Life Extension Magazine®

Issue: Jun 2015

Testosterone Replacement Therapy

In his book Testosterone Replacement Therapy—A Recipe For Success, Dr. John Crisler has written a practical guide for any man seeking the benefits of testosterone replacement therapy, discussing everything from appropriate blood testing to ideal methods of delivery.

By Will Brink

A Recipe For Success

Until recent years, testosterone replacement therapy (TRT) was on the fringes of traditional medicine.

This is unfortunate because millions of men suffer from testosterone deficiency (low T), along with other hormones that grow out of balance with normal aging.

Some adverse outward effects associated with low testosterone are depression, low libido, abdominal weight gain, lack of energy, and "brain fog." These common effects of testosterone deficit went untreated for decades. And that's only the tip of the proverbial iceberg.

Testosterone deficiency imposes a substantial public health burden. Numerous studies show that low T is a predisposing factor for various chronic illnesses such diabetes, cardiovascular disease, osteoporosis, and sarcopenia (muscle loss). All of these conditions—as well as others not covered here—can be improved greatly with proper hormonal management, especially in conjunction with changes in other risk factors.

A recent study determined that over a 20-year period, testosterone deficiency is projected to be involved in the development of approximately 1.1 million new cases of diabetes, 1.3 million new cases of cardiovascular disease, and over 600,000 osteoporosis-related fractures, with a cost of $190 to 525 billion in inflation-adjusted US health care expenditures.*

Some in the medical community overall have recently embraced the fact that low T is a serious problem and risk factor for men, and the ubiquitous "low T" commercials show that the pharmaceutical industry has finally realized a large consumer market exists. However, there's still resistance within the mainstream medical community in terms of the best ways to treat low T, and those who have embraced the use of testosterone tend to be well behind the learning curve on the optimal approach.

The problem is there's only a handful of medical professionals who have extensive clinical proficiency with testosterone/estrogen balancing therapy in men. Pioneers such as Dr. John Crisler are among the few practitioners with decades of hands-on clinical experience in this emerging field. Even those practitioners now willing to treat low T only understand the very basics of the topic. For example, the majority of medical practitioners currently willing to treat low T will simply have a man tested for total testosterone (TT) then make a decision to treat based solely on the results of that one lab test. That's poor medicine and poor hormonal management. Many doctors don't even require blood testing before prescribing testosterone to men complaining of andropausal symptoms. This failure to perform requisite blood testing is a recipe for disaster.

Dr. Crisler goes into depth on not just how to assess testosterone blood levels correctly, but he gives a long list of other hormone tests that should be done and how to interpret the test results. Perhaps even more importantly, Dr. Crisler clearly states that people need to pay close attention to not just lab results, but subjective symptoms as well.

Dr. Crisler has taken his extensive clinical experience and written a practical "best practices" guide for both clinicians and patients to follow. Testosterone Replacement Therapy—A Recipe For Success is not a tour de force of the published studies per se, but a reflection of Dr. Crisler's extensive decades-long clinical experience working with men and adjusting their hormones to greatly enhance their physical and mental well-being. This book is not just a discussion on managing testosterone, but how to test and manage the total picture of what makes the male hormonal milieu function to its full potential.

Obviously testosterone is covered at length, including doses, types, and other essential information, but the use of other medications such as human chorionic gonadotropin (hCG), Clomid® (clomiphene), anastrozole, and more are discussed in regards to proper usage and dosage. Dr. Crisler also covers the important topic of the hypothalamic-pituitary-gonadal axis (HPG) and whether low T is due to primary versus secondary causes. In men, the HPG is the primary feedback loop by which the body senses and produces testosterone and other essential hormones, so a discussion of the HPG is important to an overall understanding and approach to low T.

The book also covers the known external causes of low T in men, many of which men may not be aware of, such as opioids, radiation exposure, corticosteroid drugs, spironolactone, antidepressants, ketoconazole, cimetidine, statins, and chemotherapy. Many men are exposed to one or more of these causes of low T.

One of the more useful sections in the book for both practitioners and patients is the topic of testosterone delivery systems. There are now many choices, from shots, patches, gels, creams, pellets, and more, which can lead to a great deal of confusion for both medical professionals and men seeking the best options for themselves. Dr. Crisler prefers properly applied and dosed T gels, but provides details on the proper use of other methods, such as injections (both intramuscular and or subcutaneous). But he stresses the "right" choice of delivery should be determined by both lab results and subjective symptoms.

Dr. Crisler stresses strongly what virtually every medical professional tends to emphasize with decades of hands-on clinical experience treating men with low T: successful treatment of male hormones (testosterone in particular) comes from the correct use of lab work, and a genuine respect for the subjective experiences of the men they work with. That's the balanced approach that's "a recipe for success" among all highly experienced medical professionals and Dr. Crisler is a shining example of that.

Dr. John Crisler
By Dr. John Crisler

If one is looking for a book that covers recently published studies in depth, this is probably not the book for that purpose. But if one is looking for a "best practices" practical guide, written by a practitioner who has treated thousands of men over many decades for testosterone deficiency—then Testosterone Replacement Therapy—A Recipe For Success is an excellent choice that could save men years of searching for the right answers.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.

*Moskovic DJ, Araujo AB, Lipshultz LI, et al. The 20-year public health impact and direct cost of testosterone deficiency in U.S. men. J Sex Med. 2013;10(2):562-9.

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