Testosterone Replacement Therapy (TRT)

Our clinic offers Edmonton TRT

Our clinic has always offered our male patients natural hormone balancing options.

Although we usually start by balancing Testosterone naturally, some patients need stronger support.

Our clinic's Nurse Practitioner Melisse Smith offers Edmonton a range of Testosterone replacement options.

TRT, also known as Testosterone Replacement Therapy, is the most effective way to substantially increase Testosterone levels. 

In addition to TRT, we work with other Testosterone boosting options such as hCG & Clomid.

Low Testosterone

Longitudinal studies have shown that (total) Testosterone levels fall at an average of 1-2% per year after the age of 30 and prevalence has increased steadily since the 1970s.

Approximately 40% of men over the age of 45 have low Testosterone, however, many of our Edmonton patients have low normal values in even in their 30s.

Our practitioners want values above 8.0 nmol/L (which corresponds to about 300ng/dL - US labs).

For most of our male patients we are shooting for values above 20 nmol/L once a Testosterone boosting strategy has been chosen.

We consider Vitamin A, D and K as well as Mn, Mg, B, and Zinc levels in our Edmonton patients with low Testosterone.

There are many other contributors to low Testosterone: age, obesity, insomnia, sedentary lifestyle as well as heavy metals, tobacco smoke and pesticides / herbicides.

Testing

Testosterone Replacement Therapy with our Edmonton clinic always begins with hormone testing.

Although we work with all hormone testing options (blood, salivary and urinary testing), most commonly we are running blood based panels in our Edmonton patients to assess candidacy for TRT. 

Our standard Testosterone Replacement Therapy panel includes: AM Testosterone, Estradiol, DHEA, LH, FSH and Prolactin

We also measure closely related hormones such as Cortisol, as well as TSH and Free T3 & Free T4.

AM Testosterone - Testosterone follows what we call a "diurnal pattern" with peak levels around 8 am. AM Testosterone is usually tested between 8 - 10 am alongside other AM hormones like Cortisol & Insulin.

Estradiol - Testosterone naturally undergoes aromatization whereby it is converted to Estrogen (Estradiol). To determine the cause of your low T, we want to have a measure of your aromatization. 

DHEA - Dehydroepiandrosterone or DHEA is an androgen that is made primarily in the adrenal glands and testes and is "up-stream" from Testosterone in the steroid hormone cascade. 

LH & FSH - These hormones are secreted from the anterior pituitary and are involved in Testosterone and sperm production respectively. They also give insight as to the cause of low Testosterone levels.

Total serum Testosterone consists of free Testosterone (3%) and Testosterone bound to SHBG (40%) and other proteins like albumin (45%).

Testosterone binds only loosely to albumin and so this Testosterone as well as free Testosterone is available to tissues and is termed Bioavailable Testosterone - which both correlate well with clinical sequelae. 

Blood based TRT testing is the best well rounded approach - blood is the fastest and lowest cost methodology and certain parameters like LH & FSH are only measured in the blood.

Urinary hormone testing has the advantage of providing insight on male hormone metabolites that are not available to be tested via blood in Edmonton through Dynalife.

Salivary hormone testing gives us insight on "free hormone" levels available to the tissues but turn around times are slow and costs are dramatically higher than with blood testing.

Treatment

Although our Naturopathic Doctors often work with herbal and nutritional Testosterone  boosting options, their reliability for large increases in Testosterone is poor.

Consequently, our clinic staffs a Nurse Practitioner who prescribes the following to improve Testosterone levels: Clomid, hCG, TRT and aromatase inhibitors for our Edmonton patients. These different Testosterone boosting therapies are often intermixed on a case-by-case basis.

Clomid - Clomid is a clinic favorite for boosting Testosterone and sperm production reliably. Many of our Edmonton patients using Clomid see large scale, clinically meaningful elevations in Testosterone.

Mechanism of action: Clomid is a SERM (Selective Estrogen Receptor Modulator) that inhibits the negative feedback of estradiol in the hypothalamus which increases LH & FSH release from the anterior pituitary which increases Testosterone and sperm production respectively.

hCG - Yes, that hCG - the hormone secreted by the placenta during pregnancy. hCG has been studied as both a Testosterone boosting treatment on its own, as well as a therapy used during TRT to maintain testicular volume and fertility.

Mechanism of action: hCG is structurally similar to luteinizing hormone (LH) secreted by the anterior pituitary gland and can stimulate the testes to produce Testosterone. Intratesticular testosterone production from hCG stimulates spermatogenesis.

TRT - Testosterone Replacement Therapy typically involves either injections or creams. Our preference is to inject Testosterone twice weekly as it is more cost effective and results in higher serum levels than a daily topical Testosterone although cream may be more beneficial in needle averse patients.

Mechanism of action: Injecting testosterone result in effectively 100% absorption into the blood stream. Our preference is to use Testosterone enanthate in our Edmonton patients which is injected once or twice weekly because of its excellent tolerability and relatively short half life.

Aromatase Inhibitors - This class of medications blocks the conversion of Testosterone into Estrogen. Most commonly our clinic works with Armidex (anastrozole) which can be custom compounded into smaller increments if needed and are regularly used along Clomid & TRT at our Edmonton clinic.

Mechanism of action: Arimidex reversibly binds to the aromatase enzyme and prevents conversion of Testosterone into Estrogen via competitive inhibition. This is also used in men who experience low Testosterone secondary to over-conversion to Estrogen. 

Frequently asked questions

What benefits can I see from TRT?

Most commonly, we are looking for the following: enhanced energy, muscle mass and libido. Mood, cognition, sleep and stamina can also all improve.

How safe is TRT?

When using responsible dosages for physiologic Testosterone replacement, the incidence of adverse effects is extremely low. Current literature suggests that TRT has a neutral to beneficial effect on cardiovascular events, cholesterol, liver health and incidence of prostate cancer.

Changes in PSA (prostate serum antigen), estrogen levels and blood cell counts can occur with TRT but we closely monitor these in our Edmonton patients.

Will TRT affect my fertility?

Testosterone Replacement Therapy can lower testicle size and sperm production. For those interested in maintaining fertility, hCG injections can be used alongside TRT to maintain both. Alternatively, Clomid or hCG can be used to boost Testosterone with favorable effects on sperm production and testicle size.

Does it cost money to do my blood work?

When our Naturopathic Doctors run private testing at Dynalife in Edmonton, there are out of pocket test costs involved. However, if our Nurse Practitioner is involved in your care for our TRT program, the blood work should mostly be covered through Alberta Health.

What costs are involved?

Costs to see any of our practitioners, including our Nurse Practitioner for TRT are $265 for the initial consultation and $165 for follow up visits.

Exact costs for treatment depend on form of therapy chosen (eg. injections vs. cream) as well as simultaneously used treatments (eg. hCG along with TRT). This will also differ depending on your medical benefits and the pharmacy used - we typically work with two different compounding pharmacies in Edmonton. 

Questions about TRT?

Call Us
(780) 757 8378