Frequently asked questions
Emphatically yes!
Our patients meet with Dr. Abdullah, who analyzes lab results and adjusts the treatment plan accordingly. He is a licensed Physician who has an MD degree and an MPH/Master's degree in public health. Please find out more about Dr. A here.
When it comes to your hormones, you would want a physician to do the assessment and plan. Physicians go through a minimum of 7 years of schooling and countless clinical hours. They are the most knowledgeable members of the healthcare team when it comes to how the human body functions in terms of health and disease.
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Yes.
Men/Women's Bioidentical Hormone Replacement Therapy (BHRT), Testicular Atrophy, and Erectile Dysfunction (ED).
Weight Management/Medical Weight Loss: We use Injectables and Orals, as well as novel GLP1 injectables such as Semaglutide (Wegovy ®/Ozempic ®), Trulicity®, Mounjaro®, and others within the same class.
We know the numerous online subscription programs presenting themselves as "men's health" or "TRT." They're everywhere on Instagram (IG).
Truthfully, the best way to describe them is faceless, high-price, low-value, low-dose, nurse-managed Testosterone IG mills. The service is ineffective, and patient turnover is high, ensuring quick short-term profit. They are not expecting or interested in long-term relationships with their patients.
So, what sets us apart?
A real Doctor who is genuinely knowledgeable and passionate about hormonal and metabolic health will evaluate you and your blood work, which means better and safer results.
We are a comprehensive Andrology clinic. We don't just prescribe Testosterone; we prescribe all the other agents required for an effective and safe Testosterone Replacement Therapy (TRT) program. The IG mills don't
We manage the side effects. The IG mills don't.
We manage ED and Testicular atrophy. The IG mills don't.
We personalize the dosing so you see results. The IG mills don't because they need a low-dose-fits-all approach as they are large volume-based businesses that need to reduce liability and maximize profits.
Our physician evaluates you every time! The mills will have a physician as a medical director. Still, a nurse or physician assistant will be assessing you without meaningful supervision by a qualified physician, even if they tell you otherwise. The physician/medical director usually knows nothing about hormone replacement therapy. The IG mills pay a remote physician a monthly fee to borrow the medical license.
We question the accuracy of novel home-based hormonal testing; many virtual mills employ these novel testing methods. Sure, there is the convenience factor, which is extremely important for today's busy man. Still, lab result accuracy is vital to an effective and safe hormone replacement program, especially given that home-based testing is variable in terms of quality control and reliability depending on proper sample collection by the patient.
We don't sell snake oil, such as NAD and peptides. The IG mills do! They sell you peptides like Ipamorelin and CJC, promising to increase your natural Growth Hormone production, which is false. These "peptides" are fake and don't work even if they are real; their source is undisclosed, and the practitioners and medical directors themselves would never be on them. But they still sell them at a high price to people.
All the hormones we prescribe are manufactured by CGMP-compliant facilities. Very often, one cannot verify the source of the meds the IG mills prescribe as they brand them or give you an prefilled syringe. Do you know what's in the syringe?
For convenience, you can use our mobile phlebotomy service, get your blood drawn at home or the workplace, and then review lab results with Dr. Abdullah via telephone.
When you consider the details of what we offer and our prices, it becomes evident that ours is a value proposition.
Just because someone looks great on social media and has 10 million followers, it does not mean they are telling you the truth about what they’re on and how high their dose is.
You cannot ascertain that they are on the same stuff that they are stirring you to. Also, if they are hugely muscular and look like the Incredible Hulk, you can rest assured that they are on large doses of Human Growth Hormone (HGH), but they won’t tell you that.
They’re not going to give you their secret sauce recipe, and they won’t stir you to their HGH dealer because there’s a tiny amount of black market HGH to go around.
On that note, please don’t buy HGH—or HCG, for that matter--from the black market or Mexico. It’s all fake!
Indeed, finding a dealer through your friend, personal trainer, or some bodybuilder on social media is relatively easy. But....
You need to know what you are getting. How do you know if the “Deca” is Nandrolone? How do you know if the “Test” you are getting is Testosterone? And how will you find a way to test them for purity? Very often, when we draw labs on patients who admit that they procured their anabolic steroids from the black market, stacking upwards of 800 mg weekly and up, we find lab results consistent with someone who is not on an anabolic or a minimal dose, despite reporting injecting large amounts of whatever they procured.
Pharmaceutical-grade Testosterone is safe, effective, and affordable. So why spend money on substances of questionable quality, purity, sterility, and concentration? You end up paying more and getting less.
We prescribe either Testosterone or Nandrolone. They are both bioidentical because they are the same hormones your body makes; this guarantees safety.
Trenbolone and Boldenone/Equipoise are popular because they are more anabolic than Testosterone. Still, they are not bioidentical and intended for animals to get them big for sport (horses) or slaughter (cattle). Their cardiac safety profile remains unknown.
Trenbolone is more anabolic than Testosterone, but it has unique effects on the brain that may be permanent even after you stop using it. These effects are low libido, sexual dysfunction, drug-resistant ED, and personality changes that can affect your relationships. Is it worth it?
Boldenone increases blood thickness and the likelihood of chronic kidney disease more than any anabolic steroid. It also causes permanent intestinal damage in some men. And it's not even more anabolic than Testosterone, so why bother with it?
The same applies to dose strength; dosing anabolic steroids beyond a particular weekly amount confers no additional anabolic gains, as the muscle will have reached its genetically determined anabolic potential. Higher amounts would only increase the adverse effects, such as heart muscle remodeling and possibly heart failure. They will convince you that you need to "stack" more. Please don't believe it! You'll get more veins, more acne, more mood swings, accelerated skin aging, and, most importantly, a higher probability of developing ventricular fibrillation or a blood clot before you turn 65. Is it worth it?
I don't judge men who decide to live life on the fast lane. Man has a right to self-determination and to choose a certain quality of life. But it must be understood that when you decide to use large doses of veterinary steroids, you are indeed choosing that life.
In terms of oral anabolic steroids such as Anavar (Oxandrolone) or Winstrol (stanozolol), these come in small doses and have short half-lives and hence must be dosed frequently throughout the day. They are suitable for certain women because they require much less Testosterone than men. They are also excellent for people on chemotherapy for cancer to help them with their appetite and to counterbalance the catabolic state they're in from both the cancer and the chemo; in these scenarios, they are used short-term. Their long-term safety has not been evaluated.
If men take them for HRT purposes, they'll take larger doses that are toxic to the liver; more importantly, why take an oral anabolic when you are already on an injectable? If the injectable amount is insufficient, we will safely increase the dose; remember, more anabolism means more heart remodeling and not necessarily a more admirable body!
Please understand that all anabolic agents are actual “steroids,” including the ones made by your testicles, such as Testosterone.
Testosterone is safe if it’s dosed appropriately and monitored by a qualified physician.
The stories you hear about “roid rage” and massive heart attacks among young men involve the use of extremely high doses, and usually veterinary steroids such as Trenbolone and Equipoise. These anabolic steroids are artificial and marketed for the sole purpose of maximizing the animal’s growth and strength with disregard for the animal’s lifespan.
HCG is not an essential component of HRT unless a man on HRT is trying to conceive. Many HRT patients get on it to preserve testicular volume for cosmetic purposes. It does work for that purpose, but one needs authentic, unexpired, and adequate strength and frequency, as determined by a qualified physician.
As of June 2021, the US government began reinforcing the March 2020 rule that HCG is a biological medication, and as such, a pharmacy cannot compound it and hence must be originating from the brand name manufacturer via an electronic controlled substance prescription from a qualified physician, and the medication must be either picked up in person from the pharmacy or shipped from the pharmacy to the patient’s home.
Currently, the commercially available brand is Pregnyl®. Any HCG you get from a dealer, Mexico, virtual or high volume TRT mill, or an “HCG Diet” clinic is fake. Some clinics might have residual inventory from bulk HCG obtained from compounding pharmacies before June 2021, but rest assured that it’s expired and not worth your money.
We know the numerous online subscription programs functioning as "men's health" or "ED" mills.
Please note:
These services often underdose and overcharge to reduce liability and maximize profits.
They use lower-quality generics to maximize profits.
You need to find out if the medication has expired.
Due to quality issues and ensuring that medications are not expired, we reserve the right to determine the pharmacy we associate with; we also dispense these medications at the office in the manufacturer's original bottle with the original insert and the expiration date. We include the manufacturer's original insert because it contains all the instructions for proper use for your convenience and safety.
What's the "insert"?
It is a physical paper pamphlet with a complete description of the medication, its use, side effects, and drug-drug interactions. It ensures that you get the maximum effect of the drug while minimizing risk. We can make that available to you when we dispense the medication at the office. If you purchase the medicine through our website, please go through the description section to get all the relevant information included in the original insert.
Let’s set up a consultation!
I hope to persuade you that we may get the same results with lower doses but higher quality pharmaceutical-grade bioidentical hormones.
Even if I cannot persuade you to join our vitality program, we can aim for maximal harm reduction. I know you’re getting your labs checked on your own, and you’re getting your blood dumped every few months, and your blood pressure is good. However, there are other adverse effects to monitor and affordable harm reduction tools at our disposal, such as a cardiac echocardiogram and the molecular age-reversal drug Rapamycin.
Acne is a side effect of anabolic steroids such as Testosterone.
However, it occurs with higher doses, and it is almost always mild and treatable with moisturizers, antibiotic lotions, and sometimes oral antibiotics such as minocycline.
The severe cases of acne you see on the face and back of some guys are because of veterinary steroids such as “Tren.”
Testosterone DOES NOT CAUSE new prostate cancer. If it did, we would see lots of it among young men, as they have high levels of Testosterone.
Testosterone, however, aggravates pre-existing/undiagnosed prostate cancer, which is why we screen everyone with a PSA before initiating HRT and we screen frequently during HRT.
Prostate cancer is the most common cancer in men, and its incidence increases with age. Luckily, we screen for it frequently, and it’s one of the slowest-growing tumors in the world.
Also of note, HRT is safe in men who have had their prostate removed from a prior diagnosis of prostate cancer.
Let us be clear: We have not had a single patient or heard of anyone complaining of getting “too big.”
On the contrary, guys are always trying to lose fat and gain lean mass. Getting “too big” requires years of impeccable diet and exercise discipline, as well as large doses of anabolic steroids. I assure you that that will be the least of your concerns.
In terms of testicular atrophy, 90% of men on HRT--regardless of dose--will experience testicular shrinkage; most of the time, it’s about 20% of the pre-HRT testicular volume.
But yes, sometimes it’s as much as 50%.
It is a subjective and cosmetic issue, not a medical issue--unless you are trying to conceive.
Still, if it becomes a source of mental distress or discomfort during erections, or if you are trying to conceive, we could prevent or reverse testicular atrophy with Human Chorionic Gonadotropin (HCG) therapy. Often, men don’t believe in HCG, but that’s because it was not dosed appropriately by their former prescriber, or it was fake or expired.
It’s not about your chronological age!
So, what if you are 60 or 80 years old? Does that mean hormones don’t work on you?
Does that mean you cannot be coached?
Does that mean you should not seek a better quality of life? Does that mean you should be frail?
Some men start TRT at 80 years old. Some men are 100 years old and still on 100 mg of Testosterone Cypionate weekly.
Dr. Abdullah does not recommend hormone pellets for the following reasons:
If your PSA comes back high and we need to rule out prostate cancer, we want you off Testosterone ASAP, which is easier if you are on an injectable or topical. If you're on pellets, will we wait a few more months until the pellet is metabolized? Are you going to find an available appointment ASAP to get the pellets out, and how will they find them if you've had them for a few months and they're buried somewhere in your subcutaneous fat?
Pellets generally do not deliver a dose effective enough to experience desirable results, so you're paying lots of money for very little Testosterone.
Changing dose is more complicated with pellets, and you have to wait months before you do so; with injectable TRT, men become proficient at self-dosing with time and can quickly change dosing by consulting with their physician by phone, text, or email. You cannot do that with pellets. Ironically, many men on pellets end up having to supplement with oral or injectable Testosterone, which increases their costs and defeats the whole convenience purpose of pellets.
Extrusion: The pellet spontaneously exits from the implantation site, which happens in about 10% of cases; remember that this is painful, and you would have to get another procedure and reinsert pellets and pay more money. It will also increase the likelihood of cosmetic deformity and scarring in the area.
You NEVER want a "set it and forget it" kind of situation with hormones!
As far as self-injecting, we will coach you until you become comfortable with it. I have never had a patient who agreed to train and did not become proficient at self-injecting. Give us a chance, and we will teach you well.
Testosterone, as well as all anabolic steroids, exert an effect on the brain. They cause a feeling of vigor, masculinity, confidence, Joi de vivre, libido, and youthfulness.
But there are two situations when anabolic steroids, including Testosterone, may cause "roid rage," extreme irritability, extreme mood swings, and, you know….make you act very douchy!
You have classic bipolar type 1 or schizophrenia, and you did not inform your doctor that you have these conditions or that you are on mood stabilizers such as lithium.
You are using constantly high doses of an anabolic steroid.
I do not prescribe Testosterone to patients with certain psychiatric conditions or on certain psychiatric drugs.
I also do not prescribe large doses of anabolic steroids, and I hope I can convince you that you don't need these large doses.
Yes, and it’s worth it and then some!
Just ask the men on it if you don’t believe me.
Please go ahead and read my section on anabolic steroids and the heart.
Fake news!
You will often see the word "boost" or "booster" on these products. These are all marketing terms, and there is no such thing as a "boost" or "booster" in medicine.
None of these supplements work. NONE! But they do give you IBS, and they probably have carcinogens in them since they are not regulated by the FDA the way pharmaceutical drugs are.
It's all false advertising. If your testicles are making less Testosterone, then the only way to replace that is by taking exogenous Testosterone.
Fake news!
Of course, you can stop. It's not meth or heroin. Generally, guys don't stop because it makes them healthier, sexier, and happier, not because they can't.
Now, if a man wants to stop Testosterone if he wishes to conceive or for another reason, then all he needs to do is discuss a quit date with the physician and get on HCG so that there is ample time for pre-HRT testicular function to return by the designated quit date.
The interest in Gonadorelin stems from the desire to reverse TRT-related testicular atrophy, especially since HCG has become a brand medicine, which tripled its price, causing rationing, underdosing, and less satisfactory results.
However, Gonadorelin is currently not available in the US. It requires a special pump apparatus to be administered in a pulsatile fashion. It's also costlier and less effective than HCG. Therefore, we believe that "Gonadorelin" prescribed/sold at so-called "anti-aging" and "men's health" clinics is not authentic and ineffective. If you are getting care through a clinic that prescribes it, you can verify the authenticity by measuring LH levels before and after taking the Gonadorelin. You will then discover for yourself that it is fake.
But what if you traveled to another country and got yourself real Gonadorelin?
Well it wont work either!
Gonadorelin works by stimulating the pituitary gland to release a hormone called LH, which then makes your testicles bigger. However, this effect is offset by the presence of Testosterone and Estradiol in your brain, both of which coming from your Testosterone injections. So in a man who is not taking Testosterone, Gonadorelin may increase the volume of the testicle. But if you are taking Testosterone, then Gonadorelin won't work even if you procured an authentic Gonadorelin product.
We hope the FDA will reverse its decision regarding HCG so that it becomes an affordable generic medicine as it used to be.
Until then, we are prescribing Pregnyl (brand HCG).
Assuming that recreational drugs and prescribed psychiatric medications are not involved, there are three reasons behind erectile dysfunction (ED) in a man with adequate libido and who is on high doses of anabolic steroids.
Non-bioidentical anabolic steroid use: The direct effect of these hormones on the penile erectile tissue is unknown.
High estrogen levels: Estrogen in a man is poorly studied and has a complex interaction with both Testosterone and Testosterone-responsive tissues, such as the corpora cavernosa of the penis. High levels cause erectile dysfunction, but there is evidence that low levels may also cause it. Therefore, estrogen must be regularly monitored and stabilized by adjusting the aromatase inhibitor dose.
Nandrolone (AKA "Deca"): The exact association between nandrolone and ED is poorly understood. It may cause changes in the lining of the blood vessels of the penis, which can reduce blood flow, causing ED. Nandrolone may also bind penile alpha estrogen receptors, which can also cause ED. If Nandrolone is used alone without Testosterone, estrogen levels may fall below physiologic levels, which may lead to reduced libido, which then contributes to ED.
Endogenous Testosterone production begins to decline at the age of 35. Indeed, we see men in their 20s with low Testosterone levels. Brain tumors, Brain trauma, Diabetes, HIV, Obesity, using anabolic steroids at a very young age, and HIV drugs all cause low Testosterone, either by affecting the pituitary gland or the testicle itself. Even intense psychological trauma can cause testicular failure.
We don't sell snake oil, such as "peptides," NAD, and Glutathione.
Peptides like Ipamorelin, Sermorelin, CJC, and all the others promise to increase your "natural" Growth Hormone production or accelerate recovery from sport-related injury, which is utterly false and unproven.
If these "peptides" are effective, why aren't pharmaceutical companies making and selling them? Why can't you get a legitimate, reputable physician to prescribe them?
If they are genuine and legitimate, why can't you tell who the manufacturer is? Grab your Ipamorelin bottle and look for the name of the manufacturer. I bet you won't find it. You may find the name of a dispensing pharmacy. But you won't find the manufacturer.
Peptides and proteins must be refrigerated to remain stable, so how are these "anti-aging" clinics storing them at room temperature? Why are legitimate peptides like Ozempic, HGH, and Human Chorionic Gonadotropins stored and shipped in cold boxes, yet the "anti-aging" peptides you get from the local clinic are at room temperature?!
Why are the nurse practitioners, physician assistants, and medical directors of these "clinics" themselves NOT on the peptides they are selling you? If they are that good and safe, should they not be on them as well?! Aren't they practicing what they're preaching?!
Go ahead and request a meeting with the medical director. These "anti-aging" clinics tell you the medical director is available upon request. I bet you won't be able to meet them, and if you do, you will know within 5 minutes of the conversation that the peptides are indeed fake.
ANY "clinic" selling these peptides is not only engaging in false advertising, fraud, and click baiting but also blatantly committing harm by injecting into your body substances of unknown origin or efficacy. This should also call into question the legitimacy of all their other services. Please remember that false advertising is reportable to the state medical board.
Tesamorelin (Growth hormone-releasing hormone) is often marketed as a "peptide ."But it is a patented protein that is available commercially as EGRIFTA SV®, which costs even more than Human Growth Hormone, so obviously, ANY "clinic" mentioning it on their website or social media account is not only engaging in false advertising. They do not have real Tesamorelin. Ask to speak to the "medical director" about the source of the Tesamorelin.
Unlike Ipamorelin, Sermorelin is the generic name of a legitimate peptide drug called "Geref®" that was manufactured by EMD Serono, which is a world-class pharmaceutical company; clinical trials back then showed that Sermorelin/Geref® increases IGF levels--which is also how Human Growth Hormone (HGH) works. However, the manufacturer took it off the market within two years, citing higher costs of production and the inability of the drug to compete with HGH; this makes sense since the original manufacturer's recommended dose of Sermorelin was 2 mg nightly, whereas the dose of HGH is usually around 0.5 mg for the same effect! Now ask yourself, how is a world-class pharmaceutical company (EMD Serono) no longer producing a drug due to high costs and lower efficacy than HGH? Yet, you can purchase it from some random "anti-aging" clinic nearby?! Also, if the original manufacturer (EMD Serono) dosed the drug at 2 mg nightly, how are the "anti-aging" clinics dosing it at 0.25-0.5 mg nightly?! So not only is the drug fake but so is the dosing!
To get muscular, you need to work out like a spartan, eat like a Viking, and sleep like a king, but yeah, you also need to be on Testosterone, so they’re lying to you.
And if they tell you the truth, don’t ask them about their dose because they will lie.
Remember, society is still ignorant and judgmental about anabolic steroids, and the government considers the elective use of anabolic steroids to be illegal. They’re getting their steroids from the black market. For all these reasons, men generally lie about their use of steroids and about the amount they are using.
If you have the symptoms, your levels are low, and you don’t have a contraindication, then yes.
If your levels are optimal, you have no symptoms, and you want to use super high doses to get super jacked. You may permanently disrupt your Hypothalamic-Hypophysial-Gonadal axis and develop permanent testicular shrinkage and permanent reliance on exogenous Testosterone.
Most importantly, when guys start high doses of anabolic steroids that young, the heart will suffer from more cumulative severe damage at the genetic level, which could lead to early death. Remember, you want to look good, feel good, and live long, not die young.
Human Growth Hormone (HGH) Therapy:
Growth Hormone Therapy benefits a subset of patients when prescribed and clinically and biochemically monitored by a qualified physician. The FDA has approved certain brands of recombinant Human Growth Hormone for treating Adult Growth Hormone Deficiency, which is diagnosed by clinical and laboratory findings.
Important to note: Even with a diagnosis of Adult growth hormone deficiency that is verified both clinically and biochemically through a blood test, we do not prescribe HGH without achieving the full potential of anabolic steroids/Testosterone.
"Peptides" such as Ipamorelin, Sermorelin, and CJC are being peddled as a cheaper, safer alternative to HGH. These are blatant lies. Peptides are not effective at mimicking either GHRH or HGH. Save your money, and don't fall for that Cool Aid!
HGH therapy (when indicated) has an added cost to the price of the visit ($100) and the labs ($100)--in addition to the cost of the medication itself ($500 and up/mo).
Although we understand the appeal of "set it and forget it," we vehemently recommend AGAINST hormonal pellets for men or women for two main reasons.
On pellets, you will be underdosed for the last 1.5 to 2 months before they insert new ones. Besides, hormone replacement therapy (HRT) is never a "set it and forget" treatment plan. With time, our bodies change, our needs change, and our hormone receptor density changes. Therefore, it is imperative to use HRT routes that permit timely dose adjustment, which is not possible with pellets. On pellets, people seem to be either underdosed or overdosed.
Equally important, the incidence of prostate cancer is high in men, and it increases with age, regardless of hormonal status. Testosterone does not cause prostate cancer. We don't know the cause of prostate cancer. However, should prostate cancer be diagnosed while a man is on HRT, we have to be able to stop HRT as soon as possible; so if you have pellets, how are they going to locate each one of these pellets and remove them timely?
Enclomiphene is an oral medication that works with the brain; it is considered a selective estrogen receptor modulator (SERM). In the context of its novel repurposing as a TRT alternative, it tells the brain to stimulate the testicle. The brain stimulates the testicle to work harder, and when the testicle works harder, it makes more Testosterone. Enclomiphene may increase total Testosterone levels by 200-800 ng/dl, depending on the dose, age, and baseline gonadal status. In many men, this increase is satisfactory. Since Enclomiphene does not cause the same peak plasma Testosterone elevations as injectable Testosterone, it is less likely to cause erythrocytosis that is high enough to merit regular phlebotomy. Counter to popular belief, estrogen still needs to be monitored and controlled during Enclomiphene therapy. Still, it's easy to understand the appeal of Enclomiphene when compared to exogenous Testosterone. It's a pill, so it's easy to take; it's generic, so it's affordable; it's less likely to require therapeutic phlebotomy; and perhaps most importantly, it does not shrink the testicle the way exogenous Testosterone does, which is by far the most undesirable effect of TRT.
Whatever happened to the old adage, "If it's too good to be true, then it's too good to be true?"
Enclomiphene reduces IGF levels! IGF is the messenger protein of Human Growth Hormone (HGH); therefore, IGF plasma level should be considered a surrogate for HGH activity for practical purposes. HGH is AKA the "fountain of youth" for good reasons: It maintains and builds bone, muscle, and skin. It is also the most potent hormone for burning mid-section fat. Optimizing IGF levels is associated with remarkable metabolic and cosmetic benefits and a 5-10-year reversal of skin aging. This is not an implication that people should go on HGH to improve their skin. However, it is beneficial to avoid factors that decrease IGF levels; decreasing IGF levels also counters the desirable anabolic effects of Testosterone, as these effects are partly IGF-mediated. The degree to which it reduces IGF is still being determined because, so far, the research was done on men with basal IGF levels under 100 ng/ml; most men start HRT in their 30s, and their IGF is usually over 150 ng/ml. This effect does not appear to be dose-dependent. We measure IGF levels before and after starting Enclomiphene.
Also, as a SERM, Enclomiphene is an estrogen antagonist in the bone, which means that long-term use reduces bone mineral density, which is unacceptable.
So what's the verdict? Take it or leave it?
The short-term use of Enclomiphene is relatively safe and effective at partially reversing androgen-induced testicular atrophy.
Its long-term use for the treatment of hypogonadism "low T" also appears to be a relatively safe and effective option. However, the risks of reducing bone mineral density coupled with a reduction in growth hormone outweigh the benefits, and this must be explained to the patient before considering is as an alternative for TRT.
Yes, we understand that in some cases, we may recommend therapeutic phlebotomy at a particular frequency. Dr. Abdullah will help and direct you through the proper channels.
The upper limit of prolactin for men is 20 ng/ml.
The upper limit of prolactin for women is 30 ng/ml.
The concern of elevated prolactin is that it may be from a benign tumor in the brain that is overproducing prolactin and exerting pressure injury to nearby structures of the brain. Additionally, prolactin levels at a certain point may reduce the endogenous production of sex hormones or cause gynecomastia and nipple discharge. A large tumor, even if benign, may cause headaches and visual disturbances, at which point we'd refer for surgical removal of the tumor.
If the tumor is large, prolactin levels are usually over 200 ng/ml. If the tumor is small, levels are below 200 ng/ml. Small tumors are treated medically and monitored by serial prolactin measurements. Most of them don't change over time or regress.
It's quite rare to detect symptoms and signs of hypogonadism or chest symptoms, such as nipple discharge when prolactin levels are under 50 ng/ml.
However, the vast majority of the time, prolactin elevation is not from a tumor. It's idiopathic, which means that the cause is unknown, and it's clinically insignificant and does not warrant any treatment; idiopathic hyperprolactinemia may increase levels up to 100 ng/ml. Alternatively, it's from an identifiable cause, such as elevated estradiol levels, stress, and certain psychoactive medications.
For instance, in both men and women, supraphsiologic levels of estradiol may increase prolactin. We see that in women who are pregnant with circulating estradiol levels in the 100s or 1000 pg/ml. We see it in men who are on TRT but not controlling their estradiol levels. We also see it in transwomen.
Also, remember that stress alone—due to increased cortisol (stress hormone) production—may increase prolactin by 20 ng/ml on top of normal levels. It's not uncommon to see levels in the 40s ng/ml in patients undergoing a stressful period in their lives. Nipple stimulation also increases prolactin.
Moreover, commonly prescribed psychiatric medications such as Prozac and Lexapro can very well increase prolactin to up to 100 ng/ml at the usual dose of these medications. That's why I always try to guide my patients through a "weaning" process to get off of these psychiatric medications. Antipsychotics like risperidone may increase levels to 300 ng/ml.
Our lab panel includes prolactin, so rest assured that we would not miss a tumor.
Please don't.
Ashwagandha is one of the newer scams on social media. This stuff grows in parts of India, Africa, and the Middle East; men in these regions are not necessarily in optimal health. I would take any "Eastern" medicine or herb with a generous helping of salt. This plant supposedly increases testosterone levels and reduces stress. Well, it does neither. But it does affect the metabolism and hence therapeutic efficacy of legitimate drugs that your doctor is prescribing to you, so it's harmful.
Please remember that over-the-counter supplements are not harmless. They are unregulated, and the manufacturer does not need to prove efficacy, quality control, or long-term safety. The rate of colon cancer among Americans under the age of 50 has doubled since the late 1990s. These supplements also contain irritants that can affect your intestine's ability to absorb nutrients and cause irritable bowel syndrome. We recommend against ingesting supplements unless they are specifically recommended by a doctor, for a specific reason, and monitored by laboratory methods.
Tongkat Ali--AKA Longjack--is a plant root extract used in Eastern medicine, specifically in Malaysia.
Only a little research has been done on humans; the long-term effects are unknown. Still, from the few human trials, this root extract has been identified as a peptide of 32 amino acids that improves sexual function, decreases stress, increases free testosterone, and decreases cortisol (the primary stress hormone); the mechanism by which it does this remains unknown.
The required daily dose of the extract is 200-400 mg.
But here is why you should not purchase Tongkat Ali. A patent has been issued jointly to the Government of Malaysia and the Massachusetts Institute of Technology for extracting the peptide from the plant's root; all the research on humans and animals showing positive effects is done on Tongkat that is extracted via that patented method. This means that the grand majority—if not all—of the products on the market are fake. The plant does not grow in many regions, and it's impossible to ascertain the source of the plants used in the supplements. The active ingredient is a peptide, so it's impossible to guarantee effectiveness if it is not stored in a sterile vial. The exact ingredients and their quantity in the marketed supplements are unknown. Sometimes, they include ground-up generic Viagra and Cialis in these supplements; you're better off getting generic Viagra or Cialis if that's what you want.
Please remember that over-the-counter supplements are not harmless. They are unregulated, and the manufacturer does not need to prove efficacy, quality control, or long-term safety. The rate of colon cancer among Americans under the age of 50 has doubled since the late 1990s. These supplements also contain irritants that can affect your intestine's ability to absorb nutrients and cause irritable bowel syndrome. We recommend against ingesting supplements unless they are specifically recommended by a doctor, for a specific reason, and monitored by validated laboratory methods.
A tiny minority of men on TRT do not experience an increase in Estrogen levels, but most of them do.
Most men think of adverse effects related to elevated Estrogen in the context of gynecomastia and nipple sensitivity, but these are the least significant and take a long time to develop; supraphysiologic Estrogen levels in men have more common and more detrimental effects.
Examine the list below:
Estrogen is the female sex hormone; too much of it counters the benefits of the male sex hormone, Testosterone. So why diminish the effect of your Testosterone?
Estrogen increases insulin resistance, increasing the risk of diabetes and weight gain.
Estrogen increases Triglycerides, which is a type of fat that increases your risk of a heart attack.
Estrogen causes water retention, making a man's face more round and puffy. The extra water can also raise blood pressure.
Estrogen at certain levels may increase the risk of blood clots because it causes the liver to produce many clotting proteins.
Estrogen at certain levels also causes depression, erectile dysfunction (ED), and low libido.
Estrogen amplifies Testosterone's testicular shrinkage effect.
Estrogen decreases IGF, decreasing the benefits of endogenous and exogenous Human Growth hormone.
That does not mean we should get rid of Estrogen in a man.
In the 80s, men on Testosterone were taking aromatase inhibitors--pills that reduce the conversion of Testosterone to Estradiol, controlling the Estrogen levels in the blood--daily, and they started getting heart attacks.
Low Estrogen in a man causes:
Blood clots! Yes, both low and high Estrogen are associated with clots.
Erectile dysfunction (ED)! Yes, both low and high Estrogen are associated with ED.
Low libido! Yes, both low and high Estrogen are associated with ED.
Joint pain.
When a man is on hormone replacement therapy, Estrogen levels must be physiologic, not too high but not too low.
Every man has their happy medium when it comes to Estrogen levels. We'll make sure you stay there. We prescribe Anastrozole, Letrozole, and Exemestane to achieve this goal; collectively, these medicines are classified as Aromatase Inhibitors (AIs); each one of them has unique characteristics, and we will help you choose the right one for your needs and budget.
We do not accept insurance. We are happy to furnish you with any receipt or superbill for any service at our clinic, although we cannot guarantee reimbursement to you by your insurance company.
Our Hormone Replacement Program:
We charge per visit, but we calculated the average monthly price. Call us if you need any clarification.
Average Monthly Expense (includes visits, labs, and prescriptions):
Year 1: $338/month.
Year 2 and after: $190/month.
See pricing details and program description here: here.
I am licensed to practice medicine only in California. Therefore, physical evaluations must be at my office in California. If you live outside California, I can still help you once we discuss how often you would need to be seen at my office. Many patients see me two times a year but live in a different state. We can arrange for blood draws and get medicines shipped to every state.
This guarantees adherence to physician-recommended needle size and quantity of needles/syringes. Retail pharmacies often do not dispense the prescribed amount or needle size, as it depends on what they have in stock, which is inconvenient, and using the wrong needle size can cause trauma and scar tissue formation.
We are aware that some patients purchase these supplies from various websites, but we advise against that because we cannot guarantee the sterility of these supplies. We purchase our supplies from world-class, reputable suppliers such as McKesson. However, we may still prescribe through retail pharmacies if it is more convenient for patients who live too far from our clinic.
It is on a Case-by-case basis. You would have to try and see. We'll help you as much as we can.
First, consider the practicality of your goal. Are you trying to get big like the fitness models in fitness magazines, or more like Arnold Schwarzenegger in The Terminator? Are you fixated on that 200 pound goal?
If you're looking to become like the Incredible Hulk, you would have to be on at least 6-8 units of HGH daily and at least 800 mg of injectable steroids weekly; you're looking at roughly $3000 a month for all that, at least 1 pound of steak daily, and hopefully, you have all the time in the world to cook and work out. But you would also give up something more valuable than money: Your long-term health. It is these doses that are associated with irreversible heart failure and fatal cardiac rhythm abnormalities. When you hear about a jacked guy dying suddenly at the age of 54 while he was cooking or sleeping, now you know why.
Guys also want to put that 200 pound statistic on their dating profile. Speaking of realistic goals, if you are under 5'10 unless you are exceptionally thick-boned, there is no HEALTHY way of weighing 200 pounds! And if you do it, it won't be sustainable, you won't look good, and you won't be healthy. So, don't focus on numbers; focus on how you feel and look.
Your goals are practical; you are taking hormones and going to the gym, and your form is good, so why no gains?
You keep interrupting muscle recovery and damaging your tendons. With weight lifting, less is more; think fewer reps, higher weights, and less frequent workouts. You can do yoga or cardio seven days a week, but you should not lift weights more than four times a week. The gain in lean mass occurs during muscle recovery, which usually takes 48 hours after muscle loading.
You think you're eating enough, but you're not, which is the most common reason behind stagnant gains. To support the anabolic process, you must consume 3 grams of animal protein for every pound you currently weigh daily. This requires discipline, motivation, time management, and meal prepping.
You may control your time, the intensity of your workouts, your hormone levels, and your animal protein intake, but you cannot exceed the limits of the muscle-building machinery at the biomolecular level because your genes and age set these.
Setting realistic, sustainable goals that do not affect your long-term health is essential. Your growth journey should include both physical and spiritual growth. Enjoy the process of self-improvement and learn to love yourself, appreciate what you have, and be grateful for it.
No!
I'll explain why.
When a man has suboptimal testosterone levels (<400 ng/dl), the goal is to get the level to at least 600 ng/dl, preferably over 800 ng/dl. In clinical practice, many men feel their best when it's 1000 ng/dl. The point here is that assessing the efficacy of testosterone replacement therapy (TRT) requires both target levels as well as a man's subjective feeling of "joie de vivre" from the TRT.
The clinical trials for novel oral testosterone formulas--such as Jatenzo and Kyzatrex--did not show significant improvement in testosterone levels, and the very grand majority of patients on these formulas had a post-treatment level that was under 800 ng/dl. The follow-up phase was around six months, so long-term efficacy and adherence are still being determined; however, we can make an educated guess that they are neither effective nor easy to adhere to in the long term. We know they're ineffective because clinical practice shows that most men feel their best when their level is over 800 ng/dl. Long-term adherence is terrible because all these formulas require a twice-daily dosing regimen. We know from clinical experience that almost all twice-daily regimens fail. People tend to forget one dose or the other.
Why are these drugs ineffective?
It's because your liver breaks them down before they enter the rest of your body. That's why the dosing is extraordinarily high and twice a day. The manufacturers of these brand medicines claim that lymphatic absorption patented biotechnology prevents liver breakdown, but their own published data argue otherwise. To understand this, let's look at a real-life example:
John is on brand-name oral Testosterone Kyzatrex. He takes 400 mg twice a day, which translates to 800 mg per day and 5600 mg a week. His testosterone level is 650 ng/dl on this regimen.
Jack is on injectable Testosterone. He injects 100 mg once a week. His testosterone level is 650 ng/dl on this regimen.
As you can see, it takes John 56 times more testosterone to achieve the same results as Jack. Also, John has to deal with this daily vs Jack, who injects every Sunday.
If John does not feel benefits with a testosterone blood level of 650 ng/dl, then he's SOL because 400 mg twice a day is the maximum dose of Kyzatrex he can be on. Compare that to Jack, who is on a relatively low dose of injectable Testosterone with plenty of room to increase his dose.
Also, does anyone know the long-term consequences of swallowing 5600 mg of Testosterone weekly? The follow-up time for these studies was less than a year!
But it gets even trickier when you consider access. Access to a medication in the United States is determined by the sticker price of the medicine, coverage by insurance plans, and pharmacy stock/manufacturer supply, which in turn follow demand.
Consider the real-life example below:
Injectable Testosterone through my practice is procured for an average of $80 a month when the dose is 200 mg weekly. That's the sticker price, so there's no insurance involvement. The cost of one month of Jatenzo is currently $1000! The cost of Kyzatrex is unclear, but per GoodRx, it is a "limited distribution drug," most likely due to its extremely high price, likely higher than $1000 a month. Now you see how these sticker prices limit access.
Therefore, patients taking Jatenzo or Kyzatrex must obtain them through insurance, but insurance coverage for brand medicines like these is notoriously inconsistent. Insurance companies change their coverage capriciously without prior warning or explanation. Suddenly, the plan no longer covers the medicine at all, requires different criteria to cover, covers a smaller portion of the price, or a shorter duration of therapy. Sometimes, your plan stays the same, but you change doctors, and now the new doctor needs to resubmit their medical necessity documents to the insurance company. Now you see how insurance coverage limits access.
But say your doctor, plan, and insurance company all remain the same (infrequent these days); because demand for these brand medicines is very low, manufacturers may stop making them or the pharmacy may stop restocking them; sometimes, the insurance company whimsically decides not to reimburse the pharmacy after it had dispensed the medication to you, so the pharmacy stops stocking the medicine; all of these scenarios are guaranteed to leave the few patients who take these medicines high and dry.
That's not to say that oral Testosterone is a bad option for everyone. Women require 10% of the amount of Testosterone that men do, making oral Testosterone a compelling option for them. Still, oral Testosterone for women is available at a very affordable price through various reputable compounding pharmacies all over the United States, negating the need for the costlier and inaccessible brand of oral Testosterone.
But what about men who are unable to inject, such as men who have hand arthritis, carpal tunnel syndrome, or needle phobia?
These men can be on topical/transdermal Testosterone cream; applying a cream on the shoulder daily is easier than taking a pill twice a day. Although less effective and less affordable than injectables, it is more effective and a lot cheaper than oral brands.
So why are some doctors pedaling brand oral Testosterone on social media for men?
I have no idea. But if you figure it out, let me know.
Dr. Yazan Abdullah MD MPH
If TRT were not worth it, many men would not take it. The dramatic benefits outweigh the costs, risks, and upkeep. With a doctor-managed TRT program, men who would otherwise not have gone to the doctor get their health assessed periodically, which ensures preventive care and early detection and treatment of cancer and metabolic disease.
Yes I do prescribe it, on a case by case basis.
19-nortestosterone, also known as nandrolone, Deca-Durabolin, or, as it is called in the street, "Deca," is one of the two commercially available bioidentical human male androgens, the other being testosterone. The human male testicular androgen is primarily testosterone. Nandrolone is secreted in minute and clinically insignificant amounts, usually around 2%.
As an androgen, nandrolone, like testosterone, exerts its effects by binding to the androgen receptor. Its affinity to the androgen receptor is at least 2-3 times higher than that of testosterone. It may be considered at least twice as anabolic as testosterone when it comes to lean mass development, which also means that it's twice as effective as testosterone at breaking down fatty tissue.
However, its superior anabolic effect is not its only benefit. Nandrolone does not aromatize into estradiol or any other estrogen, which reduces the continual need to adjust the dose of the aromatase inhibitor and sometimes negates the need for one altogether.
Additionally, nandrolone, unlike testosterone, does not become DHT. Too much DHT accelerates male pattern baldness and increases predisposition to acne.
Nandrolone, like testosterone, causes negative feedback in the brain, resulting in testicular hypofunction and, hence, a dramatic reduction in testosterone levels and, therefore, estradiol and DHT levels, as they are both derived from testosterone. It's important to note that too little estradiol and DHT are as bad as too much; estradiol in a man is required for libido and cholesterol optimization; DHT is required for erectile function and libido.
While a tiny minority of men are on nandrolone alone for HRT, the most beneficial method of administering nandrolone is combining it with testosterone. That way, one gets the superior anabolic effect of nandrolone with just the right amount of estradiol and DHT from testosterone.
While discussing nandrolone's pros and cons, let's dispel some of its bro-science mythology.
Counter to what the "bros" say, nandrolone has no special positive effects on joints. It does not reduce joint pain.
"Deca dick" is partly true, but it is dose dependent. What ends up happening is that many men use way more nandrolone than testosterone. On top of that, they're on propecia/finasteride and lots of aromatase inhibitors, so they become severely deficient in estradiol and DHT, significantly reducing their libido and erectile function. Weekly doses of nandrolone beyond 200 mg may have a detrimental effect on erectile function that is unrelated to DHT deficiency; for instance, nandrolone has a small affinity to the alpha estrogen receptor in the breast and penile tissue; at high doses nandrolone can activate these receptors causing gynecomastia and erectile dysfunction.
"Deca heart" is a real issue, but it is not unique to nandrolone. It can happen with all androgens because it involves the anabolic effect of the androgen receptor on the heart's muscle. Remember, the heart is a muscle, so whatever is growing your biceps also grows your heart. Too much stimulation of the androgen receptor in the heart causes it to enlarge in an abnormal and harmful pattern. Since nandrolone is more anabolic than testosterone, this effect may be more pronounced with nandrolone, although research remains minimal. Load bearing/strength training/weight lifting is a cofactor in this effect, but it can be opposed by aerobic exercise (endurance, like swimming or Stairmaster). Regardless of which androgen you use, it's therefore imperative that you make time for aerobic exercise, AKA "cardio." I cannot overemphasize this. The ideal amount of time you should spend on "cardio" is at least 150 minutes weekly. The American Heart Association recommends 300 minutes, but this needs to be more practical in real life, hence the 150-minute recommendation. Preliminary research also indicates that nandrolone at a dose higher than 200 mg weekly may lead to abnormal heart rhythms.
So let me rephrase this: Men on androgens, especially if they are on higher doses or on nandrolone, need "cardio" more than men who are not to prevent heart failure. You would be shocked to realize how deconditioned many muscle guys are; they look amazing at the gym or the beach, but they can't swim two laps without ending up in the emergency room. Those are the ones who won't make it past fifty-five.
Lastly, nandrolone is in short supply throughout the country, especially in California. Laws restrict many affordable pharmacies from shipping nandrolone into the state, leaving Californians with fewer options. That's why we are excited to make it available to you, legally and in pharmaceutical grade. Black market nandrolone is almost always fake, especially NPP, the phenylpropionate ester of nandrolone, so we hope you avoid it; you could easily be getting Trenbolone without even realizing it since nandrolone is actually derived from trenbolone. Many of the guys who buy "deca" from the black market and complain of "deca dick" are actually getting "tren dick." Search for my article on Trenbolone in this FAQ section to learn more.
I hope that you learned something from this article.
If you plan to include nandrolone in your HRT regimen, please consult me about risks, benefits, and treatment planning.
Trenbolone is not bioidentical, which means it does not exist in Mother Nature. We use it in cattle. Months before a cow is set for slaughter, it is given Trenbolone; it makes the cow beefier so that it can feed more people. Trenbolone is more potent than testosterone, building lean mass in the cow quicker. Remember, a cow's life span on the farm is shorter than that of a human. Longevity is not a concern in the farming industry, but size is.
Trenbolone is a derivative of nandrolone; it is more anabolic than nandrolone, which is more anabolic than testosterone. Now you understand the appeal among the bodybuilding and fitness community. The fact that it's available commercially for veterinary purposes should also explain the ease of its procurement through the black market.
While most nandrolone purchased off the black market is fake, Trenbolone is usually authentic, albeit impure.
Tenbolone has other desirable properties. For example, tren does not aromatize, reducing the need to adjust the aromatase inhibitor. Furthermore, it does not become DHT, the androgen that accelerates male pattern baldness. Unlike nandrolone, it does not have estrogenic activity in the breast, which makes men think that they're not going to get gynecomastia with it. But as you will learn by the end of this article, Trenbolone does cause gynecomastia. Trenbolone increases dopamine in the brain, which is euphoric; it has other unique yet poorly understood psychogenic effects, such as extreme libido.
Human longevity, specifically in heart health and function, should be of grave concern. We should only take a substance if its long-term safety profile is known. The cow is slaughtered a few months after it goes on Trenbolone, so we have no idea what would happen to its heart, kidneys, clotting factors, sexual function, or blood pressure in the long term. Moreover, altering a hormone's molecular structure should never be taken lightly. For instance, when the nandrolone molecule is modified to become Trenbolone, we are changing the anabolic or androgenic potency and altering many unknown or poorly studied interactions between the hormone and various organ systems in the body.
So now you know why men love Trenbolone.
But you also need to know why you should avoid it.
Let's say you don't care much about your heart and choose to live in the fast lane, keeping it short and sweet.
For starters, Trenbolone has a significant progestin-like activity leading to gynecomastia.
Trenbolone increases dopamine and adrenaline in the brain via poorly understood mechanisms. These neurotransmitters are a double-edged sword: You get excited, happy, and horny, but you also get severe erectile dysfunction that is usually resistant to Viagra and Cialis, an effect that is also observed with stimulants such as adderall and MDMA. Trenbolone gives you all the desire but takes away all your performance. That's called "tren dick," which is much worse than "deca dick." Also, just like Adderall or other amphetamines, Trenbolone causes personality changes such as irritability and aggressive behavior. Have you met a guy who is on Trenbolone? They're friendly and smiling one moment, then suddenly, they are unfriendly and irritable. A guy on Trenbolone is big, buff, horny, angry at the world, and can't get it up. While official research is lacking, many men who have used Trenbolone, especially those who cycled with it for many years, report permanent depression and loss of libido even after total cessation of Trenbolone. This is consistent with the well-established notion that Trenbolone has unique yet poorly understood long-term effects at the central nervous system level.
Since Trenbolone is very anabolic, men gain lean mass quickly, but the gains are notoriously difficult to maintain. So why get so big so that you can deflate and then end up with permanent personality changes and sexual dysfunction?!
If some dude is trying to talk you into Trenbolone, walk the other way as fast as possible.
When someone is on an all-protein or all-meat diet, sometimes described as carnivore or keto, their carbohydrate intake is minimal. As a result, they need more water throughout the day since protein foods are water-deficient, while carbohydrates are water-rich. Salt increases thirst, which makes people on the keto diet drink water to ensure sufficient hydration. In this case, the increase in table salt would prevent low blood pressure, not cause high blood pressure. With a functioning kidney, any excess salt would be expelled from the body by the kidney.
However, this advice does not work with men on TRT, and I highly recommend against using excessive table salt even if you are on a strict "keto" diet. Testosterone may cause the kidney to be less eager to expel salt and hence may cause a rise in blood pressure if coupled with excessive table salt intake.
So, if you're on TRT, try to avoid salt or use minimal amounts with your steak. To ensure hydration, don't use salt. Just drink lots of water.
Aim for a daily intake of 1.5 grams of animal protein per current body weight in pounds. But if you are trying to increase lean mass, you need 3 grams daily. Animal protein includes meats, milk, and eggs.
The most challenging aspect of health, fitness, and bodybuilding is ensuring adequate animal protein intake daily. We, therefore, understand the appeal and convenience of "protein shakes." But we can't tell if protein exists in the "shake."
"protein shakes" are considered a "dietary supplement" by the FDA, meaning they are not regulated to the extent that food or medicines are. Manufacturers are responsible for ensuring that their products are not harmful, though many companies do not test for safety or efficacy before marketing them. The FDA created Good Manufacturing Practices (GMPs) to help minimize adverse issues, but compliance with these procedures remains a concern. In 2017, about a quarter of supplement-manufacturing companies whose products were tested received citations related to purity, strength, and ingredient content.
Please remember that over-the-counter supplements are not harmless. They are unregulated, and the manufacturer does not need to prove efficacy, quality control, or long-term safety. The rate of colon cancer among Americans under the age of 50 has doubled since the late 1990s. These supplements also contain irritants that can affect your intestine's ability to absorb nutrients and cause irritable bowel syndrome. We recommend against ingesting supplements unless they are specifically recommended by a doctor, for a specific reason, and monitored by laboratory methods.
No!
Your cells are capable of assessing their creatine needs and producing creatine accordingly. We are aware of the creatine supplements sold on social media. However, the research on creatine is low-quality, inconclusive, and sparse.
Please remember that over-the-counter supplements are not harmless. They are unregulated, and the manufacturer does not need to prove efficacy, quality control, or long-term safety. The rate of colon cancer among Americans under the age of 50 has doubled since the late 90s. We recommend against ingesting supplements unless they are specifically recommended by a doctor, for a specific reason, and monitored by laboratory methods.
That is the most loaded question I get from my patients when I see them for the first time.
So here's the loaded answer: Yes and no!
Testosterone increases appetite, which may increase daily caloric intake. But Testosterone also increases metabolic rate. There should be no weight gain besides lean mass with proper exercise. Sometimes, the weight stays the same, but it gets redistributed as more fat is burnt and more muscle is built. Either way, an increase in appetite leads to increased caloric consumption. Not all calories are created equal. A calory is a calory, but where the calory comes from matters. When derived from carbohydrates, it activates lots of insulin; if derived from protein or fat, it activates a lot less insulin; the more insulin, the more salt and water retention in the kidney, the higher the blood pressure. Additionally, carbohydrates--from their name including "hydrate"--contain a high percentage of water, which may also increase your blood pressure.
Testosterone increases the production of red blood cells, which is desirable as it makes us look more youthful and guarantees adequate oxygenation in a body working at a higher metabolic rate and actively building muscle. However, if this effect is too extreme, as we see with men who don't have a doctor monitoring their labs or with men who use incredibly high doses, the increased red blood cell production thickens the blood and raises the blood pressure.
Testosterone is the source of estrogen in both men and women. That's why we have to monitor estrogen in a man on Testosterone. Suppose estrogen gets too high because you skip your doctor visits or you are getting hormones from an unqualified facility (Telemed hormone mill or HRT chains manned by non-physicians) or pellets. In that case, it will cause salt and water retention, raising blood pressure. Moreover, estrogen increases insulin resistance, which may lead to higher insulin levels, which increases salt and water retention and blood pressure.
Testosterone has multiple psychiatric effects. It improves mood, youthfulness, and motivation, possibly leading to excessive resistance training (weight lifting), especially when you want to attain that jacked look. The effect of exercise on blood pressure depends on the type of exercise. Endurance exercise, AKA "cardio" or "aerobic," reduces blood pressure and improves cardiac function. Strength training (weight lifting) increases blood pressure. It is, therefore, extremely important to have a good balance of both when you are on Testosterone replacement therapy. When you combine endurance and resistance training, the pressure effects balance out, giving you a more robust, healthier heart.
However, large doses of Testosterone, or any other androgen, for that matter, may increase irritability by elevating the resting sympathetic nervous system tone, which would raise blood pressure.
Lastly, it is unknown whether non-bioidentical androgens such as Trenbolone or Winstrol have properties that make them bind to the aldosterone or cortisol receptor, causing an increase in blood pressure. It is also not inconceivable that extremely high doses of Testosterone itself cause binding to aldosterone and cortisol receptors. Remember, all androgens come from the same steroid molecule that also serves as the precursor of less desirable steroids, such as aldosterone and cortisol, which increase blood pressure.
Are you confused enough?
I am about to confuse you even more, so take a deep breath!
Testosterone can--and quite often does--reduce blood pressure. Just ask the young 25-year-old men with high Testosterone levels and blood pressures under 120/80, and that's despite all the burgers they eat.
The higher metabolic rate induced by Testosterone and exercise reduces midsection adiposity and blood pressure. The antidepressant, motivator, energetic, and euphoric effect of Testosterone improves productivity, sleep, sexual function, and appearance and reduces the stress related to all of these issues above. These psychological components have a profound impact on blood pressure since blood pressure is mostly neuropsychiatrically driven. Men who are on TRT experience positive reward reinforcement, which often promotes healthier keto and paleo eating habits; the associated reduction in carbohydrates also reduces blood pressure. They look in the mirror and see an improvement in their appearance; then, they start cutting back on smoking and drinking to look even better, which also reduces their blood pressure and increases their longevity.
With the appropriate dosing and monitoring by a qualified doctor (not a nurse, a physician assistant, or a remote medical director who has no say in any part of the treatment plan), a mild increase in red blood cells is good for you; the red blood cells release vasodilatory chemicals such as nitric oxide that reduce blood pressure and at the same time deliver lots of oxygen to give you the energy you need to exercise and be productive, both of which reduce your blood pressure.
Keeping your doses in check, cycling higher doses with a decent, nonjudgmental doctor who uses bioidentical hormones only, and avoiding veterinary steroids such as Trenbolone can ensure that you do not experience aldosterone and cortisol effects and stay out of the troubles of high blood pressure, lipodystrophy, puffy face appearance, and diabetes.
So now, back to the original question. Does Testosterone increase blood pressure?
I gave you the long answer.
Here's the short one:
Testosterone DOES NOT DIRECTLY increase blood pressure. When used appropriately It may decrease it. When used inappropriately, it may increase it.