From Guidelines to Practice—Navigating the TRT Treatment Spectrum

madman

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* Tatem shares his path from fellowship under Larry I. Lipshultz, MD, to leading national men’s health strategy, blending clinical experience with a personal perspective on testosterone deficiency. He outlines the most effective and sustainable treatment options—from injectables like cypionate and enanthate to newer oral therapies like Kyzatrex—explaining how he customizes regimens based on body composition, aromatization risk, and patient lifestyle.




Explore the latest insights on testosterone therapy, its benefits, and practical applications from leading urologists in men's health.

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In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Alex Tatem, MD, a urologist with Urology of Indiana and corporate director of men’s health for US Urology Partners, for a deep dive into the practical and nuanced realities of testosterone therapy.

Together, they unpack what it means to deliver meaningful care in a landscape crowded with confusion, outdated messaging, and inconsistent training. Tatem shares his path from fellowship under Larry I. Lipshultz, MD, to leading national men’s health strategy, blending clinical experience with a personal perspective on testosterone deficiency. He outlines the most effective and sustainable treatment options—from injectables like cypionate and enanthate to newer oral therapies like Kyzatrex—explaining how he customizes regimens based on body composition, aromatization risk, and patient lifestyle.

Pearlman and Tatem dig into the art of hormone management, discussing injection technique, frequency, side effect mitigation, and how to guide patients through formulation decisions. They touch on evolving views around estradiol, the limitations of past training models, and how a few key lab values (like LH, FSH, and prolactin) can dramatically change management—especially in younger men or those considering fertility.

Later, they address broader questions about medical trust, guideline gaps, and testosterone’s misunderstood cardiovascular risk profile. Tatem calls for providers to be the first line of preventive care for aging men, noting that although testosterone has become culturally controversial, proper management is rooted in physiology, long-term health, and personalized care.

Together, Pearlman and Tatem demystify testosterone therapy, positioning it not just as a treatment—but as a critical tool for enhancing longevity, independence, and quality of life.
 
Pay attention!

Start low and go slow we have always stressed here!

As I have been preaching for years on here the majority of men can easily achieve a high-end/high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Some men can hit stellar levels injecting <100 mg T/week.

Yes there will always be some outliers who need the higher-end dose 200 mg T/week but it is FAR from COMMON as in RARE!

Such dose would have the MAJORITY OF MEN OVERF**KING MEDICATED!

As I have stated numerous times before the standard starting dose across the board used by most doctors in the know is 100 mg T/week.

Of course you can start lower but it is not common practice!




Where to begin in terms of the dose?

14:37-16:24

* for some patients its straight forward you can start them on .5CC (100 mg T) or .3CC (60 mg T) per week




16:25-18:20

* the rule of thumb that I tell other docs is you know START LOW because you can always GO UP and its A LOT EASIER TO INCREASE THE DOSE than to be CHASING DOWN SIDE-EFFECTS




18:21-20:39

* for MOST patients I START ONCE A WEEK alright and I'm COMMONLY looking at you know about .5 CC (100 mg T) as being my BASELINE for the MAJORITY of patients and then I can consider kind of moving that down or moving that up from there, if I have an older patient with less muscle mass okay that is someone where they probably dont need .5CC (100 mg) they could probably do FINE on .3CC (60 mg) or .4CC (80 mg) so lets go ahead and lets try it, now if Ive got a well muscled guy in his early 40s then I am going to start miving him up a bit
 
 

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