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New to Testosterone Replacement Therapy? Your TRT Questions Answered.

By Dr. Jason Leep
September 21, 2021

What’s better than helping someone live their best life? 

That thought strikes me every time I begin hormone restoration therapy on a new patient. I am excited to begin a conversation when asked about the subject, and am eager to dispel myths and shed some light on the subject of hormone therapy. Testosterone replacement therapy or (TRT) is not a new concept, but it takes some research to figure out what questions to ask yourself to see if you’re a candidate, and if hormone restoration is right for you and your lifestyle.  

How did it start? 

Synthetic testosterone was first produced in the mid 1930’s and was awarded the Nobel Prize in 1939 followed by scientific and commercial interest. TRT began with an article in Journal of American Medical Association in 1944 called "The Male Climacteric'' where two internists from Detroit, Carl Heller and Gordon Myers, showed that some aging men develop symptoms attributable to hypogonadism. Climacteric meaning the period in some men's lives that has been compared to female menopause associated with declines in hormones such as testosterone, today may be commonly referred to as Andropause. The symptoms include depression, impaired memory, easy fatigability, and loss of sexual drive. Heller and Myers also showed that in men with the climacteric, symptoms and gonadotropin levels reverted to normal with administration of testosterone. Satisfactory therapeutic results were obtained by intramuscular injections of testosterone propionate and by implantation of testosterone pellets, but not by the oral or sublingual administration of methyl testosterone.

Why do I need testosterone? 

The Biological effects of testes and testosterone are known since antiquity and with the advent and scientific use of testosterone its effects became better understood, and symptoms of a hormone deficit established. Reduced sex drive, erectile dysfunction, loss of lean muscle mass, fatigue and low energy, obesity, depression, difficulty with concentration and focus are a few of the more common symptoms experienced with low testosterone levels. 

How did Testosterone Replacement Therapy for Men (TRT) start?

Fast forward to modern times, in 1990, clinicians assembled at a workshop sponsored by the FDA, and came to the conclusion that the major goal of therapy is to replace testosterone levels at as close to physiologic concentrations as is possible and demand that new testosterone preparations better suited for clinical use be manufactured. Testosterone first became available as pellets, then injectable, starting with testosterone propionate with short half-life, and then testosterone enanthate with a long half-life. These preparations remain as the major preparations for testosterone therapy worldwide. Because of its “first pass” effect by the liver, oral preparations fell out of favor and are generally obsolete. Transdermal gels and patches became available as effective alternatives by 2000. 

But what about testosterone and prostate cancer?

In 1941 a researcher, Huggins C, posted a warning about testosterone influencing prostate carcinoma that induced a general fear of testosterone especially among urologists. Only recently it became clear that neither endogenous testosterone levels nor testosterone treatment have an impact on prostate carcinogenesis. 

How do I find out if I have low testosterone?

Many symptoms may be tied to low testosterone (Low-T), and total blood testosterone level is the most important measure for testosterone deficiency. This can be checked with a blood test, and along with a medical visit, health history, and physical exam, you and your healthcare provider can determine if testosterone replacement therapy is an option for you.

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I began my medical experience accompanying my Father on house-calls to his elderly post-op patients in rural northern Michigan during mid-winter snowstorms. The virtues of a small town Doc were instilled in me with these early experiences, and I often reflected upon those during my residency in Rural Family Medicine at University of Kansas Medical Center. 

While fostering an interest in preventative medicine, anti-aging and minor procedures, I was exposed to a wide variety of medical industries during my training. After completing my residency and becoming board certified in 2012, I began my professional career as Medical Director of a small town Urgent care in Wisconsin where I advanced painless techniques for fish hook removals. Fostering a growing passion for medical aesthetics, I relocated to Denver and founded Willpower Medical & Fitness and Altitude Aesthetics, focusing on anti-aging and regenerative medicine. Today, I specialize in advanced medical aesthetics, bioidentical hormone replacement through my practice, 406MD in beautiful Whitefish, Montana, and hold medical directorship for skilled nursing facilities, and co-founded a membership based health care co-op called Core Healthcare. 

I continue to follow the progression of medicine and apply what I've learned to help enrich and improve the lives of my patients. With a wide variety of Family Medicine and Urgent Care practice experiences, medical director positions, and business management, I have enjoyed the role and responsibility of improving efficiencies, patient satisfaction, safety, and providing feedback and guidance for multiple industries within the field of Anti-aging Medicine.

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