Testosterone Replacement Treatment Options

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T options

From the book: Testosterone: A Man’s Guide

Testosterone Formulations

In theory testosterone replacement should approximate the body’s own natural production of the hormone. The average male produces 4 to 7 mg of testosterone a day with plasma levels in early morning and lower levels in the evening. Women produce around a 12th of those rates.

Testosterone replacement is usually a lifelong commitment. It is a decision that should not be made without a discussion with your healthcare provider. Starting and stopping testosterone can have negative effects on someone’s quality of life (more on this topic later).

There are testosterone replacement products that require daily dosing (orals, buccal, and gels), once a week or two weeks dosing (injections), and once every three- to four-month dosing (long-acting testosterone undecanoate injections or testosterone pellets).

Males who are hypogonadal can be given continuous testosterone replacement therapy in a wide assortment of ways. These include:

1. Oral capsules

2. Testosterone injections

3. Transdermal (absorbed through the skin) testosterone cream or gel

4. Transdermal testosterone patch

5. Buccal (sublingual and gum adherent)

6. Pellets (that are implanted subcutaneously)

Oral Agents

Oral testosterone formulations are quickly absorbed by the liver and therefore require relatively large doses. Because of the risk of liver toxicity they are rarely prescribed. Do not waste your money or time using oral testosterone. Also, avoid over-the-counter supplements that claim to increase testosterone. Most do not increase testosterone for more than a few minutes and can also affect your liver and blood pressure. Oral testosterone also seems to cause larger decreases of the good cholesterol (HDL) than other forms of testosterone therapies.

Chemically unbound testosterone, if taken orally, is immediately deactivated by the liver. Two chemically modified forms of testosterone are available that require several doses a day: methyl testosterone and testosterone undecanoate (not approved in the United States but popular in Canada).

Methyl testosterone

Methyl testosterone is one of the earliest available oral testosterones. Its chemical structure is the hormone testosterone with an added methyl group at the c-17 alpha position of the molecule to slow down its clearance by the liver. The use of oral c-17 alpha methylated testosterone causes toxicity to the liver and is not recommended for testosterone hormone therapy. Brand names around the world include “Metesto,” “Methitest,” “Testred,” “Oreton Methyl,” and “Android.” These products are responsible for many of the misconceptions that still exist about testosterone replacement due to their liver and lipid problems. The same information is applicable to fluroxymesterone, another oral formulation no longer used in the United States.

Testosterone undecanoate

Testosterone undecanoate is not a c-17 alpha alkylated hormone. Therefore it is considered a safer oral form of testosterone. It is designed to be absorbed through the small intestine into the lymphatic system, and has fewer negative effects on the liver. Brand names around the world for oral testosterone undecanoate include “Andriol,” “Androxon,” “Understor,” “Restandol,” and “Restinsol.” It is not available in the United States but widely used in Canada and some European countries.

One disadvantage of orally administered undecanoate is that it is eliminated from the body very quickly, usually within three to four hours. Frequent administration is necessary—usually from three to six capsules a day, which makes it impractical for most men with busy lives.

PERSONAL COMMENT: I’ve never used oral testosterones and I never will. Other formulations are so much more user-friendly.

Intramuscular Injections

The most common testosterone replacement used by men worldwide is intramuscular testosterone injection. It’s also the oldest and most economical way to increase blood levels of testosterone. This most cost effective option is usually covered by insurance programs and community clinics.

The two most common esters, testosterone cypionate and testosterone enanthate, are both generic medications in the United States. They are given at a weekly dose of about 100 to 200 mg a week (or 200 to 300 mg every two weeks).

Currently, a 10 ml bottle of 200 mg/ml (2000 total milligrams per bottle) of testosterone cypionate obtained in U.S. pharmacies cost around $85-$115. The cost of the same strength and amount of testosterone cypionate costs $33- $50 from compounding pharmacies. It is the same product, so if your insurance company does not pay for testosterone, make sure that you use compounding pharmacies. More information on compounding will be provided later.

Some physicians have patients come to their office for injections and others empower their patients to do so at home. A minority of physicians charges a fee for the office visit when you come for an injection, which can increase your costs.

When you get a prescription for any testosterone ester, make sure that it is for a 10-ml vial, not 1-ml vial. In the U.S., 1-ml vials are available but they are usually more expensive and not very practical. Many physicians will write an open-ended prescription that will look like this:

1. Testosterone Cypionate (or Depo Testosterone), 10 ml, 200mg/ml, #1, as directed, 1 refill

Others will write:

2. Testosterone Cypionate, 10 ml, 200 mg/ml, #1, 200 mg q 2 weeks, 1 refill

Or
3. Testosterone Cypionate , 10 ml, 200 mg/ml #1, 100 mg q 1 week, 1 refill

Be sure your physician gives you a more flexible prescription that reads like my first example. This type of prescription will provide room for you to adjust the dosage during the first two months as well as get a refill whenever you need it.

Optimum testosterone doses can range from 100 mg to 250 mg a week but it is practically impossible to predict an individual’s response. Giving yourself a little room for adjustment keeps you from running out of testosterone if your insurance company denies your next refill because they think it’s too early. Of course, your physician has to ensure that your dose is adjusted based on your total or free testosterone blood levels.

When using injectable testosterone, your doctor will want to measure your total blood testosterone levels right before your next injection after the first month (it takes a while for the blood levels to stabilize). If testosterone is >900 ng/dl (24.5 nmol/liter) or < 500 ng/dl, adjust dose or frequency. Anecdotally, most men seem to need to have total testosterone levels above 500 ng/dl (mid point of normal range) to experience any of the expected sexual function benefits.

A dose for women is anywhere from 2.4 to 20 mg/week but because it is difficult to inject such low doses and because of the risk of masculinization (growth or facial hair, deepening of the voice, and growth of clitoris), many doctors prefer low dose creams to treat women. Compounding pharmacies like Women’s International Pharmacy can guide doctors on how to test and prescribe testosterone gels to women. Their website is womensinternational.com. They have an excellent information packet that they send to people for free that contains several research papers and protocols for women.

There is no commercially available FDA-approved testosterone therapy for women in the United States as of 2011, but one option may be approved in 2012 (Libigel, mentioned later). However, many doctors can legally prescribe testosterone to women in an off-label manner using compounded gels and creams. However, some doctors are reluctant to prescribe any hormones to women since the discouraging results from female hormone replacement in women showed increased cardiovascular risk in women.

Injections have the advantage of once-per-week (or every two weeks) administration, so it may be a more acceptable option for men who do not want to deal with the daily administration typically needed with gels. However there are concerns about their “peak-and-valleys” testosterone blood level patterns.

The standard dose of 200 mg testosterone injections currently used in the United States produce an unnaturally high blood testosterone and estradiol levels during the initial few days after an injection. Then the blood level drops off each day and falls to baseline in about 10 days. This method does not effectively deliver sustained normal blood levels of testosterone or mimic the natural daily pattern of testosterone release as well as other treatment options. There is a concern that some men using 200 mg of testosterone cypionate every two weeks may have low levels of testosterone by day 10, so they spend four days with low testosterone before their next injection. For this reason, I have seen that a dose of 100 mg of testosterone cypionate or enanthate weekly is becoming more and more commonly prescribed by doctors who treat a lot of hypogonadal men.

Your doctor should re-check your testosterone level after one month (after steady state occurs) right before the next injection. This testing schedule allows him to see whether normal levels are still present when you reach your lowest testosterone blood level. If serum total testosterone level is more than 900 ng/dL or less than 500 ng/dL right before the next dose, he /she can adjust the dose or the frequency accordingly.

Due to testosterone’s effect as a stimulant of red blood cell production, injections produce unusually strong stimulation during the first peak days. This appears to increase the potential for elevated hemoglobin and hematocrit indicating that you have too many red blood cells. These can increase your cardiovascular risks. Creams, gels, and patches appear to be less likely to produce this side effect, though study results are conflicting.

Anecdotally I hear that injections promote elevations in blood pressure more than creams, gel, and patches. It also appears that the effect on brain chemistry and the nervous system that might promote increased assertiveness can be stronger with injections. There will be more discussion on this subject later. But I would love to see head-to-head comparison studies between testosterone injections and gels, since none have been performed to date. Hopefully, with the potential approval of Aveed (a longer acting testosterone ester) in the future, its manufacturer would be compelled to do such a study to convince insurance companies that their product may be more cost effective and less problematic than the daily gels currently approved in the United States (Androgel and Testim) or the weekly or bi-weekly injections that many men are currently using.

I have met some men that have switched from injections to gels and then eventually switch back to injections. It seems that they need the higher level of overall metabolic stimulation that injectable testosterone provides. Usually, those men also say they feel very little improvement with the use of gels or creams. They also usually prefer the convenience of an injection every one or two weeks to the daily administration of a gel. And, unlike gels, injections have no potential risk of transferring testosterone through skin contact with other people.

Injectable testosterone has also shown to increase blood levels of testosterone and DHT in proportion with the dose. But gels seem to increase DHT a lot more than the expected increase due to higher testosterone, so some men with benign prostatic inflammation may prefer injections than gels. The mechanism for this observation may be based on the fact that they may be more DHT receptors in the skin layers, but no one has really proven this fact.

As you can see, there is no one-size-fits-all approach that works for everyone. Blank statements about one option being better than other have to be done in the context of other factors that go beyond the obvious. Convenience, doctor’s prescription habits, personal life style, cost, and what your insurance company pays are factors that determine what you use.

It is important to follow a strict injection procedure (for helpful tips, see the section on How to Inject Testosterone Safely). Some men report soreness in the injection area and experience coughing spells after injecting. In rare cases, some men have had infections in the injection site due to unsanitary techniques!

Commonly Used Injectable Esters for Testosterone Replacement Therapy

Testosterone esters are modifications made to the testosterone molecule to increase the time the liver breaks it down, so that you do not have to inject every day. Esters consist of the actual testosterone molecule, with a carbon chain attached to it. This carbon chain controls something called the partition co-efficient, which translates into how soluble the drug will be once in the bloodstream. Also, the larger the carbon chain, the longer the ester, the less soluble the drug is in water, and the longer it stays in your body. Also, additions to the basic testosterone molecule make it harder for the liver to break it down, which also increases the time testosterone stays in your system (a good thing since we do not want to deal with injections too frequently).

There are several types of testosterone esters: testosterone cypionate, enanthate, propionate, or undecanoate. Outside the United States, there is a product with a combination of the first three esters that is called Sustanon 250 (250 mg of a mixture of cypionate, enanthate, and propionate). Since every ester may have slightly different blood level decay after administration, it is speculated that this combination may allow better distribution of testosterone blood levels in 14 days. Sustanon is not available in the United States but compounding pharmacies may customize similar formulations.

Testosterone cypionate, enanthate, or other ester is injected slowly into the muscle of the buttock where it forms a reservoir of the hormone. Then testosterone is gradually released from the reservoir into the bloodstream. There is usually a peak concentration in the blood within the first two days and then a gradual decrease to baseline. Everyone is different and the rate of decrease of blood levels tends to change depending on body weight, fat content, activity level, medications, illness, and liver metabolism.

Testosterone Enanthate

Testosterone enanthate is one of the main forms of testosterone prescribed to men in the United States. It is a slow-acting ester, with a release time between 8 and 10 days. The name brand of testosterone enanthate available in the United States is called “Delatestryl,” which is suspended in sesame oil. Testosterone enanthate is typically injected once every week to once every two weeks. Generic testosterone enanthate can also be obtained through a compounding pharmacy; such pharmacies can mix the enanthate in either sesame, grape seed or cottonseed oil. Some mix different esters for patients since this may give better blood level distribution, although no studies have been done in the United States using ester blends.

For more details about this product, refer to the Appendix section for the package insert. Package inserts are required by the FDA to be provided with every product when you pick it up at the pharmacy. They are also required when magazine ads or promotional materials are provided on products. That is why I thought it would be a good idea to include a package insert on an injectable and a gel at the end of this book. Every patient should read package inserts of every medication they take, but keeping in mind that a lot of the side effects listed are not common and only happen in special circumstances. But it does not hurt to know them just in case!

Testosterone cypionate

Testosterone cypionate is the other main injectable form of testosterone prescribed to men in the United States. It is a slow-acting ester with a release time of 8 to 10 days, similar to that of enanthate. The name brand available in the United States is called “Depo-Testosterone,” which is suspended in cottonseed oil. Testosterone cypionate is typically injected anywhere from once every week to once every two weeks. Some doctors like to prescribe 300 mg every three weeks, but I believe that really accentuates the peaks and valleys of testosterone blood levels a lot more than the most commonly used dose of 200 mg every two weeks. Cheaper generic testosterone cypionate can also be obtained through a compounding pharmacy which can mix it in either sesame, grape seed or cotton seed oil.

Sustanon 100 or 250

“Sustanon” is the brand name for two formulas of injectable testosterone that contain a blend of esters. “Sustanon 100” contains 100 mg of three testosterone esters: testosterone propionate, testosterone phenyl propionate, and testosterone isocaproate. “Sustanon 250” contains a total of 250 mg of four testosterone esters: testosterone propionate, testosterone phenyl propionate, testosterone isocaproate, and testosterone decanoate. Both formulas feature fast-acting and slow-acting esters, and can be injected anywhere from once every week to once every four weeks. Sustanon is prescribed outside the United States, but a formulation similar to it can be compounded legally by compounding pharmacies since all of its esters are available in the United States.

Other Injectable Esters of Testosterone

Testosterone propionate

Testosterone propionate is a fast-acting ester with a release time of three to four days. To keep blood levels from fluctuating greatly, propionate is usually injected from one to three times a week. It is for this reason that it is not usually prescribed that much. Some users also report that propionate is a more painful injection, with swelling and noticeable pain around the injection site.

Testosterone phenyl propionate

Testosterone phenyl propionate is a slow-acting ester, with a release time of one to three weeks. A popular name brand for T-phenyl propionate is “Testolent.” Testosterone phenyl propionate is also one of the components of Sustanon.

Testosterone Undecanoate

Testosterone undecanoate injections are known as the brand name Nebido around the world. In the United States it is called Aveed. This ester may stay longer in your system so that less frequent injections may be needed. The injection is usually given once every 10 to 14 weeks, though the frequency will depend on your individual testosterone levels. After your first injection you may be asked to come back for another injection at week six. For use in the United States, the company claims that only five injections a year are needed (compared to 48 injections per year for a 100 mg per week regimen). In other countries, a large injection dose of 1000 mg are allowed. The FDA did not allow the manufacturer to use this dose in studies done in this country due to fears of side effects. More information on Aveed

In an open-label study which enrolled 130 hypogonadal men with blood total testosterone levels below 300 ng/dL at study entry, Aveed was dosed as an intramuscular injection (750 mg) at baseline, at week four, and then every 10 weeks throughout the remainder of the 21-month study. Approximately 70 percent of patients completed all injections and 94 percent of them had total testosterone from 300 to 1,000 nanograms/ml through the entire study.

After Nebido was approved in Europe a small number of European patients experienced respiratory symptoms immediately following an intramuscular injection of 1000 mg in a 4 cc injection volume, (versus the 750 mg, 3 cc injection volume used in the United States). The makers of Nebido believe, and the FDA concurs, that the reaction is likely the result of a small amount of the oily solution immediately entering the vascular system from the injection site. This known yet uncommon complication of oil-based depot injections may be related to inappropriate injection technique or site.

The problem is characterized by short-term reactions involving an urge to cough or a shortness of breath. In some rare cases the reaction had been classified as serious or the patient had experienced other symptoms such as dizziness, flushing or fainting. In U.S. clinical trials of Nebido 750 mg (3 cc injection volume), the proposed dose in the U.S., there was a single, mild, non-serious case of oil-based coughing.

PERSONAL COMMENT: I have used testosterone enanthate, cypionate,and Sustanon 250. I cannot say I can tell the difference in the way I felt. I also tried one injection of Nebido in Mexico. After a big injection of the recommended dose of 1,000 mg, my testosterone blood levels remained above 450 ng/ml for four and a half months; my mood and stamina remained very good throughout. It was nice not having to worry about remembering to inject every week.

Transdermal Systems

Transdermal gels (Androgel, Testim)

Creams and gels may provide lower and more sustained concentrations of testosterone in the blood without the “yo-yo” effect that weekly injections can cause. Testosterone gets absorbed through the skin in a once or twice daily use.

The best application areas for the gel include the stomach, shoulders,the inner thighs, and the pectorals. Be aware that some people complain about dark hair growth where the cream or gel is applied, especially if one site is used over and over again without rotation.

As mentioned if you use testosterone this way, it can rub off onto a female partner or children when you hug them. So, it is important that this is kept in mind.

I think that its application on the back of the legs may help avoid this potential transfer of testosterone to other people. Most testosterone in gels and creams gets absorbed in the first one to two hours, but some residual testosterone may still be present after a few hours.

Topical testosterone products represent approximately 65.6 percent of the total number of testosterone prescriptions dispensed between 2000 and November 2008, according to the FDA. Two prescription-based commercial testosterone gels are available in the United States: Androgel, approved by the FDA in February 2000, and Testim, approved in October 2002 (See Figure 11). Approximately 1.4 million prescriptions were dispensed for Androgel and 400,000 prescriptions were dispensed for Testim in 2008. The majority of prescriptions for Androgel are dispensed to adult males 50 to 59 years of age.

Both gels are colorless and evaporate quickly after being applied to the abdomen, shoulders, or arms. Androgel and Testim come in three dose levels (2.5 g, 5 g and 10 g with 1 percent testosterone each). Ten percent of the applied testosterone is absorbed into the blood stream through the skin. The usual starting dose is a packet of 5 g a day.

Androgel also comes in a pump that allows for higher dosing for those men who do not reach normal testosterone levels with the available gels. Each pump container is capable of dispensing 75 grams or 60 metered 1.25- gram doses. The starting dose of 5 grams a day requires four pump squirts. Many men require up to 10 grams per day to reach total testosterone blood levels above 500 ng/ml. This makes for eight squirts a day of Androgel. For some, that is a lot of volume to spread on the body. Luckily these gels dry up fast and leave little to no residue.

Auxilium, the maker of Testim, claims that their gel has a slightly better absorption rate than Androgel; however, many men do not like its slight soapy smell (Androgel has none).

Androgel and Testim are usually covered by insurance. Their monthly cost is around US$700 a month, with insurance co pays ranging from US$20 to US$50 a month. A patient assistance program has been set up by both companies to provide free drug to low-income patients with no insurance (read the resource section in this book for additional information).

At the time of writing this book, some companies were getting ready to manufacture generic testosterone gels which may provide a cheaper alternative.

Regardless of which gel you use, make sure your doctor re-checks your blood levels after two weeks to see whether you need to readjust the dose.

Testosterone gels should be applied to clean, dry skin. Do not apply to the testicular area since this has been shown to increase DHT conversion.

Application sites should be allowed to dry for a few minutes before dressing. Hands should be washed thoroughly with soap and water after application. In order to prevent transfer of testosterone to another person, clothing should be worn to cover the application sites. If a direct skin- to-skin contact with another person is anticipated, the application sites should be washed thoroughly with soap and water. Users should wait at least two hours after applying before showering or swimming; for optimal absorption, it may be best to wait five to six hours.

Men who may carry babies should be extra careful to avoid skin-to-skin contact after applying the gel since testosterone exposure in babies may have negative effects on the baby’s growth. This fact was included in a recent label change for both Testim and Androgel described in the FDA web site: “Since the initial marketing approval of testosterone gel in 2000 to May 2009, FDA’s Adverse Event Reporting System (AERS) received 20 reports (18 U.S. and 2 non-U.S.) describing adverse events in children who were exposed to testosterone gel that was used by another person (referred to as ‘secondary exposure’). The adverse events reported in these children included one or more of the following signs or symptoms: enlargement of the penis or clitoris, premature development of pubic hair, advanced bone age, increased self-stimulation, libido, erections, and aggressive behavior. An increased testosterone level was reported in more than half of these cases. The children ranged in age from 9 months to 7 years. Three of the 20 cases are described in the medical literature.” So, be careful not to come in contact with another person during first 4 hours of administration.

Compounded creams and gels

Compounded creams and gels can be mixed by compounding pharmacies, and are similar in dosing, application, and precautions to what is described above for Androgel and Testim. There are various qualities of creams and gels made by compounding pharmacies around the United States, and some of the poorer quality products are gunky and flake off after they dry. Be sure to buy from a reputable pharmacy.

The best gels are clear and basically disappear shortly after application. Most men prefer alcohol-based gels, which absorb through the skin better than water-based gels. Creams should not be greasy and should resemble good moisturizing creams. Many compounding pharmacies make cheaper gels and creams with higher testosterone concentrations (2 to 10 percent) for men who do not respond to the commercially available 1 percent testosterone gel products (Testim or Androgel).

Some doctors do not feel comfortable prescribing gels from compounding pharmacies since they worry about quality control. There is also concern that higher concentration gels may induce more DHT conversion, which may cause more prostatic hyperplasia (inflammation) causing urinary flow restrictions especially in older men. Also, higher DHT can cause acne and hair loss.

There are many compounding pharmacies around the United States. I have used several compounding pharmacies in the past 15 years.

You can also Google the key words: “compounding pharmacy” and your zip code to find compounding pharmacies close to you. Compounding pharmacies ship across state lines, so it is not imperative that you have one in your area. They do not typically take insurance, so you have to request reimbursement from your insurance company. Your doctor has to be willing to call or fax a prescription to the pharmacy for you to order any testosterone products. The compounding pharmacy will need your credit card before shipping the product to you, so make sure you call them to set that up.

Most compounded testosterone gels of 1 to 10 percent concentrations can range between $17 and $70 a month so it’s worth calling around for price comparisons. Your doctor may have an established relationship with a local compounding pharmacy, so be sure to ask. As mentioned before, some doctors have trust issues with compounding pharmacies’ quality control and ask to see their certificates to prove that they have proper quality control standards.

There are two main advantages of using compounding pharmacies when getting a testosterone gel or cream. The first is cost: until a generic version of the gel is available, compounded gel will usually be the cheaper alternative. This is a non issue if you have an insurance policy that pays for the product and that it does not require you to pay high out of pocket co-pays when getting Androgel, Testim, Fortesta or Axiron.

The second is customization: your doctor can write a prescription of varying concentration for gels or creams. I have used gels containing 5 and 10 percent testosterone with great results. Of course the volume needed is lower when the concentration increases. Some researchers believe that higher concentration gels tend to increase DHT levels more strongly than the regular 1 percent gels. However many men need more than the usual amount of Testim or Androgel and do not want to smear their bodies with lots of gel, so 5 percent gels may be an option for them.

Most compounding pharmacies dispense the creams in “Topi-Click” (see Figure 13) that are more practical (typically) than the large pre- loaded syringes they are usually supplied in. The Topi-Click is more like a “deodorant stick” which can be more convenient and better looking than the bigger syringes.

Factors that Can Improve Testosterone Gel Absorption

PERSONAL COMMENT: I tried both Androgel and Testim for a few weeks. Both were effective but I admit to having a little sticker shock ($260 to $600 per month depending on dose, if not paid by insurance). Testim had a soapy smell that I didn’t particularly like, but some gave me compliments on my “cologne.” I did like the large pump dispenser for Androgel since I could adjust the dosage if needed (I needed 10 grams of gel a day. Most doctors start you at 5 grams per day). I am currently using a testosterone gel/cream formulation with 5 percent testosterone. The prescription is written like this: Testosterone gel/cream 5 percent 30 mL in Topi-Click, 1 mL a day. I find the Topi-Click container to be a very easy way to administer the daily dose. You can also order the gel in a large graduated plastic syringe if you want to precise on your dose.

More on transdermal testosterone products: Types of Transdermal Testosterone Products Currently Available

Transdermal patches

Another option for testosterone replacement therapy is a testosterone patch such as Testoderm or Androderm. For many men two 5-mg patches will bring them into the effective mid-range (500 ng/dL and above) of the testosterone blood test. The most frequent complaint with the patch is skin irritation at the application site. Some men do not like the potential of an unwanted “disclosure” since the patch can be visible to anyone who may see you without clothes. You also run the risk of having the patch fall off after sweating or bathing.

Androderm

Androderm comes in two doses: A 2.5 mg/patch and a 5.0 mg/patch. The actual amount of testosterone in the 2.5 mg patch is really 12.2 mg, while in the 5.0 mg patch it is 24.3 mg. Similar to what happens with the gel, much of the testosterone in the patch will not be absorbed into your system. So the aim of the 2.5 mg patch is to get 2.5 mg of testosterone successfully into the blood stream each day. It is possible to absorb slightly more or slightly less than the 2.5 mg patch’s ideal dosage (this applies to the 5.0 mg patch as well). Most men need not one but two patches of 5 mg each to attain total testosterone blood levels above 500 ng/dL.

Androderm patches are usually applied on the back, abdomen, thighs, or upper arms. Because the active area of the patch is covered, you can enjoy some worry-free skin contact with your partner. As with any form of testosterone, your blood level will need to be checked by your doctor to readjust your dosage. Since dosages vary between 2.5 and 10 mg daily, this may require one or more patches.

It seems from the data that Androderm does not raise DHT or estrogen levels too much, so this may be an advantage for this option.

PERSONAL COMMENT: I have used Androderm and I have to say that I was not very fond of this product. I felt kind of exposed when I was naked, I didn’t want to have to talk about testosterone replacement therapy just when things were getting interesting. Some countries and public clinics provide only Androderm as the only option for TRT; it is a good option I would not discourage anyone from using it.

Testoderm TTS

Testoderm was first introduced as a patch that you would have to apply to the scrotum (testicular sack) after shaving it. For obvious reasons, it was not very practical and discreet (imagine explaining to any sexual partners what that patch is doing there and that you are not injured as it may seem!). It also showed large increases in DHT since the scrotum tissue seems to facilitate the conversion of testosterone into DHT. For this reason a new non-scrotal patch was developed. Testoderm TTS patches are available in two doses: 4.0 and 6.0 mg/patch. As with Androderm, the actual amount of testosterone in these patches is greater than the listed dose because much of the testosterone will not be absorbed.

Testoderm TTS patches are usually applied on the back, abdomen, thighs, or upper arms. Since the patch is covered ( like in the case of Androderm) you don’t have to worry about transferring the testosterone through skin contact with a partner. Dosages will vary between 4.0 and 12 mg daily requiring one or more patches. Again, after a starting dose, your testosterone level will need to be re-checked by your doctor a month after to determine the right dose for you.

Anecdotally Testoderm TTS seems to increase DHT levels more than most other options in the market, although a study showed constant testosterone/DHT ratios, meaning that both values increased in the same proportion.

For information on testosterone patient assistance programs (Androgel, Testim, Fortesta, Axiron, testosterone cypionate): Click here

More testosterone options:

Testosterone Pellets, Sublingual and Buccal (Mouth)

The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility

What You Should Know About Weight Loss Supplements

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What You Should Know About Weight Loss Supplements

It’s a well-known fact: excess body weight can be seriously dangerous for your health!

Being obese or overweight can take a toll on literally EVERY one of your internal organs and functions. It can increase your risk of psychological disorders, speed up cerebral degeneration, prevent healthy respiration, interfere with your digestion, slow your metabolism, reduce the production of energy, block your blood vessels, strain your heart, overwork your organs, prevent healthy reproductive organ function, damage your musculoskeletal system, and the list goes on. If you want to be healthy, it’s in your best interest to lose weight.
Name: fat loss supplements

Easier said than done, right? If weight loss was easy, we’d all be in amazing shape. No, on the contrary, weight loss is one of the hardest things you will ever do. Remember that your body is designed to STORE body fat, not burn it. Losing weight is essentially going against your body’s innate design, so it will take a lot more effort than gaining weight.

Difficult, but not impossible. Weight loss is absolutely possible through a healthy lifestyle, balanced meals, and daily exercise. However, there are a few supplements that may lend a helping hand to your efforts. Here are a few of the best weight loss supplements for you to try:

Green Tea — Hard to believe a cup of green tea can help you to lose weight, but it’s true! Green tea contains antioxidants that help with the oxidation (burning) of fatty acids, making it easier for your body to turn fat cells into energy. There are bioactive substances in green tea that will actually target the fat around your belly, the dangerous fat that increases your risk of metabolic disorders and reduces organ function. The caffeine in green tea can stimulate your metabolism and increase energy production, helping you to burn more calories every day.

Irvingia Gabonensis — Irvingia Gabonensis, or the African mango as it’s commonly known, may be just what you need to suppress your appetite, control your cholesterol, and increase your weight loss. A 2005 study out of Cameroon found that Irvingia not only helped obese people to lose weight, but it also lowered their “bad” LDL cholesterol levels while increasing their “good” HDL cholesterol levels. The high fiber content of the fruit helps to suppress your appetite and fills your stomach, making it easier for you to say “no” to food you know you shouldn’t eat.

Calcium — Did you know that eating dairy products can help you lose weight? High fat content or no, milk, cheese, and yoghurt can all contribute to fat burning thanks to their high calcium content. Calcium does so much more than just strengthen your bones, but it enables your body to activate fatty acids for burning. There is plenty of evidence to back up the claim that calcium plays a role in weight loss, particularly among the already overweight/obese. Those who consume more calcium while cutting back on calories have a much greater chance of serious weight loss/fat burning results.

Capsaicin, Green Tea Extract (w/ Caffeine), Tyrosine, and Calcium — In a 2005 study, it was discovered that mixing these four ingredients could help to increase energy expenditure by up to 2% even without exercise. There were no changes to heart rate and no adverse side effects resulting from this combination.

Capsaicin, Green Tea and CH-19 Sweet Pepper — This combination of ingredients has the potential to be a serious weight loss booster. A study in the Clinical Nutrition journal found that this supplement helped to suppress the appetite of those taking it. At the same time, it increased the amount of energy produced by their bodies (calories burned). This led to a positive expenditure-intake ratio, making it easier for the subjects to consume fewer calories than they burned. That, right there, is the secret to effective, sustained weight loss, and this trio of unique ingredients may be a useful addition to your diet!

L-Arginine — This is a potent nutrient that plays a vital role in your reproductive health, particularly in the production of nitric oxide. However, according to a study published in the Journal of Nutrition, taking L-arginine can encourage the production of healthy muscle tissue over fat tissue, and it can lower glucose and triglycerides in your blood. Mice who took L-arginine supplements gained less weight on a high-fat diet than their control group counterparts.

Conjugated Linoleic Acid — CLA, as this supplement is known, is an Omega-6 fatty acid that has proven to have anti-carcinogenic properties. One study, conducted in 2008, found that just 3.4 grams of CLA per day helped to reduce body fat significantly. CLA won’t just target overall body weight, but it can be the key to losing that stubborn body fat!

Calcium Pyruvate — Calcium pyruvate is a naturally-occurring compound that is produced when your body turns food into energy. The compound has been known to increase fat burning, and it can help to stimulate your metabolism. One 1999 study found that calcium pyruvate can, in tandem with a mild exercise regimen, have noticeable effects on body weight and fat.

Glucomannan — Glucomannan is definitely one of the strangest weight loss supplements, but a highly effective one nonetheless! It comes from a plant called the “elephant yam”, or konjac. It’s a water-soluble type of dietary fiber that will do wonders for suppressing your appetite. When you take the glucomannan, it will absorb so much water and liquid that it will swell up and fill your stomach. It makes you feel full, preventing you from eating too much. It’s low in calories and will slow down the rate at which your stomach empties, keeping you satiated for longer.

Water — While not technically a “supplement”, water can be your best friend when it comes to weight loss! First off, it will help to fill your stomach and keep you from feeling hungry. Having a few glasses of water prior to your meals will prevent you from overeating when you sit down to eat. Water also increases your metabolic rate and helps your body to function better, leading to better calorie-burning. Best of all, water has no calories, so you can drink as much as you want without overdoing it!

Video: Truth and Lies About Fat Loss Supplements

What You Should Know About the Main Side Effect of Testosterone

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testosterone side effects

What You Should Know About the Main Side Effect of Testosterone

Testosterone replacement therapy (TRT) is one of the most effective ways to combat low testosterone levels, but it’s vital that you understand the risks associated with the treatment. As with any form of hormone replacement therapy, there are a few downsides to receiving regular injections of testosterone. But do these risks outweigh the benefits? That’s a decision you’ll have to make for yourself!

Note: Remember the purpose of TRT: to restore testosterone to NORMAL, healthy levels in the body. Ideally, testosterone levels should be normal after TRT. Even at normal levels, there is a risk of side effects.

high hematocrit polycythemia testosterone

One of the primary risks of testosterone that is you need to be aware of is called polycythemia. This is a condition where your body produces too many red blood cells, also known as “high blood hematocrit levels”. Hematocrit refers to the red blood cell content in your blood. If your hematocrit levels rise, there is the fear that the blood will become too thick or viscous. This can, in turn, make it more likely that you will develop blood clots–leading to strokes, heart attacks, and other clotting events. Polycythemia is serious, potentially life-threatening if untreated.

In recent years, there has been an increased association between TRT and polycythemia. With TRT becoming a more mainstream treatment, more people are experiencing the symptoms of polycythemia, which include:

-Weakness
-Fatigue
-Headache
-Itching
-redness of the skin
-bruising
-joint pain
-dizziness
-abdominal pain
-shortness of breath
-breathing difficulty when you lie down
-numbness, tingling, or burning in the hands, feet, arms or legs
-Turning very red or “flushing” after workout

When polycythemia occurs, the blood becomes very thick, almost like a sludge. But instead of being able to carry MORE oxygen, the increase of red blood cells can be dangerous. The risk of clotting increases as a result of the red blood cell count increase.

Note: While there is a risk of hematocrit increase, there is no proof that TRT increases the risk of clotting events. It’s vital to be aware of the potential risk, so doctors need to be careful when prescribing TRT to men with high hematocrit levels, red blood cell disorders, and obstructive pulmonary disease. All of these things increase the risk of clotting events as a result of the hematocrit increase caused by TRT.

There are a number of factors that can increase your risk of developing this problem. According to Dr. Michael Sally, polycythemia “occurs quite frequently in people who are just on replacement testosterone.”

Age also plays a role in your polycythemia risk. Young men are far less likely to experience this problem than older men.

The mode of delivery and the dose of testosterone affect the increase in your hematocrit levels. Men who receive formulations of pharmacokinetically steady-state delivery hormones are far less likely to develop the problem than men who receive intramuscular injections of testosterone.

Topical preparations only cause the problem in up to 20% of cases. 5 to 15% of those who use testosterone patches develop polycythemia, while 10 to 20% of those using the testosterone gel develop the problem. Of course, the amount of testosterone delivered per day (50 to 100 milligrams) also affects the risk of developing polycythemia.

So what can you do about the problem? Is there any way to manage it?
Those undergoing TRT must be aware that polycythemia is a real risk, as do their doctors. They must keep a close eye on their hemoglobin and hematocrit levels. If hematocrit rises above 52%, further examinations may be necessary.

Some doctors counsel reducing or stopping the hormone treatment. However, for those who are undergoing TRT as a means of restoring healthy hormone levels, this may not be an option. Some means of managing and reducing the risk of high hematocrit levels include:

Scaling back on the amount of testosterone delivered per day or week (50mg or less)
Changing the method of administration (smaller and more frequent injections or using a gel)

If these options do not work, a phlebotomy may be the answer. Removing just one pint of blood can help to lower hematocrit by as much as 3%. For those with very high hematocrit levels, the therapy may continue for weeks, gradually reducing hematocrit to safe levels over time. Some physicians even prescribe regular phlebotomies (every 8 to 12 weeks) as a means of preventing overly high hematocrit levels.

While phlebotomies are not covered by your insurance, they can be performed at any blood bank. Even if your insurance company won’t cover the cost, you can solve the problem by donating blood (provided you are free of hepatitis, HIV, and other blood-borne infections). Experts agree that donating every 2 to 3 months is safe, and it’s a good way to keep your hematocrit levels under control.

Warning: Donating more than 1 unit of blood at this frequency can lower your iron and ferritin levels. This can cause fatigue. Make sure to replace the lost iron in order to prevent anemia.
It’s recommended that you donate when you are in the 51-52% hematocrit range. However, some organizations (like the Red Cross) will reject blood with a hematocrit higher than 52%.

Fun Fact: Did you know that grapefruit can help to reduce hematocrit levels? A 1988 study found that the compound naringin in grapefruits helped to reduce cell aggregation (clumps or clots), promoting the elimination of those red blood cells. The hematocrits ranged from 36.5 to 55.8% at the start and 38.8% to 49.2% at the end of the study. Those with the highest hematocrit levels noticed the greatest change as a result of the grapefruit.

More information in this link:

How to Manage Polycythemia Caused by Testosterone Replacement Therapy

What Every Man Should Know About HCG, Testosterone and Testicular Size.

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hcg vials

What Every Man Should Know About HCG, Testosterone and Testicular Size.

Testosterone is one of the most important hormones for a man’s health.

While most people see it as the men fertility hormone, it does so much more:

It plays a role in the development of facial and body hair
It promotes an increase in both muscular mass and strength
It helps to maintain sex drive
It protects against degenerative bone and muscle diseases
It increases energy metabolism, helping to reduce body fat and maintain a healthy body mass
It boosts self-esteem and sparks aggression and competitiveness
As you can see, testosterone is vital to your health and wellness as a man!

Low Testosterone 101

Testosterone levels are at their highest during adolescence, when they are helping to make the transition from boy to man. They peak during the early years of adulthood (early 20s).

However, by the time you reach the age of 30, testosterone production in your body begins to decline. The decrease in production is roughly 1% per year. After 15 to 20 years of this (by your 40s and 50s), you may begin to suffer from low testosterone levels, also known as male hypogonadism.The symptoms of hypogonadism include:

Reduced sperm count
Decrease in muscle mass
Lower sex drive/libido
Erectile dysfunction/impotence
Hair loss
Testicle shrinkage
Increase in breast size
Hot flashes

Testosterone Replacement Therapy: A Solution?

Male hypogonadism is often treated using Testosterone Replacement Therapy. TRT involves the use of testosterone patches, gels, pellets, or injections, which are meant to provide the testosterone your body is no longer producing.

Those undergoing TRT often report feeling more vigorous, having more energy, noticing a boost in their sex drive, an enhancement of their memory and focus, and even (in some cases) a reduction of testicle shrinkage. For aging men looking to prevent low testosterone levels, TRT is an option worth considering.

However, despite science’s best efforts, Testosterone Replacement Therapy comes with a number of risks, including:

Sleep apnea
Breast size increase
Thrombosis
Testicle shrinkage
Acne/skin reactions
Higher risk of benign prostate hyperplasia
Worst of all, testosterone replacement therapy can lead to reduced male fertility!

TRT decreases the production of two vital hormones:

Luteinizing hormone (LH) — This hormone helps to regulate the testes’ production of hormone, and converts androstenedione to testosterone. Together with FSH (see below), it is needed to maintain healthy testosterone levels.

Follicle stimulating hormone –– This hormone controls the production of sperm in the testicles. It is necessary to begin the spermatogenesis process: turning male primordial germ cells into sperm.

Both of these hormones play pivotal roles in male fertility. Without them, the testicles are unable to produce healthy, viable sperm in sufficient quantities. The fact that TRT affects these two hormones means that the testosterone replacement therapy may have the OPPOSITE of the desired effect! Instead of boosting fertility, TRT can cause azoospermia (no viable sperm produced) by up to 40%!

All of these risks could make testosterone replacement therapy a less-than-effective infertility treatment for men. Unless, of course, science discovered a way to counteract the negative side effects…

A New Addition To Save the Day: HCG

 

hcg for men

According to TWO separate studies, HCG injections may be the solution to the problems posed by Testosterone Replacement Therapy!

Before we take a look at the studies, it’s important to know what HCG is.

HCG, or human chorionic gonadotropin, is a hormone that plays a vital role in fertility and fetal development. HCG triggers the female body to release eggs during ovulation, and it supports the development of the egg in the ovaries. Once the egg has been fertilized, HCG keeps the fetus protected by maintaining the corpus luteum.
However, what makes HCG useful for treating low testosterone levels is the fact that it’s similar in structure to luteinizing hormone. Not only is this useful for stimulating ovulation in women, but it can increase the testicles’ production of testosterone. HCG is used in fertility treatments for both men and women.

But how does it work with Testosterone Replacement Therapy to prevent testicular shrinkage and increase sperm production?

Study #1: A 2013 study published in the Journal of Urology discovered that low-dose HCG injections helped to prevent a reduction in sperm count as a result of testosterone replacement therapy.

26 men (mean age: 35.9 years old) participated in the study.
19 were given testosterone injections once per week
7 were given transdermal testosterone gel once per day
In addition to the testosterone, the men were given 500 IU of HCG every 2 days.
The researchers measured blood testosterone levels, free testosterone, estradiol, and semen parameters, both before and during the treatment. Pregnancy rates among the men were also measured to determine the outcome of the therapy.

The results were fascinating:

All hormone levels increased. Blood testosterone, free testosterone, and estradiol levels all increased significantly as a result of the treatments.

9 of the men contributed to pregnancy with a partner.

Semen parameters remained the same for more than 1 year of treatment. This means the HCG treatments prevented the TRT from reducing sperm count, motility, and viability.

That last result was the most important of all. Not only did the study prove that HCG injections help to increase the levels of testosterone, but they also prevent sperm reduction as a result. The low-dose injections of HCG preserved the fertility of the men treated.

Study #2: A 2005 study conducted at the University of Washington School of Medicine examined the effects of HCG on the intra-testicular testosterone (ITT).
While serum (blood) and free testosterone levels are a good marker of overall health, intra-testicular testosterone is a more accurate measure of male fertility. According to an older study, low ITT levels leads to reduced sperm production and poor sperm health.
The 2005 study examined how HCG helped to maintain healthy ITT levels, maintaining proper spermatogenesis among the men the participated in the study.
29 men were evaluated as part of the research, all with “normal reproductive physiology”. They were divided at random into four groups:

Group 1 (Control): This group received a saline placebo.
Group 2 (Experimental 125): This group received 125 IU of HCG every two days.
Group 3 (Experimental 250): This group received 250 IU of HCG every two days.
Group 4 (Experimental 500): This group received 500 IU of HCG every two days.

In addition to the HCG injections, the men were also given testosterone enanthate. During the three-week study, the researchers measured both baseline serum (blood) testosterone levels and intra-testicular testosterone. The men’s LH and FSH levels were suppressed greatly in order to examine the effects of the HCG/testosterone levels without interference from the other fertility hormones.

The results of this test proved one fact beyond a doubt: the higher the dose of HCG, the lesser the effects of the TRT.

The Experimental 125 group saw a 25% reduction in their ITT levels as a result of the testosterone treatment.

The Experimental 250 group saw only a 7% reduction in their ITT levels throughout the 3-week study.

The Experimental 500 group saw a 26% INCREASE in their ITT levels by the time the study had run its course.

This study backs up the evidence discovered in the first study. Just 500 IU of HCG every 2 days is enough to counteract the negative effects of Testosterone Replacement Therapy. Not only will it help to promote healthy spermatogenesis, but it can maintain healthy sperm count, motility, and viability. Injections of HCG may be just the thing to make your TRT more effective at boosting fertility and testosterone levels.

Note: HCG drops or supplements are NOT a viable alternative to medical-grade HCG. Your doctor will need to write you a prescription for HCG injections.

Not only will HCG help to restore your fertility and sperm production, but it can reduce the testicle shrinkage caused by the TRT. Using HCG with TRT can restore your testicles to their normal, healthy size and function. Thanks to the TRT/HCG therapy, you may experience normal intra-testicular testosterone production, leading to increased fertility and overall health.

More information :

The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility

References:
J Clin Endocrinol Metab. 2005 May;90(5):2595-602. Epub 2005 Feb 15.
https://www.ncbi.nlm.nih.gov/pubmed/15713727

J Urol. 2013 Feb;189(2):647-50. doi: 10.1016/j.juro.2012.09.043. Epub 2012 Dec 20.
https://www.ncbi.nlm.nih.gov/pubmed/23260550

Testosterone and Acne: What You Need to Know

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Testosterone and Acne: What You Need to Know

Testosterone replacement therapy (TRT) is the prescribed treatment for men with low testosterone levels. It has become a widespread treatment–as many as 11 million men were undergoing TRT in 2013, a number that has grown significantly since.

However, as with any treatment, there are a few adverse side effects of TRT. Thankfully, most are fairly minor. One of the most common is one you probably thought you wouldn’t have to deal with once you passed your teenaged years. That’s right, I’m talking about acne!

acne treatments

Testosterone and Acne: The Link

How does testosterone replacement therapy lead to the formation of zits? It may seem like a bit of a stretch, but it all comes down to one simple hormone: dihydrotestosterone, or DHT.

DHT is a hormone that is produced by your body from testosterone. It’s actually five times more potent than testosterone, and it plays a vital role in your sexual development and health. When young men are going through puberty, their bodies produce a lot of DHT in order to encourage the growth of their reproductive organs.

But did you know that DHT also causes your body to produce more skin oils? This increase in skin oils causes the skin to become more oily, which means more oil may get into your pores. When the oil mixes with dead skin cells, the result is that thick white sebum that spurts out of your pimples every time you pop them. Oily skin is one of the primary causes of acne.

So, is it any surprise that TRT increases your risk of acne? TRT is basically flooding your body with testosterone, which is then converted to DHT. The potent hormone increases the production of skin oil, which in turn increases your risk of developing pimples. The P. acne bacteria already lives on your skin, speeding up the rate at which your skin cells die off. Mix the dead skin cells with the increase in skin oil, and you have a TRT-fueled recipe for acne.

If you’ve been on TRT for a few weeks and are noticing more pimples breaking out on your face, back, and chest (yes, the zits aren’t confined to your face), it’s a sign your body is turning the testosterone into DHT. While this is a good thing for your overall health, it may affect your appearance. Thankfully, there’s plenty you can do to deal with the problem!

How to Deal With TRT-related Acne

Want to get rid of pimples or prevent your TRT treatment from causing an outbreak? Here are a few things you can try:

Use Accutane — Accutane, or isotretinoin, is one of the most potent prescription treatments to cure acne. It’s usually used to treat cystic acne, which is a much more serious form of acne that is likely to cause scarring. The treatment is effective in up to 85% of cases. Taking 40 mg of Accutane every day for a week can do wonders for your acne. However, be aware that the medication does come with side effects, and it may lower testosterone levels. Consult your physician before mixing TRT and Accutane.

Use Sporanox — Sporanox, or itrconazole, is another useful medication to try as a means of curing your acne. It is an anti-fungal drug that may be able to kill off the P. acne bacteria that is increasing your skin cell turnover rate, thereby increasing your risk of clogged pores. Once again, check with your doctor before mixing TRT and Sporanox.

Try Vitamin B5 — Vitamin B5, or pantothenic acid, is needed by your body in order to produce CoEnzyme A (CoA). This enzyme helps to oxidize (burn) fatty acids, particularly in your skin. If you don’t have enough of this CoA, your body won’t be able to eliminate the fatty acids produced by an increase in DHT, so the skin oil will increase and lead to acne. By taking Vitamin B5, you give your body what it needs to keep the fatty acid production under control.

– Try anti-acne soap — There are a number of anti-acne soaps available at every pharmacy and supermarket in the country. These soaps are often made with Benzoyl Peroxide or Salicylic acid, two highly effective anti-acne treatments. Ideally, you should shower after a heavy workout, and use the soap to wash your face and any body parts where there is an acne breakout. Topix Benzoyl Peroxide is a body wash worth trying.

Try zinc — Zinc is one of the most important minerals for a healthy body. It plays a vital role in many important internal functions, not the least of which is your body’s immunity to disease. But how can it help to protect against acne? Zinc ensures that your bloodstream carries sufficient Vitamin A to your skin, and it helps to regulate the cellular apoptosis (death) of your skin cells. By ensuring that your skin cells die at a healthy rate, zinc essentially prevents the buildup of dead skin cells that soaks up skin oil to clog your pores.

Get out — Your body NEEDS sunlight in order to produce Vitamin D, one of the vitamins that play a role in fatty acid oxidation. However, be warned: too much sunlight can dry out your skin, causing it to produce even more oil. No more than 30 minutes of sunlight per day is needed to encourage healthy Vitamin D production.

If your acne is the result of the TRT, you may want to consider reducing the dose of testosterone. This can reduce the amount of DHT produced in your body, preventing acne. However, this is something you should discuss with your doctor. You can also discuss other useful treatments for dealing with the TRT-related acne.

Pregnenolone: What You Need to Know About this Precursor Hormone

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Pregnenolone: What You Need to Know About this Precursor Hormone

As the years slip slowly by, our bodies begin to decline. It’s an unfortunate truth, but the good news is that we can DO something about it. Hormone supplements can help to restore our vitality, boost our sex drive, enhance cognitive function, increase muscle mass, and the list goes on. It’s all about finding the right hormone for the job.

For those who are looking to increase their hormone levels, pregnenolone is one of the best options to consider. Read on to find out everything you need to know about this amazing hormone…

What is Pregnenolone?

You could almost say pregnenolone is the “father” of all hormones!
Your body produces hormones from cholesterol, the sterol lipid molecule synthesized in our liver. But your body has to go through a process in order to produce hormones like testosterone, estrogen, DHT, and so on. First, it has to turn the cholesterol into pregnenolone. From there, it can produce hormones like progesterone (which is where cortisol comes from) and DHEA (which is needed for the production of testosterone).
But that first step (turning cortisol into pregnenolone) is the most important step. Pregnenolone is essentially the precursor to these other hormones, as you’ll see on the chart below:

Name: steroid pathway.jpg Views: 1416 Size: 58.0 KB

Here is another chart that shows ALL the hormones resulting from pregnenolone:
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In a young adult male, pregnenolone levels are at their peak. However, as you age, the levels of this precursor hormone drop, until, at the age of 75, our bodies produces just 40% of the pregnenolone it needs. That’s a severe drop in the precursor hormone, which leads to a drop in ALL the hormones resulting from pregnenolone.

What Can It Do?

As mentioned above, pregnenolone is the primary precursor hormone from which all other hormones are produced. However, it serves a number of important functions in the human body:

Alleviate Arthritis — Arthritis is a swelling of the cartilage around the joints as a means of protecting the joints from damage. The cartilage has been worn away (either through use or as the result of an autoimmune disorder), so the joints swell up to prevent the bones from rubbing against each other. This inflammation can be both painful and limiting in terms of mobility.

So how can pregnenolone help? One study found that rheumatoid arthritis (autoimmune disorder) increased their mobility and reduced pain thanks to pregnenolone. Daily injections of pregnenolone over four weeks provided “dramatic” improvements, even in one patient who had proven unresponsive to traditional arthritis medications.

Enhance Cognitive Function — There are many ways pregnenolone helps to enhance the function of your brain. It increases the levels of acetylcholine, a neurotransmitter that makes it easy for brain cells to communicate. By enhancing acetylcholine production, pregnenolone helps to reduce the risk of neurodegenerative disorders.

The hormone also promotes the production of new neurons, improving your brain’s ability to communicate with every part of your body. Pregnenolone also helps to regulate GABA, a neurotransmitter that promotes sleep, relaxation, and a proper chemical balance in the brain.
Thanks to pregnenolone, your brain will work better for longer!

Eliminate Excess Cholesterol — While cholesterol is very important for the production of hormones, too much cholesterol can be a VERY bad thing. The cholesterol floats around in your bloodstream, sticks to the walls of your arteries, and hardens. The hardened cholesterol (plaque) is inflexible and stiff, so an increase in blood pressure can cause cracks in the plaque–potentially in the arterial walls as well. This can lead to heart attacks, strokes, and peripheral arterial disease. Excess cholesterol can also cause the arteries to narrow, reducing blood flow while increasing the strain on your heart.

But when your body turns cholesterol to pregnenolone, it eliminates the excess cholesterol. By restoring pregnenolone to healthy levels, you can get your cholesterol under control. The presence of pregnenolone will increase overall hormone levels, encouraging your body to naturally produce more hormones from your cholesterol. A regular dosage of pregnenolone can significantly improve your total cholesterol levels. After all, if your hormone levels are normal, your body is better able to regulate itself–including producing less cholesterol.

Counteract Stress and Fatigue –– Stress is one of the contributing factors in upwards of 80% of diseases, so you can understand why it’s so important to keep stress under control. Psychologists have discovered that pregnenolone helps to improve the brain’s performance even when under stress. The hormone can make it easier to remember important details and complete difficult tasks even in stressful, high-pressure situations. Not only that, but it will help to enhance your overall well-being during periods of high stress.

The effects don’t stop there! The hormone can help to decrease the output of adrenal hormones, which will in turn help to counteract the fatigue resulting from increased adrenal hormone production. In one study, just 50 mg of pregnenolone per day was enough to enhance performance and reduce fatigue, all with ZERO negative side effects.

Combat Depression — Depression is a lot more common than you might think! According to the Anxiety and Depression Association of America, roughly 18% of the U.S. population suffers from depression. That’s over 40 million adults over the age of 18 dealing with emotional disorders like clinical depression.

Studies have indicated that people who suffer from depression often have abnormally low levels of pregnenolone. One specific study found that pregnenolone could help to treat and possibly even prevent depression. 80 adults with Bipolar Disorder received either pregnenolone or a placebo for 12 weeks, and the depression remission rates among the pregnenolone group was almost TWICE that of the placebo group–61% compared to 37%!

The effects of pregnenolone on depression may not be limited to those with bipolar disorder. While this study looked at the benefits of the hormone specifically for BPD, further research may prove that pregnenolone could help to combat all forms of depression.

Enhance Thyroid Function —Your thyroid gland produces the T3 and T4 hormones, both of which are vital for a healthy body. People with hypothyroidism tend to have lower levels of not only pregnenolone, but also DHEA. Taking pregnenolone supplements may help to increase the production of DHEA and combat the reduction in thyroid function.

Boost Central Nervous Function — A number of people using the hormone supplement have reported noticing a significant difference in their central nervous system function. The pregnenolone supplementation has produced a feeling of “enhanced wellbeing” and “high energy” similar to those produced by DHEA supplements, and some have even reported seeing colors “clearer and sharper” as a result of the hormone.

Of course, this benefit is highly subjective. Not everyone will experience the enhancement to their central nervous system resulting from the pregnenolone supplements. However, it is one of the benefits commonly mentioned.

Boosted Libido — The fact that pregnenolone is the precursor hormone means that it will increase the production of ALL the hormones in the body. This could lead to a boost in sex hormones–testosterone and DHT among them. Many people taking pregnenolone have reported an enhanced sex drive and libido, the result of the increase in male sex hormone production.

If your goal is to improve your sex drive, pregnenolone may be a good option to consider.

The TRT Problem

As you can see from the long list of benefits above, pregnenolone is a very important hormone!
However, there is a problem…

Aside from the natural decrease in pregnenolone that occurs as you age, research shows that the anabolic steroids used for Testosterone Replacement Therapy (TRT) causes pregnenolone levels to drop even further. This leads to a decrease in both DHEA and sex- hormone binding globulin (SHBG), two very important hormones for sexual health and libido. The decrease can be as high as 80 or 90%!
However, there is a simple solution: add HCG to your supplementation.

If you are considering undergoing TRT and are worried about your precursor hormone levels, adding HCG into the mix will help to keep your pregnenolone, progesterone, and DHEA levels consistent. HCG is a luteinizing hormone analog, and it activates the enzyme that turns cholesterol into pregnenolone. This ensures that your body gets the pregnenolone it needs to produce all the other important hormones.

Drawbacks of Pregnenolone Supplementation

Now, as with any hormone, there are a number of drawbacks of pregnenolone supplementation. Not everyone will experience side effects, but most users report one or more of the following:

Bloating — Many pregnenolone users have reported feeling bloated and puffy with regular use, even when taking the hormone in tandem with DHEA or other steroid hormones. This may be due to the fact that pregnenolone increases the production of ALL sex hormones, including estradiol (the precursor to estrogen). An increase in estrogen can increase water retention, leading to bloating.

High Estrogen Levels — As mentioned above, pregnenolone is turned into a lot of different sex hormones, including various forms of estradiol. This increase in estradiol can cause your estrogen levels to rise.

Strange Dreams — A number of people taking pregnenolone have reported vivid, strange dreams after taking the supplement. While pregnenolone can help to reduce anxiety and stress (as we saw above), it has been known to cause your brain to be over-active when you sleep, and may lead to odd dreams.

Other Side Effects — According to WebMD “There isn’t enough information to know if pregnenolone is safe when taken by mouth.” However, it has been known to cause effects similar to those resulting from other steroid hormones: arrhythmia, hair loss, facial hair growth, headaches, negative mood changes, acne, anger, anxiety, irritability, and insomnia. For those with hormone-sensitive conditions (like breast, ovarian, or uterine cancer, or endometriosis), the hormone may increase health problems thanks to the fact that pregnenolone increases the production of estrogen.

However, the truth is that these drawbacks are really fairly minimal. For the most part, pregnenolone is a fairly safe option with limited side effects. However, it’s important that you understand what you’re getting into when taking pregnenolone.

How Much Do You Need?

If you are considering taking to increase natural hormone production, it’s vital that you know HOW MUCH to take. The last thing you want is to overdo it and end up suffering the negative side effects!
According to the experts, the optimal levels of serum pregnenolone is 180 ng/dL. If your pregnenolone is below those levels, you can look into supplements. If your levels are around that number, you may not need to take pregnenolone.

The typical dose of pregnenolone is between 50 and 200 mg per day, usually taken first thing in the morning. The pills are meant to be taken on an empty stomach, or you can use a cream (transdermal application).

However, you may want to consult with your endocrinologist before taking any pregnenolone. They may recommend a higher or lower dosage according to your pregnenolone levels, or they may counsel you against it. It’s essential that you get the recommendation from a medical professional before you undergo any sort of supplement, especially hormones like pregnenolone.

The good news is that there is A LOT of information on pregnenolone available for you. For example, Dr. John Crisler has recorded a podcast that can help you learn more about pregnenolone–both the risks and benefits. If you’re interested in pregnenolone, you’d do well to listen and see exactly what the experts have to say on the hormone.

Worry Free Erections: Trimix

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5mL Tri Mix

Worry Free Erections: Trimix

Did you know that erectile dysfunction is a surprisingly common problem among older men? Roughly 5% of men over 40 suffer from ED, but that number jumps as high as 25% by the time you reach your mid-60s.

While ED is fairly common, it’s important to understand that it’s NOT a normal part of growing older. While older man may require more stimulation to maintain and achieve erections, erectile dysfunction is a disorder that should not be accepted as “commonplace”.

Causes of ED include:

– Obesity
– Diabetes
– Heart disease
– Low testosterone
High prolactin and low thyroid function
– Atherosclerosis
– High blood pressure or cholesterol
– Metabolic syndrome
– Parkinson’s disease
– Stress
– Depression
– Medication side effects
– and the list goes on…

Treating Erectile Dysfunction can help to restore normal, healthy blood flow to your penis, returning your erections to the hard, long-lasting things they once were. For those who are trying to deal with ED, Trimix is one of the best options to consider.

Below, you’ll find out everything you need to know about Trimix, such as how it works, what it does, and how much you need to take. We’ll also look at potential side effects and dangers of the medication. By the end of this article, you’ll be able to make an informed decision as to whether or not Trimix is the treatment option for you.

About Trimix

For those who have difficulty achieving and maintaining a full erection, Trimix is a unique medication that presents a solution to erectile dysfunction.

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It is a combination of three medications that work synergistically:

1. Alprostadil, which helps to stimulate the production of prostaglandin.
2. Papaverine, which is a vasodilator that can increase blood flow to your penis, thereby improving your erections.
3. Phentolamine, which helps to combat high blood pressure, one of the primary contributing factors in ED.

The result of this “tri-mix” (hence the name) is harder, firmer, easier erections. Not only can the medication help to improve erections, but it makes it possible to achieve erections even without sexual stimulation (though stimulation makes it works better). The three medications work together to dilate the smooth muscles of the penis, increase arterial blood flow to the penis, restrict the outflow of blood, promoting erectile rigidity.

The beauty of Trimix is that it combines these three medications into one triple threat. The combination has proven more effective than any of the medications on their own, making Trimix one of the most potent, useful treatments for ED.

Effects:

The effects of Trimix are rapid–erections will usually appear in as little as 5-10 minutes–and will work in up to 80% of men. The length of your erections depend on a number of factors (such as your general health), but the average duration is around 30 minutes.

In some cases, men have developed a resistance to Trimix, forcing doctors to upgrade the dose. However, in many cases, men have been able to continue using Trimix indefinitely without developing a tolerance.

Injections

Trimix is injected directly into the penis, using a fine-gauge needle (the sort used to inject insulin). Thankfully, the dosage is very small (see the “Dosage” section), so there is minimal discomfort in this very sensitive body part. However, even the small dosage is effective at increasing blood flow to the penis, thereby improving erections and making them stronger and last longer.

The medication can be injected in a number of locations on the penis. Most injections will be administered on the 3 o’clock and 9 o’clock positions on the penis, as that ensures the medication is injected directly into the corpus cavernosum. However, the injections can also be administered at 2, 4, 8, and 10 o’clock positions.

There will be a slight discomfort, but thanks to the limited number of nerve endings in this location, the pain should be minimal.

For information on how to properly inject the medication, visit this Excel Male discussion: https://www.excelmale.com/showthread….ections-Part-2

Dosage:

Not sure how much Trimix you should be taking? You should ALWAYS consult a doctor before taking medications, especially potent ones like Trimix.

The most common initial dose for Trimix ranges from 0.05 cc to 0.2 cc, though the dosage will usually depend on your level of ED (more severe cases may require a higher dosage).

However, if this initial dosage doesn’t have the desired effects, your doctor may recommend increasing the dosage. The dosage will usually increase in increments of 0.025 to 0.05 cc’s, but only until the satisfactory dosage (the one that yields the desired results) is reached. You should not reinject within 6 hours of your last injection due to potential cumulative effect that can lead to priaprism (more on this later).

Your doctor may change the dosage of your injections, according to the results obtained.

Note: Trimix is a strictly-controlled medication, one that can only be obtained via prescription. Any Trimix sold or purchased without a prescription is illegal.

The three medications will be mixed by the pharmacist, and it MUST be refrigerated to last. If left outside the fridge, it will degrade. However, it can survive up to 6 months when properly stored. (For people who travel a lot, there are options for medications that do not require refrigeration.)

Side Effects

As with any medication, there is a risk of side effects when using Trimix:

Priaprism — Priapism is an often-painful, prolonged erection that continues hours beyond sexual stimulation–or is not caused by the stimulation. If you inject too large a dosage, it may cause priapism, as well as damage to the erectile tissue.

Pain — Pain is a common side effect with any type of injection. Thankfully, there are fewer nerve endings in the part of the penis you will be injecting, so the pain should be minimal. However, you can use topical anesthetic creams and jellies to reduce the pain of the injections. Auto-injectors are also an effective way to overcome hesitation and fear about pain. The spring-loaded auto-injectors insert the needle very quickly for more effective injections. In very few cases, there is pain experienced during erection (priapism).

Bleeding — This is only a side effect if you inject in the wrong location or at the wrong angle. There is a chance you will hit a small blood vessel in the penis with the needle, and you may notice a few drops of blood when you remove the muscle. Thankfully, it shouldn’t be serious, and with the 5 minutes of pressure you will apply to the injection area, the bleeding will stop. If there is a lot of blood, you may have hit a large blood vessel or the urethra. Apply pressure for 5-7 minutes, and abstain from intercourse until the bleeding stops.

Incorrect Injections — For those who are new to the Trimix injections, there is a risk that nothing will happen after an injection. This is usually the result of an injection that was too shallow, too deep, incorrect dosage, or using expired medication.

Infection — While rare, it has happened that infections develop at the injection site. It’s vital that you keep your penis clean and use alcohol swabs before using Trimix injections.

Scarring — Frequent injections (more than twice a week) can cause scarring on the penis at the injection site. For this reason, doctors caution against injecting more than two times per week. The more time between injections, the more your penis can heal–reducing the risk of scarring. Peyronie’s disease is a rare side effect of injections. Essentially, it’s scar tissue that forms inside the penis, reducing blood flow and function. For this reason, it’s recommended to alternate sides of the penis for the injections.

Curvature — Abnormal curvature of the penis is one of the known side effects of Trimix injections. The curvature is the result of scar tissue building up inside the penis. However, it only results in 3-8% of men using Trimix injections.

Negative Interaction With Vacuum PumpFor men who use vacuum pumps to achieve and maintain erections, it’s vital to understand that using the pump after a Trimix injection can be VERY dangerous. Use of the vacuum pump can lead to serious bleeding. Use the pump before the injection, or skip it altogether–let Trimix do its thing.

Negative Interactions with ED drugs — Men using Viagra should NOT inject Trimix, and vice versa. Taking both treatments at the same time can increase the risk of painful erections.

As you can see, Trimix does offer a lot of benefits to those trying to deal with ED. However, it’s important to understand as much as possible about the medication so you can use it safely and efficiently.

For details on how to use TRIMIX

Testosterone and Hair Loss: What You Need to Know

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compounded hair loss products

Testosterone and Hair Loss: What You Need to Know

Testosterone replacement therapy (TRT) is one of the most effective methods for treating hypogonadism, erectile and sexual dysfunction. Sadly, as with any treatment, a minority of men may experience hair loss.

A small but concerning percentage of men (mostly under 45 years of age and with genetic predisposition to hair loss) undergoing TRT begin to notice that their scalp hair tends to thin drastically within 3 to 6 months of the hormone therapy. This isn’t the case with all men, and it’s still not quite clear WHY men undergoing TRT begin to lose their hair although some studies speculate that one of testosterone’s main metabolites, DHT, may exert negative effects on hair follicles. However, if you’re unlucky enough to fall into the “going bald” category, you may be wondering what to do. After all, you can’t stop the TRT, but you don’t want to have to continue to lose your hair. It’s like being caught between a rock and a hard place! What can you do?

Many men turn to Rogaine (Minoxidil) or Propecia (Finasteride) as a means of combatting hair loss. These are the two most popular anti-balding topical drugs, the ones that receive the most media attention and advertising time.

But, one thing you need to understand is that they may not be the best solution in your case. Why is that? Two words: drug interactions.

Oral Finasteride, the medical name for Propecia, is designed to block dihydrotestosterone (DHT), an androgen hormone that is believed to play a large role in hair loss. However, while it may help to combat balding, it may contribute to low sperm count, impotence, and a number of other significant (and terrible) side effects. The medication may reduce the effectiveness of the TRT, as it’s essentially blocking another form of testosterone. You may not be able to stop the hair loss, and you’ll only make your testosterone replacement therapy less effective.

If you’re looking for another solution to combat hair loss, here are a few alternatives to consider:

Rogaine

Unlike Propecia, Rogaine doesn’t come with all the negative side effects. This OTC treatment is a topical one rather than oral, so it is applied directly to the scalp as a means of combatting male pattern baldness–or, in this case, baldness as a result of the testosterone replacement therapy.

How does it work? Rogaine helps to increase the flow of blood to your scalp and hair follicles, preventing the follicles from shrinking–basically jump-starting them and getting them back into working order. The topical treatment is very unlikely to interact negatively with oral medications (or topical testosterone), so it should be fairly safe for your use.

Bonus: There are a few preparations of Rogaine that have been fortified with Propecia, which may prove even more effective at combating hair loss. The addition of finasteride can help to maintain hair density, though it’s usually only used after taking oral finasteride. However, it won’t be absorbed into your body, just directly to your scalp. Topical finasteride (Propecia) mixed with Rogaine is far less likely to cause negative side effects, and may be safe to use while on TRT. Consult your doctor before using.

Platelet-Rich Fibrin Matrix Injections

In 2014, a study was published in the journal Facial Plastic Surgery, detailing the results of using platelet-rich fibrin matrix as a means of treating hair loss.

Platelet-rich fibrin matrix (PFRM) is a mixture made by separating the red and white blood cells from the platelets and plasma. According to the Journal of the American Medical Association, ” It is collected in a vacuum-sealed collection tube with a thixotropic separator gel, and the tube is centrifuged for 6 minutes at 1100 rpm. This process separates the red and white blood cells from the plasma and platelets, which are then transferred in a closed system to a second tube containing calcium chloride; it is this small amount of calcium that initiates the fibrinogen cleavage and the fibrin polymerization.”

In the Facial Plastic Surgery study, 15 men and women with androgenetic alopecia were given injections of PFRM three times a month over the course of 1 year. During that time, their hair density indexes were monitored. After just 1 year, hair density indices increased significantly, meaning the patients’ hair grew thicker and more dense on the scalp.

For those looking to combat the hair loss resulting from TRT injections, PFRM may be a viable, safe option to consider.

Fat Stem Cell Injections

In a 2015 meeting of the ISHRS, a Spanish doctor presented clinical data regarding the use of Kerastem regenerative cells as a means of treating genetic alopecia in both men and women. The injections enriched fatty (adipose) tissue in the patients, and all 9 of the patients showed a positive response to the injections. Hair count and density improved by an average of 29% in the men with early grade hair loss, and an average of 17% for all of the subjects studied.

Latanaprost

Latanaprost is a medication used to help regrow eyelashes that have fallen out as a result of thyroid disorders or stress. However, studies have shown that the hair re-growth benefits extend beyond just the eyelashes, but the medication can even help to replenish hair that has been lost from the head.
A 2012 study published in the Journal of the American Academy of Dermatology found that latanaprost “significantly increased hair density (terminal and vellus hairs) at 24 weeks”. Essentially, it could help to stimulate activity in the hair follicles, making it a potentially effective treatment for hair loss. Best of all, there should be no negative interactions with the TRT, as it is another topical treatment.

For more information, visit: https://www.excelmale.com/content.php…eyond-Propecia

Is Estradiol a Friend or Enemy of Men?

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Is Estradiol a Friend or Enemy of Men?

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Estradiol is a very important sex hormone–in fact, it’s the primary female sex hormone. It plays a central role in female reproductive health, as it promotes the development and maintenance of the ovaries, eggs, and other reproductive tissues.
The male body does produce some estradiol, though in much lower quantities than the female body, via the actions of the aromatase enzyme that converts some testosterone into estradiol. Excess or too little estradiol can have health consequences in men. These are a few of them:

It Can Cause “Man Boobs”

Men who develop “man boobs” suffer from gynecomastia, a condition where their glandular breast tissues are enlarged. The condition is the result of the body converting too much testosterone into estradiol, which in turn causes growth in glandular tissue. Testosterone replacement therapy can increase the risk of gynecomastia, particularly in men with high levels of the enzyme aromatase. This problem can be prevented with the use of an estradiol blocker (aromatase inhibitor) like anastrozole, but the dosage has to be adequate to avoid low estradiol.

It Plays a Role on Fat Mass

Testosterone is the hormone that plays a central role in the production of muscle mass, but did you know that estradiol is needed for the control of fat mass?
In one study, men with high blood testosterone levels saw a decrease in their total body fat percentage, abdominal fat specifically, and subcutaneous fat. However, the testosterone alone didn’t control body fat. The men who had lower estradiol levels in their body saw an increase in total body fat, subcutaneous fat, and even the fat in their abdominal area.

This proves that estradiol hormones–specifically estradiol–play an important role in your body’s ability to regulate fat mass. Blocking estradiol can have negative consequences, including weight and total body fat mass increase.

It’s Vital for Sexual Health

In the same study mentioned above, the men with higher testosterone levels scored higher on sexual desire questionnaires than men with low testosterone levels. Not only that, but their erectile function was significantly better.

However, despite high testosterone levels, men with low estradiol levels still saw a decrease in their sexual desire and erectile function. If estradiol levels were over 10 pg per milliliter, sexual desire decreased by only 13%. But if estradiol levels dropped too far (to less than 10 pg per milliliter), sexual desire experienced a serious drop–by as much as 31%.

This proves that estradiol plays a central role in both sexual desire and erectile function! According to the study, “estradiol deficiency is largely responsible for some of the key consequences of male hypogonadism”. If this is the case, monitoring estradiol levels could be a useful measure for assessing sexual dysfunction among men who suffer from hypogonadism (low production of testosterone).

In another study, men undergoing TRT had both their testosterone and estradiol levels measured. The men were also asked to rate their libido on a scale from 1 to 5. Those with higher testosterone and estradiol levels consistently rated their libido/sexual desire higher than those with low testosterone and estradiol levels.

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It Affects Mortality Rate

Hard to believe that something as simple as a reproductive hormone can play a role in how long you live, right?

According to one study, levels of estradiol lower than 21.80 pg/ml or higher than 30.11 pg/ml increases mortality risk in men with history of heart disease with low testosterone. This is due to the fact that androgen deficiency is a common risk factor in chronic heart failure, and the too high/too low estradiol levels indicate improper androgen metabolism.

It’s Necessary for Healthy Bones

Estradiol is vital for healthy bones–affecting bone loss, bone mineral density, and peak bone mass. One study examined what happens if estradiol levels fall too low, and the results were terrifying: Elderly men (between 60 and 90 years old) have a much higher chance of bone loss if estradiol levels fall too low (below 11 pg/ml).
The more estradiol available in the body, the higher the bone mineral density. The less estradiol available, the greater the bone density loss. Bone resorption markers also increased as estradiol levels plummeted. According to this study, estradiol levels that drop below 40 pg/ml may be a major cause of bone loss among men!

It Affects Hemoglobin Levels

Hemoglobin is the protein molecule in your red blood cells that transport oxygen from your lungs throughout your body. It also eliminates carbon dioxide from your body. Basically, it’s one of the most important molecules in your body!

Hemoglobin production decreases with age along with hormone production. According to one study, the two are very closely linked. Of the 900 men between the ages of 70 and 81 that participated in the study, the ones with higher estradiol levels had higher hemoglobin levels. Testosterone, on the other hand, had little to no effect on the hemoglobin levels in men.

What does this mean? Simple: estradiol is a vital hormone to keep your body functioning properly as you age!

These are just a few of the studies that examine the role of estradiol on the human body, but suffice it to say, this particular estradiol is VERY important for male health. The benefits extend far beyond simple reproductive health, but plays a role in a wide range of vital bodily functions.

Most Informative Articles on Testosterone, ED, Trimix, HCG and More on ExcelMale.com

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Most Informative Articles on Testosterone, ED, Trimix, HCG and More on ExcelMale.com


Affordable Lab Tests- No prescription Required- Most US Cities

How to Use ExcelMale.com For Your Maximum Benefit

Reviews of Testosterone: A Man’s Guide (from amazon.com)

How to Print Factsheets for Your Doctor from ExcelMale.com

How long does testosterone take to show effects?

What is a Normal Blood Level of Testosterone?

Testosterone Replacement Treatment Options

How to Increase Testosterone Naturally

Top Mistakes Men Make When Using Testosterone Replacement Therapy

Suggested Lab Tests Before and After Initiation of Testosterone Replacement

Testosterone Side Effect Management Table

Does Testosterone Increase the Chance for a Heart Attack?

Does Testosterone Cause Prostate Cancer? Can Men Treated for Prostate Cancer Use TRT?

How should doctors monitor men receiving testosterone replacement therapy?


Download Nelson Vergel’s Testosterone and Erectile Function Lecture Handout

How to Find a Good Doctor that Prescribes Testosterone?

How to Inject Testosterone Safely

How to Use HCG to Prevent Testicular Atrophy and Improve Sex Drive

Role of Estradiol in Men and Its Management

Is Clomid (Clomiphene) Effective to Increase Testosterone, Fertility and Sperm Volume?

How to Manage Polycythemia Caused by Testosterone Replacement Therapy

Fatigue- When Testosterone Is Not Enough

Penis Injections for Hard Erections: TRIMIX

Erectile Dysfunction Risk Linked To How Many Medications Are Taken

When Testosterone Replacement Doesn’t Lead to Better Erections

DHEA Supplementation: What Do Studies Show?

Thyroid Hormone Diagnosis and Treatment Algorithm – Dr Rothenberg

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The Science of Healthy Eating

Exercise Tips to Lose Fat and Gain Muscle

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