Frequently Asked Questions

Testosterone is a hormone made by the body and is responsible for the normal growth and development of the male sex organs and for maintenance of other sexual characteristics.  In men, testosterone is produced in the testes, the reproductive glands that also produce sperm. The amount of testosterone produced by the testes is regulated by the hypothalamus and the pituitary gland. Some effects of testosterone may include:

• Growth and maturation of prostate, and other male sex organs
• Development of male hair distribution such as facial hair
• Changes in body muscle mass and strength and fat distribution
• Sex drive and sexual function
• Mood and energy level
• Bone strength

Benefits of testosterone replacement therapy vary based upon the pre-therapy symptoms and other factors, but can include:

  Increased Energy

  Decreased irritability and depression

  Improved muscle mass and strength

  Higher motivation

  Improved cognitive function and verbal memory

  Decreased body fat

  Improved erectile function

Testosterone levels between 350 ng/dL and 1,100 ng/dL are referred to as “normal” range.  This is a wide range and their is a lot of variability among individuals.  Men who once had a peak testosterone level of 1000 ng/dl will likely experience severe symptoms at 500ng/dl.

The proper method of testosterone delivery for you is a matter for your physician to determine; however, many find that some gels tend to be messy and less convenient than other treatment modalities. In addition, there can be a risk of unintentional transmittal to children or others with whom you may have physical contact with the use of gels. Testosterone patches can create a significant rash at the site of application, or do not stick well, especially in the summer months. Experience has shown that gels and patches may require dosage adjustments to obtain medically appropriate blood concentrations and some patients may never absorb enough testosterone from gels or patches to improve symptoms. These modalities often have a higher conversion to less desirable hormones in the process of transfer through the skin. The Man Clinic will regularly employ intramuscular testosterone injections because of their clinical effectiveness and convenience.

Some patients could experience one or more of the following side effects:

  Increase in red blood cells.  This can be beneficial if you have anemia. However, it can be potentially dangerous, since an increase in red blood cells can lead to blood clots, heart attack, or stroke.

  Enlargement of your prostate.  If you have an enlarged prostate already, testosterone may worsen your symptoms, particularly if you are more than 50 years of age.  If you have a history of prostate cancer, you cannot receive testosterone therapy, without prior clearance from the urologist who is overseeing your care.

  Skin reactions such as acne, oily skin, increased body hair and flushing have been reported. These side effects are not very common, but when/if they occur, often are transient.

  Rare but potential infertility.   Testosterone therapy down regulates production of a man’s sperm.  If you are still wanting to have children The Man Clinic will provide a monthly dose of hCG (human chorionic gonadotropin) which will prevent any testicle atrophy and help prevent infertility.  Ensure you are upfront with your desire for children with Dr Fong, and be sure to discuss the situation with your spouse/partner if appropriate.

  Worsening sleep apnea.   This is a condition that disrupts breathing during sleep, and if already present, may be worsened by the use of testosterone therapy. If you snore, or suspect you may have sleep apnea, be sure to talk to your medical provider about the situation. Considering a sleep study for further evaluation may be appropriate prior to starting therapy.

  Fluid retention.   Although uncommon, you must use caution if you have a history of heart failure or kidney disease.   If this occurs, The Man Clinic will be happy to provide diuretics to help get rid of this extra fluid.

Low Estradiol Symptoms: 

• Fatigue along the lines of sleepiness
• hypersomnia (sleeping too much and too often)
• strong erections but limited sensitivity
• loss of erections
• osteoporosis and osteopenia
• joint pain, clicking or popping joints
• eye fatigue (eyes seem more tired despite adequate sleep, dark circles)
• loss of libido (interest in sex)
• difficulty retaining water (constant urination)
• anxiety, depression, irritability

High Estradiol Symptoms: 

• Soft erections, inability to maintain an erection
• water retention (less frequent urination), leading to excessive sweating, blood pressure spikes or high blood pressure (from the water retention)
• insomnia
• hot flushing (flushing around the ears or on the face)
• night sweats (from estradiol lowering, causing loss of water retention)
• bloating; brain fog (like your head’s in a bubble)
• testicles seem smaller than usual

Andropause is the natural gradual decline in a man’s testosterone level after the age of 22 to 30 at an average of 1-2% per year.  Symptoms are often not notice because of this gradual decline.

Menopause is the natural rapid decline in estrogen when a woman reaches the average age of 52.  Within a few years woman can lose 50% of their estrogen which is the cause of usually rapid onset of mood swings and many other symptoms.

Hypogonadism, in a male, refers to a decrease in either testosterone production, sperm production, or both. The physicians at The Man Clinic, address the testosterone aspect of this condition. Decreased sperm production requires a careful, thorough evaluation by a trained specialist.

Testosterone Therapy can enhance your life within just 30-40 days. Men who exercise and eat lean, healthy meals typically see accelerated outcomes. Results are typically in full effect within the first 6 months of testosterone therapy.

To determine testosterone levels, the medical professionals at The Man Clinic will perform a simple blood test, the results of which you will often know in 30 minutes or less.

The Man Clinic’s process offers a quick and easy way to diagnose and treat low testosterone.  Your testosterone levels will be tested during your initial visit in our in-house laboratory.  The test takes just a few minutes and will be performed by the professional medical staff dedicated to helping you get your quality of life back.

You will have your test results in 30 minutes or less. If your test indicates your testosterone levels are below clinically acceptable, the medical professionals at The Man Clinic will discuss your individual treatment options.

You will then return every 7-10 days to receive your booster injection.  Each subsequent visit takes about 10-15 minutes.

In general testosterone replacement therapy is not recommended and/or is prohibited for patients with:

• Breast or prostate cancer
• A palpable prostate nodule
• Erythrocytosis
• Hyperviscosity
• Untreated obstructive sleep apnea
• Severe benign prostatic hyperplasia symptoms (AUA prostate symptom score > 19)
• Uncontrolled severe heart failure
• Unexplained PSA elevation
• Severe lower urinary tract symptoms associated with benign prostatic hypertrophy
• Unstable severe congestive heart failure (class III or IV)

Sermorelin (GHRH) is a bio-identical hormone that has recently been genetically engineered to stimulate the secretion of Growth Hormone Releasing Hormone (GHRH) from the hypothalamus, a gland adjacent to the pituitary gland.

GHRH is a peptide that contains the first 29 amino acids of our own GH. These 29 amino acids are the active amino acids of GHRH.  It is GHRH that stimulates the pituitary glands to release GH.  As we get older, the hormones produced by the anterior pituitary are depleted. It has now been shown that GHRH can restore the GH-RNA to a youthful level causing elevation of levels of IGF-1.

Actually, no.  Sermorelin has an ongoing effect in which optimal HGH levels can be sustained long after the last injection.  Sermorelin initially must be injected every day.  Once optimal HGH levels are sustained, Sermorelin injection frequencies can be decreased or stopped altogether.  Once results are achieved, patients are then switched to a maintenance protocol eliminating the need for ongoing daily injections and reducing the total cost of therapy.  However, periodic HGH levels need to be monitored after stopping therapy.

Patients usually report improved sleep within the first few weeks of therapy.   This is only noticed in patients who have trouble sleeping in the first place, however most patients will notice consistency in overall sleep quality.  This is usually concurrent with increased energy levels and improved mood.  After 3-6 months of therapy patients start reporting noticeable or significant body changes, such as increase in muscle tone and a leaner physique. Over time patients will also notice a significant improvement in skin tone and health.

Sermorelin is presented in a multi-dosed, injectable vial.  Or easy dosing personal pens with cartridges.  Each vial contains a powder which contains lyophilized Sermorelin Acetate and we carry it with added GHRP2 and or GHRP6 which are 2 additional sectretagogues (stimulate the pituitary gland to release more HGH that is one of the Growth Hormone messengers). The vial is vacuum sealed by the pharmacy for your protection and for the preservation of the hormone peptide.  Each Sermorelin vial also comes with a bottle of Sodium Chloride as a diluent.  The Sodium Chloride is mixed with the Sermorelin to provide a solution for the injection.
We do have it in oral droplet form but it costs more and does not work quite as well as the injection. The injection however is from a very small needle the size of an insulin syringe injection and only goes just under your skin or subcutaneous injection. No one has felt it yet in the belly fat.

There has been six double blinded studies, and every participant receiving sermorelin had HGH levels in the normal range had no adverse side effects.  It has been shown to be very safe if properly monitored.

Due to the pulsatile nature of endogenous HGH, a single blood draw is not sufficient for accurate measurement.   Most physicians who prescribe Sermorelin and similar peptides measure effectiveness in patients through symptomology (the study of your symptoms-see benefits); physical appearance and measurements; and more frequent blood analysis.  We would like to see a upward trend in your HGH level.  The ideal HGH level should be between 0.01-0.97 ng/mL.

Sermorelin is injected into the body fat, subcutaneously, using a very small needle similar to what a diabetic uses to inject insulin.  Injections are initially prescribed for every day and are decreased in frequency over time after 6 months.

The best time to take Sermorelin is prior to bedtime.  Growth Hormone is primarily released during sleep and most beneficial to the body’s recovery and repair during this time.  Sermorelin has a promoting effect on sleep and can therefore make you tired if taken during the day. You have to take it on an empty stomach which means 2 hours away from food, and once you are in bed no snacks after going to sleep.