The aim of Perpetual Men’s Health is to bring men’s health is to allow men to access medical services in a manner that is acceptable to them and their needs.  Men are typically poor at engaging with men health concerns for good number of reasons.  These include:

• The lack of awareness and knowledge surrounding men’s heath.

• Preconceived perceptions about who provides their care and the care they will receive.

• Stigma around seeking medical care.

• Access to medical care during working hours

The consultation under men’s health at Perpetual Health Centre will be to diagnose male hypogonadism and treating men with Testosterone Replacement Therapy where indicated. The clinic will focus on prevention rather than cure so that men can lead both active and healthy lifestyles, improving both quality and quantity of life.

The target population is all males over 30 who are more likely to have health issues such as low testosterone. 

 It is widely accepted that testosterone is integral to men’s health, the physical and psychological health benefits of having an optimal level can be measured both quantitatively and qualitatively, yet there also seems to be a reluctance to prescribe testosterone even when a patient has a quantified low level.

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Testosterone Replacement Consultations

The aim of this consultation is to address Testosterone Deficiency Syndrome (TDS).  Males do not have a definitive cut off point where the testicles fail to produce testosterone, instead they have a gradual decline in testosterone production typically after the age of 30.  This can happen sooner due to TDS and the cause is often multifactorial.

Symptoms of low testosterone include lethargy, low mood, loss of lean muscle mass, increased visceral body fat, decreased bone mass, decreased libido, erectile dysfunction.

The obvious benefits of Testosterone Replacement Therapy include increased energy, improved mood, increased lean muscle mass, decreased body fat, increased bone mass, improved sex drive and erectile function. We use qualitative assessments - the AMS, IIEF-5 questionnaires and blood investigations such as testosterone to measure deficiency.

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Treatment Options at The Men’s Health Clinic

Testosterone Replacement Therapy (TRT) is a medically supervised treatment designed to manage Testosterone Deficiency. The premise behind hormone replacement is to restore your testosterone levels to that of a healthy person.  

Our gold standard TRT is daily subcutaneous Testosterone Cypionate and for some Human Chorionic Gonadotropin (HCG) injections, we believe this is the most effective method of not only achieving healthy stable male androgen levels, but also mimicking the diurnal variation in testosterone levels that occurs naturally’.

We believe that TRT should be viewed as Hormone Replacement Therapy (HRT), which is why we recommend the use of Human Chorionic Gonadotropin (HCG) alongside testosterone; however, this is personal choice. 

Whilst microdosing daily subcutaneous Testosterone Cypionate and HCG may be the option that most men choose, it is important to offer an element of choice.

 

Option 1

• Testosterone Cypionate +/-HCG

Our gold standard TRT, Testosterone Cypionate is suspended in olive oil which is well-tolerated via the subcutaneous injection route. There is less conversion of testosterone to oestradiol with subcutaneous injection. 

Option 2

• Testosterone Enanthate +/-HCG

The half-life of Testosterone Cypionate and Enanthate are practically identical, which means that they are interchangeable when administered via the intramuscular route. Testosterone Enanthate is less suited to subcutaneous injections due to the viscosity of the carrier oil and its preservative.  You would therefore likely need to switch to intramuscular injections if you choose this treatment option. 

Option 3

• Testosterone Gel (Testogel) +/-HCG

Testogel is often more suited to older patients or patients who are extremely adverse to the idea of injections. We have had many patients who originally started on Testogel, transfer over to injectable testosterone after realising the positive effects of TRT and appreciating the potential for tighter control, resulting in improved qualitative symptoms.

 

Benefit of HCG in TRT Protocol?

Human Chorionic Gonadptropin (HCG) used alongside testosterone:

• Increases fertility

• Maintains/restores testicular size

• Improves libido and penis sensitivity

• Up-regulates other steroid hormones

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Testosterone Deficiency Diagnosis

Testosterone Deficiency is a well-recognised medical condition. Not only do you need two confirmatory blood tests to establish the diagnosis, you also need to explore possible reversible conditions for low testosterone, such as thyroid dysregulation.  This is one of the reasons that you need a thorough diagnostic work up.

You should only commit to TRT after you have explored all natural ways of improving your own testosterone levels

Here is a list of things that we can control or reverse:

• Inadequate Sleep

• Malnutrition

• Excess Weight

• Underweight

• Sedentary Behaviour

• Chronic High Stress

• Alcohol

• Reversible Non-Communicable Diseases – ie. Type 2 Diabetes Mellitus

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TRT Options We Do NOT Advocate

If you cannot improve your natural male androgen levels through sustained changes to lifestyle, nutrition and exercise, testosterone replacement is the most suitable option available.

TRT is a lifelong therapy, not a quick fix.  We do not support the use of TRT to attain supraphysiological testosterone levels, nor the use of TRT as a Performance Enhancing Drug.

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The Aim Of TRT

• Reverse your negative symptoms – i.e. low mood, anxiety, depersonalisation, brain fog, fatigue, low libido

• Replace the deficient hormones

• Monitor and titrate your hormone levels to optimise long-term physical and psychological well-being

 

Testosterone Replacement Complete PLUS

This gold standard blood test encompasses all of the necessary blood investigations required to make a preliminary diagnosis of testosterone deficiency.  In addition to a full hormone panel, it also looks at other general health parameters to help identify any potential reversible causes of low testosterone, and give you a more complete picture of your overall health.  This advanced test goes one step further by looking for some vitamin and mineral deficiencies, which can also have a negative impact on your testosterone levels.
 

Test Includes:

• Lutenising Hormone (LH)  

• Follicle Stimulating Hormone (FSH) 

• Prolactin 

• Total Testosterone 

• Sex Hormone Binding Globulin (SHBG) 60

• Free Testosterone 

• Oestradiol  

• Liver Function Tests 

• Lipids, including Cholesterol 

• Thyroid Function Tests 

• Full Blood Count 

• Urea & Electrolytes 

• HbA1C 

• Prostate Specific Antigen (PSA) 

• Vitamin D 

• Zinc

• Vitamin B12

• Folate 

• Ferritin 
   

Special Instructions:

• If you are NOT on Testosterone Replacement Therapy, this diagnostic test should be performed fasted (from midnight the night before your appointment), between 07:00-11:00, and not during an episode of acute illness.  

• If you ARE on Testosterone Replacement Therapy, it does not need to be a fasted or morning sample, but you should avoid administering your medication/s that day until AFTER your blood test.

• Please ensure that you drink plenty of water prior to your blood test.  

• For an accurate PSA result, you should NOT have an active urinary infection, ejaculated or exercised heavily in the last 48 hours; had a prostate biopsy in the last 6 weeks or had a DRE (digital rectal examination) in the last week. 
   

Testosterone Replacement Treatment – Use or Abuse?

You should only commit to TRT if you have a true deficiency and you cannot reverse your low levels without the need for testosterone and HCG.  TRT is a lifelong medical therapy, it’s not a supplement to ‘top up’ your levels, it’s an essential medication for health.  TRT is effective if you have TD, however it is not as effective as your own body if your levels can be improved without disruption of the Hypo-Pituitary Gonadal axis.

The purpose of TRT is to restore your androgen levels so that homeostasis can be achieved, no more, no less.  From a biological perspective, irrespective of whether you are a creationist or evolutionist, we are supposed to pass on our DNA to the next generation and provide a stable environment, nature and nurture.  In order to do that we need healthy, stable androgen levels and with that comes adequate sexual function in order to procreate.

 

Who Is Not a Suitable Candidate For Testosterone Replacement:

According to the BSSM Guidelines, TRT is contraindicated in males with:

• Locally advanced or metastatic prostate cancer

• Male breast cancer

• Haematocrit higher than 54%

• Severe chronic heart failure
   

Additional contraindications can (but not necessarily in every case) also include:

• A Prostate Specific Antigen (PSA) measurement of more than 4 ng/mL (or more than 3ng/mL in men at high risk of prostate cancer, such as African Americans and those with first-degree relatives who have had prostate cancer)

• Untreated severe sleep apnoea

• Severe Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia