Hormone evaluation and replacement is what we’re most known for at Performance Medicine. It’s something I’ve studied for many years, and as a physician it’s been incredibly fulfilling.

I’ve said before that no patient has ever thanked me for putting them on a blood pressure or cholesterol medicine.

But everyday it seems I have people come up to me and tell me their story about how we put them on testosterone and it changed their life.

The sad part is that in medical school we weren’t taught anything about it.

When I first started practicing, we didn’t check for low testosterone.

If we did in fact check a patient’s testosterone level and they were low, we were taught to give them 400mg of testosterone once a month ( this is one of the worst things you can do).

There just wasn’t a lot of good information out there about hormones and hormone replacement.

I don’t know for sure, but I’m going to bet that we’ve treated more Low T at Performance Medicine than most any other clinic and physician in the state of Tennessee.

So in this Doctor’s Note, I want to help you better understand how we go about Low T.

In my opinion, everyone needs to know this stuff.

A few days ago we had a patient come in who had already been to his doctor. His testosterone level was 522, but he had all the symptoms of Low T.

  • He was tired
  • Decreased sex drive
  • Erectile Dysfunction
  • Irritable
  • Fell asleep after eating
  • Belly fat

He was a former athlete who wanted to get back into the gym, but it was a waste of time because he couldn’t build muscle.

He had all the symptoms of low T, but his “Total Testosterone” level was at 522.

What this guy had was a low “Free Testosterone” level, which is the part that works.

His “Free T” was low by any scale.

When someone comes in and they have a low total testosterone level, we already know that their free testosterone level is low.

When you evaluate for low T, depending on age, you have to figure out why they have low T in the first place and work that up. And then you have to replace it without knocking down their own ability to produce testosterone.

You also have to know that it can aromatize and change into estrogen when you do this. As a man you want some estrogen, but not too much.

You also have to make sure that it doesn’t bump up your hematocrit, which is your red blood cell count.

Note: As you get older, your hormones decline. And as your hormones decline you decline in every way.

If you don’t want your brain, bones, and muscle to deteriorate you better check your hormones levels.


Testosterone Myths 


There are a lot of myths around hormone replacement therapy.

Here’s some things I can tell you:

It doesn’t cause prostate cancer. It prevents it. It also doesn’t cause an enlarged prostate.

It doesn’t cause heart disease. Your heart is a muscle. It has more receptors for testosterone than your testicles do.

You have to watch your levels though. This is why we make sure you come in for labs regularly, and require follow up visits. For example, as we mentioned above you have to check hematocrits. If that’s high, then you simply need to donate blood.

Every man that’s on hormones at Performance Medicine we check prostates and their PSA.

When a man comes in to see us for hormones, it gives us the opportunity to check for things they wouldn’t normally check.

We aren’t just here to give you t-shots. We’re here to help you optimize your health.


The Three Ways You Replace Hormones


Creams – We’re not real fans. We don’t think they work too well.

Weekly Shots – Yes, you need it weekly. In some cases we will put people on twice a week shots at a lower dose. We also let people self inject.

Pellets – This is probably my personal favorite. This is where we implant tiny pellets in the hip area. The entire procedure takes about a minute. These pellets slowly dissolve over about 5-6 months to give you a nice even level. You might have a sore butt for a few days, but most people love them. The other nice thing about pellets is that if we know you’re converting to estradiol, we can put some anastrozole in your pellets.

Note: You never start with pellets. If you’re new to hormone therapy, we always start with shots to help us figure out your dose. 

Also know that you cannot take an oral testosterone replacement.


Supplements For Low T


50mg of Zinc. This boosts your t-level and prevents some aromatization to estradiol. It can act as an estrogen blocker.

Men sometimes ignore their health. They don’t like going to see their doctor.

Low T gives me such an opportunity to do this.

It opens up avenues to talk about their health. It’s one of the many reasons I love treating it.