My first testosterone shot was at the clinic on a Monday. I chose that day because my weight training days are Mon/Wed/Fri, so I figured a Monday shot would provide the greatest benefit as far as test levels throughout the week.
As I mentioned here, I wasn't feeling much difference a week after getting the first shot. Maybe a bit hungrier over the week, but no renewed and sustained energy, no clarity of thought or purpose.... From the reading I did, most of the effects began to be felt in 2 - 3 weeks. I wasn't disappointed. Not yet anyway.
My prescription wasn't stored at the clinic - I had it at home. This, of course, meant I had to remember to bring it to work with me. The clinic was much closer to my workplace than home, a slight detour on my end-of-day commute.
I didn't even notice I'd forgotten it until it was time for me to leave. I shut down my computer, and stood up to leave, thinking, Well, off to get my - DAMMIT! I forgot the vial of testosterone!
Yes, friends, only my second shot and I'd already forgotten to bring the vial to work. So I had two choices: 1) wait and do it the following day or 2) do it myself at home.
Now I'd already self administered two hCG shots myself, simple easy things done to the abdomen with an insulin needle. The testosterone was quite a bit different though. Where hCG was water-based, the testosterone was oil-based and thick. The hCG was subcutaneous, the testosterone was intra-muscular. The hCG was administered with a tiny 29 gauge needle, the testosterone with a 25 gauge 1.5-inch harpoon.
I was a bit nervous on the ride home thinking about jabbing that thing into my leg.
An aside: I'd faced up to the realization that sooner or later I'd want to be doing the shots myself, and I'd done plenty of research in that direction. I'd found plenty of information supporting the subcutaneous injection of testosterone, and the practitioners of this method attested to it's ease and effectiveness, proving proof in the form of blood test results.
I'd also read about shallow intra-muscular, done with a 1/2-inch 27 or 28 gauge insulin needles, most commonly into the thigh or deltoid.
So I'd sort of decided I'd be doing one of those myself, to free me from the shackles of going to the clinic once a month. I'd even ordered some half-inch, 28 gauge insulin needles online.
So I get home and lo and behold the needles I'd ordered had arrived! At least now I wasn't faced with sticking that javelin into my leg.
The syringes I'd ordered (100 of them for $16 from an insulin supply company) had fixed 28 gauge needles a half-inch in length. Because testosterone is thick due to being oil based, it was a common practice to draw the fluid out of the vial with a larger needle (like an 18 or 20 gauge), then swap that needle out for the injection needle (usually a 25 gauge, or even 23 if you were fearless).
You COULD draw with a smaller gauge, but it would take longer. And the underground lab testosterone used by many bodybuilders was often so thick it couldn't even be drawn with anything much smaller than a 22 gauge. Since the needles I'd ordered were fixed, I could swap; I had to draw with teh 28 gauge.
I wasn't drawing underground lab testosterone though, I had nice, pharmaceutical grade testosterone courtesy of my hormone replacement therapy doctor. And from everything I'd read, I'd be able to draw fine, albeit slowly, with the 28 gauge needles I'd ordered.
I grabbed my vial, two alcohol swabs, and a syringe. The fluid is much thicker than water - it took me about a minute or two to draw out 1ml, my weekly dose. I swabbed my right thigh, upper/outer part, and arrived at the moment of truth.
I was surprised at how easily the needle went in, with nothing more than the faintest sensation of a pinch. It took maybe about 20 seconds or so to complete the injection, and I pulled the needle out. That was it. No stinging, no pain, just a bit of pressure and a feeling somewhat akin to slight heat as I'd emptied the syringe into my leg.
I massaged the injection spot for about 30 seconds and BAM! I'd just completed my first testosterone shot, delivered as a shallow intra-muscular injection!
Overall, there was less discomfort than when I'd gotten the shot at the clinic. Smaller needles, shallow IM versus deep IM maybe. Maybe the clinic nurse pressed the plunger a lot faster where I'd taken my time.
All I know is I felt quite a bit of relief knowing I could, henceforth, do the injection myself.
Friday, May 31, 2013
Tuesday, May 28, 2013
My First hCG (human chorionic gonadotropin) Shots
Starting with Monday being as day 1 (the day I get the testosterone shot), my treatment plan calls for hCG (human chorionic gonadotropin) shots on days 5 and 7. My hCG was already mixes up, courtesy of my first visit to the clinic.
While the testosterone solution can be kept at room temperature, the hCG has to be kept refrigerated. The test injection was done with a 1.5 inch 25g needle; the hCG would use a 29g 1/2 inch insulin needles (provided along with the prescription).
I confess to a bit of nervousness the first time. I'd done some reading, and injecting with a 29 gauge was supposed to be pretty much undetectable. Heck, diabetics injected insulin multiple times a day with the same thing. Only one way to do it though, and that was to do it.
I got my syringe (fixed needles 29g, as mentioned), the hCG vial from the fridge, and two alcohol wipes. I wiped the top of the syringe the way they showed me in the clinic - a good, vigorous wiping for about 5 seconds. I popped the cap on the syringe, and drew in air for 40u (the syringe has a 50u capacity, with 50u being .5ml).
Carefully, (and wearing my reading glasses - yes I need reading glasses) I inserted the syringe into the vial and injected the air. I think turn the vial over and began slowly drawing in the hCG liquid. The syringe filled easily, took maybe 10 seconds. I filled it just past the 40u mark, flicked it a few times, and then injected the excess back into the vial. I withdrew the needle and capped it again.
Out came the second alcohol swab. I picked a spot about 1 inch to the right of my navel and swabbed it well for about 10 seconds, uncapped the syringe....
And poked it right in.
Barely more than a slight pinch. I pressed the plunger, took about 10 seconds or so to get it all in, and pulled out the needle. My first successful self-injection! Yeah, I know it was an insulin pin and hCG, but still.
Overall, a much less traumatic experience than I expected.
While the testosterone solution can be kept at room temperature, the hCG has to be kept refrigerated. The test injection was done with a 1.5 inch 25g needle; the hCG would use a 29g 1/2 inch insulin needles (provided along with the prescription).
I confess to a bit of nervousness the first time. I'd done some reading, and injecting with a 29 gauge was supposed to be pretty much undetectable. Heck, diabetics injected insulin multiple times a day with the same thing. Only one way to do it though, and that was to do it.
I got my syringe (fixed needles 29g, as mentioned), the hCG vial from the fridge, and two alcohol wipes. I wiped the top of the syringe the way they showed me in the clinic - a good, vigorous wiping for about 5 seconds. I popped the cap on the syringe, and drew in air for 40u (the syringe has a 50u capacity, with 50u being .5ml).
Carefully, (and wearing my reading glasses - yes I need reading glasses) I inserted the syringe into the vial and injected the air. I think turn the vial over and began slowly drawing in the hCG liquid. The syringe filled easily, took maybe 10 seconds. I filled it just past the 40u mark, flicked it a few times, and then injected the excess back into the vial. I withdrew the needle and capped it again.
Out came the second alcohol swab. I picked a spot about 1 inch to the right of my navel and swabbed it well for about 10 seconds, uncapped the syringe....
And poked it right in.
Barely more than a slight pinch. I pressed the plunger, took about 10 seconds or so to get it all in, and pulled out the needle. My first successful self-injection! Yeah, I know it was an insulin pin and hCG, but still.
Overall, a much less traumatic experience than I expected.
Friday, May 24, 2013
End of the First Week
I had my first testosterone shot Monday afternoon, and went through a normal week. My regular work schedule is 6:15am - 2:15pm, which gets me home about 3:15. My 14 year-old son gets home from school around 3:30. We have a home gym, a power cage we built ourselves along with an olympic bar and bumper plates and other weights up to 315 pounds. We lift together 3x per week, a reverse pyramid workout on Mondays, Wednesdays and Fridays.
I try to hit the hay around 9ish and read a bit, with lights out before 10. That typically gives me 6-7 hours of sleep a night, depending on how quickly I fall asleep, how many times I wake up to take a leak, and how (or if) I'm able to fall back asleep again.
Boring stuff, I know, but I'm telling you all this so you'll have an idea of my schedule. Maybe you'll see some aspects of your own in it....
As I mentioned at the end of my first shot post, I didn't feel any different in the days following the injection. No increased energy or coalescing of mental focus, still sleeping fitfully, no sudden reversal of the lethargy I'd been in the grip of for some time.
However...
That first weekend following the shot, I was was hungry. And I don't mean a bit peckish, I mean hungry. Like can't get full hungry. So I ate. A lot. Generally, I kept it healthy (I tend to eat fairly healthy most of the time anyway). But I powered through a more than normal amount of food, no doubt.
I don't generally pay much attention to my weight. I mentioned in an earlier post that I've been within a pound or two of 185 for a long time. But my hunger and the resulting feeding frenzy over the weekend made me curious enough to step on the scale, where I was greeted by a surprise: 189.
So it looked as though I'd gained a few pounds. Maybe I'd been eating more all week? I hadn't been bothered by hunger until that weekend, but it's a possibility.
So end of first week, not feeling any different, but up around 4 pounds. Make of that what you will.
I try to hit the hay around 9ish and read a bit, with lights out before 10. That typically gives me 6-7 hours of sleep a night, depending on how quickly I fall asleep, how many times I wake up to take a leak, and how (or if) I'm able to fall back asleep again.
Boring stuff, I know, but I'm telling you all this so you'll have an idea of my schedule. Maybe you'll see some aspects of your own in it....
As I mentioned at the end of my first shot post, I didn't feel any different in the days following the injection. No increased energy or coalescing of mental focus, still sleeping fitfully, no sudden reversal of the lethargy I'd been in the grip of for some time.
However...
That first weekend following the shot, I was was hungry. And I don't mean a bit peckish, I mean hungry. Like can't get full hungry. So I ate. A lot. Generally, I kept it healthy (I tend to eat fairly healthy most of the time anyway). But I powered through a more than normal amount of food, no doubt.
I don't generally pay much attention to my weight. I mentioned in an earlier post that I've been within a pound or two of 185 for a long time. But my hunger and the resulting feeding frenzy over the weekend made me curious enough to step on the scale, where I was greeted by a surprise: 189.
So it looked as though I'd gained a few pounds. Maybe I'd been eating more all week? I hadn't been bothered by hunger until that weekend, but it's a possibility.
So end of first week, not feeling any different, but up around 4 pounds. Make of that what you will.
Thursday, May 23, 2013
First Testosterone Shot: at the Clinic
My first shot was scheduled for a Monday at 3:00, with my plan being to stop by the clinic on the way home from work. I'd decided on Monday, because my workout days were Monday, Wednesday and Friday, so I figured Monday was the best bet for having the highest levels during all my workouts. I'd picked up my prescription the week before; one 10ml bottle of testosterone cypionate, 100mg per ml, and the HCG. The HGC prescription came in 2 vials, one with the HCG powder and one with the sterile water to be mixed with the powder to make the solution. I took both of them to the clinic with me. My goal was to be able to self-administer the shot, but I wanted the first one to be done as "training" so I could understand the process and get a feel for it. I asked them to mix the HCG first.
Next up was the testosterone injection. The needle was a 1.5 inch 25 gauge - it looked like a harpoon. Loading the syringe with the testosterone cypionate followed the same proceedure as loading the HCG water syringe.
The injection itself stung a bit more than one of those flu shots you get in your shoulder, only the stinging lasted even after she withdrew the needle. Not quite as bad a bee sting, but definitely noticeable. I'm guessing it was about 2 hours before the stinging completely went away.
She didn't inject the HCG. As I mentioned above, I'd be doing that myself on days 5 and 7. You can store the testosterone at room temperature.
The HCG needs to be stored in the fridge. From personal research, I learned the test will last a few months, but the HCG is only good for 2 or 3.
All told, it wasn't that bad an experience, but I left there pretty uncertain about my ability to do the injection myself. For that reason, I made an appointment for the upcoming Monday to have them do the injection again. Injections at the clinic are "free" in that they are included in the $75 I paid the clinic each month for the prescription and monitoring.
My butt cheek was a bit sore the next day, like a it had a bruise, but it was gone by the third day. I'm not sure what I was expecting, but I didn't feel any different in the days following this first injection.
- Swap the top of the water vial with an alcohol swab
- Preposition the plunger in the syringe to the required amount (3.5ml in this case)
- Insert the needle and depress the plunger to put the air into the vial (this creates positive pressure inside the vial to help extract the water)
- Retract the plunger to draw 3.5ml of purified water out
- Cap the needle
- Swab the top of the HCG vial
- Insert the needle and depress the plunger to put the water in the vial
- Don't squirt the water right on the powder; instead tilt the needles to make it run down the inside of the vial
- Once the 3.5ml is in, extract the needle and mix by gently rolling the vial back and forth in your hands
- Don't shake the vial, mix it gently!
- HCG solution is done!
Next up was the testosterone injection. The needle was a 1.5 inch 25 gauge - it looked like a harpoon. Loading the syringe with the testosterone cypionate followed the same proceedure as loading the HCG water syringe.
- Swap the top of the test vial with an alcohol swab
- Pre-position the plunger in the syringe to the required amount (1ml in this case)
- Insert the needle and depress the plunger to put the air into the vial (this creates positive pressure inside the vial to help extract the testosterone oil)
- Retract the plunger to draw 1ml of testosterone cypionate into the syringe
- Cap the needle
- Swab my butt cheek (left one in this case)
- Insert the needle into my butt inject the test
- Ouch!
The injection itself stung a bit more than one of those flu shots you get in your shoulder, only the stinging lasted even after she withdrew the needle. Not quite as bad a bee sting, but definitely noticeable. I'm guessing it was about 2 hours before the stinging completely went away.
She didn't inject the HCG. As I mentioned above, I'd be doing that myself on days 5 and 7. You can store the testosterone at room temperature.
The HCG needs to be stored in the fridge. From personal research, I learned the test will last a few months, but the HCG is only good for 2 or 3.
All told, it wasn't that bad an experience, but I left there pretty uncertain about my ability to do the injection myself. For that reason, I made an appointment for the upcoming Monday to have them do the injection again. Injections at the clinic are "free" in that they are included in the $75 I paid the clinic each month for the prescription and monitoring.
My butt cheek was a bit sore the next day, like a it had a bruise, but it was gone by the third day. I'm not sure what I was expecting, but I didn't feel any different in the days following this first injection.
Wednesday, May 22, 2013
Testosterone Esters and Injections
I was prescribed testosterone cypionate for injection, one shot every 7 days. The shot size is 1ml for delivery of 100mg of testosterone. Naturally, when I found out my prescription, I did some research to figure out what I'd be injecting into my body.
Most testosterone prescribed for testosterone replacement therapy is in the form of a testosterone ester. Esterification is done to improve the solubility of testosterone in oil, which in turn slows the release of the testosterone once it's injected into the body. Testosterone comes in numerous types of injectable esters, including the common testosterone enanthate and testosterone cypionate, as well as the less common esters caproate, propionate, acetate, phenylpropionate, isocaproate, decanoate, and undecanoate. Each of these esters is a molecular chain composed of carbon, hydrogen, and oxygen atoms, the difference being how many carbon and hydrogen atoms make up the chain.
Once an ester group has been added, testosterone becomes more soluble in oil, but less soluable in water. It's also interesting to note that, in general, the more carbon atoms an ester has, the more oil-soluble it becomes. Testosterone propionate, for example, has 3 carbon atoms in the ester group and is less soluble than testosterone cypionate which has 8. The ratio between oil and water solubility is called the "partition coefficient". The higher the oil solubility, the higher the partition coefficient. As far as oils goes, testosterone compounds usually use cottonseed or sesame seed oil.
The partition coefficient is important because it indicates how quickly the testosterone is released into and stays in your system. Generally, the quicker the release, the shorter the stay. If the testosterone is released too quickly, testosterone rises quickly, but then soon starts declining once the dose has been used. So a testosterone solution with a very low partition coefficient is immediately available and used up quickly once it's injected, while a solution with a higher coefficient is released more slowly and lasts longer.
Testosterone cypionate is an example of a slow-acting compound with a high partition coefficient. When injected, the compound slowly dissolves, resulting in a slower release of testosterone with more stable, longer-lasting testosterone levels.
For testosterone replacement therapy, slow-acting compounds are usually prescribed, since a slower releasing compound means fewer injections and more constant testosterone levels. Testosterone enanthate, which has 7 carbons in the ester, and testosterone cypionate, which has 8 carbons, both take around 8-10 days to be fully released. As such, these testosterone esters are usually injected once every 1 to 2 weeks. In contrast, testosterone propionate with only 3 carbons in the ester, is fully released in 3-4 days. Using testosterone propionate would mean smaller doses injected more frequently.
So from the above, you can see that the dosage and frequency of shots depends a good deal on which testosterone ester is prescribed. Testosterone dosages range from 50mg to 300mg per injection, depending on the ester and dosing schedule. A typical dosing schedule might be 200-250mg every 2 weeks, or 100mg every week to 10 days. Blood levels should be monitored and the dosages adjusted according to an individual's response.
My Prescription
The clinic I went to prescribed a 1ml testosterone cypionate once weekly, with each ml containing 100mg of testosterone. I do the injections for a month, then get my levels checked, with adjustments (if required) made according to my individual results.
Below is some more information on the individual testosterone esters:
Testosterone enanthate is one of the two most commonly prescribed testosterone esters in the United States. It's slow-acting with a release time of 8 - 10 days. Testosterone enanthate is usually injected between once a week to once every three weeks.
Testosterone cypionate is the other most common injectable form of testosterone prescribed in the United States. It's also slow-acting, with a release time of 8-10 days. Testosterone cypionate injection schedules run from once every week to once every three weeks.
Sustanon is the brand name for two formulas of injectable testosterone that contain an ester blend. Sustanon 100 contains three testosterone esters: testosterone propionate, testosterone phenylpropionate, and testosterone isocaproate. Sustanon 250 contains four testosterone esters: testosterone propionate, testosterone phenylpropionate, testosterone isocaproate, and testosterone decanoate. Both formulas feature both fast-acting and slow-acting esters, and are typically injected once every week to once every four weeks.
Testosterone propionate is a fast-acting ester with a release time of 3-4 days. To keep blood levels stable, propionate is usually injected one to three times a week.
Testosterone phenylpropionate is a slow-acting ester with a release time of 1-3 weeks. Testosterone phenylpropionate is one of the components of Sustanon and Omnadren.
Omnadren is the brand name for a blend of four testosterone esters: testosterone propionate, testosterone phenylpropionate, testosterone isocaproate, and testosterone decanoate. It is pretty much the blend as Sustanon, featuring both fast-acting and slow-acting esters. It's injected from once every week to once every four weeks.
Injectable aqueous (water based) testosterone is available, but it is very short-acting, being completely released in the system within hours. It's not used for replacement therapy, since it would need to be re-injected multiple times daily to maintain stable blood levels.
Most testosterone prescribed for testosterone replacement therapy is in the form of a testosterone ester. Esterification is done to improve the solubility of testosterone in oil, which in turn slows the release of the testosterone once it's injected into the body. Testosterone comes in numerous types of injectable esters, including the common testosterone enanthate and testosterone cypionate, as well as the less common esters caproate, propionate, acetate, phenylpropionate, isocaproate, decanoate, and undecanoate. Each of these esters is a molecular chain composed of carbon, hydrogen, and oxygen atoms, the difference being how many carbon and hydrogen atoms make up the chain.
Once an ester group has been added, testosterone becomes more soluble in oil, but less soluable in water. It's also interesting to note that, in general, the more carbon atoms an ester has, the more oil-soluble it becomes. Testosterone propionate, for example, has 3 carbon atoms in the ester group and is less soluble than testosterone cypionate which has 8. The ratio between oil and water solubility is called the "partition coefficient". The higher the oil solubility, the higher the partition coefficient. As far as oils goes, testosterone compounds usually use cottonseed or sesame seed oil.
The partition coefficient is important because it indicates how quickly the testosterone is released into and stays in your system. Generally, the quicker the release, the shorter the stay. If the testosterone is released too quickly, testosterone rises quickly, but then soon starts declining once the dose has been used. So a testosterone solution with a very low partition coefficient is immediately available and used up quickly once it's injected, while a solution with a higher coefficient is released more slowly and lasts longer.
Testosterone cypionate is an example of a slow-acting compound with a high partition coefficient. When injected, the compound slowly dissolves, resulting in a slower release of testosterone with more stable, longer-lasting testosterone levels.
For testosterone replacement therapy, slow-acting compounds are usually prescribed, since a slower releasing compound means fewer injections and more constant testosterone levels. Testosterone enanthate, which has 7 carbons in the ester, and testosterone cypionate, which has 8 carbons, both take around 8-10 days to be fully released. As such, these testosterone esters are usually injected once every 1 to 2 weeks. In contrast, testosterone propionate with only 3 carbons in the ester, is fully released in 3-4 days. Using testosterone propionate would mean smaller doses injected more frequently.
So from the above, you can see that the dosage and frequency of shots depends a good deal on which testosterone ester is prescribed. Testosterone dosages range from 50mg to 300mg per injection, depending on the ester and dosing schedule. A typical dosing schedule might be 200-250mg every 2 weeks, or 100mg every week to 10 days. Blood levels should be monitored and the dosages adjusted according to an individual's response.
My Prescription
The clinic I went to prescribed a 1ml testosterone cypionate once weekly, with each ml containing 100mg of testosterone. I do the injections for a month, then get my levels checked, with adjustments (if required) made according to my individual results.
Below is some more information on the individual testosterone esters:
Testosterone enanthate is one of the two most commonly prescribed testosterone esters in the United States. It's slow-acting with a release time of 8 - 10 days. Testosterone enanthate is usually injected between once a week to once every three weeks.
Testosterone cypionate is the other most common injectable form of testosterone prescribed in the United States. It's also slow-acting, with a release time of 8-10 days. Testosterone cypionate injection schedules run from once every week to once every three weeks.
Sustanon is the brand name for two formulas of injectable testosterone that contain an ester blend. Sustanon 100 contains three testosterone esters: testosterone propionate, testosterone phenylpropionate, and testosterone isocaproate. Sustanon 250 contains four testosterone esters: testosterone propionate, testosterone phenylpropionate, testosterone isocaproate, and testosterone decanoate. Both formulas feature both fast-acting and slow-acting esters, and are typically injected once every week to once every four weeks.
Testosterone propionate is a fast-acting ester with a release time of 3-4 days. To keep blood levels stable, propionate is usually injected one to three times a week.
Testosterone phenylpropionate is a slow-acting ester with a release time of 1-3 weeks. Testosterone phenylpropionate is one of the components of Sustanon and Omnadren.
Omnadren is the brand name for a blend of four testosterone esters: testosterone propionate, testosterone phenylpropionate, testosterone isocaproate, and testosterone decanoate. It is pretty much the blend as Sustanon, featuring both fast-acting and slow-acting esters. It's injected from once every week to once every four weeks.
Injectable aqueous (water based) testosterone is available, but it is very short-acting, being completely released in the system within hours. It's not used for replacement therapy, since it would need to be re-injected multiple times daily to maintain stable blood levels.
Saturday, May 18, 2013
Blood Test Results for Testosterone Levels
My second visit to the clinic was on another Friday, a week after my first visit. It was at this appointment I would go over my lab results with the doctor and get recommendations (if any) for a course of treatment.
I'd done plenty of research in the meantime on testosterone and testosterone levels, so I had a preconception going in. From my research, it seemed that "normal" testosterone levels encompassed a pretty wide range. It was commonly accepted that testosterone declined as one aged, and that your age influenced your levels, in that a 20-year old should have higher levels than a 40-year old.
A "soft" lower limit to serum testosterone of 300 ng/dL was mentioned in more than one place.
The blood test was for a full panel, the most pertinent of course (in this case) are the testosterone (both serum and free), my LH (luteinizing hormone) and FSH (follicle stimulating hormone) and IGF-1 (insulin-like growth factor 1) and a bunch of other stuff I'm not going to cover.
First up the testosterone:
I was surprised at the results. As I mentioned, I kind of considered the whole TRT replacement/anti-aging clinic thing to be sort of a wink-wink-nudge-nudge-here's-your-prescription-steroids sort of thing. They had hinted that even if my testosterone levels came back in the "normal" range, if I was experiencing the mere symptoms of low testosterone, I would still be a candidate for therapy. I read that as: pay the money, get the goods.
But surprise, surprise, my serum testosterone was actually low. Considerably low in fact, being more than 100 points under the bottom of the "normal" range, a range not established by the clinic whose job it was to sell testosterone, but by the medical society at large. Ditto for my free testosterone, which, while not under the bottom of normal, was pretty close to it.
Wow.
Given my lifestyle of exercise and healthy eating, I was shocked. I mean, I honestly never expected my testosterone to be actually be low. I maintained a muscular appearance, I picked up heavy things and put them down, and although my recovery time was longer and gaining strength and mass (without fat to go along with it) was tough, I figured that was the normal price of being 47 years old.
To see that low number staring right at me was a harsh and tangible confirmation of my physical decline and ultimate mortality.
Ouch.
While I wrapped my head around that realization, the doc went on to talk about some of the other results:
No issues with IGF-1, so I've got that going for me, which is nice....
My estradiol was low, probably as counterpoint to my testosterone being low, as they tend to be somewhat synched. Higher testosterone = higher estradiol. It's this increase that, for stronger androgens like steroids, makes Post Cycle Therapy a good idea.
'Cause it works like this: you take steroids, the steroids artificially raise your testosterone, your body reacts by 1) reducing its natural production of testosterone (because it sees there's plenty) and 2) increasing estradiol (to balance out what it sees as higher testosterone). Then, when you stop taking the steroids, your testosterone drops rapidly (as your body isn't producing as much, or any, and your no longer artificially raising it) leaving you with excess estradiol.
It takes your body a while to realize this and get everything in balance again. Too much estradiol and not enough testosterone and suddenly your nipples get puffy and aching and maybe even leaking fluid. Welcome to gynecomastia my swole friend.
In any case, mine being low isn't an issue since my test is low too. One potential long term effect of low estradiol could be reduced bone density (osteoporosis). Hopefully all the weight training I do keeps my bone density up.
My LH (luteinizing hormone) is in the normal range. I'm giving a very top level summary here, but LH is released by the pituitary to stimulate the testes to produce testosterone. Low LH can be another effect of steroid use, as in your pituitary won't be making it if it sees enough testosterone there already. My LH being normal could be seen as anecdotal evidence that everything is working as it should and I just have naturally low test.
FSH (follicle stimulating hormone) luteinizing hormone (LH) act together reproduction, so it's also involved in the process your body uses to decide if it needs to make more testosterone. It's particularly related to telling your testes to make sperm.
So there you have. According to widely accepted standards, I have medically low testosterone, and the clinic was going to help me do something about it.
I'd done plenty of research in the meantime on testosterone and testosterone levels, so I had a preconception going in. From my research, it seemed that "normal" testosterone levels encompassed a pretty wide range. It was commonly accepted that testosterone declined as one aged, and that your age influenced your levels, in that a 20-year old should have higher levels than a 40-year old.
A "soft" lower limit to serum testosterone of 300 ng/dL was mentioned in more than one place.
The blood test was for a full panel, the most pertinent of course (in this case) are the testosterone (both serum and free), my LH (luteinizing hormone) and FSH (follicle stimulating hormone) and IGF-1 (insulin-like growth factor 1) and a bunch of other stuff I'm not going to cover.
First up the testosterone:
| Test | Result | Reference |
| Serum Testosterone | 239 ng/dL | 348 - 1197 |
| Free Testosterone | 8.0 pg/mL | 6.8 - 21.5 |
I was surprised at the results. As I mentioned, I kind of considered the whole TRT replacement/anti-aging clinic thing to be sort of a wink-wink-nudge-nudge-here's-your-prescription-steroids sort of thing. They had hinted that even if my testosterone levels came back in the "normal" range, if I was experiencing the mere symptoms of low testosterone, I would still be a candidate for therapy. I read that as: pay the money, get the goods.
But surprise, surprise, my serum testosterone was actually low. Considerably low in fact, being more than 100 points under the bottom of the "normal" range, a range not established by the clinic whose job it was to sell testosterone, but by the medical society at large. Ditto for my free testosterone, which, while not under the bottom of normal, was pretty close to it.
Wow.
Given my lifestyle of exercise and healthy eating, I was shocked. I mean, I honestly never expected my testosterone to be actually be low. I maintained a muscular appearance, I picked up heavy things and put them down, and although my recovery time was longer and gaining strength and mass (without fat to go along with it) was tough, I figured that was the normal price of being 47 years old.
To see that low number staring right at me was a harsh and tangible confirmation of my physical decline and ultimate mortality.
Ouch.
While I wrapped my head around that realization, the doc went on to talk about some of the other results:
| Test | Result | Reference |
| IGF-1: | 146 ng/dL | 59 - 201 |
| Estradiol: | 7.4 pg/mL | 7.6 - 42.6 |
| Total Estrogens: | 62 pg/mL | 40 - 115 |
| LH (luteinizing hormone): | 2.2 mIU/mL | 1.7 - 8.6 |
| FSH: | 2.8 mIU/mL | 1.5 - 12.4 |
No issues with IGF-1, so I've got that going for me, which is nice....
My estradiol was low, probably as counterpoint to my testosterone being low, as they tend to be somewhat synched. Higher testosterone = higher estradiol. It's this increase that, for stronger androgens like steroids, makes Post Cycle Therapy a good idea.
'Cause it works like this: you take steroids, the steroids artificially raise your testosterone, your body reacts by 1) reducing its natural production of testosterone (because it sees there's plenty) and 2) increasing estradiol (to balance out what it sees as higher testosterone). Then, when you stop taking the steroids, your testosterone drops rapidly (as your body isn't producing as much, or any, and your no longer artificially raising it) leaving you with excess estradiol.
It takes your body a while to realize this and get everything in balance again. Too much estradiol and not enough testosterone and suddenly your nipples get puffy and aching and maybe even leaking fluid. Welcome to gynecomastia my swole friend.
In any case, mine being low isn't an issue since my test is low too. One potential long term effect of low estradiol could be reduced bone density (osteoporosis). Hopefully all the weight training I do keeps my bone density up.
My LH (luteinizing hormone) is in the normal range. I'm giving a very top level summary here, but LH is released by the pituitary to stimulate the testes to produce testosterone. Low LH can be another effect of steroid use, as in your pituitary won't be making it if it sees enough testosterone there already. My LH being normal could be seen as anecdotal evidence that everything is working as it should and I just have naturally low test.
FSH (follicle stimulating hormone) luteinizing hormone (LH) act together reproduction, so it's also involved in the process your body uses to decide if it needs to make more testosterone. It's particularly related to telling your testes to make sperm.
So there you have. According to widely accepted standards, I have medically low testosterone, and the clinic was going to help me do something about it.
Friday, May 17, 2013
First Visit to the Clinic
Go to Google (or Bing) and type in the name of your city followed by "TRT" or "Testosterone Replacement". I can pretty much guarantee you'll find a few places close by that specialize in "bio-identical" hormone replacement therapy, both for men and women. I had the fortune of a recommendation to a place from my co-worker, a satisfied customer, but in my city there are probably a dozen or more places that offer the exact same thing.
When you start doing a bit of research, you realize pretty quickly that hormone replacement therapy is popular, and getting more popular all the time. I can't speak to the female side of the equation, but more and more men are looking for ways to stay feeling stronger and more energetic. Enter testosterone replacement therapy. Note that the claimed benefits of TRT are not a longer life, but rather a more vital one. It doesn't claim to add years (or any time) to your lifespan, but it does claim that you'll be more energetic and physically capable in your declining years. Hence the often found word "rejuvenation" or "anti-aging" nomenclature found in the clinic names.
The clinic I chose (yes, it has the word rejuvenation in the name) is close to where I work, only a bit of a detour to stop by on the way home. As I mentioned above, it's the same one used by my coworker.
I scheduled my first appointment for a Friday. I have the good fortune of flexible hours, and typically wrap up my daily 8 hours of indentured servitude around 2:00 - 2:30pm. I made an appointment for 3:00 and went there right after work. It's a small but busy place. I was interested to see three women in the waiting area, but no men (although one came in while I was waiting). Hormone therapy for weight control is a big part of their business, not just old guys looking to get jacked. Most of their clients are women.
I met the "operations officer" a fairly jacked guy himself. Late 30s, muscular, obviously a lifter. Yes, he replied in response to my question, he does TRT himself. He took me into his office and went over some of my symptoms. Yes, I'm:
Tired
Unmotivated
Not sleeping well
Not making gains in the gym
Having some joint pain
Generally dissatisfied with my career
Etc....
Honestly, I feel these symptoms pretty much describe just about anyone entrenched in the banality of modern life. Ceaseless labor on the behalf of others to make little bits of green-inked paper to trade for the things we need to survive, with, hopefully, enough left over to afford a little fun every now and then. The interview had the feeling of being a check-the-box sort of thing. A rout confirmation of yes, I have symptoms that justify me seeking hormone therapy.
He went over the program. For $75 a month plus prescription costs, I would get a monitored hormone replacement therapy program. I would see the doctor once a month, get my prescription, be able to get my weekly testosterone shots at the clinic (if I wanted), and get blood tests every 3-6 months to monitor my hormone levels. My prescription costs would depend on my exact medications, but I'd probably be looking at another $150 or so a month. So total cost was around $200 - 250 a month. Oh, and the initial visit was $399. It would include an additional consultation with the doctor and a full blood workup. Oh, by the way, if my testosterone level was below normal, my insurance (CIGNA) might pay toward the prescription.
Having confirmed my willingness to pay the initial $399 (and my potential as a candidate for TRT based on my symptoms), he escorted me to see the doctor. Who was actually a nurse practitioner. She and I went over pretty much the same symptom diagnosis I'd just done. There was an up-sell for some additional supplements (multivitamin,sleep aid, thyroid health....) I declined.
Off to another room with standard issue doctor's office stuff in it: cabinets with gauze and other medical supplies, biological waste trashcan, sharps container, raised doctor platform in the middle of the room covered in paper. Another friendly lady (they were all friendly) appeared. I was weighed, my body fat measured (15%, not bad for 47), my blood pressure (118/74) and pulse rate (62) taken. I was pronounced to be in good shape and look much younger than my years. Flattery will get you everywhere. Rubber band, syringe, and half a dozen vials of my blood were taken for the lab work (at LabCorp).
I was escorted back to the front desk, where I paid my $399 and made an appointment for the following Friday (a week later) to go over my lab results. Total time between in and out was about 45 minutes.
There's no denying hormone replacement therapy for men is effective for treating a variety of ailments, I'm just not sure the malaise of modern life or the natural decline in vitality due to aging should be among them. I feel as though the whole thing was sort of a wink-wink, nudge-nudge sort of situation. Oh, you're tired and not quite as strong or energetic as you used to be? Let's take a look at that testosterone.....
I'm not against people doing pretty much whatever they want as long as it doesn't negatively impact anyone else. If there's a safe and reliable (and legal) way for me to improve my energy, strength, attitude, and body composition, count me in.
I'm curious to see my blood labs and if that will have any impact on their recommendation for treatment.
When you start doing a bit of research, you realize pretty quickly that hormone replacement therapy is popular, and getting more popular all the time. I can't speak to the female side of the equation, but more and more men are looking for ways to stay feeling stronger and more energetic. Enter testosterone replacement therapy. Note that the claimed benefits of TRT are not a longer life, but rather a more vital one. It doesn't claim to add years (or any time) to your lifespan, but it does claim that you'll be more energetic and physically capable in your declining years. Hence the often found word "rejuvenation" or "anti-aging" nomenclature found in the clinic names.
The clinic I chose (yes, it has the word rejuvenation in the name) is close to where I work, only a bit of a detour to stop by on the way home. As I mentioned above, it's the same one used by my coworker.
I scheduled my first appointment for a Friday. I have the good fortune of flexible hours, and typically wrap up my daily 8 hours of indentured servitude around 2:00 - 2:30pm. I made an appointment for 3:00 and went there right after work. It's a small but busy place. I was interested to see three women in the waiting area, but no men (although one came in while I was waiting). Hormone therapy for weight control is a big part of their business, not just old guys looking to get jacked. Most of their clients are women.
I met the "operations officer" a fairly jacked guy himself. Late 30s, muscular, obviously a lifter. Yes, he replied in response to my question, he does TRT himself. He took me into his office and went over some of my symptoms. Yes, I'm:
Tired
Unmotivated
Not sleeping well
Not making gains in the gym
Having some joint pain
Generally dissatisfied with my career
Etc....
Honestly, I feel these symptoms pretty much describe just about anyone entrenched in the banality of modern life. Ceaseless labor on the behalf of others to make little bits of green-inked paper to trade for the things we need to survive, with, hopefully, enough left over to afford a little fun every now and then. The interview had the feeling of being a check-the-box sort of thing. A rout confirmation of yes, I have symptoms that justify me seeking hormone therapy.
He went over the program. For $75 a month plus prescription costs, I would get a monitored hormone replacement therapy program. I would see the doctor once a month, get my prescription, be able to get my weekly testosterone shots at the clinic (if I wanted), and get blood tests every 3-6 months to monitor my hormone levels. My prescription costs would depend on my exact medications, but I'd probably be looking at another $150 or so a month. So total cost was around $200 - 250 a month. Oh, and the initial visit was $399. It would include an additional consultation with the doctor and a full blood workup. Oh, by the way, if my testosterone level was below normal, my insurance (CIGNA) might pay toward the prescription.
Having confirmed my willingness to pay the initial $399 (and my potential as a candidate for TRT based on my symptoms), he escorted me to see the doctor. Who was actually a nurse practitioner. She and I went over pretty much the same symptom diagnosis I'd just done. There was an up-sell for some additional supplements (multivitamin,sleep aid, thyroid health....) I declined.
Off to another room with standard issue doctor's office stuff in it: cabinets with gauze and other medical supplies, biological waste trashcan, sharps container, raised doctor platform in the middle of the room covered in paper. Another friendly lady (they were all friendly) appeared. I was weighed, my body fat measured (15%, not bad for 47), my blood pressure (118/74) and pulse rate (62) taken. I was pronounced to be in good shape and look much younger than my years. Flattery will get you everywhere. Rubber band, syringe, and half a dozen vials of my blood were taken for the lab work (at LabCorp).
I was escorted back to the front desk, where I paid my $399 and made an appointment for the following Friday (a week later) to go over my lab results. Total time between in and out was about 45 minutes.
There's no denying hormone replacement therapy for men is effective for treating a variety of ailments, I'm just not sure the malaise of modern life or the natural decline in vitality due to aging should be among them. I feel as though the whole thing was sort of a wink-wink, nudge-nudge sort of situation. Oh, you're tired and not quite as strong or energetic as you used to be? Let's take a look at that testosterone.....
I'm not against people doing pretty much whatever they want as long as it doesn't negatively impact anyone else. If there's a safe and reliable (and legal) way for me to improve my energy, strength, attitude, and body composition, count me in.
I'm curious to see my blood labs and if that will have any impact on their recommendation for treatment.
Wednesday, May 15, 2013
Testosterone Replacement Therapy: is it Right for Me?
A buddy of mine at work has been singing the praises of his Testosterone Replacement Therapy (TRT) for some time now. At age 50, he’s few years older than my own 47. Like me, he’s been consistent with exercise for most of his adult life (although not as consistent as I’ve been).
Physically, we’re quite different. He’s about 5’9” and built like Gimili the dwarf; thick muscular neck, shoulders and chest with a wide, squat barrel-like build, like a power lifter or strong man. In contrast, I’m 6 feet tall, muscular, but much slimmer. When I graduated college 25 years ago, I weighted 155. He weighed more than that as a freshman in high school!
I don’t see him every day – he works at a different location – but I ran into him after not seeing him for a couple of months. The thick upper body was still there, but so was a now-noticeable waist. He wasn’t a barrel anymore and was developing a definite v-taper. I asked if he’d lost some weight and he said he was down about 15-20 pounds. He was back in the gym more regularly, had changed his diet (mainly cutting out bread and pasta), and had started Testosterone Replacement Therapy.
And that was what he mostly talked about. How much more energy he had, how much better he was sleeping, how his focus had increased, how much more motivation he had. He mentioned (ahem) increased relations with his long-time girlfriend. He was getting stronger in the gym again after years of no gains. And he credited it all to TRT.
He gave me a few numbers: His blood test has shown his free testosterone to be in the mid 200s, which he said was almost 100 below the accepted bottom of normal range of 348. (I’ve since learned the range of normal for free testosterone is pretty wide, from about 350 – 1100, but I’ll talk more about in another post). Based on his blood test, the doctor had prescribed once weekly shots of 100mg of testosterone cypionate. After 30 days, his free testosterone had almost tripled to the mid 700s.
So he’s feeling pretty good. And he’s looking pretty good too.
I was pretty interested in all this. I’ve been working out with weights regularly for over 30 years, having first gripped the bar at age 15 after reading too many Conan comic books. With few exceptions (vacations, moving, injuries) I hadn’t missed more than a week or two in the gym in all that time.
I was never big though, never bulky. Like most inexperienced lifters, it took me a long time to figure out what worked best for me. I did way too much for way too long, and I’ve got the joint pain and past injuries (partially torn triceps tendon, disc ruptures, muscle strains, bone spurs requiring elbow surgery) to show for it. I never did any chemical augmentation, and my natural weight seemed to top out around 185-190 with around 15% body fat. That’s what I weigh now and what I’ve weighed since I was around 30 years old.
A few years ago I sensed my impending decrepitude and went on a hardcore Madcow 5x5. I managed to gain a few pounds and my lifts went up. At 44, I competed in a power lifting meet, lifting raw, and totaled an even 1,000 pounds in the 181 weight class (I cut about 8 pounds for weigh in the day before, and showed up to the meet just over 187). My squats and dead lift were pretty much on par with where they were in my low 30s; my bench was down (and will probably remain so) due to the elbow surgery and inability to go as heavier as I'd like. Not long after the meet, I hit a personal best dead lift of 435.
I was feeling pretty good about my progress, and seeing gains after a long period of stagnation motivated me. It motivated me right to a severely ruptured disc. It was my third warm-up set where I pull 305 for 3 or 4 on my way up to a working set of 405+. The weights felt heavy that day, but, ignoring the wisdom of my years (or rather not having any despite my years), I saddled up, pulled two, and on the third felt something I can only describe as a cork going off in my lower back.
My right leg went numb. Well, a weird mixture of numb and painful tingling, like when you hit your funny bone. That burning-numb feeling… I knew it was a bad one.
Here’s what they do most of the time when you have a ruptured disc: nothing. Unless you can’t control your bowels or bladder, which would indicate a level of nerve compression that could result in permanent damage, in which case they do surgery. Otherwise, you wait. If it gets better over time, even a tiny bit, you keep waiting. If, after about 3 months (so the doc said) there’s no improvement at all, then it MIGHT be time to start looking at a surgical solution.
Fortunately, I did get better over time. It took a few months for all the numbness in my leg to go away and for it to return to full strength. I was still in the gym, but staying away from exercises that put stress on my back. I was doing light weight for most things, and using slow reps to maximize time under tension. It seemed to work for keeping my mass, in that my weight changed only a little (dropping back to around 185) and my appearance stayed pretty much the same.
I’ll shorten up this whole boring story. It was almost a year before I felt comfortable trying squats, dead lifts and standing military again. And when I started back, I went very slowly and very carefully. Even now, more than three years after the injury, I’m still cautious when it comes to squats and dead lifts. Gone are the days of pulling 405 for a triple, and the most I’ve squatted since was 275 for a set of 4… and that made me very nervous. I mainly stick to front squats now, and changed my dead lifts to sumo style to minimize stress on my lower back.
So the point of the wall of text above was to paint a picture of an individual to whom age was starting to grip and who didn’t want to go down without a fight. Was testosterone replacement therapy an alternative treatment that might help?
I had many of the same symptoms my buddy had complained of: fatigue, poor sleep, a feeling of malaise, dry skin (especially my lips), and a few others straight off the Do You Have Low T pamphlet.
Maybe aging didn't have to be a slow descent into infirmity. Maybe it could be a period of decent vitality followed by a sudden decline instead of a long drawn-out one.
I got the name of the clinic from him and decided to find out what it was all about.
Physically, we’re quite different. He’s about 5’9” and built like Gimili the dwarf; thick muscular neck, shoulders and chest with a wide, squat barrel-like build, like a power lifter or strong man. In contrast, I’m 6 feet tall, muscular, but much slimmer. When I graduated college 25 years ago, I weighted 155. He weighed more than that as a freshman in high school!
I don’t see him every day – he works at a different location – but I ran into him after not seeing him for a couple of months. The thick upper body was still there, but so was a now-noticeable waist. He wasn’t a barrel anymore and was developing a definite v-taper. I asked if he’d lost some weight and he said he was down about 15-20 pounds. He was back in the gym more regularly, had changed his diet (mainly cutting out bread and pasta), and had started Testosterone Replacement Therapy.
And that was what he mostly talked about. How much more energy he had, how much better he was sleeping, how his focus had increased, how much more motivation he had. He mentioned (ahem) increased relations with his long-time girlfriend. He was getting stronger in the gym again after years of no gains. And he credited it all to TRT.
He gave me a few numbers: His blood test has shown his free testosterone to be in the mid 200s, which he said was almost 100 below the accepted bottom of normal range of 348. (I’ve since learned the range of normal for free testosterone is pretty wide, from about 350 – 1100, but I’ll talk more about in another post). Based on his blood test, the doctor had prescribed once weekly shots of 100mg of testosterone cypionate. After 30 days, his free testosterone had almost tripled to the mid 700s.
So he’s feeling pretty good. And he’s looking pretty good too.
I was pretty interested in all this. I’ve been working out with weights regularly for over 30 years, having first gripped the bar at age 15 after reading too many Conan comic books. With few exceptions (vacations, moving, injuries) I hadn’t missed more than a week or two in the gym in all that time.
I was never big though, never bulky. Like most inexperienced lifters, it took me a long time to figure out what worked best for me. I did way too much for way too long, and I’ve got the joint pain and past injuries (partially torn triceps tendon, disc ruptures, muscle strains, bone spurs requiring elbow surgery) to show for it. I never did any chemical augmentation, and my natural weight seemed to top out around 185-190 with around 15% body fat. That’s what I weigh now and what I’ve weighed since I was around 30 years old.
A few years ago I sensed my impending decrepitude and went on a hardcore Madcow 5x5. I managed to gain a few pounds and my lifts went up. At 44, I competed in a power lifting meet, lifting raw, and totaled an even 1,000 pounds in the 181 weight class (I cut about 8 pounds for weigh in the day before, and showed up to the meet just over 187). My squats and dead lift were pretty much on par with where they were in my low 30s; my bench was down (and will probably remain so) due to the elbow surgery and inability to go as heavier as I'd like. Not long after the meet, I hit a personal best dead lift of 435.
I was feeling pretty good about my progress, and seeing gains after a long period of stagnation motivated me. It motivated me right to a severely ruptured disc. It was my third warm-up set where I pull 305 for 3 or 4 on my way up to a working set of 405+. The weights felt heavy that day, but, ignoring the wisdom of my years (or rather not having any despite my years), I saddled up, pulled two, and on the third felt something I can only describe as a cork going off in my lower back.
My right leg went numb. Well, a weird mixture of numb and painful tingling, like when you hit your funny bone. That burning-numb feeling… I knew it was a bad one.
Here’s what they do most of the time when you have a ruptured disc: nothing. Unless you can’t control your bowels or bladder, which would indicate a level of nerve compression that could result in permanent damage, in which case they do surgery. Otherwise, you wait. If it gets better over time, even a tiny bit, you keep waiting. If, after about 3 months (so the doc said) there’s no improvement at all, then it MIGHT be time to start looking at a surgical solution.
Fortunately, I did get better over time. It took a few months for all the numbness in my leg to go away and for it to return to full strength. I was still in the gym, but staying away from exercises that put stress on my back. I was doing light weight for most things, and using slow reps to maximize time under tension. It seemed to work for keeping my mass, in that my weight changed only a little (dropping back to around 185) and my appearance stayed pretty much the same.
I’ll shorten up this whole boring story. It was almost a year before I felt comfortable trying squats, dead lifts and standing military again. And when I started back, I went very slowly and very carefully. Even now, more than three years after the injury, I’m still cautious when it comes to squats and dead lifts. Gone are the days of pulling 405 for a triple, and the most I’ve squatted since was 275 for a set of 4… and that made me very nervous. I mainly stick to front squats now, and changed my dead lifts to sumo style to minimize stress on my lower back.
So the point of the wall of text above was to paint a picture of an individual to whom age was starting to grip and who didn’t want to go down without a fight. Was testosterone replacement therapy an alternative treatment that might help?
I had many of the same symptoms my buddy had complained of: fatigue, poor sleep, a feeling of malaise, dry skin (especially my lips), and a few others straight off the Do You Have Low T pamphlet.
Maybe aging didn't have to be a slow descent into infirmity. Maybe it could be a period of decent vitality followed by a sudden decline instead of a long drawn-out one.
I got the name of the clinic from him and decided to find out what it was all about.
Subscribe to:
Posts (Atom)