testosterone that are commonly injected on a once every two or three week basis. Traditionally, this is done intramuscularly (IM) but the new and very popular kid on the block is subQ (subcutaneous) injections. SubQ is how I am currently doing my cypionate injections and I have had excellent results with this.
c) Scrotal Patches. These are easy to use but tend to result in higher DHT levels than other delivery methods. In addition, almost everyone that uses them gets some sort of skin irritation, rash, etc. and has to discontinue usage.
d) Longer Term Solutions. Some men do not want to mess with daily transdermals or even weekly injections due to concerns about travel, convenience, etc. For these men, protocols that occur every 6 weeks to 3 months include Pellets or testosterone undecanoate. The former are small "capsules" inserted just below the skin by a urologist and the latter a longer-lasting (but high volume) injection.
For more information about all of these HRT options, I have fairly detailed pages here on the basics, all of which should help in any discussions you have with your physician: HRT Information and Deliver Systems.