The Ultimate TRT Guide for Aussies – Part 1

The Ultimate TRT Guide for Aussies – Part 1

Within this multiple part series guide, I will explain for the lay person what one needs to know about Testosterone Replacement Therapy (TRT) in Australia. I will do my best to make this read as concise (and enjoyable) as I possibly can, but some explanation needs to be had with what is still a rather dubious topic in Australia. testosterone deficiency can be defined as the presentation of both low serum levels of testosterone accompanied by symptoms of testosterone deficiency. These symptoms include:

A. More specific symptoms and signs
• Incomplete or delayed sexual development, eunuchoidism
• Reduced sexual desire (libido) and activity
• Decreased spontaneous erections during sleep
• Breast discomfort, gynecomastia
• Loss of body (axillary and pubic) hair, reduced shaving
• Very small (especially <5 ml) or shrinking testes
• Inability to father children, low or zero sperm count
• Height loss, low trauma fracture, low bone mineral density
• Hot flashes, sweats

B. Other less specific symptoms and signs
• Decreased energy, motivation, initiative, and self-confidence
• Feeling sad or blue, depressed mood, dysthymia
• Poor concentration and memory
• Decreased penile sensitivity
• Sleep disturbance, increased sleepiness
• Mild anemia (normochromic, normocytic, in the female range)
• Reduced muscle bulk and strength
• Increased body fat, body mass index
• Diminished physical or work performance

“We get it already! Low testosterone isn’t good.”

As you are probably already aware, testosterone deficiency isn’t much fun. There are enough Google articles and clinical citations available that I am sure as you’re reading this, you’re wondering whether or not this text is yet another generic article on the topic of testosterone deficiency. Well I have great news for you, it’s not! In this text, I will explain TRT for Australians specifically. I will outline some of the common dilemmas men requiring testosterone therapy in Australia may face in what is still not a 100% Pro-testosterone therapy country. Of course, I won’t limit this text to a rant on all of the problems we Aussies seeking TRT face. Instead, I will also provide some insight to potential solutions for those in need who are unable to find direct help within the Australian medical system. But before the solution comes the problem. So without further discussion, let the whinging begin.
So what defines low testosterone in Australia? Is this definition fair?
The below paragraph is an extract from an official Australian prescribers’ source. The two paragraphs outlined below are considered the current guidelines for diagnosis of testosterone deficiency in Australia.

Source: https://www.nps.org.au/australian-prescriber/articles/low-testosterone-in-men

When serum total testosterone is less than 6.9 nmol/L in repeat samples, there is little doubt that true hypogonadism exists. If the results are in the range 6.9–11.1 nmol/L, therapy might be considered if there are symptoms and signs of androgen deficiency. In Australia, the Pharmaceutical Benefits Scheme subsidises testosterone (Box 4) ‘on authority’ for males with established pituitary or testicular disease. For men over 40 years old without such disorders the serum total testosterone must be below 8 nmol/L, or below 15 nmol/L in association with concentrations of serum luteinising hormone more than 1.5 times the upper limit of normal. To qualify for subsidised treatment, the patient must have a low testosterone on at least two occasions.

Do the current guidelines for testosterone deficiency in Australia match up with the most up to date data on testosterone deficiency?

The short answer is “no.” If a patient presents symptoms that are classical of testosterone deficiency but his testosterone is above 8 nmol/L, then of course he should qualify for testosterone deficiency diagnosis. In my clinical experience, I have found most men to be often symptomatic under 15 nmol/L for Total Testosterone (TT) and I often find the majority of men feel their best between 20-30 nmol/L (TT). There is no magic number for what “the best testosterone level is,” however some updating is needed within the Australian guidelines because 8 nmol/L is not just low, it is likely very low for most. From male to male the ideal level of testosterone may and likely will be different.

Not only do I notice this, but so does the data support my findings—along with the clinical experience of other renowned physicians in the field. Before I go on further, a quick note for the science savvy. I could reference citation after citation where relevant but seeing as how I have wrote this this text for the layman, I have left out references within this text because most reading will not be able to interpret the data and/or bother to. However, if you are reading this text and would like any formal evidence for anything discussed, please feel free to comment and I will make sure I respond accordingly with the appropriate reference/s. Okay, where were we. Current TRT guidelines in Australia. It is at this point in the discussion I’d like to point out our first issue with TRT in Australia:

Issue Number 1 – The current Testosterone deficiency guidelines in Australia do not best support the suffering patient as the guidelines are outdated and are limited to numbers, whereas the guidelines for diagnosis need to be based on both symptoms and numbers.
What are the most common causes of testosterone deficiency in Australia?
Australia, like our slightly fatter cousins in America, share some common lifestyle choices that can do a number on testosterone—a very low number. It is widely accepted among the global TRT medical community that if you’re overweight, do not sleep enough [or sleep right], consume a pro-inflammatory diet, lead a high stress lifestyle and you’re taking medications and/or alcohol to deal with this modern way of living—that you stand a fantastic chance of having testosterone deficiency. You’re probably thinking to yourself:

“Ah shishkebabs, that’s definitely me.”

Well, don’t feel too guilty because that’s the majority of us. You’re actually in the minority if you’ve done all of this right.

“So if we can correct our testosterone deficiency by correcting our lifestyle choices, then why would we consider TRT?”

One word: Compliance. There is a difference between knowing the plan and sticking to the plan. In a modern world full of unknown contaminants in our air, food and water supply, coupled with the temptations of technology and indulgent foods—it is fair to say it is unrealistic to expect the average Joe to take himself away from modernity into the wilderness, spear himself a wild caught barramundi for dinner and exfoliate his skin with the river-banks substrate that is laced with the purifying properties of the brackish water solvent. Wherever you turn in modernity lies a potential enemy to testosterone, so even if you did somehow possess the monk-like ability to refrain from your biologically wired urges, then you still are at risk for testosterone deficiency. On top of all that is known, a lot is not known. However, what we do know is that testosterone deficiency is now reaching epidemic proportions and these trends are growing exponentially. This leads us to issue number 2:

Issue Number 2 – The modern world contains known and potential testosterone enemies within our food, cosmetic, air and water supply. The modern world also contains temptations wherever we turn our heads—many of which are known enemies to healthy testosterone levels. It is unrealistic to avoid all of these temptations and we cannot currently measure the magnitude of damage each individual enemy is playing in the testosterone deficiency epidemic. All we know for sure is that we are experiencing an increase in testosterone deficiency diagnosis.

In Part 1 we only touched the topic of testosterone deficiency in Australia. Stay tuned for Part 2, 3, and probably several Parts thereafter. There is a lot to cover and I find it most efficient for the brain to absorb information in smaller increments. I encourage anyone to ask me any questions you want to regarding this text in the comments section below. Otherwise, until next time lads and lasses.