In this educational video Dr. Ashley Frazee explains why testosterone optimization requires individualized treatment rather than a single “one‑size‑fits‑all” approach. She begins with a factory‑warehouse analogy to illustrate the hypothalamic‑pituitary‑testicular (HPT) axis, describing how the hypothalamus (board of directors) releases GnRH, the pituitary (floor manager) issues LH and FSH, and the testes (factory floor) produce testosterone and sperm. She stresses that patients fall into two broad diagnostic categories – low LH/FSH (a “lazy manager”) or high LH/FSH with low testosterone (a “tired factory”). Accurate blood work, which she recommends via the at‑home Rhythm kit, is essential to identify the category. She then reviews the major therapeutic options: • Testosterone Replacement Therapy (TRT) – direct testosterone delivery that quickly restores levels but suppresses endogenous LH/FSH, can shrink testicles, and may reduce sperm in 60‑70% of men (though not a reliable birth‑control method). • Human Chorionic Gonadotropin (HCG) – an LH‑mimetic that binds testicular LH receptors, has a long half‑life, supports intratesticular testosterone and sperm production, and can be used as an “insurance” when on TRT. Downsides include cost and injection burden. • Gonadotropin (Gonadorelin) – a synthetic GnRH that stimulates the pituitary to release LH and FSH upstream. It has a very short half‑life (~10 min) requiring frequent dosing or a pump; still, some patients achieve substantial testosterone gains. • Clomiphene/Enclomiphene (Clomid) – oral selective estrogen receptor modulators. Enclomiphene blocks brain estrogen receptors, prompting a surge in LH/FSH and testosterone; however, the accompanying zyclomiphene component has a long half‑life and can cause estrogen‑related brain fog. Dosing must balance testosterone rise with mood/cognitive side‑effects. • Kisspeptin – a peptide that activates hypothalamic GnRH release, effectively “jump‑starting” the HPT axis. It may boost libido but is difficult to dose and monitor, making it a niche, precision tool. Throughout, Dr. Frazee highlights practical considerations (injection frequency, cost, side‑effects, impact on fertility) and encourages viewers to match therapy to their physiological profile and personal goals. She also promotes the Rhythm at‑home lab service for convenient, comprehensive hormone panels. The video concludes with a call to empower patients to act as the “CEO” of their bodies, choose wisely, and seek personalized care.
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Raising testosterone is easy if you just want TRT, but what are all these other options? HCG, clomiphene, enclomiphene, gonadotropin, kisspeptin. Well, today let me clear the fog for you and really demystify the differences between full-on testosterone replacement and all the other options out there. And let me tell you, there's downsides to every single one of these options, but by the end of this video, you'll be able to decide if any of them are right for you. I'm Dr. Ashley Frazee. I've been treating men's hormones for over 6 years now. I've served as the clinical director for a men's TeleMed Hormone Clinic, and I just like geeking out on topics like this and helping people feel their best. And just as a disclaimer, this is not medical advice from me to you. I wish I could be your doctor, but I'm not. Now let's set this up. To understand TRT and all of the meds that go with it, it helps to understand how your body makes testosterone. It's a feedback loop between your brain and your testicles, and I'm going to use an analogy here of a factory warehouse to make things clear. See, it starts at the very top with the board of directors, your hypothalamus in your brain, which sends out a master command, a hormone called gonadotropin-releasing hormone. That command hits the floor manager's desk, your pituitary gland. The manager then issues 2 specific sets of orders: LH, or luteinizing hormone, to tell the factory to make testosterone, and FSH, follicle-stimulating hormone, to tell it to make sperm. Finally, those orders land on the factory floor, your testicles. They receive the signals and pump out the goods. When you take TRT, you're essentially airdropping the goods directly into the warehouse. The board and the manager see the warehouse is full, so they stop sending orders and the whole chain goes silent. Now, it's worth knowing, if you're a man and you have low testosterone and also low FSH and LH, that's a problem up top. Your pituitary manager is being lazy, or your board of directors is burned out. If you have low testosterone and high FSH and LH naturally, that's a problem down below. Your factory worker testicles aren't stepping up to the plate. Why these problems occur is another video for another day. Please comment if you want me to make that video. What does it matter in the end? Well, some of these meds I'm about to talk about can heavily influence this pattern. Before we talk about which meds fix which problem, you have to know which category you actually fall into. It helps. Do you have a lazy manager or tired factory workers? You can't guess this based on how you feel, so it's important to get your blood work done. One thing that was very difficult with my telemedicine clinic is that not all of you live close to a doctor or a lab that can do all of this for you. And this is why I've partnered with Rhythm. If you live in a rural area or you don't want to spend 3 hours at a lab waiting or arguing with your insurance to get a full hormone panel, Rhythm is an at-home blood collection kit that is actually painless. I'll show you how it's done. This is the easiest blood test I have ever done. All you have to do is peel off the back, stick it on your arm, and watch this. I'm literally getting my blood drawn right now, and I didn't even feel it. And that's it. I don't have to go to a lab. I don't have to get jabbed with a big old needle. It tests all my key biomarkers, and it's shipped to my house every month. This one is just $79, which is about the same that I charge in my clinic for an actual blood draw. You get free shipping with my link below, and it's risk-free with a money-back guarantee. Try it for a clinical-grade look at your total testosterone, your free testosterone, your estrogen, and other important tests that you need that we're talking about today. Check it out. That's my blood filling up in the tube. Every time I do it, I'm just amazed. You even get the coolest looking Band-Aid I've ever seen. Let's briefly go over TRT. This is pure testosterone as a medication or treatment. TRT is the most direct, most bang for your buck way to get your testosterone levels from low to optimal, whatever that is for you. But if you go route, you will stop making your own testosterone and become fully reliant on the replacement around 8 to 12 weeks in. A huge misconception is that TRT is a form of permanent sterilization. It's not. While it's true that around 60 to 70% of men will see their sperm counts drop to basically zero, that still leaves about 30% of you on TRT who still produce TRT is not birth control. I literally had a patient who believed that from his previous hormone consultant, and then he had a baby in his 40s. But what if you don't want TRT or you just want to know all the options? Let's talk about the second most popular way to increase testosterone levels naturally. HCG, or human chorionic gonadotropin. In the hormone world, HCG and LH, luteinizing hormone, the signal that your pituitary sends out to make testosterone, well, they're like fraternal twins. Meaning HCG looks similar enough to LH that it's able to bind to the LH receptors in your testicles. So if you naturally have low levels of LH and you're not already on testosterone replacement, theoretically HCG could provide a missing link to get your testicular production of T back online. And here's what's significant about HCG. When your brain pulses out LH naturally, it hits the receptor, you make testosterone, and then the LH is gone in about 20 to 30 minutes. Because HCG is a larger lab-made, more complex molecule, it's, uh, stickier. It stays on the receptor longer and survives in the bloodstream for about 30 hours, giving your testicles the chance to really squeeze that testosterone out. There was actually a landmark study showing that men who were on TRT had their intratesticular testosterone levels drop over 90%, but by adding in HCG, they were able to maintain Intratesticular testosterone at levels high enough to support sperm production. So some men use HCG as an LH replacement, and some use it alongside TRT to tell their testicles to keep working. It can keep the testicles full for men who don't want their beans to shrink up and keeps the factory idling, ready to come back online if you ever choose to stop TRT. You can kind of think of HCG as an exit strategy or insurance should you be on TRT and ever want to come off of it. That being said, is it 100% necessary if you don't care about testicular shrinkage or fertility? No, not necessarily. HCG is expensive and it can be a pain to run multiple injections all the time, but the decision is ultimately yours. Now, there's been an alternative to HCG— gonadotropin. When I first learned about gonadotropin, I was excited because it tends to be less expensive. And it claims to do the exact same thing. It raises LH levels, just more upstream in the process. It's a synthetic version of the hormone gonadotropin-releasing hormone, which tells the pituitary to make FSH and LH. Great, but there is a catch. Gonadorelin has a half-life of about 10 minutes. In a normal body, your brain pulses this hormone out every 90 minutes to keep the system running. So unless you have a medical pump attached to your hip firing this into your body every hour, like what was used in the studies on gonadorelin, It's a little bit of a waste. That being said, I just had a great chat with one of my patients who took it upon himself to do daily gonadotropin injections, and he did raise his testosterone from 200 to 400, which is pretty impressive. He just had to commit to the daily injections. All right, enough with the injections though, because some of you have been hanging on just to hear the non-injection alternatives. I've seen enough of you, even though you've got tattoos everywhere, you're just big babies with needles. Let's talk about clomiphene and enclomiphene. Both of these are pills. Clomiphene came first. It was originally designed to induce ovulation in women by tricking the brain to make LH and FSH in order to increase estrogen levels. But don't worry, men don't have ovaries. So increasing LH and FSH still applies to increasing testosterone levels if used in men. Clomiphene is actually a mixture of 2 different molecules. Enclomiphene and zyclomiphene locked up in the same capsule. Enclomiphene works to block estrogen receptors in the brain, tricking the brain into thinking that you have no estrogen. And so the pituitary will pump out more FSH and LH to get more estrogen, but really you get more testosterone because testicles. Enclomiphene has a half-life of about 10 hours, so most men will take it either daily or every other day. Now here's an important catch. Enclomiphene blocks estrogen receptors in the brain. You get a surge of FSH and LH and a surge of testosterone, and 10 hours later the med is gone and you're left with zyclomiphene, which has a much longer, like 30-day half-life. This negates the estrogen blind and actually acts as an estrogen agonist. And to make this easier, imagine that enclomiphene works like pulling a fire alarm in the brain. When the brain sees estrogen signaling blocked, it sounds the alarm and sends LH and FSH to the testicles, which ramps up testosterone production. But Clomid also contains zyclomiphene, which is more like a fog machine slowly filling the room. Because it sticks around for weeks, that fog can build up over time and literally give men brain fog from too much Estrogen signaling. So even though testosterone may still be elevated, some men start to feel emotional, flat, their libido goes down, or they just don't feel themselves. So why does it work? Well, because as long as you keep taking the pill, enclomiphene is constantly coming back to put that estrogen blindfold back on. And for most men who take it, this works really well. Their testosterone levels go up and they feel great. However, for some men, that Zuclomiphene starts to build up over time. They might see great numbers on their labs, But then they start to feel moody or just off, and it's usually because zyclomiphene has just finally taken over. So that's why you'll see most men on enclomiphene, pure enclomiphene, for natural testosterone-boosting effects. It's just more expensive to make, and it was never fully FDA approved as a better alternative to testosterone replacement, so it's not always the go-to. Now I have to give you a warning about enclomiphene. A lot of guys think that the more the better. I just need a higher dose if I'm not getting the effect. That's not necessarily true because enclomiphene blocks your brain's ability to see estrogen. It can actually lead to that brain fog. Your brain needs a little bit of estrogen hitting those estrogen receptors to keep your memory sharp and your mood stable. And if you block those receptors too hard, you might have the testosterone of a 20-year-old but the mental clarity of like Link in the Lost Woods. I just revealed my nerdiness. Also, don't be shocked when you see your estrogen levels climb on your labs because your body is making so much new testosterone testosterone, it's naturally converting some of it to estrogen. The problem is that your brain is blindfolded by the medicines, so it doesn't know when to stop. And this is why dosing matters. You want to find that right amount— enough to feel the drive, but not so much that you're mentally foggy and emotionally all over the map. I really hope that all made sense to you. This is a very complex topic, and I don't even think very many doctors truly understand it. Please leave a comment if it did make sense to you, because that was my goal. Now let's talk about something interesting. A peptide, kisspeptin. I'm a peptide girl. It's obvious if you follow my channel. And kisspeptin is easily one of the most interesting molecules on the shelf. But in reality, it's very tricky. You know, go back to thinking of your hormones as like a business with a warehouse. If you hire HCG as the new floor manager to go to the factory floor to keep the machines running, you could also hire kisspeptin as a new member of the board of directors sitting at the very top of the chain in your hypothalamus. It's the master switch that orders your brain to release gonadotropin-releasing hormone, which then triggers your own natural LH and FSH. And Kisspeptin can kind of force your brain to make its own signal. You're not replacing anything with this peptide. You are demanding that your brain wake up and do its job. And it has a bonus. It hits arousal centers in the brain that HCG simply does not do. So in the research, you'll see an increased libido on Kisspeptin. In theory, utilizing kisspeptin therapy could reboot a system like jump-starting a car with a dead battery. So if your battery is dead because you left the lights on with stress, overtraining, or a bad diet, theoretically you could try to jump-start it back up using kisspeptin. And once your alternator is running, pull the cables and you're good to go. But if your battery is dead because the car is 60 years old and the engine is just rusted out, A jump start will maybe work for a minute, but as soon as you pull the cables, the car dies again. Does that make sense? See, kisspeptin wouldn't repair a broken system, but it could force a suppressed one to wake back up again. Kind of a precision tool for the guy who wants to keep his board of directors still in the game. It's not easily dosed and monitored, but it's interesting in the least. So my goal here was not to tell you what to do, but I hope this video demystified some of the treatment options. Once you understand the purpose and how these things work, The choices become much easier. And remember, you are the CEO of your own body. It's okay to be hesitant to go with whatever a doctor or your best friend says just because they say it. These days there's a lot of options. There's a lot of telemedicine options for TRT and discussing all the others. If you want to take matters into your own hands and get your labs done at home, Rhythm Health is a great option for doing that. There's a link in my description for that. I'm Dr. Ashley Frazee. If you like this video, please hit like for me and subscribe to my channel and have the best day.
