Testosterone Replacement Therapy
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Dr. Dylan Krueger, NMD has received extensive training in both conventional and functional medicine as well as post-graduate training in hormone replacement therapy. He combined his interests in functional medicine and hormone optimization with his dream of being a small business owner to form Atlas Health Medical Group in Gilbert, AZ. His private practice focuses on identifying and treating the underlying causes of hormone imbalance with outside the box solutions.
Dr. Krueger's passion for hormone replacement, performance, bio-hacking, nutrition and exercise is utilized with every patient he sees as he creates personalized treatment plans that fit patients' busy lives. This comprehensive approach has helped patients live their best lives, feeling strong and energized, ready to take on the world.
Dr. Krueger loves offering cutting edge therapies and has helped hundreds of patients feel great again. In his free time, he enjoys camping, hiking, golfing, weight lifting, stand-up comedy shows, watching Minnesota sports teams (sadly), reading and spending time with his wife, son Liam and his dog Lily.
Naturopathic Medical Doctor
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Frequently Asked Questions
To become eligible for testosterone replacement therapy patients must have symptoms of low testosterone impacting their lives and baseline blood work showing their free and/or total testosterone below the optimal range for their age bracket. (2) These are general guidelines and each doctor and clinic have their own criteria of when to treat.
Getting initiated on TRT starts with a consultation with a doctor, who will review your history and symptoms and determine if you are a potential candidate for the treatment. If the patient has symptoms that could be from low testosterone, the doctor will next order lab tests to establish baseline health and hormone levels. If the lab results show that the patient's testosterone levels are low as compared to their age group, and the patient is having low T symptoms, then TRT can be initiated. The patient will be started on a standardized trial dose of testosterone and labs will be re-ran in 10 weeks to monitor treatment results and patient safety. The dose may or may not be changed at the 10 week follow-up based on symptoms and lab numbers. After that, the patient will continue to have his labs monitored routinely, approximately every 4-6 months, and will continue to be under the doctor's care and guidance.
Pricing varies greatly from clinic to clinic. A general ballpark estimate would be between $100-250 per month for TRT care that would include labs, the medication, syringes, and doctors appointments. Insurance may cover the lab work, providing lower costs to the patient. Getting the testosterone medication covered by insurance can be trickier with most patients opting to just pay out of pocket for it.
Baseline lab testing is required before starting TRT. The more comprehensive the testing is, the better results and safety for the patient. Labs that should be ordered as part of a TRT and general wellness screen include:
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel (CMP)
- Lipid Panel
- Free Testosterone
- Total Testosterone
- Prostate-Specific Antigen (PSA)
- Vitamin D3
- Sex Hormone Binding Globulin (SHBG)
This varies from clinic to clinic but generally speaking, patients will need baseline labs and follow-up labs at 10 weeks and then every 20 weeks after that ongoing.
Total testosterone is the sum of the bound and unbound testosterone in your body, while free testosterone is unbound and bio-available for use in your tissues. (5) Free testosterone tends to have a stronger clinical correlation with how patients actually feel, and thus can be more of a useful metric.
The short answer is no TRT is not dangerous when managed by a hormone doctor. TRT taken off the street or bought online can be extremely dangerous that's why it needs to be managed by a medical professional. TRT when taken at the correct dosage and monitored regularly with lab work is very safe and has a long track record of safety across the globe. (3) Not monitoring blood work is where dangerous situations can arise.
- Increased sex drive
- Decreased belly fat
- Increased muscle mass
- Decreased fatigue
- Improved stamina
- Increased motivation
- Improved mood
- Faster recovery
- Increased sense of wellbeing
- Increased bone density (1)
TRT does not cause cancer and is extremely safe overall when prescribed by a trained physician. Hormone replacement therapy can potentially worsen an existing cancer and it is advised to discontinue therapy if that is the case. The main concern with males and TRT is prostate cancer. (4) Oftentimes cancerous cells are present in the prostate but undiagnosed because the patient may not have any symptoms yet. This is why all TRT patients complete regular blood work and physical examinations. Patients with elevated PSA values are not advised to take TRT and are referred out to a local Urologist.
This is a potential side effect but is relatively rare if prescribed and used properly. Testosterone can convert into estradiol through a process called aromatization, which over time can cause gynecomastia, aka man boobs. (6) Clinically, I’ve seen this happen but only in older males that just take TRT and do not incorporate any lifestyle changes or exercise, particularly weight training. Patients that weight train tend to not experience this side effect. High estradiol levels from taking TRT is easily treated by adding in a very small dose of anastrozole once weekly to block estrogen conversion. This fixes the issue very quickly.
Testosterone replacement therapy overall is very safe when prescribed and closely managed by a physician. But like all medications, there are some side effects that can happen from time to time. One side effect is higher estradiol levels that could eventually lead to gynecomastia. This is rare and happens typically if someone is not being managed by a doctor or if they are taking testosterone and not weight training.
Another side effect is acne which is also rare if the patient is taking the correct dosage. Acne can be caused by many things including hormonal imbalances and very high testosterone can lead to acne in males of all ages.
Another more common side effect is having the blood “thicken” so to speak. Medically this is called erythrocytosis, or high red blood cell count that leads to higher hematocrit levels as well. Red blood cells contain iron, a metal, so when counts are increased, the blood is more viscous and thicker. This is typically not much of a problem but theoretically could lead to a cardiac event such as a heart attack or stroke if left untreated for prolonged periods of time. Clinically, I see this in approximately 10% of my patients on TRT. There are 2 solutions that correct this side effect. First, lower the dose of testosterone down until the RBC labs return into the normal range. The second option is a therapeutic blood donation, aka giving blood. This can be done at places like the Red Cross or other local blood donation centers. Patients need to donate whole blood NOT plasma. Donating whole blood every 3 months should resolve this side effect over time without needing to change the dose of the testosterone.
An additional side effect is having your PSA numbers increase in your prostate. Testosterone itself does not cause cancer but if a patient has cancerous cells already present in the prostate it could theoretically fuel them and aid in cancer growth because testosterone is anabolic. This again, is another reason why TRT needs to be managed by a doctor. In my clinic we test for baseline PSA levels and then routinely monitor PSA throughout treatment. If PSA rises significantly or outside of the normal reference range, I have patients stop taking TRT and have them get their prostate evaluated by a Urologist. When this situation happens, it's typically in older males.
Hair loss can also be a side effect of TRT. This is largely genetic based and would happen at some point regardless of using TRT or not. For patients that have a strong disposition towards androgenic alopecia, aka male pattern balding, TRT can potentially hasten the progression of hair loss development. This happens because testosterone gets converted into DHT, dihydrotestosterone, which can cause the hair to shrink in diameter and eventually fall out. Fortunately, there are ways to minimize this side effect such as taking DHT blockers, either as supplements or medications, or having platelet rich plasma injections into the hair as a preventative.
Another concerning side effect of TRT is testicular shrinkage. This does happen and for some males is concerning and for others is no big deal. The reason this happens is because testosterone is naturally made in the testes so when you’re taking an outside source of testosterone, exogenous, your body slows down its own natural production. This in turn decreases the size of the testes. There are medications and peptides that can be taken in conjunction with TRT to avoid this problem, but from my experience most patients are not too concerned about it.
Lastly, some patients can experience mood changes and increased aggression on TRT. This typically is seen when patients are taking an incorrect dose and their testosterone gets way too high. I would say this is rare and the vast majority of patients report positive mood changes and more mental resilience. (7)
TRT can be taken in 2 ways, either injectable or topical cream. (8) The injectable is anywhere from daily to once weekly depending on the dosage and patient's preference. The cream is applied daily. There are pros and cons to each method but the vast majority of patients we treat opt to use the injectable version. The injectable is cheaper typically and increases testosterone levels faster, with the downside being you do have to inject yourself with a needle.
Do You Need a TRT Doctor Focused on Results-Based Solutions in Gilbert, Arizona and the Easy Valley?
Atlas Health Medical Group in Gilbert, Arizona specializes in providing Functional & Regenerative Medicine to the East Valley including Gilbert, Chandler, Mesa, San Tan and Queen Creek. Offering innovative treatments such non-surgical joint reconstruction, Bio-Identical Hormones, testosterone replacement therapy, Nutrient IVs and supplements that allow us to individualize care for every patient. We pride ourselves on setting the standards of patient care and result-driven treatments. This approach has allowed us to become the leading wellness clinic in Chandler, Gilbert, and Mesa Arizona. Our patients return to health and live the life they intended.
Top 5 TRT Clinics in Gilbert, AZ
1. Atlas Health Medical Group
About: The Atlas Health Medical Group is conveniently situated near downtown Gilbert, near the Gilbert Water Tower, Gilbert's First Jail House, and Liberty Market, among other significant landmarks. Their office is only a few blocks from the historic downtown district, which is home to several hundred-year-old buildings as well as a plethora of high-end shopping, dining, and entertainment options. You've been missing out if you haven't been to downtown Gilbert.
Gilbert, which is centrally located at the intersection of highways 60 and 87, south of San Tan Mountain Regional Park and just west of South Mountain Park and Preserve, serves as the area's commercial, cultural, and political center. It is located in the Phoenix metropolitan area to the southeast of the city. It's about 17 miles east of Queen Creek and Chandler Heights, and was once known as the "Hay Shipping Capital of the World." Golfland Sunsplash, Clare's Metal Store, Riparian Preserve at Water Ranch, and Mother Nature's Farm are just a few of the awesome places to visit in the area.
This makes Atlas Health Medical Group (conveniently situated on West Elliot Road) a centrally located Naturopathic clinic providing groundbreaking therapies such as Platelet Rich Plasma (PRP), Bio-Identical Hormones, testosterone replacement therapy (TRT), Nutrient IVs, easily accessible in Maricopa County and the surrounding communities.
Services Offered: Hormone Replacement for men and women, Microneedling, Platelet Rich Plasma (PRP), and Platelet Rich Plasma for Hair Loss, fertility optimization, general functional medicine.
What Makes them Different: Atlas Health Medical Group are functional medical doctors providing primary care to the East Valley including Gilbert, Chandler, Mesa, San Tan and Queen Creek, AZ Offering innovative treatments such as Platelet Rich Plasma (PRP), Bio-Identical Hormones, and nutrition that allow them to individualize care for every patient. They pride themselves on setting the standards of patient care and result driven treatments. Their patients return to health and live the life they intended. This approach has allowed them to become the leading Functional Medicine clinic in Gilbert, Arizona.
2. Naturally Balanced
About: Cheryl grew up in the Queen Creek, Arizona area. She earned a Bachelor of Science in Nursing from Arizona State University in 2004. She returned to school for a Masters of Science in Nursing after two years of practice at Mayo Clinic Hospital and working in Home Health. She graduated in 2009.
Cheryl has been working in a family practice since 2009, where her interest in the endocrine system has grown. Naturally Balanced focuses on the whole person by balancing hormones, adrenals, and thyroid while also focusing on gut health, stress reduction, and a healthy lifestyle.
Services Offered: Hormone Balance, Adrenal Support, Thyroid Regulation, Gut Health, and Weight Loss Management.
What Makes Them Different: It is a joy for the owner to watch a person's life be transformed with the right education and resources. She believes that proper tools are needed to maintain your body's optimal daily function, whether working with a male with low testosterone, a symptomatic menopausal woman, or a teenager with high stress or irregular cycles.
3. Ageless Men's Health
About: Ageless Men's Health was founded by a team with a broad clinical background that noticed a problem: low testosterone levels in men were under-diagnosed, poorly treated, and not talked about. Millions of men have suffered from low Testosterone and other health problems, and they haven't done enough about it. They have vowed to change that.
Services Offered: Low Testosterone Replacement, Skin Care Treatment, and Weight Loss Management and Solutions.
What Makes Them Different: They knew that a revolution in men's health required a client-focused approach to an easy, painless and sustainable treatment program that fits their schedules. And that's what we've done since: set up a nationwide series of clinics where men feel comfortable, well-treated, and work at their convenience.
4. Balance Hormone Center
About: Balance Hormone Center is located at the Copper Point Professional Park in Gilbert, AZ. They specialize in hormone replacement therapy for men and women, and their goal is to make you feel the best you can. Schedule an appointment today and one of their healthcare professionals can determine if you are a candidate and what steps you need to take to start feeling better about your quality of life.
Services Offered: Testosterone Replacement, Estrogen Replacement Therapy, Anti-Aging, Hormone Replacement, Acute Illness Care & Management, Menopause Therapy, The Myers Cocktail, and more.
What Makes Them Different: The doctors at Balance Hormone Center work with you to learn about your symptoms, measure your hormone levels, and find out how hormone therapy will help you improve your health and quality of life. By having an appropriate hormone replacement program, eating a healthy diet, and exercising with a supervised exercise trainer, you will look and feel better than you have in years.
5. Limitless TRT & Aesthetics
3483 Mercy Rd. # 104, Gilbert, AZ 85297, United States, +14804000105
About: Limitless TRT & Aesthetics, LLC is dedicated to the improvement of men’s health. Medical professionals founded this clinic with 15 years of experience in the men’s health field, and they are proud to offer a range of services to improve the lives of our patients.
Services Offered: Testosterone replacement therapy, permanent non-surgical treatment for male enhancement, P-Shot, shockwave therapy, concierge medicine
What Makes them Different: Their passion for this business comes from their own experiences. They have seen and felt their own decline as the years go by, both in terms of appearance and sexual performance. At the same time, they have also directly experienced what these services can do to reverse that decline – and it’s the benefits of their services that they are so excited to share with you. They even provide male enhancement in the way of permanent penis enlargement.
Common Questions about TRT
This depends on the patient's preference. Yes, some patients will be on TRT forever if they chose to be. (9) Others can take it and get off depending on their health needs and situation. There are some medications and peptides that aid patients who choose to discontinue TRT but maintain healthy hormone levels.
Testosterone replacement can most definitely impact fertility in males. It doesn't make conceiving impossible but it will be much harder. The reason being is TRT lowers your body's own testosterone production which in turn lowers your sperm count. (10) There are medications that counterbalance this effect or we can help patients get off TRT to increase their chances at successful fertility.
This is a common known side effect of taking an outside source of testosterone. Your testicles are responsible for making testosterone in your body and when they no longer need to produce as much because you're taking an outside source of testosterone, they decrease in size. For the vast majority of guys this is not much of an issue.
The cost of TRT includes not only the medication itself but also labs and doctors appointments. This can vary greatly from clinic to clinic with a general ballpark estimate between $99-250 per month.
Testosterone replacement therapy is 100% legal in the United States when prescribed by a physician or licensed medical provider. TRT is 100% illegal when bought online, off the street, or from another country.
The cause of low T varies case by case on an individual basis. Some things that can cause low T include:
- Prolonged stress
- Lack of sleep
- Inadequate calories
- Poor diet
- Medication side effects
- Lack of weight training
- Recreational drugs
There is no specific age requirement to start on TRT. That being said, most men will start to experience low T symptoms in their early 40’s to 50’s and that is typically where most will begin to consider TRT as an option. If a person has low T symptoms and low testosterone on lab work, then they would be a good candidate for hormone replacement therapy.
- Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009;5:427-448.
- Crawford C. Acp guideline addresses age-related low testosterone.
- Corona G, Torres LO, Maggi M. Testosterone therapy: what we have learned from trials. J Sex Med. 2020;17(3):447-460.
- Osterberg EC, Bernie AM, Ramasamy R. Risks of testosterone replacement therapy in men. Indian J Urol. 2014;30(1):2-7.
- Testosterone levels test: medlineplus medical test.
- Raheem AA, Zaghloul AS, Sadek AMG, Rayes B, Abdel-Raheem TM. The impact and management of gynaecomastia in klinefelter syndrome. Front Reprod Health. 2021;3.
- Ponce OJ, Spencer-Bonilla G, Alvarez-Villalobos N, et al. The efficacy and adverse events of testosterone replacement therapy in hypogonadal men: A systematic review and meta-analysis of randomized, placebo-controlled trials. J Clin Endocrinol Metab. Published online March 17, 2018.
- Trt: uses, side effects, and cost of testosterone replacement therapy. Healthline.
- Testosterone replacement therapy: is it right for you? - urology care foundation.
- Patel AS, Leong JY, Ramos L, Ramasamy R. Testosterone is a contraceptive and should not be used in men who desire fertility. World J Mens Health. 2019;37(1):45-54.
- Can testosterone injections cause hair loss? hims.
This varies greatly from doctor to doctor and from patient to patient. The optimal range and dosage for you may be way different than another person based on many factors. Generally speaking, from my experience guys typically are feeling good at 750-1300 ng/dL for total testosterone and 15-25 ng/dL for free testosterone.
Everyone’s experiences are a little different on TRT. Generally speaking, patients feel increased sex drive, fatigue resilience, leaner, better recovery after workouts / training, stronger overall, increased motivation, increased confidence, and just a general sense of wellbeing.
Unfortunately, most insurances do not cover TRT because they deem it medically unnecessary. The other issue with coverage is your lab numbers have to be out of range for men of all age groups instead of men of your age group. For example, a 50 year old male might have a total testosterone of 425 and have symptoms of low T. The insurance company will say he’s within the reference range and we will not pay for treatment even though the man is suffering and is clinically low for his age bracket. Fortunately, TRT is extremely affordable at many clinics and the medication itself is less than $1 a day in generic form.
Yes, testosterone generally helps guys lean out around the abdomen and can boost your metabolism when combined with weight training. Just taking TRT alone without any lifestyle changes will not be enough for people to lose belly fat.
The short answer is it depends largely on your genetics. TRT will increase DHT, which is believed to be the main driver of male pattern baldness. (11) Whether a person loses hair with increased DHT typically depends on their scalp’s androgen receptor sensitivities, which is based on an individual's genetics. Luckily, there are ways to mitigate the effects of DHT on the scalp such as finasteride, minoxidil, microneedling and PRP shots. These all allow individuals to take TRT and not worry about hair loss. Another strategy to decrease androgen receptor sensitivity is to take TRT in a daily small dose instead of a once weekly larger dose.
This is a common misconception. TRT does not fix ED, but it does increase sex drive. ED is typically a blood flow issue that is better treated with vasodilator medications that increase blood flow to the penis. TRT may help ED if the dysfunction is based on mental barriers, as testosterone boosts confidence, but this is an indirect approach to the problem.
This is a broad question and the answer varies by age, symptoms and baseline testosterone levels from the patients blood work. Generally, the starting dose is between 100-200 mg weekly for the injectable forms. I typically start patients at 150mg per week and readjust the dose after new blood work in 10 weeks time. Rarely do I need to increase the dose up, and typically I don't need to change the dose at all. This seems to be a good sweet spot.
TRT does many things that cumulatively increase a man’s overall wellness and sense of wellbeing. Testosterone can increase sex drive, motivation, recovery, strength while reducing fatigue and body fat. All the effects of taking TRT are amplified when used in conjunction with healthy diet and lifestyle changes.