Kitchener-Waterloo
TRT Clinic

OHIP Covered Consultations

Kitchener TRT Clinic

Testosterone Replacement Therapy Clinic in Kitchener serving Waterloo Region, Cambridge and Guelph

Patients who may have low testosterone (known as hypogonadism) can exhibit symptoms such as fatigue, low libido, erectile dysfunction, mood changes, feeling unwell and other symptoms.

These are typical symptoms of low testosterone.

Low testosterone is diagnosed with blood tests and may require a second confirmation test depending on the initial lab result.

Once the diagnosis is made, underlying causes need to be ruled out and then treatment can begin when medically appropriate.

Causes of Low Testosterone

There are numerous causes of low testosterone. We aim to find out if the cause is primary hypogonadism or secondary hypogonadism where another disease process is causing the low testosterone before we start a patient on Testosterone Replacement Therapy (TRT).

Please note we do not routinely start younger men on testosterone without an obvious indication and/or specific diagnosis that warrants it.

We do a careful history and assessment for all of our patients' symptoms before starting any intervention.

Examples of primary hypogonadism include:

Klinefelter syndrome
LH/FSH receptor mutations
Chronic organ disease such as liver disease
Certain medications
HIV
Mumps
Certain autoimmune diseases
Hemochromatosis (select cases)
Cryptorchidism
Primary Testicular Failure

Examples of secondary hypogonadism include:

Chronic opioid use
Hyperprolactinemia
Diabetes
Corticosteroid use
Infiltrative disease
Certain tumors
Kallman syndrome
Hemochromatosis
Obesity
Sleep apnea

Low Testosterone
Testing and Treatment

Diagnosing low testosterone requires blood tests that include the total and free testosterone levels, and often bioavailable testosterone. Once the diagnosis is made, then the next step is to make sure there isn't an underlying disease process. While patients with low testosterone can require testosterone replacement therapy (TRT), it is important to make sure there isn't anything else being missed.

Additional testing includes:

LH and FSH to help determine primary versus secondary hypogonadism
Ferritin and serum iron studies to rule out hemochromatosis
Prolactin levels
SHBG
Targeted testing based on your symptoms and other possible causes

The laboratory evaluation is generally quite extensive and always includes "routine" comprehensive blood work. Certain patients may also require an MRI or ultrasound depending on what the laboratory evaluation and history and exam show.

Once the decision is made to start Testosterone Replacement Therapy (TRT), there are various therapies available. Injectable testosterone is a common modality of treatment. We generally aim for more frequent dosing to ensure stability of the levels. For men who absolutely cannot inject, there are topical creams available as alternatives. In certain cases where immediate fertility is a concern, discussions can be had about non-testosterone agents.

After treatment starts, there will be the need to do periodic monitoring. Monitoring lab tests include:

hemoglobin/hematocrit
total and free testosterone
lipid panel & apoB
other targeted testing

These tests are done at approximate 6-8 weeks intervals after treatment initiation and subsequently become spaced out as time goes on. The goal is to ensure your serum testosterone levels are in an appropriate range while watching out for complications.

TRT FAQ

1) Who is eligible for testosterone replacement therapy?
Answer: Men who have low serum testosterone levels with symptoms of low testosterone

2) Do you provide virtual only consultations?
Answer: We provide virtual visits only after an initial in-person consultation.

3) Do you aim to keep patients within normal physiologic lab ranges?
Answer: Yes we target normal lab ranges within the context of symptoms.

4) Do you prescribe aromatase inhibitors alongside TRT?
Answer: The use of aromatase inhibitors is not part of our routine practice.

5) How often do follow ups occur?
Answer: The first follow up occurs relatively soon, often after 5-6 weeks. Subsequent follow ups occur every 3-4 months if there are no concerns.

6) Do you prescribe testosterone to men with normal testosterone?
Answer: We generally do not treat men who have truly normal testosterone levels. The goal of TRT is to provide replacement and get men to a healthy range. While low-normal testosterone can be treated with TRT after a risk and benefits discussion; mid-range testosterone generally does not need replacement therapy. However, we are happy to see and assess any patient with symptoms.

7) Do you recommend donating blood if my hematocrit climbs too high?
Answer: Erythrocytosis is a side effect of TRT in some cases but a proper protocol will prevent it from happening in the first place. If it does occur, we will revisit the dosing protocol. Routine and repeat phlebotomy is not part of our treatment plans as it depletes the patient's iron stores.

8) Do you monitor the prostate?
Answer: We perform a pre-TRT assessment of the prostate. If the PSA rises, we discuss next steps such as a DRE and/or prostate MRI.

9) Do you prescribe testosterone to younger men?
Answer: Any patient who has fertility concerns in the future should be wary of the risks of testosterone. For that reason, we typically avoid prescribing TRT to younger men. We do however do a comprehensive evaluation and can offer alternative treatments.

Kitchener-Waterloo TRT Clinic

*OHIP Covered Consultations*