The TRT Blog - Testosterone Replacement Therapy

Doc Says NO to Self-Administered HCG. Insurance says NO to Menopur and HCG

Sometimes it seems like the healthCARE industry is more like a healthWON'T industry. Why do we always have to color within their lines when everyone's situation is different? I don't get it.

If the insurance company wants me to NOT have to buy medication, why don't they let the doctor prescribe me something that could help me without causing me to be a lifelong dependent of a drug that THEY would have to pay for? Why not let me try Menopur, or HCG instead of only giving me one option: Testosterone?

I decided at first to say F*&^ YOU to the insurance companies and just pay for HCG out of my own pocket. I've read a lot about using HCG for hormone replacement and I like the idea that I could stop at any time and still have working testes (providing I don't go higher than about 500 IU 3x per week, above which the leydig cells can become desensitized to FSH and LH). So I got the doctor to prescribe me HCG. First, he doesn't want to do less than 1,000 IU per injection, and no less than 3 injections per week. Good grief. Did you read the part in the parentheses?

OK, I was willing to work with the guy and let them give me 1,000 IU for a few weeks, then tell him to give me an E2 test and use that as evidence for him to reduce the doses since my E2 would probably be sky high. BUT...

Then it turns out that they are going to charge me $40 for every shot (not the medication, mind you, just the activity of injecting me) which would be $480 a month! Just for them to inject me!?!?! So I asked if I could inject myself at home. This way, not only could I reduce my dosage, but I could actually AFFORD to take this stuff. But noooooooo, they just can't do that. Why? Because. What if I take a class on injecting safely? No.

So now what? Now I'm going to have to go with one of these compounding pharmacies out there. A few of them are legit alternative resources. But many more of them are very shady and could be mixing up "dirty" medicine that could give me a major infection, at worst, or maybe even giving me under/over dosed medication, or no medication at all, or the wrong medication.... I am being FORCED to go underground to treat a legitimate health issue.

FUCKFUCKFUCKFUCK FUCKITY FUCK FUCK!

Excuse my language. I hate the healthcare system here. I really do.

Testim VS Androgel

The two major testosterone gel brands are Testim and Androgel. They are very similar and generally prescribed interchangeably, but sometimes insurance won't cover one or the other. Often, I hear that they won't cover Testim and people want to know if Androgel is just as good. So here is a general guide to choosing - if you are lucky enough to have the choice - which one is right for you.

Testim Vs Androgel

I would try whichever your insurance covers first. If your insurance covers both medications, try whichever one has coupons or kickbacks.

Now that price and availability are out of the way, lets deal with smell: Testim smells. Some people think it smells good, and some can't stand it. Either way, it's a strong scent! Personally, I like it and my wife likes it. I've found that women ask me what "cologne" I'm wearing, and mention that they like it too. Still, if you or your wife don't like the smell of something you have to put on every day, that would be a deal-breaker. So try out a tube and see what you and, if applicable, your partner thinks about the Testim scent. Androgel doesn't have much of a smell at all.

Testim is sticky. Androgel goes on much like that hand-sanitizer stuff, while Testim seems to remain stickier longer. Some say this is why Testim seems to work better for them: Because it stays on the skin and "soaks in" better.

These personal statements of efficacy can't be relied on as empirical data, however. But the fact that you can feel it on your skin longer, does bring up a question about Testim gel Vs Androgel: Does it take longer to soak in and, if so, does that increase the exposure time I have to worry about when it comes to my wife and children? The short answer is: NO. In-fact, according to US National Library of Medicine's website, the wait-time for AndrogGel is much longer:

You should not shower, bathe, swim, or wash the place where you applied the medication for at least 2 hours after you apply Testim® gel or at least 5-6 hours after you apply AndroGel ®.

Waste
Testim comes in little single-use tubes so you go through more of them and it generates more waste. If you are eco-minded this may factor into your decision. Androgel comes in a dispenser with a little pump on it (like soap) so there is less waste.

But the real question when considering AndroGel Vs Testim is: Which works better? Which is the best? Which testosterone topical gel is going to get my testosterone levels on track fast, keep my levels steady, and keep me there for the long term since I'll be taking this stuff for many years to come? As you might guess, both brands have their fans. Personally, I like Testim. And here is a study to back up my personal preference:

Efficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men.
Grober ED, Khera M, Soni SD, Espinoza MG, Lipshultz LI.
Division of Urology, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.

Summary of the study:

A change in testosterone gel preparation among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive TRT. Changing from Androgel to Testim offers hypogonadal men the potential for improved clinical and biochemical responsiveness. Changing from Testim to Androgel is indicated to eliminate or minimize unwanted side effects.

Note: This study was done to find out if switching brands would help men who were unresponsive to one brand or the other.

More important to me than such a study is to find out from others who have been on TRT for more than a year, preferably several years or more, and hear about their experiences with both or either drug. Please comment below with your own experiences.

I am inclined toward a weekly or bi-weekly injection over a daily testosterone gel application, but what does one's rear-end feel like after being used as a pin-cushion for decades? I dunno... any bodybuilders out there want to elaborate on that?

Final Test Results Are Back: Time to Go Back on TRT

Well I finally got the test results back from when I had my testosterone levels checked last week. Here is what the report says:

Total Testosterone: 254
The range for men from 18-69 years old is 250-1100. So I am 4 points above the lowest level you can have and still be considered in the normal range at the age of 69. I am 33.

Free Testosterone: 46.2
The range for men from 18-69 years old is 35 - 155.

% Free Testosterone: 1.82
The range for men from 18-69 years old is 1.50 - 2.20

And this was on a good day. I just went to the gym and had a great workout the day before, a good night's rest that evening and was feeling good. I even skipped coffee in the morning.

I felt the worst the last several days than I have in the last few weeks. It's not getting better so...

I am going to start back on HRT tomorrow. I'll need to figure out the insurance situation and if I'm going to try HCG-only as HRT for awhile, or the drug Menopur I wrote about awhile back. Or - If I'm just going to give-in and take testosterone as a gel or injections. And if I'm taking gel, will it be Testim or Androgel (depends on what is covered).

Stay tuned for lots more posts about hormone replacement therapy. I'll have the next 40-60 years to write about it from first-hand experience. I am inclined to start with HCG only and see if I can stay in normal ranges with that and nothing else. I've heard it can desensitize the testes over time, but I don't see that as being an issue since the alternative is to go on permanent TRT anyway.

Menopur is still new to the world of HRT, but some doctors have started prescribing it for secondary hypogonadism. The thing I don't understand is why they usually combine it with HCG. Can anyone explain that to me?

How Old Were You When You Started HRT / TRT Testosterone Replacement?

I have three more weeks until my "last test". I told my doctor I'd give it six months to correct itself and so far, after several tests, it hasn't. I'm going to get back into the gym serious for the next couple of weeks, take my zinc, get plenty of rest, make sure I have some decent sex... basically all the stuff you're supposed to do to "naturally" increase your testosterone levels. If I'm still under 400 (have been between 200-300 on a scale of 1100 with 350+ being normal - but don't quote me on those scales, they're from memory, which is increasingly poor these days) then screw it... I'm going on HRT for life. But is 33 years old too young for PERMANENT TRT? Has anyone been on replacement level testosterone therapy for more than, say, 20 years? I'm facing 40 or so years of it!!!! I would think the long-term risks are much worse than the typical bodybuilder doing cycles at low doses, or someone who starts HRT at 50 or 60+ years of age.

But I don't know. You tell me....
How old were you when you started hormone replacement therapy (HRT) and how long have you been on?

PS: I had a friend ask me if I had cancer today. He said "Man, every time I see you it seems like you've lost another five pounds. You look like you're wasting away. You'd tell me if you had cancer or something right?" Well, that's about the end of the line for me folks. If people think I look so bad that I have cancer, maybe I need to suck it up and just start taking the shots or gel again.

I Hate My Job and I’m Getting Dumber

These are two symptoms of low testosterone, and I have them - BIG TIME!

I'm just not on top of my game when it comes to work these days. I've felt like this before, and it was during the months leading up to my diagnoses of secondary hypogonadism. As soon as I started on the Testim Gel I began to get my "mojo" back at work. I started enjoying my job again and I was kicking ass and taking names during meetings.

Now that I've been off TRT for awhile I'm getting that way again. I waste my time in front of the computer. I keep my mouth shut during meetings. I don't take on any added responsibility and if it weren't for the paycheck I'd quick my job right this second. My memory is terrible and I can't focus. I actually feel like I've lost a few dozen IQ points this month.

So if you have recently started hating your job and feeling dumber, add that as one more likely symptom of low testosterone and talk to your doctor. As for me, I know what my problem is and if it doesn't get better by next month I'm going back on TRT. I can't take this much longer.

Good luck to you all.

Respectfully,

TRT Man

Are Your Testosterone Levels Normal? It’s All About How You FEEL.

My second round of testosterone level tests results just came back. The first time I was low again, but this time I am "normal". I put that in parenthesis because I don't FEEL normal, and because I am just barely normal on a scale that goes hundreds of points and is meant for men much older than me.

[caption id="attachment_84" align="alignleft" width="300"] Click to see larger image.[/caption]

I am 33 and my Total testosterone is at 278. The scale runs from 250 to 1,100 and is meant for adult males of ALL ages. So I'm at the low end of "normal" for an 80-year-old man? To put this into perspective: The difference between 0 and 278 is less than the difference between 278 and 1,100. This doesn't make sense to me. I looked for normal ranges for men my age, and some other sites online suggest total testosterone levels around 668, which means I'm actually functioning with less than HALF of the normal range.

What I'm trying to say is that, despite having "normal" testosterone levels, I don't feel right. I'm depressed, lethargic, angry, stressed, anxious and weak. My back hurts every day and I can barely even bend over to tie my shoes. I have no sex drive whatsoever and I feel like the world is on my shoulders when, logically, I know it's not. I have nothing to be depressed about. I have a good job, a great wife, a big farm, lots of animals... life is good. But I feel like shit.

So the point is to trust how you feel. You and only you know your body and what feels "normal" to you. Don't let some test dictate your treatment. Be an active participant in your healthcare. Now, if my testosterone levels were in the 400s - 500s (still below the average in men of my age) and I felt this way, I would look at other options. Maybe I just need to be on anti-depressants or something. But I know my body and I know that's not it. I've never been a depressed person. I didn't feel this way until my testosterone started falling.

What am I going to do?
I'm going to continue trying to let my system restart since it appears that I am actually doing better than I was. I'm going to go get another blood test in a month and if I'm doing worse, or not doing better, I'm going to go back on TRT. If I'm doing better, like in the 300s, then I'll give it another month. As long as I'm making progress then I'll keep on keeping on without the TRT. And that is MY decision based on how I FEEL. The goal, after all, is to feel better.

Vermeulen, A. (1996). Declining androgens with age: an overview. In Vermeulen, A. & Oddens, & B. J. (Eds.), Androgens and the Aging Male (pp. 3-14). New York: Parthenon Publishing.

Measurements Converted to (ng/dl)

Age	Number of Subjects	Total Testosterone	Standard Deviation	Free Testosterone	Standard Deviation	SHBG (nmol/L)	Standard Deviation
25-34	45	617	170	12.3	2.8	35.5	8.8
35-44	22	668	212	10.3	1.2	40.1	7.9
45-54	23	606	213	9.1	2.2	44.6	8.2
55-64	43	562	195	8.3	2.1	45.5	8.8
65-74	47	524	197	6.9	2.3	48.7	14.2
75-84	48	471	169	6.0	2.3	51.0	22.7
85-100	21	376	134	5.4	2.3	65.9	22.8

Normal Testosterone Levels in Men (Healthy Non-Diabetic)

Simon, D., Nahoul, K., & Charles M.A. (1996). Sex hormones, aging, ethnicity and insulin sensivity in men: an overview of the TELECOM Study. In Vermeulen, A. & Oddens, & B. J. (Eds.), Androgens and the Aging Male (pp. 85-102). New York: Parthenon Publishing.

Measurements Converted to (ng/dl)

Age	Number of Subjects	Mean Total Testosterone	Standard Deviation	Median Total Testosterone	5th Percentile	10th Percentile	95th Percentile
<25	125	692	158	697	408	468	956
25-29	354	669	206	637	388	438	1005
30-34	330	621	194	597	348	388	975
35-39	212	597	189	567	329	388	945
40-44	148	597	198	597	319	378	936
45-49	154	546	163	527	329	358	846
50-54	164	544	187	518	289	348	936
55-59	155	552	174	547	319	338	866

Am I Too Young for HRT? How Early Is Too Early for TRT?

I am seeing more and more forum posts with people in their mid-twenties to mid-thirties asking about how early is too early to go on permanent HRT. They ask the same questions I've asked, including "Am I too young for HRT?" and "What are my other options?".

The sad thing is that nobody has any answers for them, including myself. I am 33 now. I was on TRT when I was 32. I have secondary hypogonadism. I am not currently taking testosterone replacement because I'm trying all other options first. I've tried HCG. I've tried natural testosterone boosters like tribulus. I've tried cutting off all estrogen using Arimidex. Nothing has worked so far. I am facing the daunting idea of spending 3/4 of my lifetime on permanent testosterone replacement therapy (TRT).

The bodybuilding forums are full of people saying they don't see the problem with it. They think we should all just go on HRT for life and not worry about it. But nobody has done any real long-term (30-40 years) studies on the effects of hormone replacement in men. And being an American citizen, there is the whole healthcare thing to worry about. What if I can't get healthcare because of it? What if healthcare is too expensive for me to afford because of it? What if I lose my healthcare and suddenly can't get my testosterone?

I also worry about the psychological effects of knowing that I'm dependent on some drug for my "manhood". I feel like a skinny, depressed little girlyman right now because I haven't been on my HRT is several months. It sucks. I'm depressed. My bones hurt. I've lost ALL of my muscle. I have no motivation, no sex drive, no energy... my memory is terrible and I'm starting to slack at work, which could have its own consequences. I tell my wife it would be like her being on her period for months straight. So when I go back on HRT I'll remember how bad this has been for me, and it will make me paranoid that I'll lose my prescription some day, or for some reason I won't be able to get testosterone.

If I was 55 or older it wouldn't be as bad. I wouldn't be facing TRT for a longer period than I've even been alive so far. I would have already had children or will be too old to have them anyway.

Are you young and facing a lifetime of TRT? Are you under 35 and are being told by doctors that you should take testosterone for hormone replacement therapy for the rest of your life? Are you over 40 and have been taking testosterone non-stop for more than 20 years? I want to hear from you. A LOT of people in my situation want to hear from you. Please share in the comments below. How young is too young for TRT?

Low Testosterone and Depression in Men

I'm feeling pretty down and out at the moment, which prompted me to write this. Right now I'm doing an experiment to try and get my natural testosterone levels back again, but so far it isn't working. My last test results came back WAY under normal levels for someone my age, and I'm really feeling it.

In fact, I feel JUST like I felt when I decided I'd had enough and was going to see a doctor in the first place, way back several years ago. He diagnosed me with depression and wanted me to take anti-depressants. Having never been "the depressed type" and knowing what I knew from talking to bodybuilders about steroids, I asked him if he would mind running a blood-test to find out what my testosterone levels were at. As suspected, they were very low. So rather than treat a symptom of low testosterone (i.e. depression), we started treating the low test levels with Androgel. Within days I felt like a new man. I was happy, energetic, full of life, sharp at work, more fun in the bedroom.... just like my old self again.

If you're a man over the age of 30 and you are starting to feel depressed, yet have never really been the type to get depressed before, get your testosterone levels checked before committing to treatment with anti-depressants.

It may be that you really do have depression brought on by all the stress that comes with growing up (kids, job, mortgage...) but it doesn't hurt to check. And it may be that your doctor will want to put you on anti-depressants for awhile anyway in addition to hormone replacement therapy (HRT) but at least you'll know what is likely the cause of that depression.

So here I am again with low testosterone, feeling completely depressed, but just knowing what is causing that depression makes it so much easier to deal with. I'll feel better once I get my testosterone levels up into normal ranges again, whether naturally or through medication.

Update: If you've read more recent content on testosteronereplacement.org, you'll know that I am still on TRT. I am on it for life. After six months of being off TRT, my natural levels still had not returned to normal.

Who Might Know More About HRT Than Your Doctor? Hint: Big Biceps & Speedos

When it comes to diagnosing and treating any hormone deficiency - including testosterone, growth hormone and thyroid - your doctor should be the first stop. A primary care physician may run some tests, but eventually he or she will probably send you to an endocrine specialist (endocrinologist). The primary care doctor needs to know a little about everything, while the specialist needs to know a lot about a little, and that little happens to be the well-studied, FDA-approved, time-tested treatments for problems with your endocrine system (aka your hormones).

What the endocrinologist may not know, however, are the many alternative treatments, unapproved (by the FDA) ways to combat side effects, and other tidbits that come with the territory of injecting yourself with more than ten times the amount of male hormones (androgens) that would be found naturally in any human being. Bodybuilders have been doing exactly that for a very long time. Think back to when the governor of California was a teenager living in Austria and television was black and white. And yes, Arnold Schwarzenegger did steroids (he has admitted to taking them, including Dianobol).

Once again, I want to make this very clear: Your DOCTOR is who should be consulted when it comes to your health, including Hormone Replacement Therapy (HRT). But what I'm getting at here is that there are decades of accumulated, anecdotal information and opinions to be had out there on the web. All you have to do is look up "bodybuilding forums" on Google and find the steroids section.

While I would never take some random bodybuilder's advice over that of my doctor's (at least the one I have now, who I happen to trust - unlike the last one) some of the stuff I've read in these forums has given me the necessary background and confidence to ask my doctor the tough questions, such as: "Why are we treating the symptoms of secondary hypogonadism with something that will cause the much worse condition of primary hypogonadism?" Or how about the question: "Could you check my estradiol levels please? Because I read online that high estradiol levels can suppress testosterone production".

Menopur - An alternative to TRT for men with secondary hypogonadism?

Two Alternatives to TRT for Secondary Hypogonadal Men

As I posted before, I have secondary hypogonadism. Read more about the difference between primary and secondary hypogonadism here if you don't already know what that means. Basically, if you have primary hypogonadism (testes are not producing enough testosterone) what you would probably end up doing is taking testosterone for the rest of your life. If you have secondary hypogonadism (testes are fine; problem is elsewhere, such as LH and FSH), taking testosterone will give you primary hypogonadism. However, that doesn't stop doctors from prescribing testosterone to treat secondary hypogonadism. They are comfortable with the medications available; have seen them work wonders for hypogonadal men; and have probably noticed relatively few side-effects for a huge improvement on quality of life.

But there ARE other options. I'm not talking about taking tribulus or zinc supplements; I mean real treatment alternatives that have been anecdotally shown to help some men return their system to its proper balance. The two I have been reading about are listed below....

#1 - Block Estrogen Production
What I'm doing is taking a drug called Arimidex, which was designed to reduce estrogen in women at risk of, or for early treatment of breast cancer. One of the places on which I've found a lot of anecdotal information are the various steroid forums frequented by amateur and professional bodybuilders. A lot of bodybuilders take this drug to combat the side-effects of juicing up with ten times or more of the "natural" levels of testosterone men are supposed to have. The body responds to this much testosterone by making more estrogen (or estradiol to be more precise). I am not doctor, but my understanding is that the male body turns some of the excess testosterone into estrogen. This is called aromatization. Aromatase inhibitors like Arimidex keep that aromatization from happening.

It has been theorized by many in the bodybuilding community, based on limited studies and decades of personal experience, that estradiol is more to blame for shutting down the natural production of testosterone than the actual testosterone that is being injected. It has also been theorized that bringing your body's estradiol levels to near-zero will stimulate your body to produce more testosterone so that it can aromatize it and make estradiol. Although I'm not going to link out to online steroid conversations, there are lots of threads on bodybuilding forums outlining some of the concept and sharing some anecdotal evidence as to the efficacy of this approach. Use Google and I'm sure you'll find them. But keep in mind this approach is using a medication for purposes other than what it was intended for, and for purposes which the medication was not tested for.

With full understanding of the above, I am currently trying this alternative with the knowledge and support of my primary care physician. If it doesn't work within 6 months I will move on to the second alternative below. By the way, an endocrinologist isn't going to want to let you try this approach. He will claim it has to do with these medications not being tested on men, but given the relatively low risk of side effects (when compared with permanent testosterone replacement) of temporarily taking aromatase inhibitors - my guess is it has more to do with the fact that this could FIX your problem. Then your endo would be out of a job. ;-)

#2 - Treat the Problem, Not the Symptom
One of the readers here pointed me to a drug called Menopur. Again, this is a drug for women. It is a fertility drug used to induce the development of multiple eggs and pregnancy in women who are able to produce and release eggs (ovulate). In other words, this is the kind of stuff to blame for Octamoms. But really the active ingredients are two hormones that are produced in men called follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These two hormones are responsible for telling your testes to make testosterone. In my case, as is often the case with secondary hypogonadal men, my body is not producing enough of either of these hormones. So why not take THIS drug instead of taking testosterone? Why not replace what I'm missing instead of replacing the hormone that what I'm missing is supposed to be producing?

If one of the two above alternatives to permanent testosterone replacement therapy (TRT) works for me I'll let you know, at which point I'll probably give up the blog. If neither works for me I will resign myself to a life of testosterone injections (I'm done with the creams; they give me terrible chest acne, and sometimes boils, not to mention the danger of contaminating surfaces like the faucet and towels, which my wife also touches) and you will have an author here at the testosterone replacement therapy blog for a long, long time...