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Originally Posted by Mojojo
Ok question for the OP or anyone taking test really.....what are the side effects and how long do you have to take them for? I've read tons about this in bodybuilding forums but results vary and one thing I've noticed is how folks don't say how long they are not this stuff for or if they get off it or have to remain on it.
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Sorry in advance for the long post, there's a lot of information being discussed here. I am not a physician but I am educated about this subject. TRT is not something to undertake lightly no matter how many ads you see on TV. I suggest educating yourself as much as possible. Even if you decide not to do it, or are not experiencing problems currently, its a good idea to establish your own personal hormonal baselines for the future.
First of all, there is a TON of misinformation out there surrounding testosterone replacement therapy TRT largely as a result of testosterone use in bodybuilding and professional sports. Much of this "Broscience" gets passed around as fact on various bodybuilder forums. There are several excellent sources of scientifically backed information. It is very important to weed out and differentiate between this information backed by clinical research and that backed by anecdotal "evidence". PubMed is an excellent resource.
Also, not all doctors are created equal, some literally only know what they learn from the pharmaceutical reps for Androgel plus whatever they remember from the 2-3 weeks they spent in med school covering endocrinology. You will find as you educate yourself about this that often you will know more then many doctors.
What should my Testosterone levels be?
Testosterone is naturally highest in the morning and that's when blood tests should be conducted.
You may get levels checked and the doctor proclaims you "normal" but what does that mean? That just means you fell within the reference range for the test.
Labcorp's reference range for testosterone is 348.0-1197.0 ng/dl
Quest Diagnostics reference range is 250-1100 ng/dl
The problem is that range is for men ages 18-90 regardless of any other health conditions or variables. Doesn't sound very scientific does it...well yeah because its not.
Generally insurance companies won't pay without a fight for TRT unless levels are below 250. The good news is that injections are very cheap if you can find a doctor who is educated.
Some studies have attempted to provide a more meaningful Age dependent reference range. Such as this one:
Potential Adverse Side Effects of Testosterone Therapy:- Fluid retention
- Testicular atrophy (explained below, but it's basically because your nuts shut down production)
- Increased blood pressure
- Increased hematocrit levels
- Increased estrogen (via aromatization, explained below)
How long do I have to keep doing it?
Basically, forever is the simplified answer, but really it depends. You have to understand what is happening when you introduce exongenous testosterone, i.e. injections, creams, pellets.
The main endrocrine system at work here is the feedback loop between your Hypothalymus, Pituitary, and Gonads/Testes referred to as the Hypothalamic-pituitary-testicular axis or Hypothalamic-pituitary-gonadal axis (HPG axis)
Basically, your Hypothalymus sends GnRH hormones to your Pituitary triggering the pituitary to send Leutinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) to your testes which then produce testosterone and spermatozoa in response to LH and FSH respectively. Testosterone levels rise in the bloodstream and the hypothalymus responds by cutting off the flow of gnrh via negative feedback (like cutting off the faucet). Testosterone then gets metabolized in the body and the faucet turns on again.
Now you begin to see why exogenous testosterone administration has to be continued for life. By injecting testosterone your hypothalamus detects high levels in your system and keeps the faucet turned off. Essentially you have bypassed your body's way of producing its testosterone on its own. The testes atrophy from disuse over time as they are no longer being used for testosterone production. The level of atrophy varies from person to person.
There are TRT protocols which call for HcG injections which acts like a synthetic Leutinizing Hormone and keeps the testes producing testosterone. There are side effects with HcG and the consensus seems to be that unless you may want children in the future its not worth trying to juggle another hormone level.
What if I just stop anyway
If you stop then your levels MAY go back down to where they were before you started. However, the faucet doesn't just turn itself back on. The process (called a HPTA restart) doesn't always work and it may be worse than before, or you may need to use HcG to "jump start" your HPG axis. Depending upon how long TRT has been in place and your own personal genetics, your testes may have atrophied and may no longer be capable of producing enough testosterone.
Man Boobs?!?! What the fuck!
This CAN occur on TRT generally not if you are monitoring the correct hormones during treatment, i.e. Estradiol (E2). It's more common among bodybuilders who are injecting massive amounts of hormones with essentially zero blood work.
Man boobs, bitch tits, whatever are what is medically known as gynecomastia. Technically, true gynecomastia is the development of glandular breast tissue, its not just fat deposits. Gynecomastia has to be surgically treated it does not go away on its own.
The male body metabolizes some testosterone into forms of Estrogen, namely Estradiol known as E2. Estrogen is far more important in men than most of us realize. In fact, too low or too high E2 levels cause the same symptoms as Low-T.
Testosterone is metabolized into Estradiol using an enzyme called aromatase, via a mechanism called aromatization. There is a correlation between T levels and the amount of aromatization that takes place. How much is highly variable based on the individual. What this means is that as T levels rise so do E levels to some degree. It is very important to keep E levels within normal ranges (not too low or too high).
Some men can obtain high testosterone levels and stay within normal Estradiol range, others require some medical method to keep E in check. This medical method comes in two forms, estrogen blockers and aromatase inhibitors. Aromatase inhibitors have the least side effects for long term use and the most commonly used one is Arimidex in a .25 mg every 3rd day dosage.
What Bloodwork do I need to have to check my hormone levels?
Here are the labs you absolutely MUST have done if you suspect Low-T or want to establish your own personal baselines. Do not accept no for an answer as if you end up going to a Urologist or an Endocrinologist they will be ordering these labs immediately anyway. Tell the doctor you have done some research (which I encourage you to do, after all you don't know me) and insist on a full workup.
Good luck!
The Labs you need:
Complete Blood Count (CBC) - full blood workup
Liver Enzymes AST and ALT -liver function test
Free Testosterone -
this is the number that is truly important not Total T, it's calculated from total T though so you need that also
Total Testosterone
Estradiol -
Estrogen levels,extremely important to have tested and many doctors don't want to do it, high E in men causes the same symptoms as Low T
Prolactin
Sex Hormone Binding Globulin (SHGB) -
SHGB binds to Testosterone leaving less free T
Prostate Specific Antigen (PSA)
Leutinizing Hormone (LH) -
This and FSH are important so you can see if the problem lies with your testes or your pituitary gland, often referred to as primary or secondary hypogonadism
Follicle Stimulating Hormone (FSH)
Thyroid Stimulating Hormone (TSH) -
Thyroid test along with T4 and T3 to rule out thyroid problem
T4
T3
Some research to get you started, you can pass these along to your doctor if he gives you a hard time...especially the first one:
Carnegie, Christina. "Diagnosis of hypogonadism: Clinical assessments and laboratory tests." Reviews in Urology 6.Suppl 6 (2004): S3.
Pantalone, Kevin M., and Charles Faiman. "Male hypogonadism: More than just a low testosterone." Cleveland Clinic Journal of Medicine 79.10 (2012): 717-725.
Forums for further research:
This is connected to a bodybuilding forum but its membership consists of many doctors and an emphasis is placed on opinions backed by clinical research not anecdotal "evidence"
http://thinksteroids.com/forum/mens-health-forum/
This is the forum for a men's anti-aging clinic which is way way overpriced but the forums contain excellent information backed, again, by science.
http://www.allthingsmale.com/forum/
My Internist in Ft. Worth won't even discuss getting me up to 6-700 . . . keeps saying i'm in the normal range. Most of my reading says my number is "normal" for a man OVER 70! 
