Testosterone replacement therapy

[+ Brad in NYC]

Hey guys -

Do any of you have experience with testosterone replacement therapy? I’d love to hear as many details as you’re willing to share about your experiences. Such as: did you inject or use gel/cream? What improvements did you see? What side effects? Please share. Thank you!

[+ FrankR]

Hey guys -

Do any of you have experience with testosterone replacement therapy? I’d love to hear as many details as you’re willing to share about your experiences. Such as: did you inject or use gel/cream? What improvements did you see? What side effects? Please share. Thank you!

I’ve certainly heard about it, but never considered it. It is my understanding that there are some side effects to consider, perhaps somebody with experience can chime in on those (breast enlargement, acne, prostate enlargement and fluid accumulation).

[+ Brad in NYC]

I did some treatments years ago, before the gels/creams existed (ie did the injections). I didn’t have any of the side effects you mentioned, but I know they’re possible. There’s been a huge uptick in people using these meds so I hope to hear from some of them here.

[EZEtoGRU]

I have done two different testosterone treatments in the last three years. Neither one really helped me. I am currently doing no treatments.

 

The first was using Axiron which is a gel you apply in your armpit. Took a while to get used to the application process. I used this for less than a year and found little improvement so I discountinued it. The second one was about a year ago. I was prescribed a concentrated testosterone cream that was prepared at a local compounding pharmacy. Again, I experienced little improvement in libido or erectile function. I did notice enhanced hair growth on my torso/chest. Since I got little benefit for using it, I decided to discontinue use. Important note: If there is a history of prostate cancer in your family, be very cautious about using testosterone replacement therapy. Prostate cancer feeds off testosterone. The more testosterone there is, the quicker that prostate cancer grows. Therefore be very careful if this condition exists in your family history.

[+ Avalon]

When I used to be able to get out and see the doctor I'd get a testosterone shot ever two weeks. I don't remember the dosage but over time he increased it.

[+ tassojunior]

I wanted it but with two tests I evidently have a fine level of T and can't get it. I understand the biggest cost is having to be tested every 3 months, although the shots and cremes aren't cheap either.

 

One thing my Endo told me was scary. She has several weightlifter patients who it seriously fucked up. As in cancer. Also, for anyone who doesn't have to have it, be aware she said that it fools your body into thinking you have too much T and your body stops producing it. Forever.

 

There may be some others who, like me, weren't really in need of it other than to boost sex drive and performance. Plenty, like me, get disappointing results with Viagra. Through a lot of experimenting, I've come to the conclusion that Cialis works best. I take one Thursday and Saturday mornings and either Tuesday or Wednesday. (It's a slight overdose). I wake up with boners, morning wood, something I thought was over for me. And weekend sex performance is good as when I was much younger.

 

I guess I just want to caution that T replacement is not something someone should do unless they really medically need it.

[ls238]

I am currently on TRT and have noticed major improvements in my mood and sex drive. I was worried at first but after the results of the injections, I am glad my doctor recommended it and walked me through all of the benefits vs. possible side effects. I am doing self-injections once a week and my levels have normalized. I do regular blood work every 3-6 months just to ensure the dosage doesn't need to be adjusted. I didn't have any major side effects, except I did notice a bit of acne but very minor and subsides with proper skin care. If your T-levels are low I would recommend it, if it is an option provided by your doctor. Honestly I wish I didn't need it but I am glad it was an option for me due to my low levels.

[+ Funguy]

Testosterone replacement therapy is not for everyone. First of all you need to have not only your Total testosterone measured but also your FREE testosterone. Total becomes a meaningless number because there are many forms of testosterone included in that number and the FREE testosterone is what we are looking for. "Normal" total testosterone does NOT mean your FREE is "normal."

 

As bio-identical hormone replacement therapy is one of my specialties, I have many men and women patients receiving replacement. As we age we produce less and less of the hormones necessary for optimum condition so we look to put our patients' levels of several hormones back to what they would have been at age 25. This includes not only testosterone, but DHEA and thyroid in men. While your levels may be "normal" I will guarantee they are not "optimum."

 

As far as testosterone goes, it can be injected weekly to every 10 days or so or topical. If you go for topical it must be a cream made at a compounding pharmacy and NOT preparations such as Androgel. Androgel is about 6% in concentration and we use a 20% cream twice a day. There is minimal risk of prostate cancer and if the PSA goes up we discontinue for a month and then restart, the PSA goes right back down. We test PSA prior to staring therapy and we have picked up a few prostate cancers PRIOR to therapy. Those patients will not get Testosterone treatment. Had we not checked the PSA these patients (and their doctors) would have blamed the testosterone.

 

Of note, there is a big difference between libido and ED issues: libido is the desire for sex and ED is trouble getting/maintaining erections. If your libido is low, who cares about ED - you're not looking for sex. If your libido is normal/high, then ED can be treated with cialis or viagra or other ED drugs. Many with low libido and ED find their ED resolves when the libido improves.

 

Yes, there is the occasional patient who develops acne but this is rare. The only other significant side effect that I have found is an increase in red blood cells (opposite of anemia) which occurs slowly and is easy to take care of should it reach too high of a level. I have this issue and simply donate (blood bank tosses it away) several units of blood 1-2 times per year. In general, labs are not necessary more than every 6 months or so once the optimum testosterone level is reached. Those on PREP wind up having their blood work done every 3 months or so anyway and it is simple to ask the doc to just add a Total and FREE (very necessary) testosterone to the list.

 

Blood work is covered by insurance, even Medicare, so there should be minimal cost. Unless you are a Kaiser patient - Kaiser, at least in my area, refuses to do free testosterone just as they refuse to do a FREE T3 (thyroid test) unless the total testosterone is low or other thyroid tests are abnormal. They just can't seem to grasp the difference between "normal" and "optimum" health.

 

A very good book, available on Amazon and free to those with a Kindle is "How to Achieve Healthy Aging" by Neal Rouzier, M.D. I suggest any and all who have questions regarding hormone replacement therapy read this book.

[+ honcho]

Blood work is covered by insurance, even Medicare, so there should be minimal cost. Unless you are a Kaiser patient - Kaiser, at least in my area, refuses to do free testosterone just as they refuse to do a FREE T3 (thyroid test) unless the total testosterone is low or other thyroid tests are abnormal. They just can't seem to grasp the difference between "normal" and "optimum" health.

 

I have the impression that @Funguy lives in southern California. Kaiser has multiple regions, and some details could vary by region. I can report (unhappily) that the the Kaiser Northern California region also refuses to test Free testosterone unless the Total is abnormal. My primary care Doctor tried to order it, but just could not find any way in the system to request it.

 

A web search turned up the following regions: Northern California, Southern California, Colorado, Georgia, Hawaii, Mid- Atlantic States (District of Columbia, Maryland and Virginia) and Northwest (Oregon and Washington).

 

Other than the lack of being able to do a Free Testosterone test, I've been very happy with the care I get.

[+ tassojunior]

Well, another test to ask Kaiser for in DC to see if they do it here. Most likely they refuse nationwide.

 

What are the risks that your body will shut down T production leaving one dependent on TR?

[MassageAdam]

Hey guys -

Do any of you have experience with testosterone replacement therapy? I’d love to hear as many details as you’re willing to share about your experiences. Such as: did you inject or use gel/cream? What improvements did you see? What side effects? Please share. Thank you!

I've been on it since I was 39 and I will be turning 46 later this year. I started with the IM weekly injections, although I gained a bunch of muscle, I also gained a bunch of weight... I switched to the creams for several years and was able to get my weight back in check pretty quickly after discontinuing the IM injections. Currently I am using the daily sub q injections (like an insulin injection for a diabetic) and absolutely love this way better than all the other ways. Since going on testosterone my energy levels are way up, my sex drive is way up, and I have built some nice muscle. I am a RN and I have gone to several conferences about Bioidential Hormone Replacement Therapy. It is very safe. Just take it like you are directed and get your labs checked when you are supposed to. I heartily endorse it. Go to a doctor that specializes in it, though. Just a word of caution, my insurance didn't pay for the compounding pharmacy testosterone and it was very expensive, when I switched the testosterone cypionate, my insurance covers most of it, so it is very cheap to get now.

[+ Brad in NYC]

I've been on it since I was 39 and I will be turning 46 later this year. I started with the IM weekly injections, although I gained a bunch of muscle, I also gained a bunch of weight... I switched to the creams for several years and was able to get my weight back in check pretty quickly after discontinuing the IM injections. Currently I am using the daily sub q injections (like an insulin injection for a diabetic) and absolutely love this way better than all the other ways. Since going on testosterone my energy levels are way up, my sex drive is way up, and I have built some nice muscle. I am a RN and I have gone to several conferences about Bioidential Hormone Replacement Therapy. It is very safe. Just take it like you are directed and get your labs checked when you are supposed to. I heartily endorse it. Go to a doctor that specializes in it, though. Just a word of caution, my insurance didn't pay for the compounding pharmacy testosterone and it was very expensive, when I switched the testosterone cypionate, my insurance covers most of it, so it is very cheap to get now.

 

 

Thanks so much for your post! I’d rather avoid the regular injections, which I did several years ago, but nobody suggested the sub q back then. I’ll check into it.

[+ Funguy]

Because of the issues with Kaiser (yes, Southern California reporting in) we have been able to work out a deal with Quest Diagnostic Labs whereby they bill us and we bill and collect directly from the patient.

 

As far as @MassageAdam 's sub-Q method, it still requires a daily injection. However, studies have shown that you can achieve the same results by giving sub-Q doses twice a week. For example, if the weekly intramuscular dose would be 200 mg, sub-Q doses of 75-100 mg could be given twice a week. In some, if therapeutic range has been realized, sub-Q doses could be given on a weekly schedule. The only way to follow this is by blood tests. @MassageAdam is also correct that insurance does not cover compounded medications and testosterone cypionate is covered by insurance. If you have Kaiser or other "HMO" you can use Goodrx.com and 2 X 10 mL vials is approximately $75 and will also last you several months.

 

Last, anybody who has an interest in "anti-aging" / testosterone replacement should read "How to Achieve Healthy Aging" by Neal Rouzier, M.D.

Replacement of Testosterone is NOT the only component to healthy aging. Thyroid, DHEA, diet, exercise are also involved.

 

Good luck to all . . .

[instudiocity]

I’ve been on full hormone replacement therapy for 24 years post surgery for a non-functioning pituitary adenoma. It gave me my life back at 34 years old. Energy, metabolism, libido, spiritual changes came rapidly and maintenance has been a breeze. I inject 80 mg of testosterone cypionate weekly. The only downside is my gonads went! They are about 1/2” in diameter! Really hard for my partners to find when I’m close to cumming.

Edited August 24, 2018 by instudiocity

[Guest]

There may be some others who, like me, weren't really in need of it other than to boost sex drive and performance. Plenty, like me, get disappointing results with Viagra. Through a lot of experimenting, I've come to the conclusion that Cialis works best.

 

I’m curious. How would you characterize your weight and body fat levels and/or do you think this is a contributing factor?

[+ tassojunior]

Overweight, not obese. I think digestion of pills is more critical. Viagra is hard to time and its effect is very short. Viagra is more dangerous to take extra.

[+ Funguy]

Because of the issues with Kaiser (yes, Southern California reporting in) we have been able to work out a deal with Quest Diagnostic Labs whereby they bill us and we bill and collect directly from the patient.

 

As far as @MassageAdam 's sub-Q method, it still requires a daily injection. However, studies have shown that you can achieve the same results by giving sub-Q doses twice a week. For example, if the weekly intramuscular dose would be 200 mg, sub-Q doses of 75-100 mg could be given twice a week. In some, if therapeutic range has been realized, sub-Q doses could be given on a weekly schedule. The only way to follow this is by blood tests. @MassageAdam is also correct that insurance does not cover compounded medications and testosterone cypionate is covered by insurance. If you have Kaiser or other "HMO" you can use Goodrx.com and 2 X 10 mL vials is approximately $75 and will also last you several months.

 

Last, anybody who has an interest in "anti-aging" / testosterone replacement should read "How to Achieve Healthy Aging" by Neal Rouzier, M.D.

Replacement of Testosterone is NOT the only component to healthy aging. Thyroid, DHEA, diet, exercise are also involved.

 

Good luck to all . . .

 

Upon reflection, @MassageAdam, if you are doing sub-Q daily, please make sure you follow your FREE testosterone. This is one of those situations where a monthly blood test would be VERY helpful. It must be FREE testosterone. If you switch to twice a week at about 50-75 mg each injection, you could add human chorionic gonadotropin (Hcg - NOT human growth hormone) on one of the days between testosterone doses and you will build even nicer muscle and you don't run the risk of testicular shrinkage as you do with daily testosterone.

[+ Brad in NYC]

Upon reflection, @MassageAdam, if you are doing sub-Q daily, please make sure you follow your FREE testosterone. This is one of those situations where a monthly blood test would be VERY helpful. It must be FREE testosterone. If you switch to twice a week at about 50-75 mg each injection, you could add human chorionic gonadotropin (Hcg - NOT human growth hormone) on one of the days between testosterone doses and you will build even nicer muscle and you don't run the risk of testicular shrinkage as you do with daily testosterone.

 

@Funguy question: I have a friend that does 10 weeks on and 2 weeks off with T. Does that avoid shrinkage? Or do you need the hcg to accomplish that?

[+ Funguy]

Age is the important factor here - how old is he?

[+ g56whiz]

Hey @Funguy. Many thanks for the thoughtful sound advice you’re offering.

[+ Funguy]

My pleasure

[MassageAdam]

Upon reflection, @MassageAdam, if you are doing sub-Q daily, please make sure you follow your FREE testosterone. This is one of those situations where a monthly blood test would be VERY helpful. It must be FREE testosterone. If you switch to twice a week at about 50-75 mg each injection, you could add human chorionic gonadotropin (Hcg - NOT human growth hormone) on one of the days between testosterone doses and you will build even nicer muscle and you don't run the risk of testicular shrinkage as you do with daily testosterone.

Thanks, my doctor does follow that. I can't get on HCG yet, as in California they are very strict, and I'm just not old enough for the doctor to feel comfortable prescribing it to me.

[+ Funguy]

You are indeed old enough - at 30's - 40's we tend to routinely use the combination of Hcg and T; the Hcg helps to avoid testicular shrinkage and maintain sperm production while on T. The problem is that you are on daily T so it's difficult to slip the Hcg into the routine. If you change to twice a week T, then you slip that Hcg in between doses.

After about 50 you don't need the Hcg nearly as much tho it is a good adjunct for muscle building. Discuss this again with your doctor.

[+ Brad in NYC]

@Funguy

It seems like HRT is something that certain doctors do “on the side”. All the doctors I’ve seen so far are either PCP, urologists, cardiologists, etc. it also seems like the patient spends a little time taking to ‘the’ doctor and more time taking to PA’s or even what seems like non-medically trained people.

 

Can you comment on the HRT ‘industry’ and how you think people could best go about finding the right practice?

 

By the way, a few of the people I’ve seen have been on HRT for 10+ years. How important do you think that is in choosing a provider ?

[+ Funguy]

@Funguy question: I have a friend that does 10 weeks on and 2 weeks off with T. Does that avoid shrinkage? Or do you need the hcg to accomplish that?

 

Sorry this reply took so long. Cycling like your friend does is unnecessary and won't prevent the shrinkage. The hcg is necessary in order to stimulate the body's production of T. Shrinkage occurs when the testes stop T production. Taking T only will eventually turn off the natural production.