Best Testosterone Book Free for Download

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Nelson Vergel, a well-known author of men’s health and hormone books, has published his fourth book called Beyond Testosterone. This TRT book not only covers 10 years of knowledge about testosterone replacement but also about best ways to use thyroid treatments, peptides, nandrolone, supplements, hCG in men, estrogen blockers, ED medications, Trimix injections for ED, and much more.

Nelson Vergel holds a chemical engineering degree and an MBA. After a HIV diagnosis over 33 years ago, he explored therapies to reverse wasting syndrome to save his life and those of his peers, leading him to co-author “Built to Survive: The Clinical Use of Anabolic Steroids for HIV+ Men and Women”,” a book that became the leading wasting treatment guide in the HIV field. He has been a member of several NIH and pharmaceutical advisory groups, and FDA review panels. Nelson also founded the Body Positive Wellness Clinic and Program for Wellness Restoration in Houston, providing health education and services to HIV+ people. To expand help to the general population, he wrote the popular testosterone book “Testosterone: A Man’s Guide” and created ExcelMale.com and DiscountedLabs.com to provide men’s health education and access to affordable blood testing. His latest project aims at improving access to testosterone and hormone replacement treatments around the world by providing the largest physician directory in the world (HormoneClinicNetwork.com)

In this free 386 page illustrated Beyond Testosterone book, you will learn key information about:

  1. Testosterone Basics & Questions
  2. Testosterone Side Effect Management
  3. Clomid for PCT, fertility or low T
  4. When Testosterone Is Not Enough
  5. Blood Test Discussion
  6. Important Testosterone Blood Test Articles
  7. Testosterone and Men’s Health Articles
  8. Prostate Related Issues
  9. Resources and Suppliers
  10. Questions for Specific Doctors & Experts
  11. Expert Interviews
  12. General Health & Fitness
  13. Workouts & Routines
  14. Health & Wellness
  15. Nutrition and Supplements
  16. Mental Health
  17. Thyroid, Cortisol, DHEA, Prolactin, and others.
  18. General GH Peptide Use & Information
  19. Clinical Use of Anabolics and Hormones
  20. HRT in Women
  21. Información de Testosterona
  22. Doctor and Clinic Reviews
  23. Compounding Pharmacy Product Reviews
  24. Supplement Reviews
  25. Blood Testing Company Reviews
  26. Book Reviews
  27. Gadget and App Reviews
  28. Other Men’s Health Product or Company Reviews

DOWNLOAD BOOK HERE

The TRT book contains the best of ExcelMale.com, one of the largest and best-moderated testosterone forums on the Internet (started in 2011) focused on increasing health, potency, and productivity in men who are considering or already on testosterone replacement therapy (TRT). With over 39,000 members (as of April 2020) that include educated men, physicians, pharmacists, dietitians, exercise trainers, nutritional supplement experts, and other professionals in the field, ExcelMale is fast becoming a leader in the TRT forum education field.

ExcelMale forum topics range from basics on testosterone replacement therapy (TRT), how to manage TRT related side effects, Trimix injections for ED, HCG use for better fertility and libido, estradiol management in men, thyroid function optimization, growth hormone peptide information, exercise routines, best supplements for men, high protein diets, mental health, HRT for women, and much more.

The site also provide men’s health information via interviews with experts, videos, and webinars. Last but not least, Excel Male members share their reviews of testosterone and hormone replacement clinics and doctors, compounding pharmacies, pharmaceutical products, supplements, and much more. ExcelMale.com moderators review every post daily to detect spammers or abuse, so ExcelMale is a safe environment for all men. And since every man wants to help important women in their lives, the site does not neglect female health information as it includes a folder called “ExcelFemale” to post the latest on HRT in women.

There are several testosterone books out there. What makes this one so different is that it is written by Nelson Vergel, a 33+ year HIV and cancer survivor that discovered in 1993 that testosterone could save him from wasting syndrome and death. Since then, he has been his own lab rat as he worked with research groups, doctors, compounding pharmacies and pharmaceutical companies to evaluate all available testosterone replacement therapy (TRT) options (gels, injections, pellets, etc) as well as products to reverse and minimize side effects of testosterone (HCG, anastrozole, and others).

For men considering testosterone replacement therapy (TRT) who enjoy illustrations to educate themselves, this book is required reading. TRT is currently be taken by millions of men, and millions more have the diagnosis of hypogonadism (low testosterone) that will have a better quality of life on TRT. In general, men hate going to a doctor and are even more hesitant to discuss or ask questions related to their sexual performance. Nelson Vergel’s newest book, Beyond Testosterone, approaches these subjects in a friendly and informative manner. This book provides the bare-knuckles’ how-to tips on the treatment of male hypogonadism. The book states how to maximize benefits while minimizing any side effects. And the book is written by someone with over three decades of personal experience. This makes the book that more valuable. Nelson deeply cares about men’s health. It is more than a passing interest. For him, it is a matter of life and living.

For more information : Testosterone Tests and Articles

Erectile Function Optimization: Interview with Nelson Vergel

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testosterone podcast Paul Nelson

Transcript from the “How is it Hanging” podcast by Paul Nelson.

Paul Nelson:                       This podcast is meant to start important conversations about medical health. In no way is this to replace a face-to-face discussion with your healthcare professional.

Paul Nelson:                       Hello, and welcome to How’s it Hanging? I am your host, Paul Nelson. We’re recording here in the heart of Midtown Manhattan. I’m sitting here on a beautiful sunny day with our wonderful producer, Shannon. Having a great time here.

Paul Nelson:                       Listen, we have a question now from Ben, age 36. This is really common guys, especially you guys at the gym, I want you to listen to this. Ben writes, “My wife and I have been trying to get pregnant for a while now. I just found out that the testosterone I was using to help me in the gym has killed my sperm production. What can I do? Did I just ruin my chance to be a father?” Ben, one of the things that nobody seems to know or tell, I don’t know how this happens, but yes, if you take testosterone in any form, it means your body no longer produces it. That means that essentially your testes, they shut down. So if you are taking testosterone cream or supplements, your balls stop working, and that means no more sperm. Now, I need you to go to a specialist, a reproductive endocrinologist, or someone who’s working in men’s fertility, and you can, we hope, get things back on track.

Paul Nelson:                       First of all, we have you taper off the testosterone and they start giving you a drug called Clomid. This is an interesting drug. It measures estrogen in your blood to tell your pituitary to start telling your balls to make more sperm. The good news is, we can usually get your sperm counts up so that you can become a father. The bad news is, you are going to feel not quite as good on the Clomid as you did on testosterone.

Paul Nelson:                       Here is what I would like you to think about. If it works, I don’t know you or your goals or anything, but let’s say you really, really, really need to be on testosterone so you can feel good, and be healthy, and all those other things, what I would recommend talking to your doctor about, again, this is with your doctors consent and permission and involvement, you’re on the Clomid. We get your sperm counts up. Everything’s good. I want you to bank your sperm, bank more sperm, a year supply, more than you’ll ever dream of needing. Then you can go back on testosterone, and it doesn’t matter what your sperm counts are because you got a whole bank full of sperm waiting to make you babies.

Paul Nelson:                       This is a bit of a surprise for couples. This can be shocking. It can be disappointing. There can be a lot of blame. There can be a lot of shame. It can be a lot of, “I should have known better.” This is why we tell guys, “Don’t screw around with testosterone on your own.” It needs to be done with a doctor. Don’t go to GNC. Don’t go to China. Don’t go to India. I can’t say that enough. But the good news is, there is hope.

Paul Nelson:                       Now on this episode, we have one of the world’s experts on testosterone. That is not at all an exaggeration. His name is Nelson Vergel. He’s at discountedlabs.com, because he has made it his life’s mission to help men who are struggling with low testosterone. He has done an amazing job of taking all the medical information and putting it in layman’s terms. He is a wonderful personality, a warm human being and somebody that you would just really want to listen to. Welcome, Nelson. Let’s figure this out, and Nelson just before I let you say anything, I remember I emailed you in 2010.

Nelson Vergel:                  Yeah.

Paul Nelson:                       You were nice enough to send me your book on testosterone.

Nelson Vergel:                  Well, I was a fan of yours, too, because your site was there already.

Paul Nelson:                       Right. I had just started Frank Talk. You’re right. I had just started Frank Talk and I needed help, and information, and resources, and you were so kind to this goofy guy just starting out, so I’ve been a fan of yours ever since. Our guest is Nelson Vergel, a renowned expert in a whole lot of areas, but I’m going to let you talk about yourself. To introduce, tell us who you are, and why I’m in awe of you. How’s that?

Nelson Vergel:                  No. Knowing you, you will say, “Who is this guy writing about implants, what are these penile implants.”? Wow, this is edgy stuff, and I loved it. You also have a lot of great info on ED. I was already following you. I was writing my book and doing my other stuff, so I learned a lot from your work. I’m more than honored to be here with you. You broke ground before this topic was even a hot topic. Well, me, I’m obviously from the accent you hear, I’m from Venezuela, South America, been here forever, like 30-some years.

Nelson Vergel:                  Really, I’m a chemical engineer that left my career with oil and gas in the early ’90s, because I was dealing with something very horrific called HIV, and I thought I really didn’t have much time to live, so started to work with wasting. I was losing lean body mass, weight and wasting away, like they say, and found out that hormones, testosterone in particular, and nandrolone, which is another FDA-approved hormone product, really was able to reverse the wasting syndrome in people with HIV. That would buy us time, because wasting was killing us before anything else was, and that was back in the dark days of education.

Nelson Vergel:                  Yeah, I became obsessed with this. I put on 35 pounds after losing most of it before, and looking good again, and living again. I was able to extend my life to the day that the new medications came in and became, basically, a preacher of a program. I called it Program for Wellness Restoration. I created a nonprofit called PoWeRUSA, powerusa.org, to basically teach doctors how to prescribe these hormones for people with HIV that needed them to survive. That’s how I started with all this work back in the early ’90s, wrote a book called, Built to Survive, which describes the program for HIV. Then things got better with HIV, obviously, thank God, I’m here. I’m 61. I’m 37 years into this disease.

Nelson Vergel:                  I started getting emails from non-HIV, straight males and women, too, saying, “Hey, Nelson, I’m not HIV-positive, but do I have to be HIV-positive for you to help me out?” Wow. Wait. No, no, no, you definitely don’t have to. I started thinking, “Wait a minute, people are really requesting information from the non-chronic illness world.” That’s how I started working in men’s health. I wrote a book called, Testosterone, I mean, it’s a guide, and found that ExcelMale.com, which is a forum where men and some women go in to ask questions about testosterone, exercise, nutrition, supplements, peptides, HCG, erectile dysfunction, and much more. I send people to your site for penile implants, for sure, because that’s a topic that I really don’t cover. You’re the expert of that.

Nelson Vergel:                  Now I have a company called DiscountedLabs.com. I provide the lowest cost lab tests that you can buy yourself without a doctor’s visit anywhere in the United States, and starting other networks, creating an international directory of hormone clinics that treat men and women.

Paul Nelson:                       No, that’s right. There are only about 14 different discussions we can have about everything you just said. A question, the discounted labs, so if I’m a guy on the street, and I’m like, “I want to find out if my testosterone is where it should be,” I go to you? What do I do?

Nelson Vergel:                  DiscountedLabs.com, create a profile there, find out what the closest lab location is to you, which, there’re over 2000 locations, and order it. It’s under $50 to find out what your testosterone blood level is.

Paul Nelson:                       I don’t need a prescription? No prescription?

Nelson Vergel:                  No, no, no. We provide the doctor’s prescription, so you don’t have to go see a doctor, so you save the doctor’s visit. You go, and we basically email you the results a few days later, and you can tell whether or not you have low testosterone before you go see a doctor. Some people email me and say, “Nelson, my results came out low. Where do I go?” I do have a network of physicians that I refer people to.

Paul Nelson:                       Okay. That’s fascinating, right. If I’m right, the family doctor doesn’t have much training about testosterone treatments, does he?

Nelson Vergel:                  The only training they get is from pharmaceutical reps.

Paul Nelson:                       Right. Your family doctor, who’s the first line of defense in dealing with this, really doesn’t know much more than the average person, other than-

Nelson Vergel:                  Don’t blame him, though. It’s not their fault. I mean, they’re busy people, but also medical school back in the day… so now it’s different, now it’s getting better… they used to say, “Don’t give anybody testosterone, hormones, because of cancer, prostate cancer.” But now, obviously, we have good data that shows no-

Paul Nelson:                       Exactly.

Nelson Vergel:                  … it was a myth, and also the cardiovascular risk is a myth. Now I see more and more medical schools teaching it. But no, most of these doctors, and I don’t blame them, because this was not part of their education. The only education they’re getting is from maybe an AndroGel rep or a Testim rep. There are 12 pharma-brand products, mostly gels and creams. The injectables are generic, so there’s not a pharmaceutical rep walking in if we’re injectable. A lot of this information has evolved, but yet that’s why I just published, I indeed mentioned that, a free book for doctors and patients, Beyond Testosterone, that you can actually download for free on beyondtestosterone.com. It’s over 300 pages. I say, “Screw it. I just want to give this out, man.”

Nelson Vergel:                  There’s so much misinformation out there. I mean, it took me two years to read all these papers. I’m putting them in graphic format. Hopefully, I can make a little bit of a difference, cause there’s so much suffering out there. I get guys on my site, saying they’ve been struggling for five years, and their testosterone is 350, and their insurance company doesn’t want to pay, because it’s borderline. I mean, there’s so much suffering. We can talk about that. I mean, obviously, I can talk about this forever, but-

Paul Nelson:                       Right. I just want to repeat that beyondtestosterone.com is where anyone can go to download your free testosterone book. I’ve downloaded it. It’s really cool. It’s highly graphic. What should I say? Mostly graphics. It’s very accurate. I’m really impressed, really accurate medical data. You mentioned, quickly, I just want to repeat the idea, not long ago, just a couple of years ago, and there are still doctors who believe testosterone treatment replacement therapy will cause heart attacks, cardiovascular problems. They think it will cause prostate cancer. There was all this bad data. There was no medical science. It was just mistaken beliefs. We now have the data that testosterone improves heart health. It improves vascular function. In fact, if your testosterone is low, you are at more risk for cancer, heart disease, diabetes, obesity, all these, high cholesterol, all these life-threatening conditions.

Nelson Vergel:                  Yeah. I may get prostate cancer, usually in old age, when their testosterone is low.

Paul Nelson:                       When their testosterone is low, they’re a higher risk for prostate cancer. For years, it was the opposite. We were being told the opposite.

Nelson Vergel:                  Now they’re using on some guys, depending on their cancer, high doses of testosterone to treat their cancer. Bipolar treatment, it’s called now. That’s a new thing that has come in the past three years. It’s completely debunking all those fears and myths.

Paul Nelson:                       For years. Yeah. I want to tell anyone who’s listening. There are still doctors out there going under misguided old information, correct?

Nelson Vergel:                  Many doctors, yeah. They don’t go to urology conferences. You always hear, in the urology conference, you know what I’m talking about? Urology conferences now have one or two days devoted to testosterone. Urologists really onboard now. Endocrinologists are falling behind, and they must be treating diabetes and all that. Most people think endocrinology, which is hormone doctors, really are the experts on testosterone replacement or even HRT, but, no, it is the urologist,

Paul Nelson:                       It’s the urologist, right. If you want to go to a doctor, go to an urologist, go armed with your labs that you guys have done at Discounted Labs.

Paul Nelson:                       Let’s go over some of the sexual symptoms of low testosterone or borderline, just suboptimal. I like the word, suboptimal, because you may be at a number that’s perfectly good for someone else, but for you, your number should be 800, not 400, or not 300. Right?

Nelson Vergel:                  Yeah. We talk a lot about testosterone, and sex, or libido, or eating, but really I want to talk about testosterone and coping. Coping, meaning how you deal with stress, how you deal. The first thing that, really the most benefit that you get from testosterone, obviously, more sex drive. There’s good data on that. When it comes to erectile function or dysfunction, there is contradictory data. It seems like the younger guys that have low testosterone get the most benefits when it comes to erectile function. Older men, with a lot of what we call comorbidities, high blood pressure that is, tend to be more complicated. Given testosterone, they may not see the benefits, all the erectile function, but yes, erectile function, fatigue.

Nelson Vergel:                  The way we handle stress, that’s the first thing I hear from guys like, “Wow, I didn’t know that things, I was overwhelmed easily by, at work or with my relationship, and now, I’m like bringing it home, man. Bring it on.” That’s really, and I tell people, we talk a lot of testosterone and sex and all that, but really it is testosterone and cope, coping with stress, dealing with all the day-to-day stuff. That makes you not only happier, it makes you actually hornier, too. You perform better in bed when you’re in control of your life. It’s not only a sexual thing, it is really coping.

Nelson Vergel:                  I know I sound like I’m a broken record, because it made a difference for me. I mean, when I had low testosterone, back in the horrible days, I couldn’t even process information. I couldn’t talk to my doctor. I couldn’t advocate for myself. I was like a doormat. Eventually, obviously, people see the difference, and sometimes that can cause problems. If you’re with somebody that is used for you to be a doormat, and now you’re not, that’s when it get… I get emails about that. How do I deal now with how I-

Paul Nelson:                       I had one patient who put it this way. He said, “Low testosterone, I lost my warrior mojo.”

Nelson Vergel:                  There you go. Perfect.

Paul Nelson:                       I thought that was really good. He wasn’t ready to fight in business at work, even the lawnmower. He wasn’t ready to do battle in any part of his life. This idea of “I feel virile, I feel strong, I feel capable,”  I feel, that was all gone.

Nelson Vergel:                  Well, you also feel more assertive.  You want to initiate sex and actually be the best stud you can be in bed when you’re with your partner. It really has a connection. It cannot only be explained by the effect of the hormone on the receptors, on the androgen receptors, and on libido itself, but there’s more and more beyond that. Nobody has really studied that side of testosterone. But as I say, obviously, when you have low testosterone, it’s basically you can lose lean body mass, increase fat, less cognitive capacity. Obviously, you probably don’t even sleep as well. You wake up a lot in the middle of the night. You, as I said, just malaise. You feel like you’re older than you really are, body aches, all the other stuff.

Nelson Vergel:                  There’s probably 30 different symptoms, but most people talk about sex drive, erectile function, and that’s about it, when in fact, we have a lot. Like you said, you have low testosterone, you have a higher risk of cardiovascular disease, higher risk of cancers. I mean, on and on. People with diabetes, if you have high blood sugar, if you’re overweight, we’re sitting on our butts most of the time. Now a lot of us are working with computers and office-based, so we’re not getting enough sun. We’re really walking away from our natural state. We’re paying the price. We’re being exposed to plastics and toxins in the environment. We’re really are, and our foods are very highly processed. Really the new man, and there’s data already showing that our fertility rates are going down, the sperm quality is going down. That’s why it’s becoming a subject now.

Nelson Vergel:                  We are really, in the United States, we are lucky. We are advanced. I know people keep trashing our medical system. Obviously, we have a lot of issues with insurance and costs of medical care, what we have here, we have a parallel system where there is a cash-basis system and an insurance system. And people say, “Well, my insurance will not pay for my treatment, even though I have symptoms.” It’s also maybe 350 or 375, some insurance consider that anything above 320, 340 or even 280 in some cases, is grounds for treatment. If you’re under that, even if you have all the symptoms, it’s not. I tell people, I say, “Well, let go of that.” The cash system, which many clinics are cash-based, we have compounding pharmacies where you can get products at a 10th of the cost of pharmaceutical products.

Nelson Vergel:                  There is another way to get treatment that may not be as frustrating. Yes, if your insurance pays, so your doctor prescribes, more power to you. But do not get frustrated by the fact you have no access to treatment because of a single number that your insurance may deem that doesn’t qualify you. The only problem I’ve seen with insurance companies is that they are making deals with different companies. They may cover AndroGel, but they don’t want to Testim. They don’t want to cover the injections. They just have deals going, pricing deals, so that you are only stuck with one option. There really are about 18 options out for testosterone treatment.

Paul Nelson:                       Wow. Okay. A quick question. Do you have a way, a question that you help guys figure out the libido? For example, I’ll ask a guy, I said, “If I’m talking to a 40-year-old man or a 35-year-old, man, I’ll say, “Remember, you were 18, your sex drive, your curiosity, interest in sex. If it was a 10 back then, what would it be now?” It’s like when they can compare. But do you have any better way of saying to a guy, “Tell me about your libido”?

Nelson Vergel:                  I would never say that because we’re never, ever going to be a teen again, never.

Paul Nelson:                       No. I won’t get back to 18, but if you’re a two, compared to 10?

Nelson Vergel:                  Maybe in ten years with good stem cells, who knows? I mean, we may be lucky to be alive, because I do believe that’s coming. There’s actually stem cell treatments for generating [inaudible 00:19:50] cells and all that. I tell people, “Remember when you used to be the best you were?” I mean, that’s sometime in our 20s, sometimes in our 30s, too, years with you where you have your self-confidence, your sex drive. The first thing I do, I do ask, because that’s a personal question. I do coach. I coach some guys on the phone sometimes I will. But I ask them, “When you get up in the middle of the night to pee, sometimes at 4:00 or 5:00 AM, do you have an erection? Do you wake up with an erection?” If they say, “No,” you know there’s a problem there. That is the most important erection to have.

Paul Nelson:                       Right.

Nelson Vergel:                  Not the erection that you have with your partner, because there may be psychological symptoms there, or you’re not really attracted, or whatever it is psychological, but the non-psychological erections, the erection that has nothing to do with your mind, is the most important. Because the body, really, in the middle of the night is flushing your penile tissue. That’s tissue that is hanging there all day, basically kind of soft and not really being fully flushed, there’s no blood flow, as much. In the middle of the night, we have a burst of testosterone, a burst of growth hormone, a burst after melatonin increases. Melatonin is, basically, the hormone that we get, makes us feel sleepy when the actually sun comes down, melatonin goes up after. After that melatonin rush, we start having those rushes of testosterone form.

Nelson Vergel:                  It really all coincides around 5:00, 6:00 in the morning. Most of us are getting up to either pee or getting ready to. When you are not waking up, no matter how old you are… you’re in your seventies, maybe it’s different… but you should have at least a hard or semi-hard erection at that time. If you’re not, your plumbing is suffering. Something is just not right.

Paul Nelson:                       Something’s wrong.

Nelson Vergel:                  That’s the first thing that people see when they get their testosterone to the normal upper range. That is relative, by the way, what’s normal and optimum for me may not be for you. I used to be drawn a little high, like 700, 800 nanograms per deciliter. You don’t want to run testosterone way too high, because obviously, there are side effects like increased rate of cells and viscosity of the blood. That definitely is a cardiovascular related-risk. Blood pressure increases, water retention, so you want to be in an optimum range that you feel good and yet you’re not having all those side effects. Obviously, there’s a lot more of that in my book.

Nelson Vergel:                  I’m digressing, but really the first question, the main question is, are you seeing, are you feeling like you have an erection? It doesn’t have to be all the way, 100%, when you get up first thing in the morning, when you get up to pee early in the morning. If they say, “No,” that really my main-

Paul Nelson:                       That would be a first physical and early physical symptom of low testosterone, possibly?

Nelson Vergel:                  Yes, yes. For sure.

Paul Nelson:                       That’s interesting. Nocturnal erections and morning wood, if those have disappeared, something’s going on.

Nelson Vergel:                  Yeah. Some people say, “I have morning wood, but I cannot get a full erection with my wife, my girlfriend.” Says, “Okay, now we can talk about something else here.”

Paul Nelson:                       We know that you can get an erection. It’s just that situation, you can’t. That’s fascinating.

Nelson Vergel:                  Women, society, there’s so many factors. Some people think it’s all about testosterone. No. We also have to have proper thyroid levels, as they work all together. It’s an orchestra. People think the main factor here is testosterone. They obsess. Now their biggest obsession in the past few years, I think, estradiol. We’re not going to get into that, because that will take us probably two hours. I’m faced with getting more and more data that estrogen is good for men. Obviously, we don’t want to have too much estrogen. We have estrogen for a good reason, like women have testosterone for a-

Paul Nelson:                       Testosterone for a good reason. Yes. There’s a women’s practice conducted with Maze Health where I work, and we often have to give women testosterone because their libido is gone. Women, yes, need to have testosterone levels as well. And yes, men need estrogen levels. Absolutely.

Paul Nelson:                       Listen, Nelson, I could talk to you all day about that. You’re fascinating. You are an absolute font of information.

Nelson Vergel:                  Thank you.

Paul Nelson:                       If guys go to beyondtestosterone.com, they can get your book, and they can download it for free. Do people contact you directly? Do you do coaching?

Nelson Vergel:                  Well, everything is in that book. It’s 300 and some pages for a good reason, because I provide every resource possible. I provide information on how to get, where to get it, how to get tested, where to get the syringes, where to get, I mean, suppliers. I literally, I put my heart and soul on this book, and I decided not to make money on this book, because I don’t know, man. Maybe I still have those days from HIV where I think I’m going to die and I want to leave something behind. But I really think… and I’m not promoting it too heavily, because obviously I’ve only had like 3000 downloads, I was expecting more in the last two months… but really everything is there. Not only that, I have live links, which that’s why I haven’t made it a real book on Amazon, because I want people to be able to click on the links that I show them where to get stuff, new resources.

Paul Nelson:                       Perfect. Perfect. Perfect. So basically, any question we can come up with, with testosterone, you’ve probably answered it in your book, which we can get for free.

Nelson Vergel:                  There are 11 years of information.

Paul Nelson:                       Wow.

Nelson Vergel:                  Obviously, I wrote my last book 10, 11 years ago. Instead of writing a book, I said, “Well, I could write an update,” but actually, you have to definitely read this book while you’re on your phone, the phone is kind of hard because it’s a lot of graphics, on a desktop because that way you see, you click on different links. I have over 400 links on suppliers, clinics, reviews of performance. I made it really for somebody that is on their desktop. I did all the research. I really am hoping for comments. I mean-

Paul Nelson:                       No, this is-

Nelson Vergel:                  … maybe I missed something, but I don’t think I have missed anything. I actually, probably, have too much information, but at least I show it in a graphic format so that if anybody is struggling, because there’s so much information out there, so much misinformation. You can click Google, testosterone treatment, oh my god, crazy stuff out there, and people really taking advantage of people. I warn people. This is me again, as an activist, there are many clinics out there that should not be in business. I’m not going to mention any, I’m not here to do that, but there’s a lot of abuse in this. There’s a lot of snake oil sales. People are buying testosterone boosters. They don’t work. They’re spending big bucks. Amazon has like a thousand testosterone boosters, and all of them have five stars, the reviews.

Paul Nelson:                       They just don’t work. Listen, I mean, I need to let you go, because you’ve given us so much time and so much information, but I can’t thank you enough. Your book is a huge resource, and I’m sure it’s going to start exploding you with downloads, because this is such important information. It’s BeyondTestosterone.com, where you can get his free book. If you have any questions you can email us at how’[email protected] Nelson, I can’t thank you enough for being with us today.

Nelson Vergel:                  Thank you, Paul. I’m a big, big fan of yours.

Paul Nelson:                       We’ve got a mutual admiration society going here. Listen-

Nelson Vergel:                  All right.

Paul Nelson:                       … thank you so much. Take care.

Download “Beyond Testosterone” book here.

High Blood Pressure and Water Retention on Testosterone ( TRT )

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trt testosterone blood pressure

High blood pressure or hypertension is a serious medical condition that can go undetected because it often has no symptoms.  It’s referred to as “the silent killer” for this reason.  High blood pressure can cause heart attacks, strokes, headaches, ruin your kidneys, erectile dysfunction and shrink your brain.

Before you start testosterone replacement TRT, it is very important to get your blood pressure under control. This is done through diet, stress management, lowering your salt intake or the use of blood pressure medications. TRT can increase water retention and blood pressure during the first weeks of treatment. It is a good idea to invest in a home-based blood pressure machine. One usually can be purchased at most pharmacy chains and cost under $ 50. Some, like the OMRON HEM-780, can measure blood pressure easily and keep track of changes with time. Take measurements twice a day until you gain control of your blood pressure again.

Testosterone increases extracellular water ECW. Testosterone acts directly on the kidney, because androgen receptors are expressed in renal tubules. There is evidence that androgens stimulate the expression of the angiotensinogen gene in the kidney, providing a potential mechanism of sodium and water retention by testosterone. This retention can increase weight and blood pressure during the first weeks of TRT. A high proportion of red blood cells (hematocrit) caused by TRT can also increase blood viscosity and blood pressure. High hematocrit can be managed by blood donations.

It is important to have your blood pressure measured during the first month of treatment to ensure that it does not increase with testosterone. The good news is that replacement doses are much less associated with this problem. More serious risks for hypertension are associated with the high testosterone doses associated with performance-enhancing use.

Edema-related swelling is one of TRT’s most troublesome and hard to manage side effects. It can occur to about 20 percent of older patients with comorbidities. The potential causes could be cortisol build up, increase sodium retention, in rare cases high estradiol, or cardiovascular issues..

Most cases of lower extremity (peripheral) edema have nothing to do with estradiol and a lot to do with cardiovascular issues. An important suggestion if edema does not get better after a month on TRT is to get a full cardio workup by a cardiologist.

Some men report decreased edema after a short cycle of a diuretic like HTZ, so that is something to explore. Low sodium intake and plenty of water plus cardio may also help. Cardio exercise and sweating in a sauna have also been reported to help. But these are speculations that should not replace a good cardiovascular work up.

Pulmonary hypertension caused by sleep apnea has also been reported as a cause of edema while on TRT.

Obstructive Sleep Apnea Associated with Leg Edema

“A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, loud snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram.”

edema[swelling] what is the cause

Ankle swelling after starting testosterone injections

How many of you are on Diuretics for water retention on TRT? 

Here are excerpts from an interesting paper:

“This is the first controlled study demonstrating that testosterone increases extracellular water (ECW). Previous data concerning the effects of testosterone on plasma volume and urinary sodium excretion are limited and conflicting. The underlying mechanism is unknown, but several possibilities exist. Testosterone could act directly on the kidney because androgen receptors are expressed in renal tubules. There is evidence that androgens stimulate the expression of the angiotensinogen gene in the kidney. Therefore, androgens could activate the local renal RAAS to stimulate sodium and water retention through an autocrine or paracrine mechanism. The epithelial sodium channel plays an important role in the sodium balance, as demonstrated by genetic abnormalities in its activity, such as in Liddle’s syndrome. It has recently been reported that androgens increase mRNA expression of the alpha subunit of the epithelial sodium channel in a human renal cell line, providing a potential mechanism of sodium and water retention by testosterone.

Plasma aldosterone levels fell significantly during testosterone treatment, whereas a modest fall, which failed to reach significance, occurred during GH treatment. During combined treatments, a significant fall in Aldo was also observed. The uniform trend toward a fall in Aldo levels observed with single and combined treatments suggests an adaptive response to ECW expansion. The observation that the fall in Aldo was greater in the presence of testosterone suggests that additional androgen-mediated mechanisms are probably involved. Androgen receptors have been identified in human adrenocortical cells and appear to exert an inhibitory influence. In vitro studies have demonstrated that testosterone reduced the proliferation of human adrenal adenoma and adrenocortical cancer cell lines (38). It is possible that testosterone directly suppresses Aldo biosynthesis or secretion, but this remains to be demonstrated.
More on aldosterone

The effects of testosterone on the volume and distribution of ECW could theoretically occur secondary to aromatization to estrogen in peripheral tissues. Estrogen may cause fluid retention through reduction of the plasma antidiuretic hormone (arginine vasopressin)-plasma osmolality set point (39, 40) or stimulating the synthesis of hepatic angiotensinogen (41), enhancing the overall activity of RAAS and leading to sodium retention. However, this postulate is not supported by the observation that urinary sodium excretion is increased during oral contraceptive use (42) or that the plasma renin concentration is reduced in women receiving estrogen treatment (43). Moreover, estrogen reduces the plasma renin concentration, the activity of angiotensin-converting enzyme, and the Aldo response to angiotensin II. These actions of estrogen putatively generated from aromatization of androgens could explain the slight reduction in plasma Aldo levels in response to testosterone in our study.” Source

Men on TRT notice that they hold more water when they eat higher sodium foods, drink alcohol, and skip the gym for more than 3 days. Higher simple carb intake also worsens water retention.  Not drinking enough water also makes the body retain water.

NOTE: Some natural ways to decrease blood pressure are decreasing your salt intake, exercising, keeping a normal body weight for your height, managing stress, and engaging in meditation and yoga. “Erection- friendlier” blood pressure medications like ACE (angiotensin-converting enzyme) inhibitors, renin inhibitors, ARB’s (angiotensin II receptor blockers), and combinations of them may be required for men who cannot maintain a blood pressure reading under 130/80 mm Hg. Diuretics, beta blockers, and calcium channel drugs used for hypertension may cause sexual dysfunction in men, but sometimes they cannot be avoided if your blood pressure cannot be controlled with ACE inhibitors or ARBs alone. Bu some studies show that blood pressure medications may be one of the main drug-induced reasons for erectile dysfunction. But managing ED with drugs is a healthier choice than allowing high blood pressure to go untreated due to fears of ED-related side effects. Not only high blood pressure ensure that you have more cardiovascular risks, but it may also negatively affect your kidneys.

Order Blood Tests Online Using DiscountedLabs.com

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order blood tests online from Discounted Labs

At DiscountedLabs.com we pride ourselves in offering not only the most affordable blood test prices but also educational information to help you take charge of your health. 

  • You can purchase blood tests and panels online from most cities in the U.S. using your credit card or Paypal.
  • Our in-house physician provides the required prescription, so no doctor’s visit is required.
  • Depending on the blood test, your results will be emailed to you privately in 3-7 business days (depending on blood test) after your blood draw at your local lab. We work with over 1,800 LabCorp locations. Note: Please check your Spam folder if you do you receive expected emails.
  • No appointment is needed at the lab. Walk-ins welcomed.
  • We provide educational information in our blog and newsletters so that you can make sense of your results.
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HOW DOES DISCOUNTEDLABS.COM WORK?

1- Go to the “Find a Location” page to find the closest LabCorp location. No need to make an appointment since walk-ins are welcomed. Once you have identified your closest location, go to step 2.

NOTE: DiscountedLabs serve all states in the U.S. except New York, New Jersey, Massachusetts, New Hampshire, Rhode Island, Maine, Vermont, and Hawaii.

2- Go to “Choose a Test” and add your selection (s) in the shopping cart.

3- If you have a discount coupon code, add it to your cart.

4- A $6 blood draw fee will be added to your total. 

5- Pay using a credit card or Paypal.

6- You will receive order confirmation and instructions on how to download your lab request form from your profile on our site by logging into your account and clicking on My Labs.

7- Print lab request form that you downloaded.

8- Take that form to the closest LabCorp location with a picture ID. Get your blood drawn.

9- You will receive an email when the results are ready for you to download from our site following same procedure as item 6.

Note: You cannot place an order under someone else’s profile. The profile person’s name will appear on the lab order form. Please create your profile. You are allowed to use someone else’s credit card as payment.

To avoid wasting your time, please review our FAQ Page.

If you have further questions, please email [email protected].

Testosterone Controversies: Lecture by Dr. Khera

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Transcript of Part 1.

Nelson Vergel:                  Hello everybody, Nelson Vergel here with ExcelMale.com and DiscountedLabs.com. I’m very honored today to introduce my urologist here in Houston. I’m very privileged to have doctor has published more than a hundred articles last time I Googled his name, and he’s one of the experts in the field of men’s health, urology, testosterone replacement, prostatic issues. I think you also treat, Doctor Khera, female sexual dysfunction, too. Very happy to have him, he’s going to give today a lecture that I think everybody’s going to find extremely interesting covering the controversies of testosterone therapy

Dr. Khera:                            Thank you for the introduction. I appreciate it. As you mentioned, there have been significant controversies with the use of testosterone therapy over the past five years. Cardiovascular risk, DVT, prostate cancer, BPH, and today I’d like to discuss some of those controversies and give you some further insight into the diagnosis and treatment of hypogonadism.

Dr. Khera:                            I always like to give you some of the statistics. I’m not sure if many of you know this, or are aware that in 2012 testosterone was one of the fastest growing medications in the United States. There wasn’t a single medication that was selling faster than testosterone. The concern that while the testosterone sales were increasing, the testing in the United States during this time was also starting to decline. One interesting statistic was that roughly 27 percent of men who initiated testosterone did not have a blood test before taking the medication, and 21 percent of men who started testosterone didn’t have a follow-up test. So clearly there was some abuse with testosterone and some concerns.

Dr. Khera:                            When I talk about controversies today I’d like to give you three different perspectives. I want to give you the perspective of what the FDA label has to say, as well as what the guidelines have to say. We were very fortunate in 2018; two guidelines came out. The AUA, the American Urological Association, came out with their testosterone guidelines the same time the endocrine guidelines also came out with their testosterone guidelines, as well. So I’d like to share with you these three different perspectives as we go forward.

Dr. Khera:                            The first is on the concept of venous thrombosis embolism or VTE, and so you should be aware that in the package insert of a testosterone products in 2005 in the adverse reactions section of the label, it was appended to note that one patient during the open-label extension trial did suffer from the DVT. Now in 2009, the label was changed again under the new medication guide that lists blood clots in the legs among the serious side effects. If you open the package insert for testosterone products, you will see, and this is just for Androgel, that they do put in the section warnings and precaution a concern for VTE. I’ll read this. There have been postmarketing reports of VTE events including DVT, PE in patients using testosterone products, Androgel in this case. Evaluate patients who report symptoms of pain, edema, warmth, and erythema in the lower extremity for DVT and those who present with acute shortness of breath for PE. If a VTE is suspected, discontinue treatment with testosterone and initiate appropriate workup and management.

Dr. Khera:                            So this is in the package insert, and you should be aware that patients will read this and they will ask you about this. We should be very careful because the guidelines slightly differ, and if you look at the American Urologic Association guidelines, it states that patients should be informed that there is no definitive evidence linking testosterone therapy to a higher instance of VTE. The entering guidelines don’t have a guidelines statement on this, but they do have some comments that they’ve made. They do state that case-control and pharmacoepidemiological studies have not shown a consistent increase in the risk of VTE with testosterone treatment. However, there is two huge testosterone associated VTE events in randomized controlled trials to draw meaningful imprints.

Dr. Khera:                            So you can see where there are three different perspectives here, and they all are slightly different in their beliefs in how testosterone affects VTE.

Dr. Khera:                            The second controversy is cardiovascular risk. Many of you may be aware of this. There was a significant amount of concern at one point that testosterone may cause a heart attack. So I’ll put this in the context of a story. It was very interesting, Molly Shores in 2006 published a very nice study looking at men at the VA and what she found was that those men with lower testosterone levels were much more likely to suffer from earlier death. They died earlier or sooner than men with normal testosterone levels. If you look at the studies following the Molly Shore study, they were prospective studies, larger studies, all finding the same thing. Those men with lower testosterone levels tended to have increased mortality, and if you look at the right-hand column, the cause of death seemed to be cardiovascular death in many of these studies.

Dr. Khera:                            Before 2010 there were also many studies suggesting that giving testosterone may decrease the risk factors for cardiovascular events. Risk factors meaning obesity, metabolic syndrome, diabetes, cholesterol, and they may have some beneficial effect in decreasing the risk factors of cardiovascular disease.

Dr. Khera:                            We conducted our review and looked at every single article we could find from 1940 to 2014. We found over 200 articles addressing testosterone and cardiovascular disease. The majority of these studies being favorable against suggesting low testosterone is a risk factor of cardiovascular events, and we could only find four studies suggesting that testosterone may increase cardiovascular risk. Now, these are the four studies; I don’t have the time to go into each one of these in detail. The majority of these studies are not randomized or placebo-controlled, and the Finkel study did not even have a control group. But suffice to say that these studies did bring up some concern that testosterone may have an increased risk for cardiovascular events.

Dr. Khera:                            Based on these studies, the FDA did put in the package insert, and you should be aware, that to date epidemiologic studies in randomized controlled trials have been inconclusive in determining the risk of major adverse cardiovascular events and patients should be informed of this possible risk when deciding whether to use or to continue the use of Androgel one percent. So this is in the package insert.

Dr. Khera:                            The EMA which is the equivalent of the FDA did look at this data and have not made any changes to their cardiovascular warnings of their products. The guidelines are a little different. I will tell you that in 2018 we also published another study looking at all the studies from the FDA warning in 2015 to the current date, and we found 23 studies also looking at testosterone and cardiovascular disease, and again we couldn’t find any studies suggesting that testosterone increases the risk of cardiovascular events. We found studies suggesting that men who normalize their testosterone with testosterone therapy had a reduced risk of MI and death compared to those men whose testosterone failed to normalize.

Dr. Khera:                            The AUA and endocrine guidelines do have statements on this, and the first statement by the AUA guidelines is very clear. Clinicians should inform testosterone deficient patients that low testosterone is a risk factor for cardiovascular disease. That’s important. Low testosterone is a risk factor for cardiovascular disease. Now, they go on to say, “Before initiating testosterone treatment clinicians should counsel patients and this time it cannot be stated definitively whether testosterone therapy increases or decreases the risk of cardiovascular events.” If a patient does have a cardiovascular event, the AUA guidelines suggest that we wait at least three to six months before starting therapy again. The endocrine guidelines are a little different. The editing guidelines recommend that we wait six months, not three to six months, but six months if a patient suffers from an MI we should wait at least six months. But the endocrine guidelines also agree there’s no conclusive evidence to support that testosterone supplementation is associated with an increased cardiovascular risk in hypogonadal men.

Dr. Khera:                            Those mechanisms, just so you know, is several, there are four theories, but the most common theory is the belief that the elevated red blood cell count, also known as erythrocytosis, could then lead to thrombosis, atherogenesis, and increased cardiovascular risk. That is the most common theory. We spent quite a bit of time studying this; this is a study that we published looking at patients. Remember that the injectables have the highest rate of erythrocytosis. In our study it was 66 percent, in other studies, it’s about 40 percent. So if a patient starts developing an elevated red blood cell count, one of the quickest things you can do is get them off the injectable, put them on a gel. A gel typically has an erythrocytosis rate anywhere from two; I’ve seen as high as 13, 14 percent. It’s a lower rate. Because there’s less of a spike that occurs with the gels. The injectables cause a spike which increases erythrocytosis rate.

Dr. Khera:                            Now that erythrocytosis typically doesn’t occur until about three to six months, so there’s no point in checking blood in two or three weeks. You have to give it some time. And the number you wanna remember is 54. The guidelines typically state that at 54 you want to either have the patient phlebotomize, which is donate blood, or you wanna decrease the dosage, but we don’t want it to get above 54.

Nelson Vergel:                  Doctor Khera, one question here.

Nelson Vergel:                  Has anybody actually published data on hematocrit versus DVT risk?

Dr. Khera:                            So two points. One, there has never been a testosterone trial, a testosterone trial showing that the elevation in the cardiovascular risk on the testosterone trial was the cause of a DVT. There’s been anecdotal data on patients taking testosterone and getting a DVT. But there’s not been a trial showing that the testosterone which caused an elevation of hematocrit that led to a DVT. Majority of the data that comes from an elevation in causing a DVT is from Polycythemia Vera data. This is a malignancy of bone marrow. There have been several studies showing that an elevation in hematocrit in this population may lead to an increase in DVT. Some studies were inconclusive; some studies did suggest that yes, in this population an elevation of hematocrit did lead to a DVT. But we should be clear that this population is very different from the general population, right, and so it’s using a transference. You’re just insinuating that this population and this data can be used in the general population.

Dr. Khera:                            So again, I think you should be very careful. We need a trial.

More information: Low Testosterone: How Low is Too Low?

Buy testosterone blood tests here without a doctor visit: DiscountedLabs.com

Erectile Dysfunction Causes and Treatments

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erectile dysfunction

By Nick Gold

Erectile dysfunction (also known more commonly as impotence or sexual dysfunction) is the inability to maintain a sufficiently rigid erection for a satisfying sexual experience.

According to the Global Survey of Sexual Attitudes and Behaviors, erectile dysfunction affects approximately 5-28% of men aged 40-80 years. The study was done on adults from 29 different countries.

This health issue has been clearly defined back in 1992, but it has been observed and recorded for thousands of years. The ancient Egyptians had papyrus drawings of sexual positions as well as remedies and cures for afflictions known as “weakness of the male member”.

Sexual dysfunction can be diagnosed by questionnaires or lab testing and there are numerous ways of managing and improving its symptoms.

Erectile dysfunction causes

This type of health problem can have multiple causes and the most common ones are:

  • Pharmacologic – caused by different types of medications such as antidepressants, analgesic narcotics, anti acids, antihypertensives, etc. There are more than 200 medications which have been associated with sexual dysfunction and some of them decrease the testosterone levels which in turn lower erection rigidity, sex drive, etc.
  • Endocrinologic – this refers to testosterone deficiency and hypogonadism. Testosterone replacement therapy could help in this case, but it might not be sufficient to achieve hard erections, and it must be combined with other treatment options. Diabetes is a disease which might be linked to ED because it causes damage to the microvasculature of the body as well as the nervous system.
  • Neurogenic – caused by aging or neurodegenerative diseases such as Alzheimer’s or Parkinson’s disease. Neurogenic causes refer to damages to the nervous system and can include strokes, injuries to spinal cord, etc. These health problems can severely affect erection quality regardless of age.
  • Vasculogenic – health issues such as arteriosclerosis, high blood pressure, high triglyceride levels can also cause erectile dysfunction. Men with blood pressure higher than 130/85, a body mass index over 30 as well as triglycerides over 150 mg/dL are at risk of developing ED at some point in the future. Do you have venous leakage?
  • Psychogenic – this refers to improper stress management, feelings of guilt, shame, depression, anxiety, lack of self-confidence, internal sexual conflict, etc. Men who have very stressful lives are more likely to have weak erections as well as poor libido.

It is worth mentioning that unhealthy habits such as smoking, excessive alcohol consumption, and lack of exercise can drastically increase the likelihood of developing impotence for men of all ages.

Before treating ED, doctors first assess the health of the cardiovascular system (heart, veins, and arteries) to determine if it is healthy enough for proper sexual activity. A high cardiac risk might indicate that the patient needs treatment for a heart condition first, before receiving treatment for erectile dysfunction.

Sexual dysfunction management and treatment options beyond testosterone

Impotence or sexual dysfunction is treated in small steps and it begins by changing lifestyle risk factors such as quitting smoking, lowering alcohol consumption, switching to a healthier diet, engaging in regular physical activities, etc.

PDE-5 inhibitors

The next step is to take advantage of first-line medical therapies such as using phosphodiesterase type 5 inhibitors (PDE5Is). Some of those inhibitors are Sildenafil (most commonly known as Viagra), Tadalafil (aka Cialis), Vardenafil (aka Levitra). These substances lead to increased smooth muscle tone and should be taken approximately 1 hour before sexual intercourse (for Sildenafil and Vardenafil) and up to 12 hours for Tadalafil.

These PDE-5 inhibitors are known to be safe and can be used by men of all ages, except for those who take nitrates on a daily basis. Some people respond better to certain types of inhibitors, so trying more than just a single substance is recommended for achieving the desired results.

How do Ed drugs compare?

Vacuum Erection Device

There are numerous types of vacuum erection devices on the market and most of them generally consist of a cylinder which is placed on the penis and creates an air-tight seal to the body, causing negative pressure and improving blood flow. A constriction band is placed at the base of the penis to maintain an erection and allowing sexual intercourse after the cylinder is removed.

This type of treatment is considered second-line therapy for sexual dysfunction and is a non-invasive way of treating it. Manufacturers create VEDs of various sizes and they ship them with instruction manuals to help patients use the cylinders properly to achieve an erection.

Intraurethral Suppositories

This treatment option consists of inserting small suppositories into the urethra to allow smooth muscle relaxation. The penis is massaged with both hands to allow the corpora cavernosa to absorb the medicine. One of the most common side effects of this treatment option is penile pain, but it can be a practical treatment option for certain people. The first Intraurethral suppository might be administered under medical supervision to prevent unwanted injuries to the shaft.

Intracavernosal Injections

Patients who suffer from erectile dysfunction might also want to try intracavernosal injections which are formulated with a special substance that inhibits vasoconstriction. This allows the patient to achieve a satisfying erection and this method is considered to be one of the safest and most common treatment options for ED.

The first injection is done under medical supervision to avoid damaging important areas of the penis such as the urethra or penile nerves. Once the patients get over the anxiety of having needles into their penis, they can learn how to administer injections on their own.

Bimix, Trimix, and Quadmix are good examples of intracavernosal injections for achieving hard erections. They are available by prescription from different pharmacies.

More information on Trimix

Penile Implant Surgery

The third-line therapy for ED consists of penile implant surgery which means inserting non-inflatable implants into the penis.

There are 2-piece and 3-piece inflatable penile prosthesis which can be inserted into the penis. A small pump is inserted into the scrotum and helps to inflate the implants when an erection is required. Although there is the possibility of developing infections, penile implant surgery is a popular treatment for erectile dysfunction and it can be more cost-effective in the long run.

Conclusion

Although erectile dysfunction is still a taboo subject for some people, this medical condition has been heavily researched, it can be properly diagnosed in a variety of ways, and multiple treatment options have been created to help patients achieve sexual satisfaction. One of the best and easiest ways to diagnose ED is by using blood tests to detect hormone imbalances.

Patients who are not happy with their performance in bed should make the first and most important step and visit a doctor to get more information about ED, getting adequate physical examination as well as treatment. Luckily, medical improvements are made each year and treatment strategies are refined and enhanced, so treating impotence is increasingly safer and easier these days!

Venous Leakage: The Cause for Your ED?

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erectile dysfunction
ED

By Lee Meyers


“Venous leakage.” Sounds nasty, doesn’t it? Kind of like a hemorrhage or something, eh? Well, most guys would probably rather have a little hemorrhaging than venous leakage, because it leads to weak and/or rapidly disappearing erections.


Venous leakage describes the condition where the blood escapes from the penis and thus a good erection cannot be achieved. An erection begins when penile smooth muscle relaxes enabling blood to infill the corpus cavernosum, two cylindrical “caverns” of spongy tissue running within the penis. Stage two of the erection process occurs with this infilling of the corpus cavernosum. The inflow of blood expands the spongy tissue, which begins to pinch off the emissary veins of the penis, decreasing outflow and – voila! – the erection begins to build.


NOTE: Venous leakage should not be confused with venous insufficiency, which is a condition in which the valves in the lower legs go out due to varicose veins, deep vein thrombosis, etc. There is some evidence that grape seed extract can help with this condition.


Venous leakage occurs when this second stage fails and bloods leaks out as fast as it infills. The “pinching off” of the outflow veins never occurs adequately and, basically, you’re sailing in a leaking boat. Again, though, it’s not really that the veins are leaking but rather that the veins are not receiving proper compression.

Causes of Venous Leakage
The causes for venous leakage can be summarized to several basic underlying conditions: 1) smooth muscle insufficiency and 2) structural changes of the corpus cavernosum. Now, what condition can lead to both of these erection killers? Low testosterone, a.k.a. hypogonadism.
That’s correct – low testosterone is a freight train ride to venous leakage and we’re going to look at why below. Here’s the good news: it doesn’t have to be a one-way train ride – you can get off the train.


1) Smooth Muscle Dysfunction. Researchers now know that testosterone both maintains smooth muscle and the nerves the fire them in the corpus cavernosum. For example, researchers have noted that in castrated animals, the nerve fibers and myelin sheaths around them actually shrink and “wither”. And they have also noted that smooth muscle content in the corpus cavernosum decreased as well. Yes, testosterone affects everything in a male!


2) Corpus Cavernosum Integrity. The research points to the fact that low testosterone can actually affect the connective tissue within the corpus cavernosum. While you are losing smooth muscle, you are also likely gaining more connective tissue, i.e. collagen. The ECM (extracellular matrix) changes for the worse, another structure implicated in erectile dysfunction. This is a sort of “hardening” similar to what causes problems throughout your body. You need for the corpus cavernosum to be flexible and expandable in order to properly compress the outflow.


The bottom line is that researchers have found that in a low testosterone environment, the inside of the penis literally atrophies and is replaced with inelastic, fibrous tissue.


For some of you that have discovered that you lived in a hypogonadal state for years without knowing it, this may be a scary prospect. “Did it do permanent damage?” is the natural question to ask yourself. Below we discuss some study results that show about where venous leakage can occur.

How to Improve Venous Leakage
However, before I write anything else, let me state that the good news is that the studies show that, if testosterone is restored, normal erectile function usually goes with it. This means that the damage could not have been too severe from a long term low testosterone environment and indicates that a significant reversal is usually possible.
Venous Leakage and Testosterone


So what is the magic number at which internal penile damage begins to occur and venous leakage begins to rear its ugly head? In one study, researchers looked at men with venous leakage, all of whom had testosterone < 300 ng/dl (10.2 nmol/l). Obviously, 300 ng/dl and less can be a problem area for many guys. Low Testosterone: How Low is Too Low?


However, could we say, then, that 300 ng/dl is the threshold? Actually, for some men, it is probably higher than that as indicated by one study where all participants had venous leakage and some men had testosterone up to 400 ng/dl. [8] In other words, it depends on the individual, but it is possible that some men will begin to experience damage to the penis at 400 ng/dl (13.6 nmol/l) with still others at 300 ng/dl or even 250.


Is there a solution? Several studies to date have shown that by restoring testosterone to more normal levels, a partial reversal is possible. Of course, just how much of a reversal can be achieved likely depends on many factors, including the number of hypogonadal years as well as various lifestyle factors. The good news is that a study of Russian, low T men with erectile dysfunction and venous leakage showed good results from testosterone therapy. In this study, almost all of these men were unresponsive to PDE5 Inhibitors such as Cialis, Levitra and Viagra and all of them had testosterone below 300 ng/dl (10.2 nmol/l). In spite of their seemingly dire circumstances, about a third of the men were cured through just testosterone therapy alone. Another third were cured through a combination of testosterone and PDE5 Inhibitors. The means that a solid majority of the men were significantly healed of their venous leakage and achieved a substantial reversal with the help of TRT.


By the way, some of you who may not respond well to PDE5 inhibitors, such as Viagra or Cialis, may find that restoring your testosterone via TRT restores your erections for the above reasons. One study looked at hypogonadal males who did not respond to Viagra and found a significant restoration of erectile function after TRT (Testosterone Therapy). Very similar results were found in a study of Cialis non-responders as well. In other words, sometimes the problem is nitric oxide and sometimes it is low testosterone (or both).

Testosterone Blood Tests Types: How to Choose the Correct One

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testosterone deficiency
Testosterone deficiency concept. Low or high level male sex hormone production. Andropause health problem. Vector illustration in modern style isolated on a dark background.

Table of contents

  1. A brief introduction to testosterone and its properties/benefits
  2. Serum testosterone assays
  3. Types of testosterone
  4. Types of testosterone assays
  5. How is testosterone measured?
  6. Wang’s analysis of testosterone assays
  7. 4 Types Of Testosterone Tests You Can Buy Today
  8. Why should you test your testosterone levels?
  9. How to get a testosterone test?

 

A brief introduction to testosterone and its properties/benefits

Testosterone is the most important male sex hormone and responsible for the correct functioning of multiple body processes.

This anabolic steroid is directly involved in the development of reproductive organs in men as well as the development of secondary male sexual characteristics.

Testosterone plays an important role in the lives of women too.

Inadequate amounts of testosterone can lead to numerous health issues such as low bone density (and susceptibility to fractures), poor sex drive and lack of concentration.

Normal testosterone levels in men are between 300 ng/dL and 1,000 ng/dL. Bodybuilders might have higher testosterone levels as a result of increased muscular mass.

Normal testosterone levels in women are usually between 15 ng/dL and 70 ng/dL. This number varies depending on various factors such as the moment of the day, mood, diet, exercise level and more.

However, certain men might have low levels of testosterone (under 300 ng/dL) and experience various symptoms such as fatigue, lack of sexual desire and the development of male breasts (gynecomastia).

Testosterone replacement therapy might be useful for men who have T levels around 150 ng/dL. This treatment will help to raise the testosterone levels to normal values.

Inadequate amounts of testosterone can also impair muscle development and slow down one’s progress in the gym. Men usually have 40 times more testosterone than women, and it’s important to keep T levels in the normal range to ensure proper muscle growth.

Measuring the testosterone level isn’t an easy task.

That’s because this hormone can be bound to certain proteins in the body and measuring it becomes very difficult when it’s outside the normal ranges.

For example, it’s relatively easy to determine the exact testosterone level of a healthy eugonadal man, but not that easy if he’s hypogonadal and it’s testosterone levels are dangerously low.

To measure low T concentrations in men, women and prepuberty children, more sensitive tests are required.

Scientists and medical professionals have managed to create a couple of reliable measuring methods for testosterone.

These are called testosterone assays.

Serum testosterone assays

According to the dictionary, the word “assay” refers to the testing of a particular material, ore or substance to find out its composing ingredients.

Serum testosterone assay refers to accurately measuring the testosterone levels in the body of a male or female.

Accuracy is important because it directly impacts the diagnosis of a particular disease or health complication.

Endocrinology is the discipline responsible for measuring hormone levels in the body.

It encompasses a wide variety of assays which help the clinician confirm a diagnosis for a patient.

For example, testosterone assays are used to determine if a male patient has hypogonadism or not.

Hypogonadism consists of reduced gonad activity. Men diagnosed with hypogonadism usually have low testosterone levels and experience different symptoms such as low sex drive and gynecomastia (man boobs).

Testosterone assays are also used to determine if certain boys have delayed puberty onset and to diagnose androgen deficiency.

When circulating testosterone levels are very low, the sensitivity of some assays is diminished. That’s why it is necessary to pick the right testosterone assay to accurately determine circulating T levels.

Types of testosterone

The majority of circulating testosterone in the bloodstream is bound to SHBG which is the sex hormone binding globulin. Testosterone can also be weakly bounded to albumin which is a water-soluble protein.

The albumin-bound testosterone combined with free testosterone makes up for approximately 35% of total testosterone levels.

This is also known to be biologically active testosterone.

Hyperthyroidism and other factors which influence SHBG can lead to changes in the amount of biologically active testosterone.

Types of testosterone assays

Measuring the testosterone levels in one’s body is not that easy.

One way to do that is by using Isotope dilution mass spectrometry. This assay measures total testosterone levels.

Laboratories also use direct chemiluminescent immunoassays. However, these assays are less accurate when testosterone concentrations are too low.

Liquid chromatography-tandem MS (mass spectrometry) is also used as well as gas chromatography-MS for more accurate results, particularly when testosterone levels are at the low and high extremes.

Measuring free testosterone is done after it has been separated from the protein-bound forms.

This can be done using equilibrium dialysis or ultracentrifugation.

Equilibrium dialysis is the most common method, and it involves introducing testosterone isotopes into a patient sample.

The free testosterone concentration is estimated based on the distribution of isotopes in the dialysis membrane.

Measuring the bioavailable testosterone can be done using ammonium sulfate which influences the testosterone bound to SHBG.

Assessing the testosterone levels began approximately 30 years ago.

Tests were done on small samples of blood, but their accuracy was somehow limited.

Modern testosterone assays are more sensitive, require a smaller sample of serum and are more affordable. They can be done using nonradioactive methods in reference labs.

How is testosterone measured?

Up to 98% of the testosterone which can be found in the bloodstream is bound to proteins such as albumin and SHBG. Just about 2% is free.

Albumin-bound testosterone and free testosterone are known as bioavailable, and they can easily be used by tissues for androgen action.

On the other hand, total testosterone can be measured using nonradioactive immunoassay and chemiluminescent detection.

These methods offer accurate results if the male patient has testosterone levels in the normal range such as 300-1000 ng/dL.

However, these assays recorded low limits of testosterone of approximately 132 ng/dL which is not normal in healthy men.

Clinicians have wondered why this happens and how they can improve the accuracy of testosterone assays when T concentrations are very low.

When it comes to total testosterone assays, the gold standard is a steroid-free serum interacting with gravimetrically-determined amounts of testosterone.

Independent measuring methods are also used such as liquid or gas chromatography with mass spectrometry.

For women, highly sensitive tests are necessary to determine total and free testosterone levels because women have much lower amounts of testosterone in the bloodstream in comparison with men.

Dr. Wang’s analysis of testosterone assays

In a paper published in 2004, Dr. Wang and her colleagues compared multiple testosterone immunoassays (both manual and automated ones) with liquid chromatography-tandem mass spectrometry.

The results were very accurate for the latter option, and the test was performed on serum samples from patients with different testosterone levels (ranging from under 150 ng/dL to 1,500 ng/dL).

This means that most of the automated and manual assays were accurate when compared with LC-MSMS, but some of the tests provided inaccurate results.

The authors of the paper concluded that most manual and automatic testosterone immunoassays are ideal for differentiating eugonadal men from hypogonadal men, but they weren’t accurate for women or children who haven’t reached puberty yet.

It’s important to notice that these automated and manual testosterone immunoassays are compared with gold standards of adult male reference ranges.

These ranges are set by individual laboratories and are usually monitored by the College of American Pathologists.

That’s why you’ll find several testosterone tests on the market. It’s important to get the right one to obtain the most accurate results.

4 Types Of Testosterone Tests You Can Buy Today

There are four different testosterone assays you can choose from to accurately determine the amount of testosterone in your bloodstream.

#1 – TESTOSTERONE Total and Free (Regular)

This test is ideal for people who have testosterone levels in the normal ranges.

It measures total and free testosterone using direct analog/radioimmunoassay (for free T) and electrochemiluminescence immunoassay (for total T).

On the other hand, if you know you have very low testosterone levels (you have hypogonadism and testosterone levels below 150 ng/dL) or you have very high testosterone levels (you are a bodybuilder with T levels over 1500 ng/dL) then you might want to use the LC/MS test because it’s more accurate.

If your testosterone levels are very high, the test will show above 1500 ng/dL, not the exact number (such as 1,700 or 1,800).

#2 – Testosterone Free and Weakly Bound (Bioavailable Testosterone)

Bioavailable testosterone can be used for steroid-receptor interaction.

This test measures the amount of free testosterone and weakly bound testosterone in the bloodstream.

The test doesn’t look at the testosterone bound to SHBG because this type is biologically inactive as it has a high binding affinity.

On the other hand, weakly bounded testosterone is usually derived from albumin, and it has a low affinity which means that it can quickly dissociate and become available for interaction.

#3 – Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS- No Upper Limit

This test doesn’t have any upper limit for either type of testosterone such as free, total and bioavailable.

It uses more complex measuring assays such as liquid chromatography-tandem mass spectrometry to accurately determine testosterone levels.

However, this test is more suitable for bodybuilders who are known to have very high testosterone levels.

If you are not into bodybuilding or you think you have below normal testosterone levels then this test is not ideal for you.

There are other tests which are more economical and can be used to determine your testosterone levels more accurately.

If you are on testosterone replacement therapy, you might want to choose a test which has no upper limit on total testosterone and up to 50 ng/dL limit on free testosterone.

An even more affordable test for people on testosterone replacement therapy has an upper limit of 1,500 ng/dL on total testosterone and 50 ng/dL limit on free testosterone.

#4 – TESTOSTERONE, Free and Total, LC/MS Assay (T > 1,500 ng/dL)

If your testosterone levels are very low (both men and women) then this test is ideal for you.

The test looks at testosterone concentrations under 150 ng/dL or above 1500 ng/dL for total testosterone.

The free testosterone is capped at 50 ng/dL for this test, but there are other tests with no upper limits for total and free testosterone if that’s what you’re interested in.

Why should you test your testosterone levels?

Measuring the testosterone levels becomes increasingly popular nowadays, thanks to direct-to-consumer labs which are affordable and easy to use.

Males and females alike can buy one of the tests described above and determine the actual amounts of testosterone in their bloodstream.

But why is this a good idea?

First of all, if you have common testosterone deficiency symptoms such as fatigue or low sex drive then measuring your testosterone levels is highly recommended.

This will help you decide if indeed a lack of testosterone is the problem and whether you should try testosterone replacement therapy or not.

Testosterone tests give you a broader insight when it comes to your hormonal health.

Secondly, if you’re on testosterone replacement therapy already, the results of the test might provide good feedback on your progress.

The clinicians who conduct these tests can give you useful pieces of advice such as how often to take testosterone gels or injections, whether you should reduce or increase the dosage, etc.

If you’re a bodybuilder, keeping your testosterone levels in check also helps you monitor your progress.

After all, testosterone is vital for muscle development, and if you have sufficient amounts of it, you’ll ensure muscle growth in the long run.

Testosterone is important for women too. This hormone is linked to mental alertness, good mood and increased sex drive.

Testosterone deficiency in women can also lead to low productivity at work and poor physical performance while in the gym.

Numerous advancements in the medical field coupled with improved testing devices make measuring testosterone levels a more affordable and accurate process.

How to get a testosterone test?

Visit Discounted Labs , pick your favorite testosterone assay, and you’ll be able to get your results in a few business days.

You can also order other blood tests to check your glucose levels, cholesterol, triglycerides, blood count and more!

 

More information on other testosterone and HCG blood tests

Low Testosterone Causes and Benefits of Treatment

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VIDEO TRANSCRIPT:

The causes of hypogonadism could be chronic liver disease, COPD, sleep apnea, renal disease, use of different drugs, like I said before: glucocorticoids, opiates, ketoconazole, which is an antifungal. Anabolic steroids can actually shut down testosterone production. HIV, hypertension, lipids, infertility, obesity, sleep apnea, arthritis, diabetes, and other conditions. I’ll explain later what that means. Genetic mutations, and there are some genetic mutations that can affect sexual development in boys. As I said before, environmental factors: metabolic syndrome, illnesses, aging, other hormone deficiencies. Thyroid is one of them, very connected to testosterone production. Nutrient deficiencies, as I said before, lifestyle issues, medications.

This is actually a slide that I got from SpectraCell, a very good company in Houston that tests micronutrient levels in lymphocytes, not in actual blood, but in lymphocytes which is supposed to be more precise. This graph doesn’t say that adding these vitamins actually improves testosterone blood levels. They may do so, only if you have a deficiency. Zinc, definitely good data. Magnesium, vitamin E, vitamin K, vitamin D, vitamin B6, and folate. If you do supplement, and you have no deficiencies, you will not see improvements in testosterone. That’s as simple as that.

The benefits of testosterone therapy. This is probably now evidenced from all the other slides that I’ve covered: improved continuity of function, mood, libido, stamina, believe it or not, improved cardiovascular health. Actually, men with lots of testosterone tend to die of heart disease faster than men with normal testosterone. There’s obviously controversial data right now that has been discussed a lot in the past three years on the use of higher doses and poorly managed testosterone therapy that has been associated with increased cardiovascular risk. Improvements in body composition, glucose control, fertility. When you improve testosterone, you can improve fertility to a certain point, and then you may have a decreased infertility depending on different factors. Exercise, functional capacity improves, and there’s some studies, not too many, very small data set, that may suggest that improved longevity and survival.

How long does it take to see benefits? That’s another one of those questions that we get a lot on Excel Male. Obviously, it’s hard to predict. Everybody’s different, depends your age, depends on morbidities, if you have diabetes, if you have high blood pressure, if you’re 29 compared to a 65-year-old. Obviously, there are different conditions and different factors that are involved in the efficacy of testosterone. You see here the different colors. The blue lines say maximum benefits are reached, and on the bottom you see weeks. The darker green is upper, and the lighter green is lower duration when benefits are reached.

Inflammation decreases. Testosterone replacement decreases inflammation very fast, within three to 12 weeks. Blood sugar control, anywhere from 12 weeks on the lower side to 52 weeks. Bone mineral density takes a long time because obviously bone is a lot harder to build. It’s a very slow process. Body composition up to 52 weeks. Depressive mood could be anywhere from as fast as three weeks to as low as 30 weeks. Quality of life could be also you can see benefits within a few weeks. That’s usually what happens. The men tend to feel really well, really good, the first month. Then it tends to plateau, and they get very discouraged after a while, but in most men, like me, therapy [inaudible 00:05:18] forever. We wake up to the fact that it’s actually improving our quality of life. If we ever run out of testosterone or we stop for any reason, out of our control, that’s when really we’re awakened to the fact that our quality of life, we have reached a new normal that we forget about.

Erections and ejaculations, that is difficult to assess. Some men do experience better erections, especially morning time erections, and some men don’t. It also depends on age and different factors, that we really don’t know all the factors involved. Sexual interest is probably the factor that improves the fastest and the most obvious, within three to six weeks. There’s more interest in sex or more attraction to potential sexual partners. There’s more interest in general to approach or proceed to have sex or masturbate. That’s one of the first in terms that if it’s not improved, there’s definitely something going on that your doctor needs to look at.

More information: https://www.testosteronewisdom.com/4196/testosterone-replacement-therapy-latest-research/

Low Testosterone Blood Level: How Low is Too Low?

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VIDEO TRANSCRIPT:

Hormones change as we age. As you can tell, these are different hormones: estrogen, thyroid, progesterone, insulin, testosterone, cortisol, growth hormone, and this is not only male related but also females. Most hormones, as you can tell, go down with age, except insulin and cortisol. Insulin, we become more and more insulin resistant, and our cortisol, which is an inflammatory hormone and stress hormone also increases. Those two trends of increasing insulin and cortisol also make us gain more weight, more fat, get more inflammation and more chronic illness that are related to aging.

Today, I’m only going to focus on one of them, testosterone. Eventually, I will have a lecture on each one of these hormones for you guys to watch, so stay tuned.

Next one. So, testosterone, the target organs. Testosterone is an androgenic hormone. The world, when you say testosterone, equates a hormone to males and the fact is that not only men have it but also women. Women have it at a tenth of a concentration that men have in your bloodstream, but the target organs are pretty much common except obviously for the penile organ. When it comes to the effects of testosterone, it has effects on hair growth, balding, sebum production that sometimes causes acne, liver actually, it improves, promotes, the synthesis of proteins in the liver. When it comes to male sexual organs, it’s responsible for penile growth, spermatogenesis, which is the production of sperm, prostate growth, and function. In the brain, it affects libido and mood. In the muscle, it increases strength and muscle volume. In the kidneys, it stimulates the production, I’m sorry, there is a misspelling there, stimulates the production of red blood cells. In the bone marrow, it stimulates of stem cells. In bone, it accelerates the linear growth in growing boys and girls. It is also obviously associated with bone density.

What are the effects of having low testosterone? I’ll go through different slides and coming up on explaining what low testosterone means and the ranges, et cetera. But one of the effects is sexual dysfunction or lack of interest in sex, some erectile dysfunction, decrease of sense of well being, increase irritation or moodiness, decrease red blood cells to the point that somebody can become anemic, decrease bone marrow density, decrease lean body mass, muscle strength and increase in fat mass. As you can tell, all of them could be associated with aging, but the fact is that normalizing testosterone blood levels can reverse most of these effects.

This is where most of the controversy and discussion occurs, even in 2018, when it comes to defining what’s normal testosterone, where are the normal ranges. Believe it or not, it not only depends on the guidelines, committees and medical groups but also on the different lab companies, like Lap Core and Quest and other lab companies have different ranges. They gather that data from their database on the spread of testosterone and in men that are using, and women, that use their companies.

In general, it’s probably safe to say that the total testosterone, and I’ll explain what that means, total and free testosterone just coming up, they range anywhere from 350 to 1100 in men and from 10 to 50 nanograms per deciliter for women. By the way, this nanograms per liter for people watching the webinar from outside the United States, the units are different. I usually talk about micromoles per liter or other units like that. So, I apologize for that. But these are units used in the States.

The symptoms of low testosterone, as I said, fatigue, low or lack of sex drive, poor appetite, loss of muscle mass and strength, depression and others.

The effect of age on testosterone. Age-related decline begins around 30 to 40 years of age, and approximately 1.2% of testosterone is lost every year, and obviously, that loss can be accelerated by different factors that I’ll be covering soon. The average testosterone of men 75 years of age compared to a younger man of 25 years of age total is about 35% in bioavailable. I’ll speak about what bioavailable means, is 50%.

However, many men in the seventh or eighth decade have normal testosterone levels. So, this is not 100% of rule for everybody. Some men are healthy enough or lucky enough not to have testosterone deficiency when they’re older. Excuse me.

Also, something that we forget sometimes is that the circadian rhythm actually promotes the production of most hormones at night, and the testosterone peaks early in the morning, around 4:00 to 6:00 AM, and it peaks both in older men and younger men. As you can in this graph, the younger men have higher levels and higher peak. The effects are blunted by age. So, you can tell in the older men, there is not as much of a peak and is more of a constant blood level throughout the day, and that happens in most aging men.

What is the testosterone level defined as low? This is another point of controversy and discussion. I don’t think we’re ever going to have groups, medical groups agree, although we’re getting closer as you can tell on this table, but these are different medical groups, European Academy of Urology, the European Association of Urology, International Society of [inaudible 00:08:25], the International Society for the Study of the Aging Male, and the Endocrine Society. The first three agree, and that was the guidelines of 2009 that anything under 350 nanograms per deciliter or for guys outside the United States is 12.1 nanomoles per liter, and free testosterone less than 65 picograms per milliliters.

The TES, which is an endocrine society, I think they just posted new guidelines, but it’s more or less the same value, 300. The disagreement here, too. On the Europeans 350 and believe it or not, there is a group of experts that got together in 2014, it’s the high prescribers, doctors have a lot of experience that agreed that anything under 400 nanograms is considered low.

There’s no agreement. Insurance companies vary, too, when it comes to approval of testosterone therapies. Most of them are going now by 300 to 350. You also have to have the symptoms and the lab test that proves that. For clinics that do not take insurance, cash-based clinics, they tend to be a little bit more flexible when it comes to testosterone blood levels, up to 500 nanograms if you have symptoms of low testosterone. It depends obviously whether or not you’re going to be getting products that are paid by your insurance company or if you’re going to be using, or instance, a compounding pharmacy. I’ll be explaining what compounding pharmacies do and what different changes in the industry are as we speak.

I also reviewed a few studies. I didn’t write the references here because there are too many, but you can go to excelmale.com. I have this information and references. But these are different studies that have linked different levels of testosterone and risks of different pathologies or diseases or issues or health issues. Less than 450, the study linked that to a risk of the increased metabolic syndrome, which is an increase in fat mass, waist circumstance, low HDL, hydro glycerides, et cetera.

Less than 400 in another study linked to venous leakage, which is internal penile damage that affects erectile function. Less than 350, a study linked that to increased death risk and anemia risk. Less than 300, lower libido, weight gain, and diabetes risk increased. Less than 300 increase risk of fractures, memory related issues and depression, risk increases. Less than 250 in another study, increase arterial plaque and decreased sleep quality. Less than 235 in another study, hardening of the arteries and less than 200, a decrease in morning erections. Less than 150, increase inflammation.

As you can tell, 300 or so, 350, 300, it’s kind of a midpoint in all this data. It makes sense so far. What the guidelines have been saying is not far off from what studies are showing when it comes to increased risks of different health issues.

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