Dr Derran M Govender offers testosterone replacement therapy (TRT) for men with low testosterone at his practice in Durban North. Treatment is based on your blood results and uses testosterone cypionate injections. Your levels are monitored closely so that you get the benefits safely.
Symptoms of low testosterone
Low testosterone can cause:
- low energy and fatigue
- low libido and erectile dysfunction
- low mood, irritability and poor motivation
- brain fog and poor concentration
- loss of muscle and strength
- weight gain, especially around the middle
- poor sleep
- insulin resistance
- a higher risk of heart disease
Testosterone falls gradually with age, but levels are low in many younger men too.
Blood tests first
Dr Govender checks your levels with blood tests before starting treatment. These include:
- total and free testosterone
- SHBG
- estradiol
- LH and FSH
- prolactin
- progesterone
- full blood count, including haematocrit
- PSA
- cholesterol (lipid profile)
- kidney function and electrolytes (U&E)
Treatment with testosterone cypionate
TRT uses small doses of testosterone cypionate, injected at least every other day or three times a week. Dr Govender sets your dose based on your blood results and symptoms.
A single large injection causes a high testosterone peak, which is followed by a delayed spike in estrogen and estrogen-related side effects. Smaller, more frequent doses keep your levels steady and keep that spike to a minimum.
Injections are given with a tiny insulin needle rather than a large intramuscular needle, which makes them quick and almost painless. Dr Govender shows you how to do your own injections at home.
Testosterone therapy can reduce sperm production. For men who want to protect their fertility, Dr Govender can add hCG to their treatment.
Managing estrogen
Some men on TRT see their estrogen levels rise. This usually comes down to two things: large, infrequent injections and excess body fat, which turns testosterone into estrogen.
Dr Govender doesn’t use estrogen-blocking drugs (aromatase inhibitors), because their side effects outweigh the benefits. Men need some estrogen for their bones, heart, mood and libido. Instead, he fixes the cause. He adjusts your dose and injection schedule and helps you lose excess fat.
Monitoring and follow-up
Dr Govender repeats your blood tests after you start treatment and adjusts your dose until your levels and symptoms are where they should be. After that, regular blood tests check your testosterone, estrogen, haematocrit and PSA to keep your treatment safe and on track.
What to bring
Please bring:
- your ID
- your medical aid card, if applicable
- a list of your current medicines
- any previous test results
Fees and medical aid
The practice accepts all major medical aids. For fees, contact the practice.
Appointments
The practice is open Monday to Friday, 09:00 to 17:00, and walk-ins are welcome. Book an online or in-person appointment.
Frequently asked questions
What is TRT?
TRT, or testosterone replacement therapy, restores testosterone to healthy levels in men whose levels are low. It treats symptoms such as low energy, low libido, low mood, brain fog and loss of muscle.
What are the benefits of testosterone injections?
Men on TRT commonly notice:
- more energy
- better libido and erections
- better mood and motivation
- clearer thinking
- more muscle and strength
- less body fat
- improved insulin sensitivity
What are the side effects of testosterone injections?
Possible side effects include:
- a raised red blood cell count (haematocrit)
- acne or oily skin
- reduced sperm production
- estrogen-related side effects
Small, frequent doses and regular blood donation keep these to a minimum, and regular blood tests pick up any problems early.
What is the difference between testosterone cypionate, Nebido and Sustanon?
All three are injectable testosterone. Nebido is a long-acting injection given every 10 to 14 weeks, and Sustanon is given every three weeks. Large, infrequent doses like these cause high peaks and a spike in estrogen. Dr Govender does not use either. He prescribes testosterone cypionate in small subcutaneous doses at least every other day to keep levels steady.
References
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- Camozzi V, Bonanni G, Frigo A, et al. Effect of a single injection of testosterone enanthate on 17β-estradiol and bone turnover markers in hypogonadal male patients. J Endocrinol Invest. 2015;38(4):389–397. Read source
- El-Khatib FM, Huynh LM, Kopelevich A, et al. Comparative assessment of outcomes and adverse effects using two different intramuscular testosterone therapy regimens: 100 mg IM weekly or 200 mg IM biweekly. Int J Impot Res. 2022;34:558–563. Read source
- McFarland J, Craig W, Clarke NJ, Spratt DI. Serum Testosterone Concentrations Remain Stable Between Injections in Patients Receiving Subcutaneous Testosterone. J Endocr Soc. 2017;1(8):1095–1103. Read source