Frequently Asked Questions
Quick Links
Testosterone Replacement
Does testosterone cause prostate cancer?
There is no medical evidence that testosterone replacement causes prostate cancer. This has been confirmed by numerous studies evaluating the risk.
Does testosterone cause heart problems and strokes?
There is no evidence that testosterone replacement therapy causes cardiac problems or strokes. Studies have shown that men with hypogonadal (low) testosterone levels are actually at a higher risk of major cardiac events.
Is testosterone the same as anabolic steroids?
Testosterone is the original anabolic androgenic steroid. This just means that it has tissue building as well as male masculinizing characteristics. The public image of athletic or body building “anabolic steroids” are synthetic compounds that are manipulated to have a much higher muscle building effect.
If I start testosterone will I have rages of anger or personality changes?
No, testosterone does not inherently change a person’s personality.
What are the risks of starting testosterone?
Testosterone replacement can lead to decreased sperm production, increased red blood cell production, nipple sensitivity, decreased testicular size, hair loss and/or acne. Most of these side effects can be controlled by appropriate dosing or assistive medications.
What are the benefits of starting testosterone?
Testosterone replacement can lead to increased energy, improved sense of well-being, loss of body fat, increased lean muscle tissue, increased sexual arousal and improved mental focus.
Can women use testosterone?
Yes, when prescribed appropriately testosterone can lead to many of the same improvements in women (increased libido, loss of body fat, improved sense of well-being).
Can I start testosterone if I want to continue to have kids?
The use of testosterone supplementation will cause a decrease in your natural testosterone level and sperm production. This can be controlled but you will have decreased chances of conception while on the medication.
Do I have to have injections?
No, there are other ways to administer testosterone to a patient (oral or cream).
Are there alternative medications that can help my symptoms if I don’t want to take testosterone?
Yes, enclomiphene citrate and human chorionic gonadotropin (hCG) or two other examples of medications that can potentially increase your natural testosterone level.
Weight Loss Treatments
What type of weight loss treatments are available?
GLP-1 agonist (semaglutide & tirzepatide), phentermine, phentermine/topiramate, MIC-B12 are all medications that can lead to weight loss.
Will I get sick if I start GLP-1 weight loss medicines?
Typically patients experience nausea, vomiting or GI distress with these medications when either the starting dose is too high or they continue to eat large, infrequent meals. Appropriate eating patterns are discussed during the consultation.
Do I have to exercise or change my diet?
While the medications can cause sufficient weight loss without diet or exercise, adding these lifestyle changes will result in a healthier, more sustainable weight loss. The hope is that the medications can eventually be tapered down (or discontinued) and dietary/exercise changes will maintain the body composition improvements.
Can men and women take these medications?
Absolutely.
How much weight can I lose with each medication option?
Average weight loss over one year on the medications:
Semaglutide – 15% of total bodyweight over one year
Tirzepatide – 15-22% of total bodyweight over one year
Phentermine – 5-10% of total body weight
Phentermine/Topiramate – 10-11% of total body weight
Is there anyone who shouldn’t take GLP-1 medications?
Yes, GLP-1 agonist medications are not recommended for women trying to get pregnant, anyone with medullary thyroid cancer, MENs type II neoplasia, acute pancreatitis or acute gallbladder disease.
Sexual Health Treatments
What type of sexual health medications are available?
Oral PDE5 inhibitors like sildenafil & tadalafil (Viagra/Cialis), bremelanotide or PT-141 for increased sexual arousal, or Tri-Mix or Quad-Mix penile injections
What is involved with a penile injection?
The procedure uses a very tiny needle (smaller than a diabetic insulin needle) to inject the medication into the base of the penis. The very first procedure is performed in the office so the patient can be instructed on how it is performed safely. Patient self-administers thereafter.
Are there any treatments to improve sexual function in women?
Yes, women can potentially benefit from testosterone, bremelanotide, low-dose sildenafil/tadalafil or vaginal arousal creams.
Hair Loss Treatments
What type of hair loss treatments are available?
Typically oral 5α reductase inhibitors (dutasteride), minoxidil scalp solution/foam and medicated shampoos and conditioners make up the cornerstone of hair treatments.
How effective are they?
Hair loss treatments vary in efficacy depending on numerous factors but patients that start treatment in the early stages of hair loss
Are these for both men and women?
Yes
Are there other treatments that can improve hair loss?
Scalp red light therapy, platelet rich plasma (PRP) injections, microneedling, spironolactone, ketoconazole, and hair transplantation are just a few of the many other treatments investigated for hair loss.
Bioidentical Hormone Replacement Therapy (Women)
What does bioidentical mean?
What are the typical symptoms of perimenopause or menopause?
Do women need testosterone replacement?
Will taking estrogen/progesterone medications give me cancer (especially breast cancer)?
No, topical bioidentical hormone replacement has NOT been shown to increase the risk of breast cancer. Even the previous studies suggesting a risk with the use of oral, synthetic estrogen products are under debate. Micronized bioidentical progesterone usage has not been shown to cause cancers.
What are the benefits of hormone replacement therapy?
Estrogen – Improvements in perimenopausal/menopausal symptoms; improved bone mineral density; improved skin/hair/nail health; reduction in cardiovascular events and all-cause mortality.
Progesterone – Protection of the endometrium, potential improvements in sleep and mood.
Testosterone – Improvements in libido, energy, mood, mental clarity, lean muscle and body composition.