BodyThe Self

Testosterone Replacement Therapy

What is Testosterone Replacement Therapy? Well to briefly sum it up, TRT is a way of re-balancing a male’s hormones as he ages so he does not experience some of the typical age related issues many males experience. Symptoms such as fatigue, weight gain, hair loss, cognitive impairment, irritability, low libido, or non existent sex drive to name a handful. Through a simple blood test a medical professional can immediately determine if you have what’s commonly referred to as Low T. If you have low testosterone, then what takes place next is determining a dose that works for you, along with how that dose gets administered. There are a few common methods of taking testosterone;

A Gel that you rub on your shoulders so you absorb the testosterone through your skin. This method has a high aromatization rate (meaning it is converting to estrogen instead of testosterone), so an anti-estrogen drug would need to be available for when you experience symptoms of gynecomastia. The most common symptom is itching around the breast area, primarily the areola, and nipple.

A more common method is through intramuscular injection. Usually the patient either goes into the doctors office, or clinic and someone administers the shot. The alternative is the doctor prescribes a vial of testosterone, and the patient does his own injections. Most people prefer to do this in the privacy of their home so self-administering is pretty common. Testosterone is suspended in cottonseed oil, so intramuscular injections are necessary. You simply draw out the required amount using an 18G 1-1/2” needle, and then replace that needle with a 26G 1-1/2” for injection. The 26G is thin so all you feel is a slight pinch on entry. There are numerous muscle sites on the body to inject from calf, to thigh, to buttocks. As long as you go into a muscle, you are good to go. Generally to be safe, you would insert needle, and draw back slightly on the syringe plunger. If you see blood then do not inject. If there is no blood then simply push the plunger all the way down until it stops. Wipe the injection site with an alcohol swab, and your done. Typically the dose is 1ml, and this is done once per week, but that often creates whats called peaks and valleys. When you first inject, the testosterone usually takes 2-3 days to rise to its peak, level off for a couple days, and then decline the last 2-3 days. This generates a roller coaster ride for the patient, so many doctors familiar with hormone replacement are having patients take 1/2ml every 5 days so there is no real peak or valley.

A newer method that is taking hold is subcutaneous injections using testosterone in grapeseed oil (which is very thin) that they are injecting every 3 days. This essentially eliminates the peak and valley entirely so there is a more stable flow of testosterone in the body at all times.

Sounds pretty simple right? In theory it should be, but since only a small percent of doctors specialize in hormone replacement, there appear to be a number of different schools of thought on administering dosage, and what ancillary drugs are needed to help balance the patient out. For instance we mentioned aromatization earlier, which all testosterone variations are subject to. Injections are less prone to any form of aromatization than other methods providing you follow directions, and not dose higher than needed. The ultimate goal is for the patient to find that sweet spot where they are dosing correctly, and at the correct time each week so there is a steady flow of testosterone in their system.

That is not to say that the body won't shift, or absorb faster or slower on occasion making there a need for ancillary drugs. Simply put, they are secondary drugs used to reduce side effects of testosterone that are unwanted... such as gynecomastia. If symptoms appear, Arimidex, an anti-estrogen medication can be prescribed. It’s only necessary to take a pill when symptoms such as itching around the areola area of the breast occur, and then only for a few days to curb the estrogen rise. Once the itch subsides, you no longer need to take Arimidex.

Another ancillary drug in the arsenal is finasteride, a drug commonly prescribed for an enlarged prostate. The prostate can swell injecting testosterone, so having at least a bottle of finasteride available is a good idea. I personally use an array of herbal supplements instead which I’ll list here in a second. I try and stay away from any prescribed medication if possible as medications only add more stress on the body; especially liver and kidneys when processing them. Herbal methods have worked for me for years, which isn’t to say they’ll work for someone else. Everyone’s body is different, and therefore requires different solutions to an issue. The effects of the testosterone you are injecting will work wonders for your mood, energy, mind, and sex drive. The negative effects can cause issues, and hormones to be thrown out of balance which is why a patient really needs to understand TRT, and how their body in particular handles it. This is a more doctor/patient relationship, and it should be as only the patient knows what it feels like inside them. It’s also important that the doctor you see understands hormone replacement, and how different medications, or herbal supplements are needed.

In order to combat some of the more common side effects of testosterone I use a number of herbal products that I buy from iHerb, an online company that is extremely reasonable, and very fast shippers. I usually have any ordered products within 4 days through USPS. They have thousands of products for sale, so browse around.

One of the items I purchase is a product called Prostate Complete which I take for my prostate. This can be bought numerous places for under $15 and has a blend of very effective ingredients. I also take a product called Curcumin C3 from California Gold Nutrition which is amazing for any inflammation in the body, prostate included. It takes a week or so to get into your system, but once in there I noticed quite a lot of reduced inflammation, and joint issues became non-existent. It’s important to note that whether you decide to buy the one I listed, or another version of your own choosing, that absorption of turmeric and curcuminoids is very low on their own. Studies have shown that by including black pepper, or piperine along with the curcuminoids, then the absorption rate increases considerably. One study showed an increase in bio-availability by over 2000% when piperine was included. That’s one of the main reasons I buy the California Gold version because the company manufacturing it is aware of that study, and includes piperine in the capsule.

I take California Gold D3 for immune support, hormone regulation, and because it is now estimated by the medical profession that most people across the globe are deficient in this particular vitamin, and once again, it’s an essential one for the body. I also take Boswellia Extract which is very effective for joints, bone density, and the body. It also works on inflammation.

I also take a fairly large amount of other vitamins, and herbs such as Vitamin C, GABA, B100, Vitamin E, Vitamin D (10K iu), Vitamin C 1000mg, Zinc 50mg, along with the one’s listed above. There are also a few additional drugs needed that aren’t herbal, but are essential in helping balance out hormone therapy. One I mentioned earlier is Arimidex; a small white pill used to counter the symptoms of gynecomastia in a male taking testosterone. Again, it’s only taken occasionally when you feel any sensitivity or itching around your nipple, and areola part of the breast.

The other drug taken is HCG (Human Chorionic Gonadotropin) which is a liquid generally used for infertility in women. Women are given shots of this to stimulate the ovaries, and reproduction. A similar reaction occurs in the male, so this drug has been used for boys going into puberty in order to help their testicles drop, and it’s also used by adult males as part of a regimen along with testosterone injections. Generally a 5ml solution is mixed up using Bacteriostatic Water to dissolve the HCG powder, and then you self administer .25cc injections subcutaneously every 3 days, making the vial last 2 months. A subcutaneous injection uses needles typically used in insulin shots. It’s a very fine 29-31 gauge needle and syringe combo. You would draw .25cc, and then squeeze or gently pinch a chunk of skin on the stomach area creating a slight bump or mound, and inject the solution into the raised bump between your fingers where basically fatty cells are located just under the skin. The needle is 1/2” so you feel nothing short of a pin prick. This solution stimulates the Leydig cells in the testicles calling for testosterone production. Now that may seem counter productive right? I mean you’re taking a shot to add testosterone, and this solution causes the body to do it naturally, why take testosterone then? Well, not so simple an answer, but it can be used by some people to boost their testosterone if they aren’t too low.

When you take testosterone, the body sees the testosterone from the injection no differently than its own, so essentially it shuts production down because there’s testosterone already in the bloodstream. This causes the testicles to either shrink, become spongy, or both since they are no longer contributing to the production of the testosterone in your system. By taking the HCG, you are telling the body to produce more testosterone, so in effect what happens is the testicles cells become stimulated causing them to return to normal size, and density in order to do the job. Taking HCG three times a year for 60 days each session helps restore your testicles to normal size, and only produces a slight amount of testosterone. Now some people who have low T can actually take HCG and have it raise their T levels to normal. It simply means their body was still producing enough testosterone to bring things into the normal range using just HCG’s ability to stimulate the Leydig cells. Once your levels drop below a certain threshold however, then you’ll need testosterone and in my personal opinion... HCG along with it to keep things balanced.

Ok now comes a very important part of TRT. Finding the right doctor. I want to stress that finding a doctor that is willing to listen to the patient in regard to TRT is extremely important simply because the patient has a direct understanding of what they’re experiencing. As long as the doctor has a solid understanding of the most current techniques, and drugs used then you should be fine. Most family practice doctors are totally out of the loop when it comes to hormone replacement therapy and will do you more harm than good. They may be a fine doctor, but unless they understand hormone replacement therapy, and what is involved on a patient scale then keep looking or trust me, you’ll regret it down the road.

I’ve also noticed a number of men’s clinics popping up recently dedicated to hormone replacement therapy; while that might sound good on the surface, many are going way too far in regard to lab work and office visits the first year you are going to them. Some even set you up on a monthly payment plan, and you go in to get the shots weekly. While it’s true that initially you have to first establish a starting point on dose, and then adjust up or down along with additional medications to balance everything out. I do have an issue with a clinic wanting lab work every 3 months for the first year considering most of them are charging 175-250 for lab results. In my opinion, no one needs more than 2 labs 6 months apart to establish a fairly solid result, and that comes from 14 years of testosterone injections with 2 very knowledgeable doctors prescribing my testosterone. Once its set, then labs are generally performed once a year unless something happens that requires a doctor visit beforehand.

I hope I’ve helped a few people understand TRT a little better. Feel free to comment. I’ve tried to explain everything as simply as possible so as not to confuse anyone just learning about this.