HRT - Using TESTOSTERONE in hormonal replace. therapy

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  Mar 13, 2007 4:23 AM GMT

  Hi guy,
  (or more Hi Sir... considering the age of dudes implicated here...lol)
  
  Did you been or are you on hormonal replacement therapy treatement???? or maybe your not yourself but know very well the subject.... or your best friend is...
  
  Since in USA at least, the clinic sold the medication maybe they have big advantage to prescribed too mush..i really dont know, and i'm just curious if a real norm exist in the form of the treatment by comparing what was prescribed to your best friend!
  
  I think it can be vey interesting to see what are the medication use for that and too what is the dosage prescribed by the doctor... i suspected it can vary a lot from a clinic, a doctor, a country.... than if you or your best friend is treated ...what is this treatment... ?
  
  my best friend was prescribed 200 mg/week testosterone enanthate or cypionathe and 200 mg/ nandrolone decanoate (both self injecting) and too 1000 mg./w of B-12 vitamin.... the doctor try to push the growt hormone therapy but my friend is afraid about what he read on the subject here and by the price too! finally he's not at all interested... and what about your best friend!
  

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  Mar 13, 2007 5:49 AM GMT

  200mg of test & 200mg of deca is just about as high a dosage as I've run into for HRT purposes. Usually the inclusion of deca is because an adequate dose of testosterone alone causes polycythemia in the patient.
  
  It's also possible to split the dose into two administrations of 100 each of test & deca.
  
  My physician is not a big fan of B-12 in this context. He is prepared to prescribe GH (in very low doses), however it is rarely covered by insurance and is very expensive here.
  
  I've been on HRT for 5 years, and my partner for nearly 10.

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  Mar 13, 2007 4:28 PM GMT

  My second-year mentor in medical school is actually a family practicioner who has unofficially subspecialized in medical urology and male aging. He is extensively published on the topic of male hormone replacement therapy and the numerous health benefits of it, so I have been learning a lot on this subject for the past few months.
  
  I am not sure if there are any specific questions that people had about this. I'm not claiming to be an expert on the topic, but this is a fascinating emerging topic in medicine.
  
  Recent research has actually shown that low testosterone is linked with the metabolic syndrome:
  -central obesity (waist > 40" or BMI > 30)
  -elevated triglycerides
  -low HDL cholesterol
  -high blood pressure
  -fasting blood glucose > 110
  -type II diabetes
  -protein in the urine
  -elevated c-reactive protein
  The presence of three of these factors triples your risk of heart disease, and the presence of all of them increases it 6-fold.
  
  A large study in Finland showed that men with low T were twice as likely to develop type II diabetes or the metabolic syndrome during 11 years of follow-up. If they had metabolic syndrome at baseline, they were 2.9 times as likely to develop low T. This latter part has been shown to be preventable and reversible through weight loss. It is currently being studied to see if replacing T can similarly reverse or prevent the development of the metabolic syndrome.
  
  My mentor is very interested in the relationship between testosterone, erectile dysfunction, and heart disease. Since the arteries in the penis are much smaller than those in the neck or heart, they get affected much earlier by atherosclerosis (hardening of the arteries). This is part of the mechanism that leads to ED. Low T is associated with both ED and heart disease, and replacing it has been shown to reverse ED. However, it is unknown whether by reversing the ED, you also reduce the risk of heart attack and stroke. My mentor is running a study now to demonstrate that testosterone replacement increases arterial reactivity, increasing that ability of arteries to dilate. This would suggest that testosterone replacement will actually help reduce the risk of heart attacks and stroke.
  
  Feel free to ask questions, I can try to answer them. Please note, I don't advocate the use of testosterone by men who have normal levels, as this has been shown again and again to have negative health consequences overall, and actually increase the risk of heart and vascular disease. I am only talking about hormone replacement therapy for men who are deficient, which is defined as a total T level of <200-300 ng/dl or a free T level of < 4-5 ng/dl. This acounts for 6-40% of men over the age of 40 (depending on the cutoff and the study--clearly, some more research needs to be done here).

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  Mar 13, 2007 4:45 PM GMT

  Here is a statistically validated screening questionnaire for low testosterone in older men (>40). It is considered positive if you answer yes to #1, #7, or any three of the other questions. It detects 88% of cases of low T, although it has a false-positive rate of 40% (as you might expect, based on the questions, it doesn't differentiate between depression and low T very well, since the symptoms overlap significantly).
  
  If you screen positive, you might want to see your doctor and possibly have your testosterone checked.
  
  Androgen Deficiency in Aging Males Questionnaire
  
  1) Do you have a decrease in libido (sex drive)?
  2) Do you have a lack of energy?
  3) Do you have a decrease in strength and/or endurance?
  4) Have you lost height?
  5) Have you noticed a decreased 'enjoyment of life'?
  6) Are you sad and/or grumpy?
  7) Are your erections less strong?
  8) Have you noted a recent deterioration in your ability to play sports?
  9) Are you falling asleep after dinner?
  10) Has there been a recent deterioration in your work performance?
  
  From:
  Morley, JE, Charlton E, Patrick P et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism 2000; 49: 1239-42.

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  Mar 14, 2007 5:39 PM GMT

  I am on long term recuperation from AIDS and my doc has me on 200 mg of testosterone replacement every 2 weeks. I am cutting it down to 100 mg because I think it is bulking me up too much and keeping me from being defined.
  For me it's a trade off. I do need some testosterone because my condition depletes it, but I don't want to much either.
  I try to stick to the Zone diet and swim laps every other day for aerobics. I also lift weights at home.
  
  Any suggestions? Am I on the wrong track?

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  Mar 14, 2007 7:04 PM GMT

  Hey Cisco... what is a good posology, dosage for HRT... i means the "biggest" dose you can use for a long term, without stacking ( going on and off) and without using too much for nothing and without high risk of toxicity?
  
  (i understand we talk here of a theorical average "good and powerfull" dosage because each case is different and the main fact is your testosterone level.)
  
  In your opinion does 200 mg/week of test. enanthate 200 mg/week of "deca." (nandrolone decaonate) is too much or a correct "big" dose?
  
  Why using B-12 vitamins injectable?
  
  

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  Mar 14, 2007 10:01 PM GMT

  First, with the B12, I would have to know why your doctor prescribed it. Were you diagnosed with megaloblastic anemia, or low blood levels of B12? In the past, if you had a B12 deficiency, we would perform the Shilling test to see why you weren't getting enough B12: not enough in the diet, not making enough of a protein called intrinsic factor that you need to absorb B12, not making enough pancreatic enzymes, or other reasons like bacterial overgrowth or celiac disease. However, all those reasons for B12 deficiency except not eating enough are treated the same way, with shots. So, unless you don't eat meat, the shots are necessary. However, the typical dose is 1000 µg/month. Even then, about 850 µg of that dose is wasted and just excreted in the urine. I dare say your friend is wasting his money using more than that.
  
  That said, if you don't have a diagnosis of a B12 deficiency, there is no reason for the shots. There is no reason to think your body can't digest B12 supplements that you take orally, and I am certain they are less expensive and easier to take.
  
  With regards to HRT (just had this lecture today), first of all, the treatment of choice, by far, is plain old testosterone (in ester form: e.g. T cypionate). The dosing guidelines are ~1.4 mg/kg/wk, or 98 mg/week for a 70 kg (154 lb) male (200 mg every other week). Higher doses of 0.4-0.5 mg/kg/day are used as contraceptives in some countries, since they completely suppress sperm production. That's 400-500 mg every 2 weeks.
  
  At these doses, your androgen receptors are pretty saturated. So, higher doses will not necessarily produce any benefit due to androgen receptor binding, and many of the side effects of high doses are actually due to binding to other steroid receptors. Androgens can bind directly to glucocorticoid and mineralocorticoid receptors, increasing blood glucose, decreasing sensativity to insulin, and causing salt and water retention which raises blood pressure. They can be aromatized into estrogens, causing gynecomastia, or be converted into DHT, which will cause male pattern baldness and prostatic enlargment. Overloading yourself and elevating DHT levels may also increase your risk of prostate cancer.
  
  Ironically, these higher doses reverse the effects of lower dose T on blood lipids, blood pressure, insulin resistance, and blood glucose: higher doses actually raise levels of LDL and triglycerides, lower HDL, raise blood pressure, increase insulin resistance, and raise blood glucose. So, at low doses, testosterone improves the metabolic syndrome, but at high doses it can actually cause it!
  
  I know very little about deca. I do know that any use for male hormone replacement is off label and relatively unstudied. I can't really speak beyond that. I do know that T is generally considered sufficient for most men, in doses of about 200 mg every other week. I would have to say that any dose that exceeds the normal physiologic levels in the body has crossed over from "Hormone Replacement" to "performance enhancement." As I laid out above, the doses in excess of "replacement" level doses begin to produce a number of metabolic changes which are all associated with shorter life expectancy and an increased risk of heart attack, stroke, liver and kidney disease.

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  Mar 14, 2007 11:13 PM GMT

  Thanks Cisco... the anti-aging clinic prescribed the injectable B12 as a part of the anti-aging treatment... (without any proof of deficiency... !!! When you ask why you have to use it... the response was ..."because it,s part of the anti-aging treatment" !!!!... i was just curious to see if my friends miss some information about new "benefits" of high B12 level. (that's a very cheap medication... about
  10$ for a 6 months treatment...than it is not for a financial reason too!)

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  Mar 14, 2007 11:26 PM GMT

  Other question please Cisco...what is this story of "fulling the receptor" and when they are full all the 'over-dose' is a waste?... After all, people who use hormone for performance enhancement, and don't hide it, for muscle building, use very big dose and seem to have result reliated to the "size" of the dose... than they overpass quickly the availability absorbtion of their receptors... why they have results relatively proportionate to the size of the dose? Thanks!

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  Mar 15, 2007 3:48 AM GMT

  Minihunk - you've got your terms scrambled. "Stacking" refers to using several anabolics simultaneously (stacking them in the syringe, so to speak). You meant "Cycling" - periodically taking breaks.
  
  Cycling is inappropriate in HRT. It is used by persons who are NOT hypogonadic and wish to retain normal testicular function. They use anabolics which have the side effect of supressing the HPTA axis, then stop them to have things return to normal.
  
  I would take issue with the "normal" levels quoted in the previous post. Some physicians insist that 800-1200 ng/dl is a healthy level, with free values in the 20's. The levels quoted are based on studies of the general population and reflect typical or unsuprising levels - not healthy ones.

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  Mar 15, 2007 3:53 AM GMT

  NotBadfor51 --- I believe you are on the wrong track for several reasons.
  
  1) ethanate is the wrong ester - you should be on cypionate - it's longer acting. Even with that, it's life in the body is about 11 days. Instead of 200mg every 14 days, you should be getting 100mg every 7 days. Also, you need this level at least to combat wasting syndrome.
  
  2) being smooth could be the result of too much aromatization - conversion to estrogen. If that's the case, reduce the testosterone and add in nandrolone (deca) to compliment it. But it also could be the result of your diet & exercise regimin. The Zone Diet has been pretty discredited. In fact, if you read Barry Sears' book, his personal diet - listed near the end of the book - doesn't even follow the zone!
  
  I suggest you get a copy of "Built to Survive" by Mooney and Vergil.

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  Mar 15, 2007 4:16 PM GMT

  Thanks for your help Joey. I will get that book asap.
  I think my biggest downfall is succumbing to binging at bedtime or when I wake up in the night. If I can keep from eating at night and go to bed on time I keep my weight down pretty good.
  
  The testosterone I am taking is Depo-Testosterone 200mg once every 2 weeks. ADAP only pays for this drug as an injection once every two weeks so that's all I can afford. I have cut it to 100mg once every 2 weeks to see if that will help keep the fat off better. Wasting is not a problem anymore, it's fat accumulation (HIV lipodystrophy).
  
  
  

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  Mar 28, 2007 5:59 PM GMT

  Just speed reading here.
  
  Enanthate has 8 carbon chains. Cyp has 7. Enan takes longer to break down. There are other esoteric esters that are even longer acting, but, cyp is NOT the longest, by far.
  
  BMI is bunk, and fails with people of muscle mass. There are much better indicators (I forget what the article I read says they are, now, but...BMI is junk.) My BMI is off the chart (about a 31...even when I'm at 11% fat).
  
  I'm constantly amazed at some of the outright bogus crap that gets floated around.

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  Mar 28, 2007 6:16 PM GMT

  Oh yeah.
  
  You can block estrogen. Check out any muscle board about estrogen antagonists (have a higher affinity for the receptor site) and estrogen converting enzyme blockers (block the conversion).
  
  Again, more crap. Go read on this before you give advice.
  
  Letro, Arimi, Novaldex...are among the main three.
  
  Smoothness can mean you're to fat. LOL. I.e, eating stupid, or not enough cardio.
  
  The are oodles of good muscle boards with study after study on them.

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  Mar 28, 2007 6:26 PM GMT

  I have to smart off about this.
  
  Anti-aging is such a racket, and part of the reason that anabolics are controlled.
  
  Testosterone is cheap, cheap, cheap, cheap. GH is now made on the cheap for pennies per IU, but, like in so many things the medical / drug community is out there to milk it for every last dollar.
  
  HRT works, and works well. I've spoken to various doctors (in geriatrics, and in GP) and they tell me of miracle stories of HRT.
  
  You DON'T HAVE to feel like crap, be a lazy, fat, bum in middle age and beyond.
  
  I have been on HRT for quite a while now. I have a compounded prescription that my pharmacist makes me. It costs $36.00 a month. I'm adjusted to that of a teenager. Is it high? Yep, and by design.
  
  In my view, in the US, it's all about TREATMENT, and not prevention, and milking the public for every last dollar they can. In a word: GREED.
  
  I think Canada has a better way of looking at a bunch of things involving health care. Now, here, in the U.S. with the way Medicare benefits are setup, we might as well hand the keys to Fort Know to the major drug companies.
  
  Again, HRT works. Exercise works. HRT is a powerful anti-depressant and mood-lifting thing. We people FEEL like being active, and aren't depressed they live longer. There's a wide range of benefits to HRT, which one can explore by "googling" on it.
  
  I would development advise HRT with anyone beyond 30 that's feeling ho-hum or that wants to perform at an optimum level. It's money well invested, on stuff that WORKS.

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  Mar 28, 2007 6:45 PM GMT

  Chucky: I am curious about your actual dose. A few years ago, when I was completely burned out, my doctor put me on 500 mg of testosterone weekly for six weeks, followed by a regular regimen of 500 mg monthly. Most of my doctor friends thought my dr. was insane to put me on a dose that high for six weeks.
  
  Are you talking doses that high?

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  Mar 28, 2007 6:59 PM GMT

  Obscene, I don't want to get into my dose levels, but, I can tell you there are near what you're talking about, yes.
  
  If one reads up on dosing, you'll find your doctor knew his stuff.
  
  I don't want to be in a position where I'm seen as giving advice on use, or use levels.

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  Apr 22, 2007 2:00 PM GMT

  Discovering this thread at this time was perhaps fortunate for me as tomorrow I visit my doctor to assess the results of HRT after 2 months of HRT--and I'm wondering if there are any specific questions I should be asking him.
  
  My first question is in regard to normal vs depressed testosterone levels. The range that I have seen most often mentioned on the internet (but still only a small number of quotes) is 300 -> 1000 ng/dL. theciscokid quotes in this thread a lower bound of 200-300 ng/dL, while PSBigJoey indicates that some doctors consider 800-1200 ng/DL to be the "normal" range.
  
  My total T levels (3 morning measurements, spread over about a month-long period) indicate a level of ~350 /- 30 ng/dL, which my doctor considers to be "low-normal".
  
  It is my level of free testosterone that is apparently of concern. A lower boundary for "low" free testosterone that I have seen stated on a medical website on the internet is 60 ng/dL; PSBigJoey indicates in this thread that some physicians consider free values in the 20's are normal, while theciscokid suggests that less than about 4.5 ng/dL are considered by some to be sub-normal. My measurements were in the range of 3-4 ng/dL, but I don't know what value I should be comparing that against since it is my understanding that the method(s) typically used to measure free testosterone yield values that can differ significantly from method to method--and should only be compared with other measurements made by the same laboratory, but I don't know what the range of levels is as measured by the lab that did my blood analysis. My doctor considers 12 ng/dL to be a threshold for HRT and prefers that the level be 20 or greater, but I would like to get some idea of what other doctors consider to be normal as measured with various methodologies as I will see if I can find out the specific methodology used to measure my levels.
  
  I notice that virtually all the persons on HRT in this thread get injections. I assume that this is on the basis of cost since a search on the internet regarding side effects of HRT suggest that undesirable side effects may be more common with injections than from transdermal supplementation since blood levels can exceed the normal range following injection, and be subnormal prior to the next injection.
  
  I'm 68 yo and on the Medicare Prescription Drug plan, so I compared the cost to me of injection (costs supplied from my doctor's office) vs the use of Androgel (using a web based drug cost calculator by my insurance carrier. Somewhat surprisingly, it turned out that with the drug insurance they were nearly equal in cost (the Androgel was actually slighly less expensive), so I chose that delivery modality. Unfortunately, it subsequently turned out that the cost of the Androgel used by the calculator was half the cost in the real world (even though the Androgel was purchased through the same company/insurance carrier). The end result was that the true cost is turning out to be a bit over 5 times that computed by the calculator. Now it is 3.5 months after the start of the HRT and the purchase of the first supply of Androgel, and the calculator still uses the wrong value for the Androgel in its cost estimate calculations--so be wary of these estimates and check its prediction by hand to see if the two estimates are the same (and if not, why not).
  
  Obviously one of the questions I will be discussing with my doctor tomorrow is the possibility and consequences of changing from Androgel to injection. Another will be to learn what data he uses to determine what the lower boundary level is for free testosterone (and the methodology used in for my analysis). What other questions would you suggest that I ask while I have the opportunity?
  
  Thanks.
  
  
  Tomorrow
  
  
  
  
  My understanding of the normal levels of free testosterone is even more fuzzy. If I understand correctly, there is only one measurement method that accurately measures free T levels, but that it is sufficiently expensive that alternate methodologies are typically used--and that they do not always agree with each other. The most common lower bound for "normal" concentrations that I have come across from searching the internet seems to be about 60 ng/dL; PSBig Joey quotes quotes of values in the 20's, and ; the free T levels was between 3 and 4 ng/dL. I do not know how to interpret the latter, since I understand that while total T measurements are relatively accurate, free T levels are method sensitive (except when done using a specific, rather expensive, methodology).

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  Apr 22, 2007 2:02 PM GMT

  Sorry about the formatting errors and any spelling and grammar errors in my previous post. I inadvertently clicked on "submit" when I had intended instead to scroll down while editing that post.
  

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  Jun 06, 2007 3:02 AM GMT

  I did Test/Deca for a year and had great results, felt great, bulked up well. Now doing Oxandralone only and get the same great results. It doesn't decrease my own body's natural test production.

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  Nov 30, 2010 3:11 PM GMT

  Those reading this forum topic should get your "base levels" of testosterone checked while you are young and the levels are normal for your body so that you have a reference for the future.
  
  I'm 44 now, and unfortunately, I never got my total and free levels of testosterone tested when I was younger. Now I have no idea what my normal level was. In the last 5 years, I have lost my libido and now I get joint pain when trying to lift weights I once found easy. I had my free and total levels tested and found that free is 96 and total is 465 for me now. Of course, the Dr. says those are normal levels. Those numbers are ng/dl measurements. I suspect that those numbers were 25% higher a few years ago, but of course I cannot prove that now.
  
  I have had some recent success with increasing libido by taking 50 mg of DHEA and 1,000 mg of L-Arginine. I do miss my previous sex drive though.

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  Jul 15, 2011 3:17 PM GMT

  "Males have a slow fall in testosterone from age 30. By 40 to 50, about 3 percent are testosterone deficient — and by 70 about 50 percent," says John Morley, MD, professor of internal medicine and geriatrics and chief of the division of geriatric medicine at Saint Louis University School of Medicine in St. Louis, Mo.
  
  Unrequired testosterone replacement can lead to early prostate cancer

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