Many patients have asked why I dismissed testosterone replacement for my patients during the last quarter century of my career but now offer it in our clinic at Family Physicians of Cedar Rapids.

My answer is that I had a Galileo moment. Galileo studied astronomy among other sciences around 1600 and had been taught that the earth was the center of the solar system. His observations of the planets did not support traditional theory, and he was one of the astronomers of the era that gave us our current understanding of planetary movement with the sun at the center of the solar system. Over the past couple years, about a dozen of my patients admitted to going to testosterone replacement clinics that are offered elsewhere in town, claiming that they felt like they were back in their 20s. The current FDA position which was taught when I was in medical school at the University of Iowa disputes the claims of my patients and recommends that providers reassure aging adults of both genders that testosterone replacement does not work and to accept low testosterone symptoms as the consequence of aging. Therefore, my classical teaching and current FDA guidance for providers conflicted with 100% of my patients’ testimonies, so I needed to choose who was misleading me. Of course, I believe my own eyes and the testimony of my long-term patients. Around that same time, Jennifer Forkner, ARNP, who is the other provider in our clinic, expressed interest in offering testosterone replacement for our patients. Therefore, I put effort into researching the risks and benefits of testosterone replacement and found that with the exception of men with prostate cancer, the risks that I had been taught were unproven in poor quality studies. The only complaint I received from the patients receiving treatment elsewhere was that the weekly injections caused a seesaw effect with feeling benefit immediately after a weekly injection followed by low testosterone symptoms returning as they came closer to the next injection. Rather than weekly injections that are inconvenient and give the seesaw effect, we chose to use pellets provided by Biote which are natural and can be given every 3 to 6 months. Think of pellets as after dinner mints that slowly dissolve, but rather than take them orally, we insert the pellets under the skin where they dissolve over months. I encourage patients to check a hormone level so that they can take charge of testosterone replacement decisions rather than assume it is something that needs to be accepted as a part of aging. Each patient should choose what they do to alleviate symptoms of aging rather than simply have the medical establishment and government tell them to live with it. An example is that we prescribe little blue pills for men with ED frequently, and using the faulty testosterone logic, we should simply tell them that they need to live with that problem of aging. My Galileo moment is why we now offer testosterone replacement for both men and women managed by Jennifer Forkner, ARNP, with about half of our testosterone replacement patients being women.