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. .

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.

Dr. A needs to examine you and provide a comprehensive aesthetic consult in order to determine how many units you would require. However, men usually need 70-80 units and women usually need 50-70 units. Currently we charge $10/unit.

Avoid taking aspirin, non-steroidal anti-inflammatory medications, St. John’s Wort, Omega 3 fatty acids (fish oil), and vitamin E supplements for five days prior to treatment to reduce the risk of bruising or bleeding at the injection site. Arrive at your appointment with a clean face, no skin product or makeup.

Do not lay down for 2 hours post treatment. Contract the facial muscles in the area injected every 15 minutes for 1 hr after treatment. Do not rub the area treated. Do not exercise for the first 12 hours after treatment. You will not see full results for up to 7 days after treatment and the maximum effect may take 2 weeks to appear. The average Botox treatment last 3 to 4 months. After repeat treatments the effect may last longer. First treatment usually lasts the least. Wait 14 days before any rejuvenation procedures such as microneedling and laser. Call our office if you have any concerns.

Yes we use neuromodulators to treat it. Each side requires 100 units. Cost is $10/unit, so $1000 per side.

Yes, we understand the inconvenience of the commute, so for patients who are not close to us, we can do that as long as we see you at least twice a year here at the office.

We are committed to providing exceptional care. The physician's time is valuable. Moreover, when one patient cancels without giving enough notice, they prevent another patient from being seen. If it is necessary to cancel or reschedule an appointment, please call or text us at (949) 229-5257 at least 24 hours before the appointment; otherwise, a $150 fee will be applied to your account. Notification allows the practice to better utilize appointments for other patients in need of prompt medical care. Thank you for understanding.

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It depends! Insurance does not cover the class of medicines Dr. Abdullah prescribes for hormone replacement therapy. And in the rare occasions they do, they don't cover the dose or strength he deems effective. A one-size-fits-all approach would not deliver results and patient satisfaction. Luckily, these medications--when purchased through our program--are affordable! When you use "insurance" to pay for something, an entity other than yourself is paying. Said entity then must have proof of "medical necessity" to pay. However, what we deem medically necessary differs from what the insurance company deems necessary, leading to delays in therapy and placing an unacceptable liability on the prescribing physician. There is however one exception: If you are needing one of the novel weight loss drugs such as Ozempic, Mounjaro, or Zepbound, as part of your HRT program with us or if you are with us just for medical weight loss, then rest assured that Dr. Abdullah will do whatever he can to get your insurance plan to cover the partial--or hopefully the complete--cost of the medicine!

Cost is relative, and you get what you pay for. Your biggest asset is your health, inside and out. Considering what we offer as a full-suite comprehensive hormonal health clinic, ours is a value proposition. Our vitality program is a form of self-investment. You will experience results that improve your personal, social, and occupational life. A PMD who is not a hormone specialist may not necessarily dose appropriately, treat side effects, or optimize estrogen levels because they lack the time and expertise and are limited by the insurance company or the employer's "guidelines." These "guidelines" are to reduce costs and maximize profit for these entities, not improve your life's quality.

Anavar/oxandrolone and Winstrol/stanozol are anabolic steroids related to testosterone, specifically dihydrotestosterone (DHT). It's easy to understand their appeal in the fitness industry. They are oral--usually dosed twice daily; the body does not convert them to estradiol, obviating the need for aromatase inhibitors. At low to moderate doses, they exert an anabolic effect without causing undesirable androgenic effects such as acne and accelerated hair loss. Some bro-science peddlers will tell you that they are good for "bulking" cycles, and some will tell you that they are good for "cutting" cycles; of course, this makes no sense. I do not recommend them for various reasons. They reduce "good" cholesterol, cause various types of liver disease, and increase water retention. The extra water raises blood pressure and causes a puffy face. Because they are very different from testosterone and DHT, we don't know what else they are doing in the body. Their side effect profile and everything we know about them come from studying subjects taking daily doses under 25 mg. The bodybuilding dose is usually at least 50 mg daily. Once dosed over 20 mg, they will exert the same undesirable androgenic effects of testosterone, such as acne, which defeats their very purpose. Additionally, unless they are fake, they cost a lot more than injectable testosterone. If a man temporarily wants a greater anabolic effect or wants to "go on a cycle," the best way to do it is just to increase the dose of testosterone! You may need to take the aromatase inhibitor more frequently or an antibiotic or topical/oral finasteride for your hair or acne; still, this is a far easier, safer, and more cost-effective approach than taking Anavar or Winstrol. What about D-Bol and Anadrol? Anadrol/oxymetholone is another oral steroid; it has the same problems and cost as Anavar and Winstrol, yet it is a weaker anabolic. There's no reason to take it. Dianabol, AKA "D-Bol"/methandienone is also an oral anabolic steroid that's as potent as Anavar and Winstrol, except it has the same problems and gets converted to a type of estrogen that's hard to get rid of. Again, there's no reason to take it.

We use serum/blood testing through LC/MS technology; the samples are analyzed by state of the art technology at Quest Diagnostics, which is a world class laboratory. We do not believe that salivary testing is accurate. To ensure that our treatment plan is effective and safe, we include a comprehensive laboratory panel that exceeds the standards of hormone replacement therapy and primary care. Furthermore, we only use the most accurate methodologies for our hormone testing, such as Chromatography combined with Mass Spectrometry. For these reasons, getting the results takes up to 10 business days.

To ensure that our treatment plan is effective and safe, we include a comprehensive laboratory panel that exceeds the standards of hormone replacement therapy and primary care. Furthermore, we only use the most accurate methodologies for our hormone testing, such as Chromatography combined with Mass Spectrometry. For these reasons, getting the results takes up to 10 business days. 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.

ESWT is an investigational modality, which means that urologists (doctors who specialize in diseases of the penis) have yet to figure out if it's of any use in treating ED. ESWT's efficacy is anecdotal. It's also costly. If Viagra and Cialis don't work for you, we can prescribe intracavernosal agents such as "Tri-Mix," which is more effective and more affordable than ESWT.

Exposure to extremes of heat and cold for health benefits is under investigation. The studies are prospective cohorts with likely many confounding factors. At this juncture, quality data and evidence are lacking.

When it comes to the specialty of hormone replacement, our lab panel is meticulously comprehensive. We don't believe in ordering unnecessary labs just to inflate the price, a practice we know some medspas engage in. As part of our commitment to providing comprehensive service, our lab panel includes all the labs your primary care physician would ever need. This means you can complete all necessary tests in one place, saving you time, money, and effort. You can access your labs anytime, anywhere, so you can show them to your primary care physician.

Testosterone has a well-studied effect on the skin's oil glands and hair follicles. It makes the skin produce more oil, accelerates male pattern baldness, and leads to overt hair growth in undesirable areas such as the back. The increased oil production may lead to acne. All these effects are also based on genetic propensity; some men will experience them more than others. So far, none of my patients have gone bald because of TRT. Yes, some of them do mention minor hair growth on their back, but it does not make them quit TRT. Some of my patients also develop acne in the upper shoulders, but most of them don't even want it treated, let alone quit Testosterone because of it. Losing hair on the head and growing more of it on the back are not necessarily signs of aging, nor is acne. So why do some guys on gear look a lot older? They have more pronounced wrinkles and a more "rough" look. Where is that coming from? I don't have actual validated data to answer the question above. But I can report a couple of consistent observations. One: Most of my patients are on Testosterone, and I have been seeing them for years, and most of them look younger on Testosterone. Two: All the guys I have known who are "roided-out" and look older than their age have used non-bioidentical steroids such as Trenbolone, Boldenone, and Masterone. Keep in mind that non-bioidentical androgens such as Trenbolone are vastly different from Testosterone. It's not just anabolic versus androgen ratios, reduction, and aromatization. These molecules have many differences that have yet to be studied. For example, to what degree do they bind non-androgen receptors such as cortisol or aldosterone receptors? To what degree do they bind non-steroid (transmembrane) receptors, and in which tissues? So, I don't have an exact answer, but I will choose to believe that non-bioidentical androgens most likely accelerate skin aging and cause guys to look older and "rougher." It amazes me that men are willing to take these risks and live it up on the fast lane.

Regardless of your Testosterone status, I start with medical therapy. If ineffective, I'd refer you to a physician who specializes in hair restoration. Regarding medical therapy, I prescribe oral minoxidil, oral biotin, and topical finasteride. I do not recommend oral finasteride because it can reduce DHT levels to an unacceptable degree; more importantly, it reduces the metabolism of cortisol, which is very harmful. When your DHT levels become too low, your libido and erections may become non-existent. When your cortisol levels increase, your blood pressure and sugar levels also increase, and yes, you accumulate fat and breakdown muscle. I no longer even prescribe finasteride for benign prostatic hyperplasia (BPH); finasteride supposedly shrinks the size of an enlarged prostate, reducing the undesirable symptoms of BPH. In clinical practice, however, this never happens. I have never had a BPH patient who went on finasteride and then stopped having symptoms, even after years of finasteride. The oral route seems to do more harm than good. Having said that, when applied topically, finasteride will not lower DHT throughout the body; it will only reduce it in the skin of the scalp. It will also not affect your cortisol levels.

This logic denotes the misconception that the sole benefit of testosterone is exercise tolerance, motivation, and anabolic gain. I cannot overstate the importance of testosterone in energy, motivation, mood, bone density, and fat burning. If you are enduring a psychosocial stressor—such as a work-related, time-sensitive project, a divorce, or funeral planning—does that mean you should stop taking the medicine that is giving you energy, a positive mood, and faster metabolism?! Do stressed-out people not need a mood and energy booster?! Do people who don't go to the gym not need a medicine that boosts their metabolism?! Stress causes the body to produce a lot of cortisol, the principal stress hormone. Cortisol is a catabolic hormone that breaks down muscles; it also raises insulin levels, increasing midsection fat. When you're stressed out, you're not just not building muscle; you're actively breaking it down and depositing fat in your midsection simultaneously! Testosterone counters these effects; it prevents the binding of cortisol to its receptor in the muscle, protecting it from breaking down. Testosterone lowers insulin levels, preventing midsection adiposity. So please don't stop taking your testosterone when you're stressed out or when you're not going to the gym. If anything, that's when you need testosterone more than ever.

Acne is best treated with a combination of topical agents. I prescribe topical Azelaic Acid, Benzoyl Peroxide, Clindamycin, Niacinamide, Tretinoin, and Spironolactone. If the acne is severe or nonresponsive to topical therapy, I will prescribe an oral antibiotic.

Dear prospective patients, none of our services is expensive, and we are proud to be accessible to anyone not wealthy. That's because we believe that hormone therapy (when indicated) should be accessible to everyone who benefits from it. The cost of Testosterone--as well as all other medications we prescribe through our portal--includes the price of our labor that is related to your chart review, prior consultation, a review of your labs, and any interaction between you and the Doctor, as well as any care coordination labor involving our staff and the delivery pharmacy; so you are paying for not just the drug; you are paying for the doctor's work involved in the prescription and monitoring of the medication (chart review) as well as the convenience. Since transparency is crucial to us, we have disclosed this on our medication ordering/refilling website, our main website, and the intake paperwork you signed upon your initial visit; you are paying for quality, consistency, and convenience; a chart review is considered a remote consultation with substances that are controlled by the state and federal government, such as Testosterone. Still, when you compare our service to the $300 monthly subscription service to some random testosterone mill where a nurse or some naturopath underdoses you with "branded" Testosterone with no way for you to know the actual manufacturer and expiration date, ours is a value proposition. We hope you understand that. Some clinics make you come weekly for shots; when you calculate what they charge you for each shot and take into account the amount they're injecting you, you quickly realize that our prices are more affordable. As far as your gym trainer, if he's selling you a 20 ml Testosterone bottle for $10 with a concentration of 300 mg/ml, keep in mind that the bottle is most likely not sterile, most likely does not include pure Testosterone, probably has some traces of "tren" in it. Oh yeah, and the actual concentration is not 300 mg/ml. It could be anything from 50 to 150 mg. Also, the HCG you are getting from your dealer, Mexico, or the internet is fake. The "gonadorelin" you are getting from the local neighborhood Testosterone franchise, the internet, and Mexico is fake, as well as the "peptides." We proudly state that we don't promote, prescribe, or sell any fake hormones or peptides. P.S.: Please note that GoodRx prices are subject to change per month and per pharmacy, are inaccurate, and do not reflect stock availability at said pharmacy.

No, I do not. Glutathione may have some benefits to reduce the side effects of anti-cancer drugs in people who have active cancer and who are on chemotherapy. Among people who do not have cancer, there is a chance that Glutathione promotes cancer. Glutathione is the most potent natural anti-oxidant in the human body. Your body already makes lots of it, so you don't need to take more. Since oxidative stress is associated with all the diseases of aging, it would be tempting to think that increasing Glutathione levels would have an anti-aging effect. However, people must realize that Glutathione is anti-aging for both normal and cancer cells. So, if there is a cancer cell somewhere in your body, why would you want it protected from oxidative stress and aging? Quite the contrary, you should be hoping that the cancer cell ages quickly and dies before it makes a million daughter cells and kills you in the process.

Yes, please set up a consultation. I will collect your medical history and happily prescribe it. Learn more here!

At this time, I do not offer that. The estrogen replacement therapy required for transitioning to a woman involves high doses of estrogen that tend to cause clots and severe metabolic and psychiatric diseases.

Please purchase a sharps and biohazard disposal container from our office or from Amazon. Once the container is filled, you can take it to a local sharps and biohazard disposal facility. If you live in Orange county, see location description below. If you live in another county please go to: https://calrecycle.ca.gov/epr/pharmasharps/sharps/ Orange county residents: Irvine Household Hazardous Waste Collection Center, 6411 Oak Canyon, Irvine, CA 92618. Hours: Tues-sat 9 AM-3 PM. Limit to disposal: 125 pounds per trip.

If you have any other questions, call or text us at 949-229-5257, or just click the chat icon in the lower right corner!

Yes, as a Hormone Replacement expert, Dr. Abdullah has advanced knowledge in metabolic and obesity medicine, including the prescription of Ozempic® and all the other injectables within the GLP-1 class (Trulicity®, and Mounjaro®) to ensure that you are able to get treated, in case one of them is in shortage or not potent enough. He also believes in practical effective coaching to both achieve weight loss and maintain it. We don’t take insurance for Dr. Abdullah’s consultation; the first visit is $300, and subsequent visits are $250. The medications cost $900-$1500 monthly, so it’s an investment. Dr. Abdullah will do his best to get this medication covered by your insurance company, and sometimes, the copay is zero for some lucky patients. If your insurance company is not covering any of the cost, we still think it’s worth it, as they are very effective, and may reduce weight by 10-15 pounds per month! In 3-4 months, you may achieve the same results as a gastric bypass/bariatric surgery, minus the surgical complications, cost, and chronic vitamin and mineral deficiency that ensues with these surgeries. The health benefits of treating obesity are too many to list. Look at it this way: One cannot live their best life if obese. We believe in body positivity as a valid and much-needed social movement, but obesity is unhealthy and will reduce your life expectancy, and we don’t think that its glamorization is body-positive. With appropriate coaching by Dr. Abdullah, you would not have to be on these expensive medications permanently. The idea here is to coach you effectively while you’re on them, so you can maintain your weight when you stop them save your money, and look good for a nice vacation!

Well, I hope you give Dr. Abdullah the chance to prove you wrong. He loves this challenge! The science of metabolism is a moving target. We know today more than we did yesterday. I am current with all the obesity medical knowledge and novel pharmaceutical marvels that can help people like yourself. It is true, that there is an obesity genetic propensity among a large subset of the population, but that is not enough to become--and stay--obese. Also, the genetic factors can be counterbalanced by certain practical and sustainable lifestyle modifications that we will teach you. Obesity is a form of malnutrition that results from food dependence, which often occurs in the context of underlying mental disorders. And to add insult to injury, these mental disorders are often treated with drugs that increase appetite and cause undesirable side effects such as erectile dysfunction, weight gain, and flat affect! Go figure. We use a multifaceted approach as well as Ketamine to treat underlying depression and cravings. We will teach you to evaluate the food in front of you quickly and practically so you can make the right decisions when you don’t have much time to think. We’re not going to make you starve or count “macros” or any of that nonsense. Even if you don’t have a genetic propensity for obesity and yet struggling with it, I still think it’s not your fault: Junk and ultra-processed foods are everywhere; we can’t escape them; we are also a product of our upbringing; moreover, the field of nutrition science is based on very low-quality research, and special interests influence the government-issued food pyramid.

It may take us six months to two years to achieve our goals, depending on how many pounds we need to shed. It’s a mental and physical marathon, not a sprint. Once we achieve the goals, we will get you off the medicine, but only when we feel that you have rewired your brain and can maintain the weight loss. Remember, obesity is associated with every disease under the sun. Hence, these novel injectable drugs are worth every penny. But yes, without lifestyle modification, you would get the weight back. One of the main benefits of novel weight loss injectables like Ozempic is that they restore an obese person’s belief that they have a healthier version inside of them that’s yearning to come out, and that alone has tremendous transformative power.

“Ozempic Face” is fake news brought to you by the misinformation of social media influencers! Any person--whether or not on Ozempic—will have more accentuated wrinkles if they lose lots of weight. Even babies have wrinkles around their mouths. So, it’s not “Ozempic Face.” It’s the underlying beautiful you, and embracing is what body positivity is! The recent social media blitz about “Ozempic Face” is to replace weight anxiety with face anxiety, so you’d go get fillers! don't fall for this!

It could be due to one of the following reasons: Inappropriate dosing: Sometimes, we need a higher strength or a more potent version. Concurrent B12 deficiency. Unaddressed concurrent mental illness. Ineffective lifestyle and nutritional coaching Concurrent undiagnosed hormonal deficiency: For example, suboptimal thyroid or Testosterone. Tolerance: Your brain has developed tolerance to the drug, and it now knows that you're trying to trick it into thinking that your stomach is full. Tolerance is genetically determined and occurs with prolonged use, which is why we need to coach you so you can get off the drug. We will address all these issues when you join our program. We test you for hormonal and vitamin deficiency at the beginning of our weight management program.

We use everything we can to help you lose weight. Fat percentages, pods, and waistline measurements are just numbers. We focus primarily on your health, your goals, how you feel and how you look.

Ozempic, like all other drugs within the same class, works on the brain; it's how it reduces your appetite and makes you eat less. All medicines that work on the brain may have idiosyncratic psychoactive effects that people with a particular genetic makeup are prone to. Still, this is not a reason not to lose weight. As far as hair loss, this is a rare and clinically insignificant effect that occurs with rapid weight loss, so it has nothing to do with Ozempic. The same applies to gallbladder issues and abdominal pain. Please communicate with us your symptoms, and Dr. Abdullah will help you alleviate them and assess any need for further investigation and management. .

Body positivity is a great attitude. Everyone should have it! But body positivity also means that no matter who you are, you should love your body enough and treat it like a temple; in return, your body will help you live life to the fullest. Obesity greatly reduces an individual's lifespan. Even if you are not interested in living long, obesity reduces your overall quality of life.

Here! (scroll all the way down the page for process and pricing)

Semaglutide is the generic name of Ozempic and Wegovy, both registered trademarks of Novo Nordisk, a Denmark-based global pharmaceutical company.

Yes, there are two reasons behind this: One of Ozempic's effects—and all other injectables in its class—is to slow down the rate at which your stomach passes ingested food and medications to the small intestine. The longer it takes for a drug to reach the small intestine, the more likely it is to fail therapeutically. The small intestine is where most medicines are absorbed. Secondly, one of the adverse effects of obesity is that it reduces the activity of your ovaries; it's a condition we call secondary hypogonadism, and it affects both obese men and women. When you lose weight precipitously, the brain sends signals to your ovary that increase ovarian activity, which may override the inhibitory effect of the hormonal birth control pill. When you start Ozempic or any other drug in its class, I highly recommend that you stop birth control so that your period returns and you're able to time sex in a way that does not lead to pregnancy. Once your period returns, you can use the following method to time unprotected sex: This method works best if your cycles are usually between 26 and 32 days long. Count the days in your menstrual cycle, starting with the first day of your period as day 1. Continue counting each day of your cycle until your next cycle starts. On days 1-7, you can have unprotected sex, but you may have menstrual bleeding on those days. On day 20 through the end of your cycle, you can have sex. When you get your next period, start counting as day 1. To help track your cycle, you may use a tool such as CycleBeads: https://www.cyclebeads.com/ CycleBeads has an app for monitoring cycle days.

Yes, but due to a worldwide shortage of brand medicine related to the manufacturing of the patented injection pen technology in the face of unprecedented demand, the US government allows the manufacturing of generic versions.

We chose this particular source for two reasons: One: The biopharmaceutical company that manufactures them is cGMP compliant, meaning the manufacturing standards meet the FDA's stringent requirements, especially for peptides. Two: The pharmacy compounding the Semaglutide and Tirzepatide is licensed to ship sterile injectables to California. Compared to the rest of the United States, California has the highest standards regarding the compounding of sterile injectables; this is why, even within the state itself, very few pharmacies have licenses to compound sterile injectables.

The compounded drugs contain the active ingredient in the branded drugs. Reputable world-class compounding pharmacies in the US procure bulk freeze-dried active ingredients from CGMP and FDA-approved biotechnology facilities located in China and the United States. These manufacturers are state-of-the-art. Unlike the branded products with a patented autoinjector pen, compounded versions are shipped to the patient in a vial; the patient is required to draw the solution and self-inject. It's important to state that not all compounded versions are created equal; not all biotech manufacturers are FDA-approved. The recent reports of product bacterial contamination and impurity are related to inferior sources. We recommend against purchasing these products directly from the med spa or an online "provider." The product is likely illegitimate or expired if you receive more than one month's supply at a time or if it arrives as powder or liquid at room temperature. The branded versions are never reliably stocked at the pharmacy. There are various reasons behind that. Demand for these brands is at an all-time high; supply chains lament shortages in the autoinjector pen apparatus; manufacturers may also purposely reduce supply to inflate prices. But there is another important reason why pharmacies often don't reliably stock these medications: Inadequate reimbursement from the insurance company; for example, say, a pharmacy purchases Wegovy for $1000 from the manufacturer Novo Nordisk; you have an insurance plan that says that Wegovy is "covered" and your copay would be $50. You pay the $50 at the pharmacy, and the pharmacy hands you a Wegovy pen. The pharmacy will then bill the insurance company $950 for the Wegovy and $10 for storing and dispensing it to you. However, the insurance company refuses to pay the $960 it owes the pharmacy; It pays only $760$, so the pharmacy loses $200! The pharmacy wants to stay in business, so it chooses not to stock the medication. The same situation applies to coupon-based 50% discounts on these brand medicines. Compounded versions are not only a lot more affordable but also more reliable in terms of stock availability at the dispensing pharmacy. Consider this scenario: You start Wegovy and complete a month of therapy, and then Wegovy disappears at all the pharmacies in your town; you and your doctor now scramble to find an alternative source to no avail. This situation not only causes anxiety to the patient and the doctor, but it also disrupts the treatment plan, disheartens the patient, and runs the risk of all sorts of mental and eating disorders from the on-again, off-again dosing. There should be at least three months of uninterrupted therapy with this class of drugs. Currently, the stocking of these medicines changes drastically from one month to the other, preventing continuity of care. We hope this changes, but until then, the compounded version is a more affordable and reliable path to weight loss.

It's crucial to understand that subscribing to an Instagram telehealth company or a medspa might only provide you with the medication without a thorough laboratory and clinical evaluation by a qualified doctor. Even if they claim the program is 'doctor-managed' or 'doctor-supervised,' the reality is that no doctor reviews your labs. If you are struggling with weight, you need metabolic medicine managed by an actual doctor who will give you updated practical counseling and comprehensively evaluate and optimize your hormones, vitamins, sugar, and iron levels. We need to identify all the reversible factors slowing your metabolism. That way, you will achieve more significant weight loss and a higher likelihood of keeping it off.

All protein/peptide-based pharmaceuticals should be stored in the refrigerator to retain their long-term potency. However, as long as the ambient temperature is under 86 degrees, these medicines are stable for eight weeks. We err on caution and recommend no more than three days at room temperature. If it's been three days or less, your semaglutide should work fine.

To ensure that our treatment plan is effective and safe, we include a comprehensive laboratory panel that exceeds the standards of hormone replacement therapy and primary care. Furthermore, we only use the most accurate methodologies for our hormone testing, such as Chromatography combined with Mass Spectrometry. For these reasons, getting the results takes up to 10 business days. 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.

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.

From a legal perspective, compounding pharmacies often combine two or more agents to differentiate their products from the commercial or branded version. However, combining Semaglutide with B12 is highly beneficial for various reasons. B12 is essential for metabolism, fat burning, energy, and nerve function. The majority of Americans have low or suboptimal levels. A large segment of this population has gastrointestinal conditions that prevent optimal dietary or oral supplemental B12 absorption, which is why so many people have to get their B12 shots weekly. Accordingly, combining B12 with Semaglutide not only optimizes B12 levels but also amplifies Semaglutide's efficacy in weight reduction. You would no longer need to take B12 supplements while you are on this combination.

Check out our competitive prices below! We offer 4 Semaglutide doses👇 The monthly cost of 0.5 mg weekly is $250. The monthly cost of 1.25 mg weekly is $250. The monthly cost of 2 mg weekly is $350. The monthly cost of 2.5 mg weekly is $350. We offer 6 Tirzepatide doses👇 The monthly cost of 2.5 mg weekly is $400. The monthly cost of 5 mg weekly is $400. The monthly cost of 8 mg weekly is $500. The monthly cost of 10 mg weekly is $500. The monthly cost of 12 mg weekly is $550. The monthly cost of 15 mg weekly is $550. We are so excited that California patients now have an affordable and legal option preventing costs from hindering their health goals. 😀

If you have any other questions, call or text us at 949-229-5257, or just click the chat icon in the lower right corner!

As a woman gets older, her sex hormones decrease. Counter to popular belief, this happens before menopause; it begins in perimenopause, which itself could start ten years before menopause! That is ten years of low sex hormone levels! So, if a woman goes into menopause at age 50, she may have been in perimenopause since the age of 40! Many breast cancer survivors who are younger than 40 become sex hormone deficient after chemotherapy. The most important sex hormone in a woman is Estrogen; the purpose of women’s HRT is to replace the low Estrogen. Watch this clip on PBS explaining why Women's Estrogen Replacement Therapy fell out of favor to the detriment of women's health: https://www.pbs.org/video/managing-menopause-1715030292/

Estrogen deficiency has profound effects on a woman’s mind and body. In the same way, Testosterone deficiency has profound effects on a man’s mind and body. Low Estrogen is associated with: Higher risk of colon cancer. Higher risk of heart attacks and strokes. Higher LDL “bad cholesterol.” Diabetes and prediabetes. Unflattering body fat redistribution. Low sex drive. Vaginal atrophy. Labia minora atrophy. Clitoral phimosis. Frequent urinary tract infections. Dyspareunia (painful sexual intercourse). Cognitive decline AKA “brain fog” in 60% of peri and post-menopausal women. Low energy. Thinning hair. Osteoporosis/osteoporotic fractures: Due to both low mineralization and low elasticity of bone, secondary to chronic Estrogen deficiency. Worse prognosis at any stage of breast cancer. Decrease skin thickness and elasticity. Depression. In today’s world, women face the same challenges and corporate pressures as men. Hormone replacement therapy can serve as a valuable catalyst in fostering women's professional advancement by optimizing their well-being and enhancing their cognitive performance, thereby empowering them to excel in their careers.

A woman of reproductive age makes estrogen and progesterone, a hormone that prevents the uterus from being overstimulated by estrogen, which would raise the risk of uterine cancer. Women who are on HRT but don’t have a uterus don’t need progesterone. Testosterone (man’s primary sex hormone) is the parent molecule of estrogen. So, if a woman has estrogen, she must also have testosterone. By the same token, if a woman is no longer making enough estrogen--due to perimenopause or menopause--then she must also be no longer producing enough testosterone. Both men and women need an optimal level of both testosterone and estrogen. The role of testosterone in a woman’s body is very similar to that in a man; it increases libido, lean mass, energy, and, yes, clitoral erectile function! Lean mass is very important for aging women, especially if they have incontinence due to pelvic muscle atrophy from multiple pregnancies or other causes. Watch this clip on PBS explaining why Women's Estrogen Replacement Therapy fell out of favor to the detriment of women's health: https://www.pbs.org/video/managing-menopause-1715030292/

Watch this clip on PBS explaining why Women's Estrogen Replacement Therapy fell out of favor to the detriment of women's health: https://www.pbs.org/video/managing-menopause-1715030292/ The reason behind that is that most women and most doctors associate estrogen with blood clots and breast cancer; a few decades ago, a couple of extensive studies showed an association between estrogen and these two diseases; the quality of these studies is questionable, but more importantly, the women in these studies were NOT on estrogen that is identical to that of humans; they were on horse-derived estrogen. In today's world, we no longer prescribe equine estrogen because we have bioidentical estrogen, the same molecule that a woman's body produces.

The same things that cause clots in men: Smoking, a sedentary lifestyle, diabetes, high blood pressure, stress, bad cholesterol, and estrogen deficiency! Watch this clip on PBS explaining why Women's Estrogen Replacement Therapy fell out of favor to the detriment of women's health: https://www.pbs.org/video/managing-menopause-1715030292/

We have no idea! Breast cancer is the most common cancer in the world, and every woman has a high likelihood of developing it. Indeed, there seems to be an association between breast cancer and estrogen, but it looks like a protective one; leading breast cancer, oncologists report a better prognosis at any stage of breast cancer if a woman is on HRT. Watch this clip on PBS explaining why Women's Estrogen Replacement Therapy fell out of favor to the detriment of women's health: https://www.pbs.org/video/managing-menopause-1715030292/

Indeed, in the 1970s, 70% of peri and post-menopausal women were on HRT. Now, only 5% are on it! This is because of a large study (The Women’s Health Initiative study) that showed an association between women’s HRT and breast cancer 20 years ago. Since then, many leading physicians—yes, including breast cancer oncologists—have denounced the study, not just because the methods of the study were flawed, but also because women in that study did NOT use bioidentical hormones. They were on horse-derived estrogen and a synthetic type of progestin, which we NEVER use these days, especially with the availability of affordable bioidentical hormones. Despite this, the breast cancer misinformation persists. Estrogen does NOT cause breast cancer; in fact, the prognosis after a diagnosis of breast cancer is better at every cancer stage if a woman is on HRT! There are 80- and 90-year-old women on oral estrogen, and they are thriving. We don’t know what causes breast cancer. Alcohol, obesity, and smoking increase the risk of breast cancer. Breast cancer is the most common cancer worldwide; every woman (regardless of her estrogen levels) has a 1/8 chance of developing breast cancer in her lifetime. It is why mammograms exist!

Unless you have active breast cancer, there is no absolute contraindication to HRT. However, a risk and benefit analysis is a conversation that every woman should have with her physician with regard to any treatment, not just HRT. Watch this clip on PBS explaining why Women's Estrogen Replacement Therapy fell out of favor to the detriment of women's health: https://www.pbs.org/video/managing-menopause-1715030292/

So, where does this 10-year cut-off window come from? Why is it not 9 or 11? That's because women's HRT studies have not been conducted on women who start HRT after ten years of menopause, so the safety of HRT in this population is unknown. "Unknown" is NOT equal to unsafe; it just means that a prudent, knowledgeable physician must weigh the risks and benefits of HRT in every woman, regardless of age. For instance, a woman who had just become menopausal at 50 and who is diabetic and smokes cigarettes is at a higher risk of developing a heart attack than a 65-year-old woman who has been in menopause for over 15 years and is healthy and not on any medication; so in this case, HRT is safe to start on the 65-year-old woman but not safe to start on the 50-year-old. Does that make sense? Because today's doctors sadly focus on a one-size-fits-all approach as they see 30 patients a day and must minimize liability, they no longer take every woman on a case-by-case basis. Every woman is different, and that must be taken into consideration.

Yes! Women with inherited mutant variants in breast cancer type 1 and 2 susceptibility genes (BRCA1/2) have markedly elevated risks of breast and ovarian cancer and must follow up with a gynecologist. In terms of breast cancer, women with a BRCA1/2 pathogenic variant may opt for bilateral mastectomy (breast removal). Otherwise, they may opt for annual mammography and magnetic resonance imaging (MRI) starting at age 25 unless they are BRCA2 mutation carriers, as they would need to be on a selective estrogen receptor modulator (SERM), such as tamoxifen or an aromatase inhibitor such as anastrozole. In terms of ovarian cancer, they may opt for removal of the ovaries after the age of 35 after childbearing is complete. Otherwise, we recommend ovarian cancer screening with regular labs (CA 125) and transvaginal ultrasound. Current research indicates that estrogen replacement therapy does not seem to have a relevant effect on cancer risk in BRCA mutation carriers.

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 breast cancer is high in women, and it increases with age, regardless of hormonal status. Estrogen does not cause breast cancer. We don't know the cause of breast cancer. However, should breast cancer be diagnosed while a woman 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?

We prescribe systemic estrogen, progesterone, and testosterone. All are available orally and topically. We also prescribe, and prefer, injectable estradiol and testosterone.

So you're in your 40s and on birth control. Now what? You are most likely perimenopausal, which is the equivalent of being hypogonadal (you have a deficiency of at least one of your sex hormones). If you are sure that you don't want children in the future, I recommend sterilization (tubal ligation). If you are not sure about it or you don't want to get off birth control, I recommend the following: If you are on a progestin-only method, you will need to be tested for estrogen and testosterone deficiency and treated accordingly. If you are on a combined method, you will need to be assessed for testosterone deficiency and be treated accordingly. To get a better understanding of my recommendations, continue reading about hormonal birth control below: Birth control methods include intrauterine devices (IUDs), pills, rings, and implants. They may be physical barriers such as copper IUDs or hormonal barriers. Hormonal barriers may be progestin-only or combined estrogen and progestin. I understand the importance of birth control and family planning. But the truth is, up to this day, besides the timing of sex and access to early medical abortion, there are no ideal birth control methods. For women who have no desire to have children, sterilization (tubal ligation) is the optimal method. IUDs are foreign bodies, and as such, they cause a hyperinflammatory state in the uterus. Hormonal methods work by suppressing a woman's ovary. When the ovary is suppressed, it does not work, so there is no ovulation and hence no pregnancy. But what's the job of the ovary? Sadly, ovaries are almost always discussed in the context of reproduction and pregnancy. This is a shame because it paints women as reproductive machines, with nary a mention of the actual primary function of the ovary: It is the woman's sex hormone production machine! The ovary's function is testosterone and progesterone production and the subsequent conversion of testosterone to estradiol, a woman's most active version of estrogen. Women need testosterone as much as men and for the same reasons men need it. Women also need testosterone because it is the main source of their estrogen. When women discuss combined hormonal birth control with their doctor, it's imperative to discuss the effect of birth control on endogenous testosterone production. When discussing progestin-only methods, endogenous testosterone and estrogen should also be discussed. In summary, women need to understand that they need three sex hormones: Testosterone, Estradiol, and Progesterone (if they have a uterus)! Progestin-only methods cause severe deficiency in testosterone and estradiol, causing an infinite number of physical and emotional ailments. Combined hormone methods also cause severe testosterone deficiency, which also causes physical and psychological disorders. Women, like men, are testosterone-reliant. In a eugonadal (normal sex hormone levels) healthy woman who is not on birth control, physiologic testosterone levels are at least 1000 more than estrogen, indicating the biological fact that women, like men, need a predominance of testosterone in their bodies. For instance, many women on birth control complain of weight gain, which makes perfect sense because they are usually testosterone deficient, which slows metabolism, causing weight gain. Women's health has unfortunately been regressing in this country for the last few decades. I am not just referring to the reversal of Roe V Wade and the stigma and misinformation surrounding women's HRT and medical abortion. Consider the recent introduction of an over-the-counter daily progestin-only birth control pill named Opill! This pill is bound to cause estrogen and testosterone deficiency, both of which have a negative impact on physical and mental health.

Generally we do not recommend that because unopposed Testosterone tends to cause acne and excessive hair growth. However, we may opt for this strategy on a case by case basis after careful assessment of risks and benefits.

It is on a Case-by-case basis. You would have to try and see. We'll help you as much as we can.

This is common, and the cause is always the same: Ineffective HRT! Ineffective HRT occurs when hormones are prescribed without adequate monitoring and dose adjustment. These patients are almost always under-dosed, a pattern that is the hallmark of HRT through insurance-based clinics and clinics manned by unqualified health workers. The route and dose of hormones need to be patient-specific, and blood levels must be monitored regularly. I cannot tell you how many women are on inappropriate doses of estradiol, progesterone, testosterone, and thyroid hormones! What's the point of HRT if it's ineffective? What's the point of thyroid replacement therapy if it's not weight and lab-based?

I do not prescribe vaginal creams because they are messy and unpleasant, and most importantly, they dont address the main problem: systemic estrogen deficiency. A dry, painful vagina in a post-menopausal woman is not an isolated disease; it's a sign of an underlying systemic disease due to systemic estrogen deficiency, which is what we need to treat. The vagina, in this case, is a reflection of a woman's overall health. Using a vaginal cream negates this fact.

We will first assess the cause of the condition. If we cannot identify factors such as medication side effects, I offer hormone replacement therapy and/or PT-141/Bremelanotide for this condition.

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 we would not miss a tumor.

Yes!

Birth control methods include intrauterine devices (IUDs), pills, rings, and implants. They may be physical barriers such as copper IUDs or hormonal barriers. Hormonal barriers may be progestin-only or combined estrogen and progestin. I understand the importance of birth control and family planning. But the truth is, up to this day, besides the timing of sex and access to early medical abortion, there are no ideal birth control methods. For women who have no desire to have children, sterilization (tubal ligation) is the optimal method. IUDs are foreign bodies, and as such, they cause a hyperinflammatory state in the uterus or excessive bleeding and iron deficiency. Hormonal methods work by suppressing a woman's ovary. When the ovary is suppressed, it does not work, so there is no ovulation and hence no pregnancy. But what's the job of the ovary? Sadly, ovaries are almost always discussed in the context of reproduction and pregnancy. This is a shame because it paints women as reproductive machines, with nary a mention of the actual primary function of the ovary: It is the woman's sex hormone production machine! The ovary's function is testosterone and progesterone production and the subsequent conversion of testosterone to estradiol, a woman's most active version of estrogen. Women need testosterone as much as men and for the same reasons men need it. Women also need testosterone because it is the main source of their estrogen. When women discuss combined hormonal birth control with their doctor, it's imperative to discuss the effect of birth control on endogenous testosterone production. When discussing progestin-only methods, endogenous testosterone and estrogen should also be discussed. In summary, women need to understand that they need three sex hormones: Testosterone, Estradiol, and Progesterone (if they have a uterus)! Progestin-only methods cause severe deficiency in testosterone and estradiol, causing an infinite number of physical and emotional ailments. Combined hormone methods also cause severe testosterone deficiency, which also causes physical and psychological disorders. Women, like men, are testosterone-reliant. In a eugonadal (physiologic normal sex hormone levels) healthy woman who is not on birth control, physiologic testosterone levels are at least 1000 more than estrogen, indicating the biological fact that women, like men, need a predominance of testosterone in their bodies. For instance, many women on birth control complain of weight gain, which makes perfect sense because they are usually testosterone deficient, which slows metabolism, causing weight gain. Women's health has unfortunately been regressing in this country for the last few decades. I am not just referring to the reversal of Roe V Wade and the stigma and misinformation surrounding women's HRT and medical abortion. Consider the recent introduction of an over-the-counter daily progestin-only birth control pill named Opill! Not only is this pill bound to cause estrogen and testosterone deficiency, but to sell a daily hormone over the counter is potentially harmful. Timing of sex is a great way to avoid unplanned pregnancy, as well as plan B, which is available over the counter. Men's condoms are usually undesirable and "pull out" method is unreliable, but both are birth control methods as well. Once you stop birth control pills, your period returns, at which point, you can use the following method to time unprotected sex: This method works best if your cycles are usually between 26 and 32 days long. Count the days in your menstrual cycle, starting with the first day of your period as day 1. Continue counting each day of your cycle until your next cycle starts. On days 1-7, you can have unprotected sex, but you may have menstrual bleeding on those days. On day 20 through the end of your cycle, you can have sex. When you get your next period, start counting as day 1. To help track your cycle, you may use a tool such as CycleBeads: https://www.cyclebeads.com/ CycleBeads has an app for monitoring cycle days.

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: $469/month. Year 2 and after: $324/month. See pricing details and program description here: here.

Yes, I am happy to help you in your journey.

If HRT were not worth it, many women would not take it. The dramatic benefits outweigh the costs, risks, and upkeep. With a doctor-managed HRT program, women 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.

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.

Most women who go on HRT will not experience this side effect. However, some women will experience painless spotting or bleeding resembling menstruation. While we don't know the exact mechanisms behind it, if it's happening after starting HRT, then it's most likely related to HRT. Specifically, it must be associated with the specific dose/strength of each component of the HRT regimen. There is no one-size-fits-all regarding women's HRT because every woman is unique. Therefore, determining the correct dose and combination takes time and skill; it takes at least six months to optimize a woman's HRT regimen, and it is during this time that vaginal (uterine) spotting or bleeding usually takes place, and it's benign. With proper hormone monitoring and effective communication between the doctor, HRT benefits outweigh the risks, and your doctor will know when it's time for a gynecologic or transvaginal ultrasound referral.

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.

Dehydroepiandrosterone (DHEA), AKA androstenolone, is often prescribed orally as part of a woman's hormone replacement regimen. It is a very weak androgen and, therefore, ineffective. Reports on its efficacy on social media are anecdotal and inconsistent. Chiropractors and naturopaths love it. It is also an unregulated supplement, which means that the long-term risk of IBS and colon cancer remains unknown. Why take DHEA when there is readily available testosterone? Testosterone is an essential component of a woman's HRT regimen, and lucky for women, they can take it orally, topically, and by injection. Save your money and protect your gut!

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.

When it comes to the specialty of hormone replacement, our lab panel is meticulously comprehensive. We don't believe in ordering unnecessary labs just to inflate the price, a practice we know some medspas engage in. As part of our commitment to providing comprehensive service, our lab panel includes all the labs your primary care physician would ever need. This means you can complete all necessary tests in one place, saving you time, money, and effort. You can access your labs anytime, anywhere, so you can show them to your primary care physician.

This logic denotes the misconception that the sole benefit of testosterone is exercise tolerance, motivation, and anabolic gain. I cannot overstate the importance of testosterone in energy, motivation, mood, bone density, and fat burning. If you are enduring a psychosocial stressor—such as a work-related, time-sensitive project, a divorce, or funeral planning—does that mean you should stop taking the medicine that is giving you energy, a positive mood, and faster metabolism?! Do stressed-out people not need a mood and energy booster?! Do people who don't go to the gym not need a medicine that boosts their metabolism?! Stress causes the body to produce a lot of cortisol, the principal stress hormone. Cortisol is a catabolic hormone that breaks down muscles; it also raises insulin levels, increasing midsection fat. When you're stressed out, you're not just not building muscle; you're actively breaking it down and depositing fat in your midsection simultaneously! Testosterone counters these effects; it prevents the binding of cortisol to its receptor in the muscle, protecting it from breaking down. Testosterone lowers insulin levels, preventing midsection adiposity. So please don't stop taking your testosterone when you're stressed out or when you're not going to the gym. If anything, that's when you need testosterone more than ever.

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.

For starters, any man or woman who is on ANY hormone needs to get their hormones checked periodically. If you are a woman who is on progestin-only birth control, then you must be both testosterone and estradiol deficient. Most of my patients who are on a progestin-only method have post-menopausal testosterone and estradiol levels. Yes, these women are 25 years old on the outside but 55 years old on the inside, and I definitely would not call that healthy. Given they are deficient in the most important hormones, it is no wonder so many of these women complain of fatigue, brain fog, lack of sexual desire, frequent UTIs, painful sex, and weight gain, making them require things like Ozempic and dieting. If you are on combined hormonal birth control, you are deficient in testosterone, which is the most abundant sex hormone in a healthy woman. In terms of estrogen, it would be hard to assess your status because the estrogen in the combined pill is not bioidentical, and it reduces the accuracy of the estradiol blood test. It is, therefore, more practical to abandon terms like menopause or perimenopause and use terms such as hypogonadism. As such, virtually all women on hormonal birth control are hypogonadal. Another way of labeling it is hormonal birth control-induced ovarian hypofunction. In the future, we will get rid of progestin-only birth control methods because they cause estrogenic and androgenic hypogonadism, both of which are detrimental to a woman's mental and physical health.

No, I do not. Glutathione may have some benefits to reduce the side effects of anti-cancer drugs in people who have active cancer and who are on chemotherapy. Among people who do not have cancer, there is a chance that Glutathione promotes cancer. Glutathione is the most potent natural anti-oxidant in the human body. Your body already makes lots of it, so you don't need to take more. Since oxidative stress is associated with all the diseases of aging, it would be tempting to think that increasing Glutathione levels would have an anti-aging effect. However, people must realize that Glutathione is anti-aging for both normal and cancer cells. So, if there is a cancer cell somewhere in your body, why would you want it protected from oxidative stress and aging? Quite the contrary, you should be hoping that the cancer cell ages quickly and dies before it makes a million daughter cells and kills you in the process.

Acne is best treated with a combination of topical agents. I prescribe topical Azelaic Acid, Benzoyl Peroxide, Clindamycin, Niacinamide, Tretinoin, and Spironolactone. If the acne is severe or nonresponsive to topical therapy, I will prescribe an oral antibiotic.

To ensure that our treatment plan is effective and safe, we include a comprehensive laboratory panel that exceeds the standards of hormone replacement therapy and primary care. Furthermore, we only use the most accurate methodologies for our hormone testing, such as Chromatography combined with Mass Spectrometry. For these reasons, getting the results takes up to 10 business days. 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.

No, it does not. It's snake oil.

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.

Please purchase a sharps and biohazard disposal container from our office or from Amazon. Once the container is filled, you can take it to a local sharps and biohazard disposal facility. If you live in Orange county, see location description below. If you live in another county please go to: https://calrecycle.ca.gov/epr/pharmasharps/sharps/ Orange county residents: Irvine Household Hazardous Waste Collection Center, 6411 Oak Canyon, Irvine, CA 92618. Hours: Tues-sat 9 AM-3 PM. Limit to disposal: 125 pounds per trip.

If you have any other questions, call or text us at 949-229-5257, or just click the chat icon in the lower right corner!