Our preferred method of Testosterone Replacement Therapy is with weekly or twice weekly injections of an intermediately long-acting testosterone ester called Testosterone Cypionate. It has a half-life of 5-8 days in most men and is well suited for intramuscular injections in the buttock. It is FDA approved and labeled for this mode of administration. That being said, some patients metabolize this medication more rapidly and excrete it too fast for it to work optimally in a once or even twice weekly injection schedule. For those patients we have other options for testosterone administration including Every-other-ay Subcutaneous injections, nasal gels, topical creams, daily oral synthetic androgens (i.e., Oxandrolone), or longer acting androgen esters such as Nandrolone Decanoate
hGH therapy is only administered by Subcutaneous injections and on a daily basis, similar to the way a diabetic injects insulin. Just like insulin, it cannot be taken by mouth because it is a protein (peptide) molecule that will degrade once it is exposed to enzymes in the digestive tract. hGH is extremely expensive and virtually NEVER covered by insurance companies unless a patient has been diagnosed with HIV wasting syndrome, Kidney Failure, Turner's Syndrome, Short Gut Syndrome, Prader-Willi Syndrome, Small for Gestational Age Idiopathic Short Stature or Noonan Syndrome. Furthermore, diagnosis of Adult Growth Hormone Deficiency is very difficult as this hormone is produced mostly at night within the first 2-3 hrs of sleep.
Anti-Estrogen medications are available in 2 basic categories, those that inhibit Aromatase enzyme and those that block Estrogen receptors. Examples of Aromatase inhibitors are Anastrozole, Letrozole and Exemestane. Examples of estrogen receptor blockers include Clomiphene and Tamoxifen.
Most TRT patients will require a small dose of Anastrozole once or twice per week, if at all. In our practice, we find that only about 1/3rd of our patients actually need an Anti-Estrogen and the remainder do well on Testosterone Cypionate and HCG therapy alone.
Clomiphene can sometimes be used as an alternative to Testosterone Therapy for selected male patients since it can raise the Testosterone levels naturally by creating a surge in Luteinizing Hormone.
Human Chorionotropic Gonadotropin (HCG) is a natural protein (peptide) hormone that is also administered by injection only. It is normally present in such tiny amounts that the serum levels are undetectable by conventional methods. HCG however is produced in very large amounts by the placenta of a pregnancy female with peak levels around 10-12th week of pregnancy. It is the substance that is tested for in a woman's urine or blood to determine if she is pregnant (Beta-HCG test). HCG acts as a Luteinizing Hormone (LH) analogue ("mimicker"). It is structurally almost identical to LH which signals a man's testis to produce Testosterone. HCG is used in TRT to maintain the Intra-Testicular Testosterone level closer to normal so that the Testis don't atrophy and Sperm production is supported.
A more affordable and alternative way of increasing GH levels is by administering Growth Hormone Releasing Factors. Like hGH, these are peptide hormones that need to be injected subcutaneously on a daily basis. They stimulate the pituitary to produce more of its own GH. They too are peptide hormones and injected once or twice daily. Examples are Sermorelin, Ipamorelin, GHRP2 and GHRP6.
Thyroid hormone is taken in tablet form on a daily basis and is available as synthetic T3, synthetic T4, synthetic T3+T4 and dessicated thyroid that is derived from animal glands and also contain a combination of T3 and T4. The choice is usually based on the patient's individual metabolic profile, lab testing and prior response to therapy.