Best outcomes require best practices.

It is so important to have regular 6 month follow up visits including blood work with the doctor managing your low Testosterone level.  The most common abnormality noted in the blood work of men on TRT (testosterone replacement therapy) is increased red blood cell count, also monitored by the correlating levels of Hemoglobin (Hgb) or Hematocrit (HCT).  I prefer to follow the HCT, which should not exceed 52 %, as compared with a normal adult male average of 45 %.  When the HCT exceeds 52 %, this condition is called polycythemia.  This situation is often called by the lay term “thick blood” and can be associated with increased risk of stroke or heart attack if these levels persist on a long term basis.

When TRT related polycythemia occurs, it is treated very simply by having the client donate blood or have a medical phlebotomy (blood removal) on a regular basis.  This type of responsible behavior on the part of the patient and his physician will reduce risk of stroke and heart attack to their normal levels.

Other important items followed include kidney and liver function.  Although I have not found either kidney or liver function to decline as a direct result of TRT, it is customary to follow these items if for no other reason than it is good for general health follow up.  Also, it is important to follow the prostate specific antigen (PSA) level screening for prostate cancer in all TRT patients on a yearly basis.

Although Testosterone therapy does not cause prostate cancer, if a man has a tiny focus of prostate cancer prior to therapy, the TRT may cause it to grow faster.  If this is followed yearly, any significant upward trend in PSA levels over time could indicate progression of an existing prostate cancer, in which case a prostate biopsy for diagnosis is indicated.  If prostate cancer is diagnosed, the likely assumption is that we will be finding it more early and at a more curable status than if the client had not been on such a careful follow up protocol.

Last, but not least, simply following the Testosterone and Estradiol levels at 6 month intervals will keep the Low T patient at optimum levels.  Coordinating visits with review of the lab results will allow the experienced doctor to adjust medication doses properly as the rate of Testosterone and Estradiol metabolism can change in an unpredictable way over time in any man.  Should you notice weight gain, joint pain, breast pain or decreased energy between 6 month visits, don’t hesitate to contact your doctor for earlier testing and follow up.

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