The Definitive Testosterone Replacement Therapy Manual

Copyright © 2015 Jay Campbell Published by

Archangel Ink

ISBN: 1942761724 ISBN-13: 978-1-942761-72-3

CONTENTS
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16

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

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17

CHAPTER 2

TESTOSTERONE DECREASES BODY FAT -.)-.,)(5#-5--(.#&5.)5."5,!/&.#)(5) 5#(-/&#(65!&/)-65(5 .5 -.),!8gi5
-5.-.)-.,)(5&0&-5*&/''.65-)5)-53)/,5)3]-5#&#.35.)5 *,)--5."5#(-/&#(65!&/)-65(5 .85#'*&35*/.655,-5#(55&0&-5#-5 #,.&35),,&.51#."5(5#(,-5#(5 .5-.),!8gj5 )5 '%5 '..,-5 1),-5 ),5 )-5'(65(5#(,-5#(5 .5&-)5 &)1,-55&0&-85Th5 ..,53)/57 )'5."5&)1,53)/,5.-.)-.,)(85 Testosterone Th#-5 ,/.&5 3&5 #-5 5 "/!5 )(7 .,#/.),5 .)5 ."5 )-#.35 *('#5 -1*#(!5 ."5 1),&85 (5 )-5 '&-5 .",5 #-5 #(,-5 ,)'7 Aromatase .-5 .#0#.365 1"#"5 #,,0,-#&35 )(0,.-5 .-.)-.,)(5 .)5 -.,#)&65 Estrogen ,-/&.#(!5 #(5 ,-5 .-.)-.,7 )(5 (5 &0.5 -.,)!(5 &0&-85 )10,65 )-5 (5 "#!"5 )35 .5'(5&#%5(5,%5."#-53&535/(,!)#(!565-5.-.)-.,)(5#-5 &#*)&3.#gk5 B#885 .5 /,(#(!C85 ./#-5 "05 &-)5 -")1(5 .".5 )(5 ) 5 ."5 *)-#.#05( #.-5) 5.-.)-.,)(5.,.'(.5#-55,-5#(5#*)-#.35&-)5 %()1(5-5 .5-.),!8gl5 5#-/--5."5,)&5) 5.-.)-.,)(65,)'.-65(5 )-#.35'/"5'),5#(5"*.,5o8

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18

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

TESTOSTERONE INCREASES MUSCLE MASS -.)-.,)(5#-5(5--(.#&5'/-&7 /#&#(!5 "),')(85 -.)-.,)(5 #-5 ."5 -#-5 ) 5 '/-&65 ) 5 -.,(!."65 (5 ."5 -)/,5 ) 5 1".5 '%-5 '(5 *)1, /&85 -.)-.,)(5/#&-5'/-&535#(,-7 #(!5'/-&5*,).#(5-3(."-#-8gm5 ".5)-5.".5'(>5 .5'(-5# 5 3)/5 2,#-5 1#."5 1#!".-5 1"#&5 /-#(!5 .-.)-.,)(53)/]&&5/#&5&,!,5'/-&-5 (5#(,-53)/,5)0,&&5-.,(!."85

It is important to understand that a clean diet and a sound resistance training program are absolutely necessary to maximize the potential benefits of TRT.18 I discuss this much more in Chapters 11 and 12.

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19

CHAPTER 2

TESTOSTERONE IMPROVES HEART HEALTH

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20

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

The hyperbolic fear about testosterone replacement therapy causing increased CVD (cardiovascular disease) 22 events in otherwise normal and healthy men is unsupported. There is little data or proof substantiating the national TV, newsCAUTION print, and internet ads you’ve likely seen from legal groups and attorneys claiming TRT increases the risk of heart attacks, stroke, CVD, etc. Absurdly, the foundational study that prompted this CVD risk witch hunt came from a clinical trial (TOM trial) investigating the use of a topical TRT in men over 65 with limited mobility---men who could barely walk or move on their own23. The preponderance of evidence clearly indicates an increased risk of cardiovascular disease and death in general, in men with low or low normal testosterone blood levels24. TRT when dosed and maintained to optimal levels offers no increased risk of CVD and may in fact offer CVD protection. Later in Chapter 10 and also in the interview with Dr. Brett Osborn in Chapter 13, I will back up this assertion with the most relevant and recent research data.

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21

CHAPTER 2

TESTOSTERONE INCREASES BONE DENSITY

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22

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

TESTOSTERONE COMBATS ALZHEIMER’S DISEASE AND IMPROVES COGNITION

./#-5-")15'(35)&,5'(51#."5'#&5)!(#.#05#--/-5-/Ŀ,5 ,)'5 &)15.-.)-.,)(8hn5 (35) 5."-5'(50(./&&350&)*5
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.5 ."5 (#0,-#.35 ) 5 )/.",(5 &# ),(#65 ,-,",-5 ().5 .".5 #(,-#(!55&0&-5#(5)&,5'(5-.&&5."50&)*'(.5) 5
&4"#',]-85 Th#-5 "-5 &5 -#(.#-.-5 .)5 -*/&.5 '#(.#(#(!5 "&."35 .-.)-.,)(5 &0&-5'35./&&35*,0(.5
&4"#',]-if85Th,5#-5&,5(5-/-.(.#&5 0#(55#'*,)0-5''),35-5'(5!8ig55 53)/5,5(5!#(!5'(5 (5#(.,-.5#(5*,-,0#(!53)/,5''),351&&5#(.)53)/,5!)&(53,-65 #.]-550,35!))5*,0(..#05'-/,5.)5(-/,53)/,5.-.)-.,)(5&0&-5 ,5)*.#'#485

hn5 #&&..5 65 ,.#(-565&,(..5 65"/5
65,/565*585&.#)(7 -"#*5.1(5.-.)-.,)(65-25"),')(5#(#(!5!&)/&#(5(5*&-'5'3&)#5.5**.#5 jf5#(5)&,5'(51#."5-/$.#05''),35&)--5),5'(.#85 5
&4"#',-5#-85hffi:k9hlm@hlo85 D/ E ho5 &-'5.-.)-.,)(5&0&-5#(5
&4"#',5(5,%#(-)(5#---85%/(5 65 )(!5

65( &.5 65,#(!5 65 035
85/,)&)!385hffj55gf:lhBiC9jgg7i8 if5 /((#(!"'5 65#(!"5 65],3(.565&&5 65,,5852#.#05-.,--65 .-.)-.,)(65(5)!(#.#)(5')(!5/-#(5(5 2#(5
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7gigooj8 ig5 (5.-.)-.,)(5,*&'(.5,-5."5''),35*,)&'5) 5)&5!>5 #'650#5 .5&8 #&53*)."--565)&/'5lf565 --/5l565noi5@5nol

23

TESTOSTERONE AND A FULFILLED LIFE CHAPTER 3 TESTOSTERONE WILL IMPROVE YOUR CONFIDENCE WITH SEXUAL PARTNERS



(5."5(#'&51),&65"#!"5.-.)-.,)(5&0&-5"05(5-")1(5.)55 &#(%5 .)5 )'#((5 #(5 ."5 ..&5 ),5 '.-85 Th5 -'5 #-5 .,/5 ),5 "/'(-85./#-5"05-")1(51"(5.1)5'(51,5#(-.,/.5.)50#5 ),5 ."5 Ŀ.#)(-5 ) 5 5 1)'(65 ."5 '(]-5 !!,--#)(65 #&#.35 .)5 #,.5 ."5 #(.,.#)(65(5"(-5) 5..,.#(!5."51)'(51,5--)#.51#."5 ."#,5.-.)-.,)(5&0&-5 ),5."5.-%8ih5)5.",5#-5.,/."5#(5."5#5 ih5 27"),')(5*((.5*,*.#)(5) 5(,)-.()(5-/!!-.-5#.-5#(0)&0'(.5#(5 )''/(#.#(!5)'*.#.#)(5(5!!,--#)(85 Ĝ%5g65/-5 85"3-#)&5"085hfgj5 (5 gm:ghi9gil7jg85)#95gf8gfglI$8*"3-"8hfgi8gf8fgl85*/5hfgi5.5hk

24

CHAPTER 3

that boldness is a powerful key to attracting potential mates. ", is little doubt testosterone is responsible for this boldness. Improving your testosterone level can increase your ability to approach suitors and build quick rapport. From an evolutionary biology standpoint, women sense and are attracted to higher testosterone in men and enjoy communication with males who give off an aura of high T.335 T"ere is even ,-,"34 indicating women smell higher testosterone5and seek it out during various points of their menstrual cycle. Knowing5this, if you struggle with approaching women or dating, why would you5not want to investigate the route of testosterone replacement therapy5 (TRT)?

MORE TESTOSTERONE EQUALS HEIGHTENED SEX DRIVE AND LIBIDO

There’s an entire industry devoted to correcting low libido and erectile dysfunction through artificial chemicals. Supplementing with TRT can dramatically increase sex drive and improve the quality and quantity of erections.35 Testosterone is the most powerful male 33 Sex-hormone dependent perception of androstenone suggests its involvement in communicating competition and aggression. Lübke KT1, Pause BM. Physiol Behav. 2014 Jan 17;123:136-41. doi: 10.1016/j.physbeh.2013.10.016. Epub 2013 Oct 25 34 http://www.huffingtonpost.com/2013/04/18/mens-smell-testosterone-attractive-towomen-study_n_3110182.html 35 145. Wang C, Cunningham G, Dobs A, et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass,

25

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

-25"),')(65(5'(35'&5-2/&5#--/-5(55,0,-5.",)/!"55 .-.)-.,)(5#'*,)0'(.5,!#'(855 ( ),./(.&365 '(35 '(5 1")5 ).",1#-5 -/Ŀ,5 ,)'5 &)15 -.)-.,)(65 ,5 ,)/.#(&35 -,#*.5 #!,5 ),5 #&#-5 (5 (5 (.#7 *,--(.5 1"(5 ."35 *,-(.5 .)5 ."#,5 ).),5 1#."5 5 &)1,5 &##)85
-./.55*"3-##(-5(5.)5&,(5")15.)5#*",51".",55*.#(.5 "-55&%5) 5-#,5),55,&5&# 5#(#&#.35.)5*, ),'5B&)15C85
-51#&&5 5-..5)(.#(/&&35#(5."#-5))%5@5-3'*.)'-5(5."(5&))5*(&-5

5 5 .%(5 #(.)5 )/(.5  ),5 0&#,&35 #-*(-#(!5 ,.#&5 3- /(.#)(5(5'))5&.,#(!5'#.#)(-85

TESTOSTERONE WILL IMPROVE YOUR MINDSET Many men today are buried under the dark soil of depression and it is abundantly clear that low testosterone levels are to blame.36 Sadly, scientists are stuck trying to figure out a biological riddle akin to the chicken or the egg: does low testosterone cause depression, or does depression cause low testosterone? Despite this confusion, research demonstrates that men undergoing testosterone treatments have reported improvements in mood and other issues related to depression.37 Many of these same men have overwhelmingly improved (5)(5'#(,&5(-#.35#(5"3*)!)(&5'(85 5&#(5(),#()&5 .85hffj:no9hfnk@hfon85 D/ E il5 Th5,)&5) 5-25(5-27,&.5"),')(-5#(5)!(#.#)(65'))5(51&&7#(!5#(5)&,5 '(5(51)'(8 Biol Psychol. 2014 Sep 6;103C:158-166. doi: 10.1016/j.biopsycho.2014.08.015. [Epub ahead of prin im5 Th5Ŀ.-5) 5*",')&)!#&&35#(/5"3*)!)(#-'5)(5'))5#(5"&."35'(85
,"5(5-3"#.,385hffj:lg9oom@gffj85D/ E5gjm85"'#.5 65,&#(5 65(/5


65.5&85

26

CHAPTER 3

."#,5 *-3")&)!#&5 *#.365 !#0#(!5 ."'5 5 &#(!5 ) 5 ,&#'#(!5 ."#,5 &# 85 (5 .65."5,#(5 )!52"##.535'(5-/Ŀ,#(!5 ,)'5.-.)-.,)(5 ̑#(365#-5) .(5&#'#(.5)'*&.&35/*)(5#'*&'(.#(!5(5#(.&7 &#!(.55*,).))&85"5 -.-.5().#&5*)-#.#05Ŀ.-5) 55#-5 &,,5."#(%#(!5(5(5#'*,)05'))8

THE COMPETITIVE EDGE FROM TESTOSTERONE

-.)-.,)(5 #-5 ,-*)(-#&5 ),5 ."5 '-/&#(5 (5 ),5 0#.),35 (5 "&&(!8in5 .5&-)5!,.&35-*-5/*5,.#)(5.#'-65#'*,)0-53-#!".5 (5(/,(5(5*,)/-5 &#(!-5) 5#(0/&(,#&#.38io5 (5 .65)(5-./35-")1-55'(]-5.-.)-.,)(5&0&-5,5*,#.#05) 5 1".",5"51#&&5*,-0,5.",)/!"5 .5),5!#05#(51"(5 51#."55 "&&(!8jf5 in5 (.,)&&!#.5-),95-�5),.#-)&5(5.-.)-.,)(5,5&0.5/,#(!5)'7 *.#.#)(65(5.-.)-.,)(5#-5,&.5.)5-../-5(5-)#&5)((.(--51#."5.'5'.-85 1,-5
g65.4&5653(,55 )5(85hfgh:mBjC9ijngj85)#95gf8gimgI$)/,(&8 *)(8ffijngj85*/5hfgh5
*,5gn8 io5 ,/'5.-.)-.,)(65!,)1."5"),')(65(5#(-/&#(7&#%5!,)1."5 .),7g5&0&-65'(.&5 ,.#)(5.#'65(5'2#'&5,)#52,#-5#(5-(.,35(5&)(!7.,'5*"3-#&&35.,#(5 &,&35'&-85 (.5 5/,)-#85hffj5 3:ggjBkC9lhi7im8 jf5 '*&##.5*)1,5').#0.#)(5*,#.-5'(]-5.-.)-.,)(5"(!-5(5#'*&##.5&,(#(!5 #(55)(.-.5-#./.#)(8 Schultheiss OC1, Rohde W. Horm Behav. 2002 Mar;41(2):195-202.

27

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

Think of the times in your life when you’ve experienced the “thrill of victory” when one of the sports teams you watched or played on won a big game. It’s quite exhilarating. The same might be felt in the business world when achieving a big sale or finalizing a huge deal. There is documented scientific evidence showing testosterone increases exponentially for days in men after winning a game or achieving a great feat.41 Imagine having those feelings as a part of your day-to-day life when using TRT.

TAKE RISKS, ACHIEVE STATUS -.)-.,)(5"-5(5&#(%5.)5,#-%7 .%#(!5 (5 "#!",5 -../-5 #(5 '(85 (5 1#."5 "#!"5 .-.)-.,)(5 (5 "#!"5 -../-5 .(5.)55'),5,#-%70,-5."(5."#,5&)15 .-.)-.,)(65&)15-../-5,.",(85./#-5 #(#.5 ."#-5 #-5 /-5 ."-5 '(5 "05 '),5 .)5 ")&5 )(.)5 ."(5 ."#,5 &)15 -../-5 ,).",-65 -5 0#(5 35 ."5 ( #.-5-/'',#45)085 (.,-.#(!&365 .-.)-.,)(5 &0&-5 ,5 ().5 .)5 #(,-5  .,5 0,35 0#.),35 5 *,-)(5 2*,#(-8jh5 Th#-5 .,(5 ) 5 #(,--5 ,.-5 5 *)-#.#05 &))*5 1",5."5"#!"5.-.)-.,)(50#.),5'35.,#/'*"5)0,5(5)**)((.51#."5 '),5-%#&&5/.5&--5.-.)-.,)(855

jg5 -.)-.,)(5(5),.#-)&5,&-5')(!5*(#-"5-),5 (-51."#(!5."5hfgf5 ),&5/*5 #(& 50(5,5 #$5 g65
&'&5 65#&!)565#&&565 $4,'(5650(5 (!5 
65&0),5
jh5 "(!-5#(5.-.)-.,)(5'#.5."5Ŀ.5) 51#((#(!5)(5-/-+/(.5!!,--#05 "0#)/,8 Carré JM1, Campbell JA, Lozoya E, Goetz SM, Welker KM. Psychoneuroendocrinology. 2013 Oct;38(10):2034-41. doi: 10.1016/j.psyneuen.2013.03.008. Epub 2013 Apr 12.

28

CHAPTER 3

OPTIMAL TESTOSTERONE, YOUR MOST POWERFUL AND ENLIGHTENED SELF

When you have higher levels of testosterone your ability to be ultraconfident in your decisions and take decisive action is exponentially increased. You are assertive and purposeful in all that you do and say. Your decisions empower you to behave in ways others find attractive. Supplementing with testosterone will help a beta-male become more assertive giving him more alpha like characteristics. It will make an alpha male more focused, determined and a leader among his peers. Th ere are many people who espouse theories on raising testosterone naturally. While it’s true tweaking your diet and nutritional supplement protocol to optimize your testosterone can offer some help as can5 certain *)-./,5 #'*,)0'(.5 2,#--, nothing is as powerful or universally proven as using pharmaceutical TRT. Especially utilizing one of the TRT protocols recommended in the pages of this book.

29

THE SCIENCE OF TESTOSTERONE 101: WHY MEN MUST UNDERSTAND THEIR ENDOCRINOLOGY CHAPTER 4

W

T
EST
OSTERONE AND H OW IS IT M
ADE? HAT IS

Testosterone is a hormone both males and females need in the right amount to function properly, not only physically but mentally. Our focus is on men who don’t want to live within what is defined as the “normal range” of testosterone. Even more important is preventing men from experiencing the symptoms of low testosterone. It is not the purpose of this book to offer a *5(&3-#-5) 5."5'&5(),#(5(5,*,)/.#05-3-.'85551#&&5 )Ŀ,55+/#%5(5-#'*&52*&(.#)(5) 51".5.-.)-.,)(5#-5(5")15#.5 1),%-5#(5'(85 -.)-.,)(5 *&3-5 '(35 #Ŀ,(.5 ,)&-5 -5 15 !85 (5 ,&35 0&)*'(.5#.5#-50#.&5 ),5,#(65-265(5)(5 ),'.#)(855 .,5#(5&# 65 #.]-5#'*),.(.5 ),5,#(5"'#-.,365'#(.#(#(!5'/-&5'--65(5-2/&5 /(.#)(8ji5 )/,5 )35 "-5 ,!/&.#)(5 -3-.'-5 #(5 *&5 .)5 %*5 ."#(!-5 )*,.#)(&85 5 ),5 2'*&5 # 5 3)/5 .5 -/!,65 3)/,5 )35 "-5 "'#&5 ,*.),-5.".5*#%5/*5."5#(,-5) 5!&/)-5#(53)/,5&))-.,'5(5 ji5

)),#(5
65 ),&35 65),('(55B,/,35gonmC85^#)&)!#&5.#)(-5) 5 (,)!(-_85(),85085n5BgC95g@hn85)#9gf8ghgfI,07n7g7g85 5ikjohmk8

30

CHAPTER 4

#(5 ,-*)(-5 ,&-5 #(-/&#(5 .)5 ,!/&.5 3)/,5 &))5 -/!,5 (5 '#(.#(5 ")')-.-#-85Th 5-'5"**(-51#."5.-.)-.,)(5*,)/.#)(855 Your brain will send a chemical sign to the hypothalamus saying it needs some testosterone made. The hypothalamus will in turn release a messenger called gonadotropin (GnRH) that is picked up by the pituitary gland. This causes the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These NERD ALERT NERD ALERT will be recognized by the Leydig cells in the testes to synthesize testosterone. The testosterone is then released where it will be bound to sex hormone-binding globulin (SHBG) and albumin or will remain in its free form and in turn find targeted cells to bind with. There is a negative feedback loop known as the Hypothalamic-PituitaryTesticular-Axis (HPTA) also now known as the hypothalamic–pituitary– gonadal axis (HPGA) that will send messages to the pituitary saying there is enough testosterone in the system. The pituitary will in turn slow production of LH and eventually FSH. Testosterone will be reduced into a number of other metabolites that serve important functions such as dihydrotestosterone (DHT) or estradiol (E2). I will discuss these in much more depth later in the book in Chapter 10.

WHY DO YOU STOP PRODUCING OPTIMAL LEVELS OF T? As we age our body isn’t as efficient with maintaining proper testosterone production and our homeostasis level is set too low. Th is could be in response to an injury such as damaged testes. Blunt trauma (a strike)44 accounts for 75% of testicular injuries. Th ese can occur from getting kicked, hit by a baseball, motorcycle/bicycle accident, etc. T"e ")nest truth which few others have the courage to write about is our horrific environmental situation. All around the world men’s endocrine systems are being )',45 via the increase in environmental pollutants, contaminants and particulates in the air produced by industrial factories, smog and emissions from cars, etc. 44 45

http:/ /www.webmd.com/men/guide/testicle-injuries http://www.ewg.org/research/dirty-dozen-list-endocrine-disruptors

31

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

Men are under siege from hormonal suppressing phytoestrogens46 (such as -)35*,).#(537*,)/.-47), and a host of other toxins as a direct result of modern day societal living. Exposure to phthalates, which are found in many plastics is “feminizing” boys by blocking normal male testosterone.48 Even men’s sperm counts are falling due to exposure to pesticides, endocrinedisrupting chemicals like bisphenol A (BPA)49, and the many other toxins increasingly pervading our water and food supplies. Phthalates are now a horrific modern day problem for not only men, but also women and children. There is now animal and human evidence that exposure to phthalates (chemicals found in plastics and personal care products) is associated with reduced androgen levels and associated disorders.50 Regardless of the cause, when this happens you will eventually have such low levels of testosterone you’ll start to feel differently, both mentally and physically over time. And before you know it, you’ll feel “old” and nothing like you used to when you were “young”. Once a man has reached this low level of testosterone and if fortunate enough to be diagnosed by a physician, he is classified as being hypogonadal. The most recent accepted data is half of all men over the age of fifty are classified as hypogonadal. As I have already stated, it is clear from societal observation this number is significantly underestimated. For the purposes of keeping it simple to understand, there are two forms of diagnosed hypogonadism: jl5
,5)-.,)!(-5#(0)&05#(5 &&#(!5-*,'5)/(.-5(5#-),,-5) 5."5'&5,*,)/7 .#05.,.>_85 (.5ijg5BnnkmC95gioh@k8)#9gf8gfglIfgjf7lmil55",*5 65%%%%55 BgooiC85 jm5 "..*9II  #. 0,jf8)'IhfgjIflIflI-)37*,).#(7 ,#(7 )I jn5 )15(!,)/-5,5*"."&.5*&-.##4,->5 (.!,.5**,)"5.)5.)2##.35-5)(5 '.)&#-'65&.,)(5.,(- ,65,.#05)23!(5-*#-5(5&&5-#!(&#(!5)0#65.,5 #&5 3*)."--565)&/'5mj565 --/5j565lhl5@5lhn jo5 )15- 5#-5#-*"()&5
>5/('(.&-5) 5.)2##.395 .)&#-'65&.,)(5.,(- ,5 (5)2#.#05-.,-Kovacic, Peter Medical Hypotheses , Volume 75 , Issue 1 , 1 – 4 kf5 ,#(,35*"."&.5'.)&#.-5,5--)#.51#."5,-5-,/'5.-.)-.,)(5 #(5'(651)'(65(5"#&,(5 ,)'5
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/!5gj8

32

CHAPTER 4

Primary Hypogonadism results from defects of the gonads. Luteinizing hormone (LH) and/or follicle stimulating hormone (FSH) are usually elevated, meaning the problem is in the testicles. Secondary Hypogonadism results from hypothalamic or pituitary defects. Luteinizing hormone (LH) and/or follicle stimulating hormone (FSH) are normal or low, suggesting the problem is in the brain, i.e. a disruption in the HTPA/HPGA. Many doctors classify ‘normal aging’ as the cause of secondary hypogonadism. This author refuses to accept getting softer, weaker, depressed and having a low libido as ‘normal’ and healthy aging. Why would you or any man you know for that matter want to feel this way? Especially knowing there was a way to keep your testosterone elevated to optimal levels for life through the intelligent and scientific usage of TRT.

33

HOW DO I KNOW I NEED TRT? CHAPTER 5




-5 5 0),#)/-5 ,-,",5 ) 5 ."5 ')-.5 ,(.5 (5 ,&0(.5 '#&5 -./#-65 1"#&5 .5 ."5 -'5 .#'5 /.##(!5 5 ),5 '),5 ."(5 5 5 /(,5 &)-5 ).),5 -/*,0#-#)(65 ]05 )'5 .)5 ,5 .",5 ,5 ,/#&5 .),-5 (--,35 .)5 )(-#,5 1"(5 '%#(!5 ."5 #-#)(5 .)5 *,)51#."58

THE ETHICAL DILEMMA OF TESTOSTERONE-PICK YOUR SIDE (5 ) 5 ."5 #!!-.5 "&&(!-5 '(5 5#-5)0,)'#(!5(35'),&5 +/&'-5."35"05 ),5/(,!)7 #(!585 .5#-5'35/.35.)52*&#(5 .",5#-5-)&/.&35()."#(!5'),&&35 1,)(!5 1#."5 ,-.),#(!5 3)/,5 .-.)-7 .,)(5&0&-5%5.)5^)05(),'&_5&0&-5),5..,85-.)-.,)(5#-55 (./,&&35)/,,#(!5"),')(5#(5)."5."5'&5(5 '&5(),#(5 -3-.'85"5 .5.".55(./,&&35)/,,#(!5"),')(65--(.#&5.)5."5 0&)*'(.5) 50,35"/'(5#(!5)(5*&(.5,."65#-5)(.,)&&5(5 ')(#45@5#-5-/,85/.5."#-5#-5."5*,#!'515 #(5)/,-&0-5#(8 34

CHAPTER 5


-55-)0,#!(5/&.5'&65#.5#-53)/,5,-*)(-##&#.35.)5./,(5&')(-5#(.)5 &')(8 Th,5 ,5 ()5 &#'#.-5 .)5 ."5 .),-5 1),%#(!5

5 3)/A -.,--65 #.65 *)&&/.#)(65 !65 *)*/&,5 /&./,65 .85 5 3)/5 )(].5 -.(5 /*5 ),53)/,-& 651")5&-51#&&>5Th#-5#-55-#&(.5*('#85Th50-.5'$),#.35 ) 5'(5,(].50(51,5&)15.-.)-.,)(5#-5(5#--/85)/,5 ,#(-5(5 '#&365 (5 &#%&35 0(5 3)/,-& 65 "05 (5 )(#.#)(5 .",)/!"5 ."5 '--5'#5.)5&#05^/-#(!5.-.)-.,)(5#-5".#(!_65^,/!-5,5_5 (5^!..#(!5)&5#-5$/-.5(5*.5*,.5) 5&# _8 "#&5."#-5))%5#-5().5'(.5.)555.,.#-5#-*/.#(!5."5/,,(.5 1,5)(5,/!-5@5&.5'5*/.5#.5.)53)/5."#-5139 R R R

53)/5"55""651)/&53)/5-1&&)15(5
-*#,#(5.&.5-) 3)/5(5-.)*53)/,5"5 ,)'5*)/(#(!> 53)/5"05#!"5")&-.,)&5(5(5 #*#.),651)/&53)/5.% ."5,/!5.)5,/53)/,5,#)70-/&,5,#-%5 .),-> 5 3)/5 "05 /(,&5 *#(5 (5 (5 )(&35 !.5 ,)/(5 #( 5 1"&"#,5 ),5 ."5 ,-.5 ) 5 3)/,5 &# 5 /(&--5 3)/5 !).5 5 "#* ,*&'(.651)/&53)/5&&)155-/,!)(5.)5,*&53)/,5$)#(.-5-) 3)/5(51&%5!#(>

If you answered “yes” to any of these questions, then please understand the morality is no different when restoring the hormone that best defines your masculinity. It’s just like waking up in the morning and making a cup of coffee so you can start your day with a little caffeine. TRT is a scientifically proven and acceptable treatment. While it has not yet gained widespread social acceptance, remember great men never follow the herd. You owe it to yourself to consider the program outlined in this book.

35

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

TESTOSTERONE DECLINES WITH AGE Th 5#-5 #-5 5 # #/&.5 .),5 .)5 .%&5 -*#&&35 #(5 &#!".5 ) 5 ."5 ^.5 &5 3(,)'kg_5 '(35 3)/(!5 '(5 #(5 ."#,5 &.5 .(-5 (5 ,&35 hf]-5 ,5 2*,#(#(!5 .)385 (5 3,-5 !)65 5 !(,&&35 1)/&5 "05 ,)''(5 5 ()5 -))(,5 ."(5 ik5 3,-5 )&5 /.5 #.]-5)'#(!5'),5(5'),5**,(.5&)15.-.)-.,)(5#-55-#!(# #(.5 *,)&'5#(5'(5) 5&&5!-A-*#&&353)/(!,5)(-8 ),5(35'(5/(,5."5!5) 5if51#."5-3'*.)'-5) 5&)15653)/5'/-.5Ȳ(5 5 ).),5 1#&&#(!5 .)5 '-/,5 3)/,5 &))5 *(&-5 (5 -&.#0&35 2'#(5 3)/,5 *,-(.#(!5 -3'*.)'-85 -*#&&35 # 5 3)/,5 .-.)-.,)(5 #-5 *,)0(5 .)5 5&)15),5&)17(),'&85
(353)/(!5'(5&)15."5!5) 5if51(.#(!5.)5 ',%5)(55)/,-5) 55-")/&5)5."#,5")'1),%85 5"051,#..(5 ."#-5))%5-55-.*737-.*5!/#5 ),5'(5) 5&&5!-5/.5 ]555 ))&5.)5 ().5.&&5'/"53)/(!,5'(5.)5*,)5/.#)/-&35(5&,(5-5'/"5-5 *)--#&5 ),5',%#(!5)1(5."5*."5) 585 The younger you are and especially if your goal is to father children, your doctor should FIRST consider alleviating the stressor or cause of your hypogonadal state. This is preferable to placing a drug in your body (T) which can PRO TIP seize control and or shut down your endocrine system (your body’s natural production of testosterone). If this fails, the next step would be prescribing medications that attempt to raise T (which are not disruptive (or minimally so) of your body’s natural production of testosterone. These medications are written about in depth later in the book in Chapters 9 and 10.

kg5

"..*9II1118(!,(*&38)'IhfgjIfkIhjI'.#(!7*7,,-7-")%I

36

CHAPTER 5

It is important to understand utilizing TRT productively (in whichever delivery system is best for you) is a lifelong strategy. Financial stability is a necessity as engaging in TRT is not without costs. Being able to pay for your treatment and also ancillary medications (when necessary) must be CAUTION factored into day-to-day life expenses. Hence, it is hard for me to recommend TRT for early 20 something’s men who are unlikely financially stable (this is assuming your blood test and presenting symptoms qualify you for a doctor’s prescription of TRT).

It is also an unfortunate fact many physicians will frown upon younger men (under the age of 35) who desire to proceed down the path of TRT. You must respect your doctor’s desire for discretion as there have been legal issues for doctors who prescribed testosterone for what was perceived to be ‘outside the bounds of medical usage.’ If you do choose this course of action, be prepared to intelligently discuss your options with an informed TRT physician based on your symptoms first, blood work second. And make absolutely sure you will be able to afford it. Most importantly, make sure your doctor pursues less disruptive forms or testosterone restoration first (eliminating stressors and using either hCG or clomid monotherapy). I have many anecdotal stories from young men who enjoy the hefty benefits of TRT in their work life (becoming assertive on the job, closing more sales, getting promotions). These men can’t imagine going back to their normal “pre-T” lives. They have fit TRT into their monthly budget as a critical investment into their personal and professional development. In a nutshell, they make more money at work and in business while on TRT to justify the costs many times over.

37

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

If you are a much younger man who feels you are suffering from the symptoms of low T and would benefit from TRT, I recommend you first go online and pay for an independent assay to see if your testosterone blood levels are at a level PRO TIP
low enough for you to seek out an experienced TRT Doctor and initiate a conversation. You can do that by going to this website: XXXTRTRev.com/ blood-tests But remember: low testosterone is a clinical as opposed to a laboratory diagnosis. It is not simply “low testosterone” on blood testing. What constitutes “low” for you may be different than what is considered low for someone else. So make sure the Doctor you are seeking a consult with is experienced and educated in truly understanding how to diagnose men who suffer from low testosterone. To find a list of some of the best TRT physicians available, visit this website: XXXTRTDoctors.com

SYMPTOMS OF LOW TESTOSTERONE 5 ')-.5 #'*),.(.5 )(-#,.#)(5 ),5 1".",5 5 '(5 -")/&5 5 )(5 5 #-5 # 5 ."35 ,5 2*,#(#(!5 ^."5 -3'*.)'-_5 ) 5 &)15 ),5 &)15(),'&5&0&-5) 5.-.)-.,)(855 Th-5(55(35) 5."5 )&&)1#(!9

g8 (.&5 )!5),5&)--5) 5 )/h8 (#-#0(--5),5"-#.(3 i8 %5) 5(,!3 j8 ,-51),%5*, ),'( k8 ,-5 #(5 -25 ,#05 ),5 #&#.35 .) ,"5),!-' l8 ,-5#(5-.,(!."5),5(/,( m8 ,-5^($)3'(.5) 5&# _ n8 ).#&5"(!5#(5"0#), 5 3)/5 "05 2*,#(5 (35 j5 ) 5 ."5 )&&)1#(!5 -3'*.)'-65 3)/ -")/&5-.,)(!&35)(-#,5 /,.",5.-.#(!5(5*).(.#&&3585 5&#05 (35,#.#&&37."#(%#(!5'(5&))%#(!5.)5)*.#'#45."#,5"&."5(51&&7 #(!5 -")/&5 5 /-#(!5 5 )(5 ."#,5 &))5 &0&-5 &&5 #(.)5 ."5 \&)15

38

CHAPTER 5

normal’ range. If your levels are below ‘low’, I see no other recourse but to seek out testosterone replacement therapy. There are two commonly used questionnaires which are sometimes used as a diagnostic in men with symptoms of low testosterone: ADAM and AMS (T"ey are never used in isolation due to their low specificity.)

ADAM (ANDROGEN DEFICIENCY IN AGING MALES) T"is survey is a simple 10 questions survey52 in yes or no format (the questionnaire is positive if there are yes answers to questions 1, 7 plus 3 other questions).

ANSWER YES OR NO TO EACH OF THE FOLLOWING QUESTIONS: g8 h8 i8 j8 k8 l8 m8 n8

)53)/5"055,-5#(5&##)5B-25,#0C> )53)/5"055&%5) 5(,!3> )53)/5"055,-5#(5-.,(!."5(I),5(/,(> 053)/5&)-.5"#!".> 053)/5().#55,-5^($)3'(.5) 5&# >_
,53)/5-5(I),5!,/'*3>
,53)/,5,.#)(-5&--5-.,)(!> 053)/5().#55,(.5.,#),.#)(5#(53)/,5#&#.35.)5*&3 -*),.-> o8
,53)/5 &&#(!5-&*5 .,5#((,> gf8 -5.",5(55,(.5.,#),.#)(5#(53)/,51),%5*, ),'(>

AMS (AGING MALES SYMPTOMS) Th #-5-/,03ki5#-5'/"5'),5.#&5(5#0#5#(.)5i5+/,(.-7 *"3-#&65*-3")&)!#&5(5-2/&5-3'*.)'-855 .5"-5gm5+/-.#)(-855 )/5(5)1(&)5#.5",955 1118!#(!7'&-7-3'*.)'-7-&8#( )I)/'(.-I+/-.#)(8* )."5 ) 5 ."-5 +/-.#)((#,-5 (5 5 /- /&5 /.5 ."35 ,5 )(&35 (5 $/(.5.)55*,)*, clinical diagnosis by an experienced TRT prescribing physician8 kh5 ki5

"..*9II1118*,)-.."&."(./,&&38)'I)1(&)-I

K/-.#)((#,8* "..*9II1118!#(!7'&-7-3'*.)'-7-&8#( )I)/'(.-I+/-.#)(8*

39

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

PRO TIP

It sure would make a lot of sense for somebody in the clinician community to develop a questionnaire designed to monitor the success and or failure of ongoing testosterone replacement therapy.

KNOW YOUR TESTOSTERONE LEVELS, UNDERSTAND YOUR TEST RESULTS Th5')-.5#'*),.(.5)$.#05)(7 -#,.#)(5 ),5 5 #-5 # 5 3)/,5 '7 -/,'(.5 ) 5 ^ ,_5 (5 ^.).&5 -,/'_5 .-.)-.,)(5 &0&-5 ,5 &)15 ),5 )/.5 ) 5 ,(!85*.#'&&3655'(5-")/&52"##.5 .-.)-.,)(5 &0&-5 .5 &-.5 .5 ."5 "#!"7 -.5 (5 ) 5 ."5 (),'&5 ,(!5 B*(7 #(!5)(5."5.).&5.-.)-.,)(5'-/,#(!5 -&C85Th5*,)&'5#-51".5 #(-5."5 \(),'&5,(!]>5Th,5#-5(5#( #(#.5"),')(&5#0,-#.35,)--5."5'&5 *)*/&.#)(5 (5 .",5 #-5 ()5 ,&5 135 .)5 )'*,--5 &&5 '(5 #(.)5 5 ,#!#5 \-.(,5*.#(.]5(),'&5,(!5')&8 Th5 )&&)1#(!5",.5-")1-5."50,#(5,(!-5.1(5."5*,#',35 &))5&5'-/,'(.5)'*(#-85 ),.),3 ),* /-.5#!()-.##)5 ,(5 ),.),#-

),'&5(!5) 5).&5-.)-.,)( ijn@ggom5(!I hkf@ggff5(!I iff@gfff5(!I

Th5#!!-.5#--/51#."5."-5'-/,'(.5)'*(#-5#-5."50,#(5 ) 5 ."#,5 --3-5 .1(5 .).&5 (5 ,5 .-.)-.,)(5 &0&-5 #(5 "&."35 3)/(!5 '(8kj5 "#&5 0,#.#)(5 .1(5 &),.),#-5 ),5 ."5 -'5 .-.)-.,)(5--35B(&3.#&5'.")C5#-5(!&#!#&65."5, ,(5,(!-5 ),5.-.)-.,)(5&0&-5D-51&&5-5&/.#(#4#(!5"),')(5B C5(5 )&&#&7 kj5 "-#(65865.5&865Th5#'*.5) 5--35+/&#.35(5, ,(5,(!-5)(5&#(#&5#-#)(5 '%#(!5#(5."5#!()-#-5) 5(,)!(5#-),,-85.,)#-65hffn85miBgiC95*85gigg7m5

40

CHAPTER 5

stimulating hormone (FSH)] differ widely and significantly between assays.55 This means a critically thinking TRT-prescribing physician can’t ultimately rely on blood levels provided by varying lab assays as an indicator of whether somebody qualifies for TRT or not. Clearly the flaws of laboratory analysis—either due to variation of hormonal production or the inaccuracy inherent to the testing methods—renders evaluation of a man’s hormonal state, at times, more guesswork than science. Do you see the conundrum this presents for TRT prescribing physicians? The assumption there is a specific testosterone level threshold below which the symptoms appear, and the threshold is the same for everybody, is not an acceptable standard. There is far too much variance. Physicians should always treat the clinical presenting symptoms first. If you have blood levels in the normal to high range (usually above 500ng/dl), YOU SHOULD PRO TIP NOT BE PUT ON TESTOSTERONE. There are always exceptions to the rule but under normal circumstances a patient must possess not only low to low normal blood testosterone levels but 4-5 of the accepted low T symptoms before obtaining a prescription for TRT. Remember: This book is written in the context of HEALTH and LONGEVITY only. This is not a book about the prescribing or use of anabolic steroids or synthetics for performance enhancement. The Long Term Goal of TRT should be about improving quality of life.

kk5 #%,#-65865.5&865*,)/.#05"),')(5, ,(5#(.,0&-5 ),5"&."35 ,.#&53)/(!5 '(950&/.#)(5) 5/.)'.5*&. ),'5--3-85 5&#(5(),#()&5 .65hffk85ofBggC95*85 kohn7il8

41

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

+2: 72*(77(67(')25/2:7(67267(521(

When working with a knowledgeable and experienced TRT physician, have him order your blood test. Realize the process may be slower and potentially more expensive (than from an online private lab measurement company) depending on whether you have a medical benefits plan. Just make sure to inform and engage your doctor about your long term goal of using TRT productively. Some doctors are more flexible in their criteria for justifying blood tests and will work with you to ensure everything is evaluated closely. I define and discuss the important lab assays (blood tests) needed in finer detail in Chapter 10. Any doctor who provides unnecessary resistance to getting a blood test (let alone discussing TRT) is probably going to be troublesome and unhelpful to the process. If he or she is unwilling to intelligently discuss your request or rejects it out of hand, it is your right to seek the counsel of another CAUTION doctor. When this happens (and it happens far too often) it usually indicates your doctor doesn’t understand the importance of optimal testosterone levels and vitality. You now know conclusively symptoms can often trump blood values when dealing with low testosterone. It is imperative the doctor you work with is able to intelligently discuss your individual condition (respective of your blood panels and symptoms) and can formulate a sound and safe clinical diagnosis moving forward.

42

CHAPTER 5

One simple and inexpensive preliminary way (before having your doctor order comprehensive labs) to measure your serum testosterone levels is to order a TRT blood test online. It’s easy, fast, convenient and as simple as ordering PRO TIP
a book from Amazon.com. You just go to the website, add the blood test to your cart, and checkout/pay. After placing the order, you then go to the closest participating blood testing lab in your area (as referred to by the website) at a time that works with your schedule and get your blood drawn. The lab visit should take less than 10 minutes You’ll receive your results typically within a few days via email. It is a good idea before embarking down the long term path of TRT under the guidance of your physician to know your current blood Testosterone levels before getting started. Your TRT-prescribing doctor should be able to use these private lab results in making a diagnosis of whether or not you qualify for TRT. However if they will not accept them (and the test does reveal suboptimal blood testosterone levels) they are still an excellent discussion point in your initial consultation and conversation.

43

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

For men in their 20’s and 30’s fortunate enough to be undergoing TRT, I recommend you get your blood drawn at least once a year. For those of you in your 40’s PRO TIP
and up, twice a year is best. An Anti-Aging Panel is highly recommended for anybody 35 and up. You can get one here: XXXTRTRev.
com/anti-aging-panel If you are not already doing so, you should begin regularly getting your blood work done so you can compile and reference all of your blood panel data for life. Having a detailed timeline from your very first/initial blood testosterone panel will provide excellent comparison points as your values and biomarkers change over time. And they will change without doubt. It is part of the process we call aging.

0#)/-&35 3)/,5 *"3-##(5 1#&&5 5 )/'(.#(!5 ."#-5 /.5 5 &-)5 ,)''(5 3)/5 %*#(!5 )*#-5 ) 5 3)/,5 &))5 *(&-5 3)/,-& 5 -)5 3)/5 (5)'5#(.#'.&351,5) 5."5"(!-53)/52*,#(85)53)/,5 ")'1),%5(5%()153)/,5)385 51#&&55#-/--#(!5."5.3*5) 5&))5 *(&-5 5 *,)!,--#05 7*,-,##(!5 *"3-##(5 -")/&5 5 ),,#(!5 &)(!51#."5."5#'*),.(5) 5')(#.),#(!5."'5#(5"*.,5gf85

44

TESTOSTERONE REPLACEMENT THERAPY NON-INJECTABLE OPTIONS CHAPTER 6



",5 ,5 5 (/',5 ) 5 **,)05 -.,.!#-5 ),5 85 Th35 #Ŀ,5 (5 0,35 &')-.5 -5 '/"5 -5 ."5 *"3-##(-5 '#(#-.,#(!5 ."'85 -5)(5(,&35gk53,-5) 52*,#'(..#)(51#."50,35#Ŀ,(.5.3*5) 5 5�,35-3-.'5B1"#&5/(,5."5&#(#&5,5) 5).),-5(5&-)5 (!!#(!5(5)(-/&.#(!51#."5"/(,-5) 5'(C5 5(5.,(-*,(.&35-35 ().5&&5) 5."'5,5+/&5#(5."#,5Ń385 .5 #-5 #'*),.(.5 .)5 #-/--5 ."5 /,,(.5 (5 ')-.5 *.5 �,35 -3-.'-5-)5."5,,5(5'%5(5#( ),'5#-#)(51"(5)'*,#(!5 #.5.)5'35*, ,,5(5,)''(5)*.#)(8 There are many TRT-prescribing physicians who will disagree with this author’s recommendation. It is important for the reader to understand this book is written as a guide for men who desire to optimally raise their testosterone to the higher end of the accepted range. My optimal protocol CAUTION doesn’t ever raise T levels to supraphysiologic levels often seen with anabolic steroid abusers. Many TRT prescribing clinicians are interested in restoring aging men to “normal” or “middle range” testosterone levels. Many of these folks are the primary prescribers of non injectable TRT. There is nothing wrong with such a strategy. In my opinion, my protocol does the best job of maximizing blood test levels (within accepted ranges) while improving health and minimizing side effects regardless of age. Maximizing blood test levels (while staying within accepted ranges) will provide the ultimate experience men are looking for when undergoing TRT. 45

CHAPTER 6

Th5 )&&)1#(!5",.5)/.&#(-5."5/,,(.5(5*.5 ),'-5) 58 TeSTOSTeRONe RepLACeMeNT THeRApieS AppROVeD FOR uSe iN THe u.S. Advantages

disadvantages

Estimated

delivery

Route of

Standard

System

delivery

Dosage for

Monthly

Androgen

Cost

(drug)

Deficiency Testosterone esters

Intermuscular

100 mg

Inexpensive;

Roller-coaster

every week

administered

pharmacokinetics,

or 200 mg

Testosterone

every 2 weeks

requires injection $65-95

every weeks

enanthate Testosterone cypionate Testosterone

Subcutane-

Two to six 75

Convenient

Expensive, requires

pellets

ous

mg pellets

6-month biological

small insision, high

duration

available only

every 3 to 6 months

rate of extrusion,

$150

through manufacturer

Buccal

Buccal

Testosterone

Testosterone

Nonscrotal

patch

topical

30 mg twice

Testosterone

Expensive, twice-

a day

levels within

daily dosing, possible

physiologic range

oral imitation

Mimics circadian

Expensive, daily

rhythm

administration,

5 mg/day

$250

$250

skin irritation Testosterone Gel

Topical

5 g/day

Testosterone

Expensive, daily

levels within

administration,

physiologic range

possible

$300

transference to intimate contacts

46

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

TRANSDERMAL CREAMS AND GELS (ANDROGEL)
(,)!&5 #-5 ."5 †g5 ')-.5 *,-,#5 5 *,).))&5 #(5 ."5 1),&8kl55 Th,5 ,5 '#&&#)(-5 ) 5 '(5 ,)/(5 ."5 1),&5 /-#(!5 #.85 (35 ).),-5 &#05 #(5 #.-5 .",*/.#5 0&/5 #(5 ,#-#(!5 &)15 .-.)-.,)(85Th5!&-5)'5#(5#.",5g65h65k5(5 gfz5 )((.,.#)(-5 (5 1"(5 **&#5 #(5 ."5 '),(#(!5*,)/5\*"3-#)&)!#5-,/'5&0&-8]5 (5'35 )*#(#)(5#.]-5-/7)*.#'&5 ),55(/',5) 5,-)(-85 ,#',#&35/-5#.]-5#Ń/&.5.)5)(.,)&5."5�,35) 5."5)-!5) .(5 .#'-5 &#(!5 .)5#(+/.5-,/'5.-.)-.,)(5&0&-85 (5'35)*#(#)(65 -),*.#)(5 .",)/!"5 ."5 -%#(5 #-5 #(Ń#(.5 /5 .)5 ))5 )(-/'*.#)(65 -1.5!&(-65.85 .(5.#'-5."#-5#()(-#-.(.5-),*.#)(5,.5*,)/-5 (5 #(,-5 #(5 5 &0&-5 (5 *).(.#&&35 -.,)!(#5 -#5 Ŀ.-5 &#%5 */Ŀ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Ń/&.5 .)5 '#(.#(5 -.&5 &))5 0&/-5 /5 .)5 *)),5 -),*.#)(5 ,.-85 (5 '35 )*#(#)(65g7hz5,'-I!&-51#&&5(0,5,#-53)/,5.-.)-.,)(5&0&-5.)5(5 )*.#'&5,(!5.".5(55"#051#."5#($.&5 ),'.-8

kl5 /565/*.5651(!565.5&85-.)-.,)(5*",')%#(.#-5 .,5** .#)(5) 5(5#(0-.#!.#)(&5.,(-,'&5-3-.'5#(5"3*)!)(&5'(85 5&#(5",')&85 goom:im9ggio@ggjk85D/ ED 5&#-.E

47

CHAPTER 6

Dr. John Crisler, author of the excellent book Testosterone Replacement Therapy-Recipe for Success57, believes transdermal delivery systems are superior to injectable formats. His belief is based on years of clinical experience with hundreds of patients. His theory is that transdermal delivCAUTION ery systems produce a serum androgen profile which varies greatly during the day-essentially mimicking the endogenous T production of a young healthy male. Better stated, entropy (randomness) in hormone levels best replicates the feelings of youth. Because they also elevate DHT, the transdermals are better at addressing sexual dysfunction58.

TESTOSTERONE PELLETS &&.-5 ."5 -#45 ) 5 i5 ''5 35 o5 ''5 )(.#(#(!5 .-.)-.,)(5 ,5 -/,!#&&35 #'*&(.5/(,5."5-%#(5B/-/&&35(,5."5 "#*C5 (5 ."(5 -&)1&35 ,&-5 .-.)-.,)(5 )0,5 ."5 )/,-5 ) 5 i7l5 ')(."-8ko5 &&.-5 ,5 &#05 .)5 "05 ."5 &)(!-.5 /,.#)(5 ) 5 .#)(5 ) 5 &&5 ),'-5 ) 5 5 )(5 ."5 ',%.5 .)385 -5 ) 5 ."#-5 ),'5 ) 5 .",*35 #-5 -/)*.#'&85 #,-.5 ) 5 &&65 .",5#-55,#-%5) 5#( .#)(5(5),5"'),,"!5.5."5*)#(.5) 5#(-,.#)(5 1"(0,5 (3)(5 #-5 2*)-5 .)5 -/,!,385 .5 #-5 &-)5 #Ń/&.5 .)5 )(.,)&5 ."5)((.,.#)(5) 5."5)-!5/*)(5#(-,.#(!5."5 #,-.5*&&.-85 53)/,5 &))5&0&-5#(#.53)/5(5'),5),5&--5) 53)/,5)-!53)/,5*"3-##(5 1#&&5"05.)5!#(5*, ),'5#(0-#05-/,!,35.)5.#.,.5.",*3850#(!5 .)5 ,)/.#(&35 "05 )/.*.#(.5 *,)/,-5 .)5 5 ),5 2.,.5 *&&.-5 #-5 5 (/#-(85 35,)''(.#)(5#-5.)5)(-#,55#Ŀ,(.5 ),'5) 58

BIO-IDENTICAL TESTOSTERONE km5 "..*9II1118.,.,08)'I.-.)-.,)(7,#* kn5 -.)-.,)(5*&'(.5Th,*37
5#*5 ),5/--7,85 )"(5,#-&,5*!8ii5

#&-.)(-5/&#-"#(!5B ,"5gi65hfgkC ko5 &&",565)(135
65(&-'(5 85 ( &/(5) 5#'*&(..# (5-#.5(5.,%5 !)'.,35)(5."52.,/-#)(5,.5(5*",')&)!35) 5.-.)-.,)(5#'*&(.-85&#(5(),#7 ()&8hffg:kk9kig@kil85D/ E

48

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

The term ‘bio-identical’ is often misconstrued. Even by physicians. It is often claimed bio-identical testosterone is “better” or more “natural” than pharmaceutical-grade testosterone. Case in point, “Bioidentical preparations are better because they’re synthesized to be exactly like human testosterone circulating in the blood.” UNTRUE. Pharmaceutical grade injectable testosterone IS bio-identical. It is an “esterified” form of testosterone. In other words, testosterone is attached to a carrier molecule (the ester) which is enzymatically cleaved (broken off), leaving testosterone, the “identical” molecule that your gonads produce. The fact that a testosterone preparation (testosterone cypionate, for example) is pharmaceutical grade, DOES NOT equate to it being a potentially dangerous “synthetic,” the all-too-often abused substance of bodybuilders. “Synthetics” are NON-bio-identical testosterone-like substances, synthesized in the lab (or potentially in someone’s garage) which promote anabolism. Foreign to the body (unlike bio-identicals), synthetics put the user at risk for a whole host of dangerous side effects (liver dysfunction and cancer, for example). I do not advocate the usage of synthetics. The risks simply outweigh the benefits. This is about health after all, right? Th is is NOT about bodybuilding.

BUCCAL PREPARATIONS Th#-5'.")5#-5**&3#(!55.&.5) 5),&5 .-.)-.,)(5'#.#)(5.1#5#&35.)53)/,5 !/'-5-)5#.5-),-5#(.)53)/,5&))-.,'85 ()1(5-55^3&)2.,#(7)'*&25.-7 .)-.,)(5-/&#(!/&5 ),'/&.#)(_5),55.,)7 "65."#-5 ),'5) 55#-5-),5,*#&35 #(.)5#,/&.#)(51"#&5."5.-.)-.,)(5#-5,&-5 ,)'5the 3&)2.,#(5 -"&&8lf5).5)(&35#-5."#-5(5#(Ń#(.5'.")5) 5!..#(!5.-.)-.,)(5#(.)5 3)/,5-3-.'65/.5."5*).(.#&5-#5Ŀ.-5) 5#-&)!5.&.-65&#(!5 !/'-65')/."5-),-65.)).""-5(5""-5'%5#.5#&&50#-85&/-5 lf5 &"#(565(!565
&2(,565.5&85",')%#(.#-65#)Ń365(5- .35 ) 5-/&#(!/&5.-.)-.,)(53&)2.,#(5#(5"3*)!)(&5'(95)'*,#-)(5.)5.-.)-.,)(5 ((.".5@55&#(#&5,-,"5(.,5-./385 5&#(5(),#()&5 .85gook:nf9iklm@ikmk85 D/ E

49

CHAPTER 6

."5#&#.35.)5.,(- ,5."5-/-.(5.)53)/,5*,.(,50#5%#--#(!5#-5135.))5 ,#-%385
(51".5)/.5."5#--/5) 5#(!-.5 ))-5(5&#+/#-5)'#(#(!5 1#."5."5/&5.-.)-.,)(5*,*,.#)(>5
!#(65'35,)''(.#)(5#-5 .)5"))-55..,5 ),'5) 58

PATCHES ,(-,'&5 .-.)-.,)(5 #-5 &-)5 0#&&5 -5 5 -,).&5 -%#(5 *."85 ,).&5 *."-5 *,)/5 "#!"5 &0&-5 ) 5 #"3,).-.)-.,)(5 BC5 /5 .)5 "#!"5 k7&*"7,/.-5 (43'5 .#0#.35 ) 5 -,).&5 -%#(8lg5 Th#-5 #-5 5  555-5"#!"5&0&-5) 55 ,5 .)5 5 0)#5 /5 .)5 ."#,5 #&#.35 .)5 *,)/5 /(1(.5 -#5 Ŀ.-5 &#%5 (65 "#,5 &)--5 (5 *).(.#&5 *,)-..5 #--/-5#(5-&.5#(#0#/&-855 Th#-5 ),'5 ) 5 5 (5 &-)5 /-5 -%#(5 #,,#..#)(5 .5 *&5 ) 5 "-#)(85 ".5 '(5 1(.-5 .)5 5 /!".5 #(5 (5 #(.#'.5 -#./.#)(5 1#."5 5 1)'(5 1"#&5 1,#(!5 5 -,).&5 *.">5 &&3>5 5 ."#(%5 3)/5 -")/&5 *--5 )(5 ."#-5 �,35-3-.'8
&&5 ) 5 ."-5 5 )*.#)(-5 1),%65 /.5 #(5 '35 )*#(#)(5 ,5 ,5 ,)'5 )*.#'&85Th#,5( #.-5)5().5)/.1#!"5."#,5*).(.#&5-#5Ŀ.-85Th#-5 ))%5 #-5 1,#..(5 ),5 '(5 1")5 1(.5 .)5 2&5 #(5 &&5 *"--5 ) 5 &# 5 0#5 )*.#'&5 .-.)-.,)(5 &0&-85 "35 1)/&5 '(5 &))%#(!5 .)5 )'5 '),5 '*)1,5(5*"3-#&&35)*.#'&51(.55*,*,.#)(-5-)5'#&5."35 )(&35 ,#-5 .-.)-.,)(5 &0&-5 .)5 ."5 \(),'&5 ,(!]>5 (5 #.#)(5 ."#,5 *)),5 -),*.#)(5 (5 '#(#-.,.#)(5 ,.-5 ,5 *).(.#&&35 #,,#..#(!65 *#( /&5 (5 5 (/#-(85 Th35 ) .(5 )(0,.5 .)5 5 1"#"5 &-5 .)5 /(1(.5-#5Ŀ.-85)5."(%-855

lg5 #'5 65")565 565#'585),'/&.#)(5) 55,-,0)#,7.3*5.-.)-.,)(5 .,(-,'&5�,35-3-.'85 (.5 5",'85hffg:hgoBg@hC9kg@ko85D/ E

50

TRT VIA INTRAMUSCULAR INJECTION AND MY OPTIMAL TRT PROTOCOL CHAPTER 7




-5 ]05#(.#'.5*,0#)/-&365(35&!#.#'.55*"3-##(5-")/&5 2*&),5&&5)*.#)(-5.)5 #(5."5-.,--),5),5/-5) 5&)15.-.)-.,)(5  ),5 #(#.#.#(!5 ./&5 .-.)-.,)(5 ,*&'(.5 .",*35 B-*#&&35 1#."5'(5/(,5."5!5) 5if5&))%#(!5.)5,'#(5 ,.#&C8 (,-.(#(!5."#-65."5.",5,)''(50#.&5&# 5',%,-5\.".5 -")/&5_5'.5 ),5!#((#(!595 g8
!5if5),5)&,5B# 53)/(!,65*,)51#."5/.#)(65)553)/,5 ")'1),%5(5'%5-/,53)/],5 #((#&&35&C85)/5'/-.5&-) Ȳ(5(51),%51#."55*,)!,--#057*,-,##(!5*"3-##( 1#&&#(!5.)51),%51#."53)/5-")/&53)/,5*,-(.#(!5-3'*.)'-5( &))5&0&-51,,(.55&)155#!()-#-C8 h8 -.)-.,)(5&0&-5&)1,5."(5kff5)(550,#fi&5&))5.-. B5#.5,&&35*(-5)(53)/,5  5# 5.5."5"#!",5(5) ."#-5^&)15(),'&_5,(!85
&-)5,'',5#Ŀ,(.5&))5.-. )'*(#-5*,)0#50,3#(!5,(!5&5--350&/-5.".5#Ŀ, 1#&35(5-#!(# #(.&5lhC5"3-##(-5-")/&55"-5& (/',-5(5&,&350&/.5-3'*.)'-5 #,-.5(5 ),')-. i8 2*,#(#(!5j5),5'),5) 5."5-3'*.)'-5) 51".5#-5,)!(#4 -5&)15.-.)-.,)(8 55555&.#'.&35 3)/,5 *"3-##(5 #-5 0&/.#(!5 3)/,5 &#(#&5 -3'*.)'-5 -5 "#-5 #(&5 .,'#((.5 ),5 #!()-#-85 3'*.)'-5 ,5 ."5 5 lh5 "-#(65865.5&865Th5#'*.5) 5--35+/&#.35(5, ,(5,(!-5)(5&#(#&5#-#)(5 '%#(!5#(5."5#!()-#-5) 5(,)!(5#-),,-85.,)#-65hffn85miBgiC95*85gigg7m5

51

CHAPTER 7


5 .,'#((.5 ) 5 1".",5 5 '(5 -")/&5 !#(5 5 5 ,!#'(8 5."-5&&5**&35.)53)/65#.5#-5,-)(&5.)5)(-#,53)/55(#.5 ),58

INTRAMUSCULAR INJECTION (IM)
-5*,0#)/-&35#-/--65.",5,5'(3513-5.)5#(,-5.-.)-.,)(5 0#50,#)/-55*,).))&-85
&.")/!"55.)*#5) .(5.5#(-#5(.#7 !#(!65 (),#()&)!35 (5 7*,-,##(!5 #,&-65 5 &#05 B-5 )(5 (,&35gk53,-5) 52*,#(51#."50,355�,35-3-.'C5."5-#(!&5 ')-.5Ŀ.#05 ),'5) 55.)5)*.#'#45.-.)-.,)(5&))50&/-5#-50#5 #($.#)(85 Th,5 #-5 ,(.5 -#(.# #5 0#(5 &-)5 -/**),.#(!5 '35 )*#(#)(li85 ",5 ,5 )/,5 '#(5 .3*-5 ) 5 #($.&5 .-.)-.,)(5 ),'/&.#)(-5 )/(5)(5."5',%.5.)38

TESTOSTERONE CYPIONATE AND TESTOSTERONE ENANTHATE Th5 '$),#.35 ) 5 7*,-,##(!5 *"3-##(-5 *,-,#5 nf@hff5 '!5 )--5 ) 5 #($.&5 .-.)-.,)(5 3*#)(.5 (5 .-.)-.,)(5 ((.".5 0,35 m@hg5 3-85 Th5'!5)-!5')/(.-50,35*(#(!5 )(5 ."5 ).),5 (5 ."#,5 #(#0#/&5 '."))&)!#-85 Th#-5 #-5 (5 )-,05 *,).))&5 ) 5 '(35 7*,-,##(!5 &#(##(-5 ),5."5 )&&)1#(!5,-)(-9 R R

/-53*#)(.5(5((.". ($)35&)(!,5"& 7�-65."3 &&)15."5/-,5.)5'#(#'#45."#,5#($.#)(5 ,+/(38

(35'(5"05(&5*")#5(5)(].51(.5.)5'#(#-., ,+/(.5#($.#)(-85),5)5).),-51(.5."#,5-.ĿI(/,--5.) *,*,5'/&.#*&5')(."&35#($.#)(-5 ),5."#,5&#(.-5(5."( -(5."'5#(5."5'#&5B1"(51),%#(!51#."5&#(.-50#,./&&3C8

li5 ($.#)(5) 5-.)-.,)(5 355 ,5(5 ),5Ŀ.#05."(5,(-,'&5
'#(#-.,.#)(5 ),5)'.#(!5 )--5) 5 /-&5(5)(5#(5&,5'(7.*"(585),-.5(5

)-"/585,,)17
'5 5"3-#)&5(),#()&5 .5B
*,#&5hg65hfgkC5

52

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

R

R

'!#(5."5&##&#.35*).(.#&&35 51#."5-)'5#(2*,#(5 *.#(.51")5(].5#($.5"#'-& 85 .5#-5&-)5'/"5'),5)(0(#(.5 ),55'(5.)50#-#.5"#-5).),])Ń5)(551%5 ),5"#-51%&35),50,37).",71%&35#($.#)( ."(5#.5#-5 ),5"#'5.)5)'5#&35),5#($.5"#'-& 5#&35B-*#. '(35#.#-51")5,5/-.)'5.)5#($.#(!5."'-&0-5)(5 #&35-#-51#."5#(-/&#(C8 ((.".5 (5 3*#)(.5 ,5 '--7*,)/5 35 )'*)/(#(! *",'#-5(5."#,51")&-&5)-.5#-5
5
8

-.)-.,)(5 3*#)(.5 (5 ((.".5 ,5 0#,./&&35 #(.#&5 #(5 ,&-5 *..,(-5 (5 .",5 #-5 &#..&5 #Ŀ,(5 .1(5 ."5 .1)5 "'#&&385 Th5 -.,5 )/(5 #(5 )."5 "-5 (5 .#05 "& 7&# 5 .1(5 k5 B((.".C5(5l5B3*#)(.C53-5/.5&))5&0&-5 &&5-",*&35j53-5  .,5'#(#-.,.#)(8lj5

Patients are often prescribed what I believe to be inadequate 80-100 mg doses of cypionate or enanthate injected once every 14-21 days. This creates wide swings in serum androgen levels. As already mentioned above, the result is too many peaks and valleys of both testosterone and estroCAUTION gen causing an emotional up and down feeling due to the lack of balance between the two hormones. Patients are then prescribed an aromatization inhibitor (AI) like Arimidex (Anastrozole) as a result to fix the lj5 )-5
65 #%&5
65
,0,565(,-565,'&65 4,5
85",'7 )%#(.#-65Ń365(5- .35) 55*,'.#)(5("(5.-.)-.,)(5.,(-,'&5-3-.'5#(5 )'*,#-)(51#."5#71%&35#($.#)(-5) 5.-.)-.,)(5((.".5 ),5."5.,.'(.5) 5"3*)!)7 (&5'(85 5&#(5(),#()&5 .85gooo:nj9ijlo@ijmn85D/ E

53

CHAPTER 7

problem of increased estrogen inadvertently created from the dosing schedule. It is very rare (except in specific cases of high body fat individuals or older men) that a patient should be started out on an aromatase inhibitor (AI). The need for estrogen control must be proven first. This is why follow up labs are crucial to understand what is really going on in that individuals endocrine system as a response to using supplemental T.

It is the author’s opinion it is imperative when undergoing TRT one avoids the peaks and valleys often caused by longer acting (half-life) testosterone esters dosed too infrequently. This produces what many prescribing physicians PRO TIP observe as a roller coaster effect of rapid fluctuations in plasma estrogen (E) and testosterone (T).65 How can the mass prescribing of cypionate/enanthate be beneficial under this “normal TRT protocol” of one shot every 14–21 Days? Clearly it is not. The most progressive TRT prescribing physicians are doing a much better job of administering cypionate and enanthate by utilizing 1-2x a week injection protocols and also providing the correct dosage necessary (80-200mgs every 7-10 days depending on patient response) to minimize peaks and valleys. Dr. John Crisler adamantly recommends (and I agree) T injections be administered at a maximum frequency of 7 days. I would also point out it is IMPERATIVE when first beginning a TRT protocol, no other medications which manipulate hormone levels (AI’s) be dosed (except for hCG potentially) to find out how the testosterone dose affects that person’s endocrine system by itself. Once follow up labs are received, it may be practical to start a patient on an AI if aromatase inhibition is warranted. There are exceptions to this rule further discussed in Chapter 9.

lk5 ",5 65.5&85",')&)!35) 5.-.)-.,)(5*,*,.#)(-85 (95#-"&!565",5  65#.),-8-.)-.,)(65.#)(65 ##( 365-/-.#./.#)(85',#!5(#0,-#.35,--:5hffj85 **85jfk@jj8

54

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

TESTOSTERONE UNDECANOATE T"#-5#($.&5.-.)-.,)(5*,*,.#)(5 #-5 ..,5 %()1(5 -5 #)5 (5 #-5 /-5 #(5 /,)*5 (5 (#(0#(5 )/(.,#-85 7 (.&365
05 ) 5 ()5 ",'/.#&-ll5 "-5 )'5 0#&&5 #(5 ."5 85 5 T")7 ,.#&&365#.5#-55*, .5 ),'/&.#)(5/-5 #.5 "-5 5 0,35 &)(!5 "& 7&# 5 (5 #-5 #($.5 )(&35)(50,35gf5.)5gj51%-8lm5 (5*,7 .#65'(35'(51")5"05/-5#.5&#'5.)5 -/Ŀ,5 ,)'5 ."5 (),'&5 \0&&3-]5 2*.5 ,)'55&)(!,5.#(!5.-.)-.,)(5-.,5&)-7 #(!5#.-5Ŀ.#0(--5.)1,51%-5m@gf85 .5 "-5 "-5&-)5().&&35(5 )/(5.)5,,&35,#-5.-.)-.,)(5&0&-5)05 ."5'#,(!5) 5\(),'&]5B1"(5'-/,5.1(5j7n51%-5#(.)5.",7 *3C85 ".5 #-5 ')-.5 )(,(#(!5 #-5 ."5 #5 ) 5 "0#(!5 "#!",5 -.,)!(5 1#."50,35&#..&52)!()/-5.-.)-.,)(5& .5 ,)'5."5),#!#(&5#($.#)(5 1"#&51#.#(!5 ),5."5(2.5#($.#)(5.)5)'85
05-5) 5,(.5,*),.65 #-5()15&&)1#(!5&#(##(-5.)5.#.,.5.",*3535,-#(!5."5/,.#)(5 .1(5#($.#)(-85 5&#05."#-5 ),'5) 55"-55*,)'#-#(!5 /./,5 /.5)-5().5,#0&5'35)*.#'&5(5,)''(5*,).))&5/,,(.&38
5(1,5),&5*-/&5 ),'5) 5-.)-.,)(5(().652.),)5 "-5,(.&35**&#5 ),5
5**,)0&5/.51-5,$.85 (5."),35#.5.))5 )Ŀ,-5!,.5*,)'#-5-5#.5#-5-),50#5."5&3'*".#5-3-.'53*--#(!5 ."5�,8 .5-")/&5&-)55().5
0]-51-#.5)Ŀ,-550,35-.,(51,(#(!5 ) 5 ."5 ,#-%5 ) 5 ^-,#)/-5 */&')(,35 '#,)')&#-'5 B C5 ,.#)(-5 (5(*"3&2#-_5/*)(5#($.#)(85Th#-5#-5/5.)5."5"'#&5*,.#/&.-5 #(5 ."5 #($.&5 ),'/&.#)(5 B.)5 2.(5 #.-5 "& 7&# C5 #(!5 *).(.#&&35 ",' /&5.)5-)'5/-,-855 ll5 "..*9II11180/-8)'I lm5 )(5%,-.#(65#-"&!585,.'(.5) 5'&5"3*)!)(#-'51#."5.-.)-7 .,)(5/(().5#($.5.52.(5#(.,0&-5) 5gh51%-955*"-5 5-./385 5
(7 ,)&8hffh:hiBiC9jgo@jhk85D/ E

55

CHAPTER 7

TESTOSTERONE PROPIONATE Testosterone propionate is a fastacting, short half-life (2.25 days) testosterone ester. The testosterone ester determines how long it takes your body to dispose of the hormone in question and propionate is one of the shortest esters available NERD NERDALERT ALERT with a testosterone base. There are enzymes in the body called ‘esterases’ which are responsible for removing the ester from testosterone. Once the ester is removed, all that is left is just the testosterone molecule itself. The longer the ester, the longer testosterone is active in the body and the less overall testosterone dosage is absorbed. Because of testosterone propionate’s short half-life, peak blood levels can be modulated via injection frequency. When dosed daily or every-otherday (EOD) propionate can mimic the testosterone your body naturally produces. Its half-life is shorter than the longer-acting esters of cypionate and enanthate. In fact, after a single injection of 50 mg, the maximum concentration is reached after approximately 14 hours.68

Th5",.5&)15-")1-5")15'/"5.-.)-.,)(5#-5-),5(5/-5 ),5 "5 gff5 '!5 #($.85 *(#(!5 )(5 ."5 1#!".5 ) 5 ."5 -.,65 ."5 #($.&5 ),'/&.#)(-5 �,5 #Ŀ,(.5 (.5 #)0#&&5 '!5 ')/(.-85 ),52'*&65# 53)/5#($.5gff5'!5) 5.-.)-.,)(5/(().65)(&35li5 '!5) 5#.51#&&550#&&5 ),5/-535."5)38 100 mg of injectable as:

Approximate Free equivalent (how much actually gets used by the body from a 100 mg dosage):

Testosterone Propionate

83 mg

Testosterone Enanthate

72 mg

Testosterone Cypionate -.)-.,)(53*#)(.

70 mg

Testosterone Undecanoate

63 mg

ln5 ",5 65.5&85",')&)!35) 5.-.)-.,)(5*,*,.#)(-85 (95#-"&!565",5  65#.),-8-.)-.,)(65.#)(65 ##( 365-/-.#./.#)(8',#!5(#0,-#.35,--:5hffj85 **85jfk@jj

56

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL


-5 3)/5 (5 -5 .-.)-.,)(5 *,)*#)(.5 #-5 ."5 ')-.5 Ŀ.#05 ),'/&.#)(5 B ,)'5 5 *%5 )((.,.#)(5 -.(*)#(.5 )(5 5 '!5 *,5 '!5 -#-C5 )/(5)(5."5',%.5.)385 .5"-5,(.&35)'5.)5'35..(.#)(5."5
5'35 ,)1(5/*)(5."5 #-*(-#(!5) 5.-.)-.,)(5*,)*#)(.5#(-.5) 5.-.)-.,)(53*#)(.5 ),5((.".535*"3-##(-85Th5,-)(5!#0(95^#.5#-5/-5'),5) .(5 ),5 *, ),'(5 )*.#'#4.#)(5 &#%5 5 B!,)1."5 "),')(C5 (5 #-5 5 ,5 &!_85 5(5-)&/.&350,# 35.",5,5(/',)/-5*"3-##(-5*,-,##(!5 .-.)-.,)(5 *,)*#)(.5 #(5 ."#,5 *,.#-5 1#.")/.5 #--/85 Th#-5 '35 1,,(.5 /,.",5')(#.),#(!5 ),5(35*.#(.5),5).),5/-#(!5.-.)-.,)(5 *,)*#)(.85

PRO TIP

30-50 mgs of Testosterone Propionate injected every other day (EOD) is an excellent option and my recommended protocol for long term TRT administration.

(5 &#/5 ) 5 ."5 
]-5 ,(.5 -.(5 )(5 ."5 /-!5 ) 5 -.)-.,)(5 ,)*#)(.5(5."5*)--##&#.35) 53)/,55*,-,##(!5*"3-##(5#(!5 /(&5 .)5 -,#*.5 #.65 ."5 *, ,,5 &.,(.#05 1)/&5 5 5 Cypionate/ Enanthate dosage protocol of 50-100 mgs every 3rd day85),5.")-5*.#(.-5 1")5,52.,'&35(&5*")#653)/5(5)5)(5#(.,'/-/&,5#($.#)(5 ) 5gff7hff5'!-50,35m."535B)(5*,51%C5#(-.8 .5#-5#'*),.(.5.)5'#(.#(5m53-5-5."5'2#'/'5.#'5.1(5 -").-5Bgff7hff5'!-5)-!C5(5"(51"35.1)5-").-5Bkf7gff5'!-5*,5 )-!C50,35-0(53-5#-5)*.#'&85Th5^,#!".5)-!_5#-5(5#(#0#/&5 ."#(!5(5#.51#&&5,+/#,53)/5(53)/,5).),5.-.#(!5&0&-5) 55(55 .)5-.&#-"5(5'#(.#(5&(85&(5-")/&55 #(5-5 &#(!5 !,.51#."5'#(#'&5.)5()5-#5Ŀ.-85

57

CHAPTER 7

CAUTION

As is continually stated in this book, if you live in a country or state where it is illegal to administer testosterone without a doctor’s prescription, then choosing the route of selfadministration without a legitimate prescription is breaking the law. I do not assume any liability for the information presented. I urge all of my readers to educate themselves on the laws of their respective country or state.

THE FDA IS NOT THE ENEMY Th5 (#.5 ..-5 
5 B))5 (5 ,/!5
'#(#-.,.#)(C5 #-5 5 0,35 #Ń/&.5 !(35 .)5 *,#.5 "0#),&&385 (5 hfgj5 #.5 **,5 ."35 1,5 Ŀ./&&35 ..'*.#(!5 .)5 ^(,,)15 ."5 )Ń#&5 **,)0&5 !/#&#(-5 ),5.-.)-.,)(5,*&'(.5.",*3_51"(5 69 their 2*,.5*(&- urged them to limit the indication for prescribing TRT “to men whose low testosterone stems from an acute medical problem such as damaged testicles or thyroid disease.” But then a recent hfgj5 ,/&#(!5 35 ."5 0,35 -'5 
70 rebutted anti-HRT studies claiming HRT increases the risk of cardiovascular disease. They were actually responding to a petition filed by two physicians, Drs. Wolfe and Carome, who were asking for the FDA to force a black box warning on testosterone products that would state increased CVD (cardiovascular disease) risks71. Strangely enough, on March 3, 2015 the 
5 )(.,#.5 ."#,5 *,0#)/-5 ,/..&72 when they ruled testosterone products will require those very same labels “to clarify that the prescription hormone is meant for use by men whose low testosterone levels are caused by certain medical conditions,” such as lo5 "..*9II1118"*�8)'I,.#&-I#&&7."7
7#!".(7."7-7) 7-.)-.,)(7 *&'(.7Th,*3 mf5 "..*9II1118*%.-.)-.,)(8)'I-.)-.,)(K
8-*2 mg5 "..*9II1118*%.-.)-.,)(8)'I
K(#&K.#.#)(K /&3zhfglKhfgj8* mh5 "..*9II1118&.#'-8)'I-#(I-#(()1I&7-#7-(7.-.)-.,)(7",.7-.,)%7 ,#-%7hfgkfifi7-.),38".'&

58

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

^!(.#5#-),,-5(5)(#.#)(-5Ŀ.#(!5."5.-.#&-65*#./#.,35!&(5 (5,#(8_ (5.,/."65."5.5/*)(51"#"5."5
5-5#.-5,/&#(!5#-5,&0(.5 .)5 5 -&.5 !,)/*5 ) 5 #(#0#/&-95 '(5 )0,5 lk5 3,-5 ) 5 !5 1#."5 *,7 2#-.#(!5",.5)(#.#)(-850#)/-&365#.5(().55**&#5.)5."5!(,&5 *)*/&.#)(5) 5'(5-/**&'(.#(!51#."5.-.)-.,)(8 )..)'5 &#(95 .5 #-5 ().5 )(&35 **,)*,#.5 /.5 - 5 .)5 *&5 1,(#(!-5 )(5 '#.#)(-5 .)5 &,.5 .")-5 1")5 '35 5 .5 ,#-%5 ),5 -#5 Ŀ.-85 )5
5


5 &&5#(.)5."#-5"#!"7,#-%5.!),3>5
,5."5h5'#&&#)(5*&/-5
',#(-5 /,,(.&35 )(5 .-.)-.,)(5 .",*35 -.#(5 .)5 0&)*5 .",)-&,).#5 ",.5 #-->5 5)/,-5()..,'Ž-.)-.,)(‰#-‰,#)‰,)..#0

59

CHAPTER 7

&-)5/-#(!55(52"##.#(!5."5-'5( #.-53)/5,5-%#(!85)/[5 #&&35 1(.5 .)5 1),%5 1#."5 5 ).),5 1")5 *,.#-5 1".5 "5 *,"-85 "#(%5.1#5)/.5&#-.(#(!5.)5."50#5) 55).),51")5#-5)-65)/.5) 5 -"*65),5&))%-5&#%5"5"-5().52,#-5535#(5"#-5&# 85 5"5#-5!#0#(!5 0#5)(5")15.)5.%5.-.)-.,)(5.)5#'*,)053)/,5&# 65."(5"5-")/&5 5�#(!5*,)) 5) 5."5-/--5) 5#.-5/-85)/&53)/5.%5 #((#&50#5 )(5")1I1",5.)5#(0-.53)/,5')(35 ,)'55)&&!5!,/.51")5"-55 "&),5!,5#(5 #((>5,5 ,)'5(5(.,*,(/,I#(0-.),51")5"-55 '/&.#7'#&&#)(5)&&,5#(0-.'(.5*),. )&#)> 5 5 5 5 .5 #-5 &-)5 #'*),.(.5 .)5 /(,-.(5 ."5 *).(.#&5 )-.-5 ) 5 &)(!7.,'5 5 ),5!#((#(!85"5 -55*"3-##(-5",!51#&&50,38 55555(5."5'),52*(-#05-#65(5(.#7!#(!5&#(#5(5",!5-5'/"5 -5 5 qhkf7g6hkf5 #(#.#&5 )(-/&..#)(5 5 &)(!5 1#."5 5 ')(."&35 '',-"#*5 5 Bqgff7kffC5 .)5 &&)15 ."#,5 *.#(.-5 .)5 ).#(5 5 *,-,#*.#)(5 ),5.-.)-.,)(65).",5(.#7!#(!5'-5(5)(#,!5--5 .)5."5*"3-##(8 55555
&.,(.#0&365).",-5(5",!55 5.)5-*%51#."55).),5),5(/,-85

#.#)(-5,5*,-,#5-)5.".53)/5(55,#'/,-5.",)/!"53)/,5 '#&5 ( #.5 *&(5 B1"(5 &&)1C85 (5 -)'5 #(-.(-65 '#&5 .,.'(.-5 ,5 ) ,5 )(0(#(.&35 .",)/!"5 5 .&'##(5 *&. ),'5 &&)1#(!5."5*.#(.5.)5)(-/&.51#."52*,.55*"3-##(-50#,./&&350#5 1'65 *")(65 (5 '#&5 -)5 .".5 3)/5 )([.5 "05 .)5 .,0&5 ,5 .)5 !.5  ),&5.,.'(.85
#.#)(&&358)'5&-)5*,)0#-5#(7")'5 &))5 -.#(!5 -5 1&&5 -5 +/&# #-5 (5 (5 )'(5 ),5 ),')(&5 *.#'#4.#)(51"(5#)',%,-5#(#.55(8 5555)50#155)'*,"(-#05&#-.5) 5,)''(5(.#7!#(!5(55 *,.#.#)(,-650#-#.951118).),-8)' 555555
-5 51#&&5)(.#(/5.)5-35.",)/!")/.5."#-5))%65)53)/,5,-,"51"(5 #.5)'-5.)5"))-#(!5."#-5)/,-5) 5.#)(8

60

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

CHAPTER 7 READER QUESTIONS What is the optimal form of TRT for a newbie starting out?

".0,5 5 %()1&!&5 5 *,-,##(!5 *"3-##(5 &#0-5 #-5 #(5 3)/,5 -.5 #(.,-.5 -5 )(5 3)/,5 &))5 .-.5 ,-/&.-5 (5 ."#,5 &#(#&5 #!()-#-5 ,)'5 3)/,5 *,-(.#(!5 -3'*.)'-855 *.#'&&365 /-#(!5 -.)-.,)(5 3*#)(.5 ),5 ((.".5 .5 .1(5 nf7hff5 '!-5 *,5 1%5-")/&55'),5."(5()/!"5 ),5(35/&.5'&5.)5&0.5."#,55 &0&-5.)5."5"#!"-.5(5) 5."5,(!51#."5'#(#'&5-#5Ŀ.-85 .5#-5'35 )*#(#)(5-555/-,5)'-5'),52*,#(5."35(52*,#'(.5 1#."5 #(,-5 ,+/(35 ) 5 #($.#)(-5 (5 *)--#&35 /-#(!5 .-.)-.,)(5 *,)*#)(.51"(5&5.)55-,#*.51#.")/.5#--/8 My doctor recommends Nebido and argues it is far superior to all other Esters. He is an author of a standard endocrinology textbook and head of the WHO Center for andrology at the university hospital of Muenster. What do you think about Nebido or Aveed?

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61

CHAPTER 7

physician must be registered and certified by Endo Pharmaceuticals and their REMS (Risk Evaluation and Mitigation Strategy). REMS is a very strict form of post marketing surveillance designed to note and record any adverse effects associated with Aveed.

On a long enough time horizon (months), is there really any difference between test cyp and test prop if you inject both at least 3x/week (given the same amount of test equivalents)?

As far as efficacy, mg-for-mg, it probably won’t matter as much. I’d bet that if you did blood work for 7 days in a row, you’d have elevated testosterone levels each day you were on prop. And you’d have days without elevated doses when on cyp. So there may or may not be a marginal benefit to using prop since you’d be at higher levels every day. Those days of having higher levels should add up. Would testosterone cypionate (E3D) be more optimal (and convenient) than propionate (EOD) since the peaks and valleys are closer together?

This is essentially my recommended protocol. But to answer your specific question, testosterone is essentially testosterone. There is no reason to concern yourself with half-lifes in the way you’re thinking. What you want to minimize are side effects. Cypionate might make you hold more water. It’s not as fast-acting (in the response you ‘FEEL’) and it also won’t clear your system as fast as propionate will. Plus propionate (due to it’s short half life) mimics your body’s natural production much more closely than cypionate/enanthate.

I’m 54 and have been doing Testosterone Enanthate 250 1/2 cc twice weekly for about 18 months, and have no side effects at all. Blood work came back great. I have never been in better shape. Lost like 20 lbs of fat and leaned out really nice. Two questions—can I maintain this dose forever? Also if I were to come off should I consider a PTC Cycle and if so what would you recommend? There is no reason to come off ever! And at 54 why would you? You have very little natural production at this stage of your life and I assume you aren’t wanting kids. There is much more info on why cycling Testosterone is ineffective in Chapter 10.

62

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

)(-#,5 /.##(!5 '#.#)(-5 .".5 %*5 3)/,5 
I
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I just had my blood work done yesterday at a local anti-aging clinic. My question is actually in regards to hCG. Recently I noticed on various boards, where guys have actually posted their labs showing on hCG and off, and one guy had as much as a 400 mg difference being on it as compared to off of it. Is this BS? Or does its impact vary from person to person?

#(5#-5,&&35*,#'#.#05(5&-51#."5&,!5*)*/&.#)(-51"(515 &&5 "05 #Ŀ,(.5 !(-5 (5 )/,5 !(-5 2*,--5 ."'-&0-5 #(5 #Ŀ,(.5 13-8 ,]-5 1".5 5 '(85
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(&3485 Th(5 3)/5 #!/,5 ."#-5 -./Ŀ5 )/.5 (5 #(5 )/.5 1".5 1),%-5 #&&35 ),5 3)/85 5 &&5 "05 /(#+/5 #)"'#&5 #(#0#/&#.385 hCG5 ')().",*35 B#-/--5 #(5 .#&5 #(5 "*.,5 gfC5 #-5 /-5 35 *"3-##(-5 .)5 &0.5 .-.)-.,)(5 &0&-85 Th,5 #-5 ,-,"5 #(#.#(!5 #.5 )-5 1),%5 -*#&&35 1#."53)/(!,5'(51")5)(].51(.5.)5#-./,5."#,5()!()/-5B(./,&C5 .-.)-.,)(5*,)/.#)(85,85 )"(5,#-&,5,)''(-5hCG5.5hkf7kff5 #/5*,5-").5)(5."5&-.5h53-5) 55)(551%5#($.#)(51%5B%()1(5-5 63

CHAPTER 7

"5,#-&,5 .")Cmk85"5(5&-)55/-5#&35.5gff5#/]-51#."5!,.5 -/--5/5.)5#.-5#&#.35.)5*,)/5,()'(--5#(5."5-,/'5(,)!(5 *,) #&5.50,3#(!5*)#(.-5#(5."5385 I’m 29. I have a very positive outlook on life. Always optimistic and looking fo,1ard to the next day. Sex drive is good, though at times a little indifferent, certainly not like it was 5–8 years ago. My body is in solid shape, training at the gym 3–5x/week and playing basketball 1–2x/week. I generally find myself sore the next day and slower out of bed after an intense workout or game. Blood pressure is low, and I eat clean. I’ll admit that I was a bit disappointed by the numbers (testosterone is 409 and free testosterone is 83.8), but they probably jive with my overall demeanor. T" numbers aren’t surprising to me. Any thoughts about short term/long term prognosis?

5 &#05 5 #-5 )/.5 .,.#(!5 -3'*.)'-65 ().5 (/',-85 ),!.5 3)/,5 (/',85 )15 )5 3)/5 &>5 5 3)/5 &5 !,.65 3)/5 )(].5 (5 .)5 !)5 )(5 85 .]-5 &13-5 5 *,-)(&5 #-#)(5 (5 ")* /&&35 )(5 3)/5 '%5 ),5 0&#5 ,-)(-85 )/,5 (/',-5 ,5 &)15 ()/!"5 .".5 3)/5 (5 ,-)(&35 #(0-.#!.5 85 /.5 !#(65 #.5 )'-5 )1(5 .)5 ")15 3)/5 &85 -5 )(5 0,3."#(!5 3)/]05 -#5 )065 5 1)/&5 #(0-.#!.5 5 /,.",8 If I am injecting 1 ml per week and am coming up for a blood test, how long should I wait after doing the injection before going to the lab for the test?

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64

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

I hear the term HRT (hormone replacement therapy) a lot. Is that for women? How is TRT different/same as HRT? HRT as defined by Wikipedia:

^(35 ),'5 ) 5 "),')(5 .",*35 1",#(5 ."5 *.#(.65 #(5 ."5 )/,-5 ) 5 '#&5.,.'(.65,#0-5"),')(-65#.",5.)5-/**&'(.55&%5) 5(./,&&35 )/,,#(!5 "),')(-65 ),5 .)5 -/-.#./.5 ).",5 "),')(-5 ),5 (./,&&35 )/,,#(!5 "),')(-8_

The term is definitely more visible in women’s circles as hormone replacement for pre – and postmenopausal women. It involves the use of one or more medications designed to artificially boost hormone levels. The main types of hormones involved are estrogens, progesterone/ progestins, and sometimes testosterone. It is my opinion testosterone can be an eĿective woman’s treatment for many of the same reasons it is so highly eĿective in men. As I stated in the preface of the book there is plenty of scientific evidence TRT for women76 is highly eĿective and safe.77 There are WAY too many proven myths surrounding women and TRT. I believe it warrants an entire book unto itself. Visit this website for more details: 111808)'I1)'(5 How much of a hassle is it to go from being self medicated to being under a doctor’s care?

T"is is an excellent question. It really depends on where you’re being self medicated? Are you in the USA? How much does it cost you to procure T, ancillaries and to regularly get your blood work? It is crucially important to find a doctor who is willing to not only prescribe testosterone, but also monitor you properly. "ere are some ańuent patients that prefer to work with a professional the caliber of Dr. Brett Osborn: 111808)'I )-),(. "en there are others that prefer a more aĿordable virtual telemedicine solution through Defy Medical: 111808)'I 35

76 Tuiten A, Von Honk J, Koppeschaar H, et al. Time course of effects of testosterone administration on sexual arousal in women. Arch Gen Psychiatry. 2000;57(2):149-153. 77 Davis SR. Cardiovascular and cancer safety of testosterone in women. Curr Opin Endocrinol Diabetes Obes. 2011;18(3):198-203.

65

CHAPTER 7

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66

THE INS AND OUTS OF PROPER INJECTION PROCEDURES CHAPTER 8



(,-.(#(!5 '35 ,)''(5 *,).))&5 (5 #(0)&05 )(5 .)5 '/&.#*&51%&35#($.#)(-65#.5#-5#'*),.(.515#-/--5(5(&345 ."5#($.#)(5*,)--85 51),%#(!51#."5(52*,#(5(5%()1&!&5 5*"3-##(653)/51#&&5"05."5")#5.)5-& 5'#(#-.,5."5#($.#)(-5 B1#."5."#,5**,)0&C855 5 )(].5 %()15 ) 5 '(35 '(5 "))-#(!5 .)5 '%5 5 5 &# &)(!5 )''#.'(.5 B1"35 1)/&5 3)/5 ().C5 ().5 -& 5 '#(#-.,#(!5 ."#,5 .-.)-.,)(5 -5 1&&5 -5 hCG85 (5 .5 #.5 #-5 ."5 ')-.5 )(0(#(.5 )*.#)(5 -*#&&35 ),5 .")-5 1#."5 /-35 &# -.3&-85 & 5 #($.#)(5 $/-.5 )'-5 5 ,!/&,5*,.5) 53)/,537.)7352#-.(5-#'#&,5.)5,/-"#(!53)/,5.."5 #(5."5'),(#(!5(5(#!".85 5 1(.5 .)5 '*"-#45 .",5 #-5 ()5 (5 .)5 1),,35 )/.5 #($.#(!5 3)/,-& 85 Th5 \*#(]5 2*,#(5 #-5 ()5 1),-5 ."(5 *#("#(!5 ."5 -%#(5 )(5."5%5) 53)/,5"(85
.,5,#0#(!55)/*&5) 5#($.#)(-5 ,)'5 3)/,5 *"3-##(65 *"3-##(]-5 (/,-5 B),5 0(5 *, ),'#(!5 ."'5 3)/,-& C5 3)/]&&5().50(5().#5#.85)'5'(5"055\(&5*")#]5/*)(5."#,5 ,-.5 #($.#)(85 Th#-5 #-5 5 *, .&35 *.&5 *-3")&)!#&5 ,.#)(85 .5 0(#-"-5)(53)/5,5.",5#-5'#(#'&5*#(5(5&--5.)51),,35)/.8

SYRINGE, NEEDLE GAUGE AND WITHDRAWING Th,5 ,5 '(35 #Ŀ,(.5 -#4-5 ) 5 -3,#(!-85 )5 %*5 ."5 '."I )(0,-#)(5 ) 5 3)/,5 .-.)-.,)(5 )-!5 -#'*&65 5 ,)''(5 3)/,5 *"3-##(5*,)0##(!55i5'&5-3,#(!5-)5#.5(55-#&35*,*,5.)5."5 ),,.5'!I5.-.)-.,)(5)-!85 5.5&&5*)--#&65-%53)/,5*"3-##(5 .)5*,7&)53)/,55#($.#)(-5 ),53)/8 67

CHAPTER 8

Th5,,&5*),.#)(5) 5."5-3,#(!51#&&5"05/(#.-5) 5'-/,5 ,)'5|5@5 i5'&5B.#%-5',%-C5&)(!5."5-#85 (5.,'-5) 5."5./&5-#45B#'.,C5 ) 5 ."5 (&65 5 hi7hn5 !/!5 g]5 (&5 -3,#(!5 #-5 )*.#'&85 .5 #-5 '/"5 -#,5 .)5 1#.",15 ."5 .-.)-.,)(5 -)&/.#)(5 1#."5 (5 gn5 !/!5 g|5 1#.",1#(!5(&8

CAUTION

For men who have higher body fat percentages (over 20%), you are likely going to have to inject with a 25 gauge needle that is 1.5 inches long. You’ll have to penetrate beyond your visceral fat to make sure you inject into your muscle. This is another reason to focus on losing excess body fat to better optimize an injectable testosterone delivery system.

WHERE AND HOW TO INJECT SAFELY #."5 ."5 -3,#(!5 -5 3)/,5 #(.,'/-7 /&,5 #($.#)(5 B C5 .))&65 #.5 #-5 -35 .)5 #($.5 .-.)-.,)(5 #(.)5 ."5 )&&)1#(!5 '/-&5 ,-95 &.)#-65 !&/./-65 ),5 /**,I )/.-#5 +/,#*-85 5 ,)''(5 ,)..7 #(!5 3)/,5 #($.#)(5 -#.-5 .)5 '#(#'#45 -,5 .#--/5 ),'.#)(85 #."5 --(.#&&35 .",5 #Ŀ,(.5 ,-5 )(5 "5 -#5 ) 5 ."5 )365 3)/]&&5 "05 /*5 .)5 l5 #Ŀ,(.5 *&-5 3)/5 (5,)/.#(&35#($.85#-#.5."#-51-#.5 ),5 -)'5 !,.5 ,-)/,-5 .)5 /(,-.(5 *,)*,5 #($.#)(5 *,)/,-5 (5 ."7 (#+/95111808)'I#($.5

/-.5 -5 .",5 #-5 ()5 ,-)(5 .)5 ,5 #(.,'/-/&,5#($.#)(-5-5/-#(!5*#(65/-!5) 5."51),-5\'#(#'#4#(!5 -,5.#--/]5#-(].5(3."#(!5.)51),,35)/.5#.",855 (5.,'-5) 5."5./&5 -#45B#'.,C5) 5."5(&655hi7hn5!/!5g[5(&5-3,#(!5#-5 )*.#'&85 .5#-5)-,05-)'55#-*(-#(!5*"3-##(-51#&&5*,)0#5 *,&)5-3,#(!-5 ),5."#,5*.#(.-85T",5#-5()5,-)(5().5.)5-%53)/,5 ).),5.)5*,)0#53)/55g7')(."5),50(5gf71%5-/**&35) 5*,&)5 5-3,#(!-5B# 53)/,5-,#*.5#-5 ),5hff5'!-5 ),5gf5]-5#(5-.)-.,)(5 3*#)(.5),5((.".C8 68

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

TRT VIA SUBCUTANEOUS ADMINISTRATION
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69

CHAPTER 8

It is my opinion injecting testosterone subcutaneously may or may not be as effective due to the potential aromatization of the testosterone in adipocytes (fat tissue). This is especially true for men who have excess body fat in their Remember aromatase loves CAUTION belly and love handle regions. to ‘hang out’ in fat tissue80. Injecting testosterone into men with higher regional body fat deposition *might* be a recipe for estradiol (E2) conversion and the resulting negative side effects that come with it. Whatever your feeling of subcutaneous injections, it is a very cutting edge and apparently promising delivery system that merits close scrutiny and more observational study for current and future TRT users.

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MINIMIZING SCAR TISSUE FORMATION WITH FOAM ROLLING AND MYOFASCIAL RELEASE -#(!5 5 )'5 ,)&&,nh5 (I),5 5 -.#5&&ni5,5--(.#&5")'5.))&-5 .)5 ,%5 /*5 -,5 .#--/5 .5 #($.#)(5 -#.-85 /-.5 5 )/*&5 .#'-5 5 1%5 ),5 )/.5 h7k5 '#(/.-5 #-5 ()/!"85 /.5 -5 3)/5 1),%5 )/.5 (5 /#&5 &,!,5 '/-&5 #,-53)/]&&5 #(#.&351(.5.)5/-5 nf5 (.,7#*)-5-25-.,)#5'.)&#-'5(5)35 .5#-.,#/.#)(5#(5##)*."#5"/'(5 )-#.385&#(5(),#()&5B2 C85hffm5 ,:llBiC9jjf7l8 ng5 nh5 ni5

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70

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

."'5'),5 ,+/(.&35.)5,&#05'/-&5.#!".(--5(5--#-.5,)0,35-)5 3)/,5'/-&-5,5ȳ2#&65"&."365(5-/**&nj8 "(0,5*)--#&65-/**&'(.53)/,5.7")'5.,.'(.51#."55*5 .#--/5'--!5@5
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71

CHAPTER 8

CHAPTER 8 READER QUESTIONS Will it be an issue going through airports and countries traveling with testosterone and syringes? Do I need to have a prescription with me?

)/5 -")/&5 "05 5 )*35 ) 53)/,5 *,-,#*.#)(5),5 .5&-.5 "05 3)/,5 '#.#)(-5#(#.51#."5."5*,-,#*.#)(5&&#(!5)(5."5*%!#(!5 (5 -.),!5 !85 .5 #-5 /(&#%&35 .)5 0,5 5 (5 #--/855 ),5 )(0(#(5 */,*)--65 *%5 3)/,5 5 +/#*'(.5 #(5 3)/,5 "%5 !!!5 /-#(!5 -)'."#(!5&#%5."#-5#.#5),!(#4,5!85 What if I develop a rash around my injection site?

.5 #-5 *)--#&5 .)5 2*,#(5 (5 &&,!#5 ,.#)(5 ,)'5 ."5 "'#&5 %*#(!5."5.-.)-.,)(5-.,5-.&5#(5#($.&5-)&/.#)(5 ),'5B/-/&&35 ."3&5)&.5),5*,)*3&(5!&3)&C85,35,,&365 (5&&,!#5,.#)(5.)5(5 #($.#)(5 1#&&5 &5 .)5 5 &)5 -%#(5 #( .#)(85  .(5 %()1(5 -5 &&/&#.#-65 ."-5 ,5 ().#5 -5 5 /,(#(!5 -(-.#)(5 .5 ."5 *)#(.5 ) 5 #($.#)(85)'.#'-5."5-%#(5./,(-5,5),5 #&&-51#."51"#.5&))5&&-85 5 3)/5 ,5 2*,#(#(!5 ."-5 -3'*.)'-65 #.5 '35 5 *,/(.5 .)5 -5 3)/,5 ).),85 (5 ."5 1),-.5 -5 -(,#)5 B(5 ."#-5 #-5 ,,&35 -(5 ),5 2*,#(C653)/,5).),5'#!".5"053)/5)55,)/(5) 5(.##).#-5 ),5 -0,&53-5.)5.,.5."5&&/&#.#-8 About a day after injection, I’m getting some soreness/bruising at the place where I injected. Is that normal? I just recently started TRT.


-55(1#5.)5651"(5 #,-.5,#0#(!5#(.,'/-/&,5#($.#)(-65 3)/5 '35 2*,#(5 '#(),5 -),(--5 .5 ."5 *)#(.5 ) 5 #($.#)(5 -0,&5 ")/,-5&.,65&')-.5&#%5."5-),(--53)/]5 &5# 5-)')(5*/("53)/5 #(5."5 ,'85 )-.5 ) 5 ."5.#'53)/51#&&5 &5 ()."#(!65/.5 #.",5135 #.]-5 ()."#(!5.)51),,35)/.5(53)/]&&5$/-.5!.5/-5.)5#.650(./&&35 &#(!5 ()5-(-#.#0#.35.5&&8

72

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

I’ve heard from other TRT Patients they use a 28-31 gauge 5/16 Insulin Syringe to inject their testosterone intramuscularly thereby reducing scar tissue formation. What is your take on this?

Th#-5 #-5 5 !))5 +/-.#)(5 (5 #.5 ,-5 (5 #(.&&#!(.5 ,-*)(-85 Th5 /-5 ) 5 5 /,/&#(5 3,#(!5 .)5 #($.5 .-.)-.,)(5 #(.,'/-/&,&35 #-5().5,)''(5B0(5.")/!"5 15)5%()15'(35&(5#(#0#/&-5 )#(!5 #.C85 Th-5 -3,#(!-5 ,5 /-/&&35 &--5 ."(5 )(5 "& 5 #("5 &)(!5(5"0550,35(,,)15(&5 ,,&85 ($.#(!51#."5-/"55-'&&5 (&5*)--5"&."5,#-%-85 55*,-)(5#-55(1#5(5)-5().5*)----5 &)15 &0&-5 ) 5 )35 .5 ."5 "(5 .5 !..#(!5 (5 #( .#)(5 .5 ."5 *)#(.5 ) 5#($.#)(52#-.-85 .5#-5&-)52.,'&35#Ń/&.5.)5*/-"5."5.-.)-.,)(5 -)&/.#)(5.",)/!"5."5-3,#(!51"(5#($.#(!5/5.)5."5."#((--5) 5."5 (&85

73

MITIGATING AND AVOIDING POTENTIAL SIDE EFFECTS CHAPTER 9



"(5/(,!)#(!565#.5#-5 
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-5 15 !65 )/,5 )#-5 "(!5 (5 ) .(5 .#'-5 +/#.5 ,*#&385Th5-#5Ŀ.-5'(5'35),5'35().52*,#(5,5,()'5(5 -)'.#'-5)(].5'(# -.5 ),53,-5# 5().5-85 .5#-5,/#&&35#'*),.(.5.)5,)!(#45."5'$),#.35) 5*).(.#&5-#5 Ŀ.-5,5'#(),5(5-#&35.,.&85 .5#-5(5/( ),./(.5#,/'-.(5 '(35'(5"05,#05B(5)(.#(/5.)5,#0C5#(Ŀ.#05,5 ,)'5 ."#,57*,-,##(!5*"3-##(-85 .(5.#'-5."5#(#&#.35.)5&&0#.5 -#5 Ŀ.-5 ),-5 '(5 .)5 (5 ."#,5 .,.'(.5 &.)!.",85 Th,5 #-5 ()5 ,-)(5 ),5."#-51".-)0,5-*#&&351"(53)/5/.#5."5-,0#-5) 55 *,)!,--#05(52*,#(55*,-,##(!5*"3-##(8 111808)'I.,.7).),-5

As I have continued to stress throughout this book, it is CRUCIAL you keep detailed files on your blood panels in order to best understand your values as they change over time. Know thyself, compile blood panel data, and do your PRO TIP homework to ensure your TRT is successful over the long term. Become your own doctor. Study your reactions. Take notes. Be vigilant in knowing your body and what allows it to work optimally. Remember, doctors are said to have “practices” for a reason. They are human and do make mistakes.

74

CHAPTER 9

You are the only one who truly knows your body, but only if you’re paying attention.

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ESTRADIOL Estradiol monitoring and management is an important topic in TRT and recent studies have highlighted estradiol as just as important to male brain and sexual function as testosterone itself.87 Most of you know estrogen is the “female hormone” and what makes women “emotional”. Actually estrogen is composed of three different NERD ALERT forms, including one that plays a huge role in NERD ALERT how men feel: estradiol (E2). So why is estradiol so important? It has profound implications for general health and has the potential to cause very unpleasant symptoms if levels are unbalanced. As testosterone levels decrease and estradiol levels increase, the ratio of free testosterone to estradiol reaches a critical point and estrogenic suppressive effects predominate.88 In my experience, both personally and in consulting with many men on TRT, the single biggest reason why TRT doesn’t “work” is because of estradiol (E2) management. Usually it’s out of balance. Unfortunately, a man can PRO TIP have side effects when suffering from low or high estradiol. From personal observation the single biggest determinant of whether estradiol (E2) is out of balance is erectile strength. Another obvious and noticeable side effect is water retention. Some men genetically overproduce aromatase which

nm5

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75

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

ultimately leads to increased estrogen production and its potential side effects. This is discussed in further detail later in this chapter.

.5#-5) 5*,')/(.5#'*),.(5.)5 1),%51#."55%()1&!&55 *,-,##(!5*"3-##(5 -)5)."5) 53)/5(5#&5#(53)/,5-.,#)&5 ,)'5."5 -.,.85),'&&35#.51#&&5.%5(5#(#.#&5-&#(5&))5-.,#)&5B%()1(5-5 hC5 *(&5 (5 ."(5 /./,5 ,#(!-5  .,5 -.,.#(!5 5 .)5 #!/, )/.5 1".5&0&5#-5-.5 ),5."5*.#(.85",5#-55(,,)15.",*/.#51#()15 ,!,#(!5-.,#)&I-.,)!(51",5#.5#-5#'*),.(.5 ),5)."5*.#(.5(5 ).),5 .)5 /(,-.(5 ."5 )*.#'&5 -.,#)&5 0&/5 ,(!85 )-.5 %()1&!&5 5 *"3-##(-5 1#&&5 -*# 35 5 \-(-#.#0]5 ),5 \("(]5 -.,#)&5--35 .,55*.#(.5#(#.#.-585"#-5) .(5.#'-5#-5,#.#&&35 #'*),.(.5/-5."5-.(,5-.,#)&5.-.5#-5-#!(5 ),51)'(5(5 .(-5.)5!,.&35)0,-.#'.5-.,)!(85

DHT

NERD ALERT

Even though the main androgen secreted by the testes is testosterone, the main androgenic signal comes from dihydrotestosterone (DHT). This includes the brain, central nervous system, skin and the genitals. Practically everything but muscle. Testosterone is converted to the active androgen DHT by the action of the enzyme 5 alpha reductase (5-AR). DHT because it binds about 3-5 times more strongly to the androgen receptor than testosterone, is much more anabolic in nature89.

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(,)!(5,*.),5-#!(&#(!5#(/535-/*,*"3-#)&)!#&5)--5) 5#"3,).-.)-7 .,)(5#(5"/'(5*,#*",&5&))5&3'*")3.-8,).)'#-85hfgf5*:gfBgmC9iglk7mk8

76

CHAPTER 9

5 B#"3,).-.)-.,)(C5 #-5 &,!&35 ,-*)(-#&5 ),5 '&5 *..,(5 &(--8555(5&-)5/-5(#!(5!,)1."5) 5."5*,)-..65#(,-5 )#&#(--5) 5."5-%#(5(5(of8555 "(53)/5/(,-.(55#(5."#-5 -"#)(5#.5#-5-35.)5&#053)/,5 !)&5 -")/&5 5 #.-5 &#'#(.#)(5 ),5 ,/.#)(85 /.5 5 #-5 --(.#&5 ),5 *,)*,5 ,#(5 "'#-.,35 (5 *,)*,5 -2/&5 /(.#)(7#(&/#(!5 &##)85 /-5 ) 5 ."#-5 )5 /&#.365 5 #-5 5 -)'."#(!5 3)/5 1(.5 .)5 ,/5 ),5 &#'#(.5 #(5 ."5 )385 /.5 /5 .)5 0,3#(!5 #)"'#&5 #(#0#/&#.365-)'5'(651#&&5"05.)5%*55&0&-5/(,5)(.,)&5-5 5*,/(.5)/,-5) 5.#)(85
-5&13-65!,.5,5(5..(.#)(5-")/&55 *,)0#5 35 3)/,5 *"3-##(5 #(5 ')(#.),#(!5 3)/,5 #(#0#/&5 5 &0&-5 ,&.#05 .)5 3)/,5 #(#.#&5 -&#(5 &))5 *(&5 (5 )(!)#(!5 &))5 *(&-5 )0,5 .#'85 5 3)/5 /.#5 5 .,(-,'&&365 #.5 #-5 0,35 #'*),.(.5 .)5 ')(#.),53)/,55&0&-5-5.,(-,'&-5(5,'-5) .(5)(0,.5.)5 5(51#&&5&0.5
5B*,)-..5-*# #5(.#!(C50&/-5.,(-#(.&37 /-/&&35/(.#&5(5Ŀ.#05)-5) 55#-5-.&#-"8

PROLACTIN

STOP

of5 #"3,).-.)-.,)(5(5."5)(*.5) 5k&*"7,/.-5#("##.#)(5#(5"/'(5 (#!(5*,)-..#5"3*,*&-#8/,5,)&85hfff5
*,:imBjC9ilm7nf8

77

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

NERD ALERT

Prolactin is a hormone that can lower your testosterone and interfere with your sex life. Excessive prolactin is also associated with Studies gynecomastia, i.e., “male boobs.”91 have found high prolactin levels (known as hyperprolactinemia) in men are linked to low sexual desire and erectile dysfunction.92 Men with severe hyperprolactinemia frequently show mild hypogonadism (low testosterone), and complain of a loss of libido and sexual dysfunction.93

5 3)/5 ,5 /-#(!5 5 &)(!5 .,'5 (5 -.,.5 -/Ŀ,#(!5 5 &#(5 #(5 &##)65 5()/,!53)/5.)5!.53)/,5-,/'5*,)&.#(5&0&-5'-/,855
5 -/*,5"#!"5,#(!5B5iffC5'35,+/#,53)/,5).),5.)5-(5 ),5(5  5 ) 5."5*#./#.,35#(5-5."5#--/5#-55*#./#.,35()'85Th#-5#-55()(7 (,)/-5*#./#.,35./'),5.".5(5/-50#-#)(5*,)&'-5(5""-85 .5#-5#.",5')(#.),5B1"#&5.#!".&35)(.,)&&#(!5-.,)!(5(5*,)&.#(C5 ),5-/,!#&&35,')05.",)/!"5(5'4#(!&35,)/.#(5*,)/,85 Many anti-aging clinics are using Cabergoline regularly in their practices with men to boost libido/and or improve sexual function94. Anecdotal studies show one 0.5-milligram cabergoline tablet twice a week improves the quality and intensity of sex drive, arousal, and orgasm. CAUTION This is clearly an “off label” usage of this medication due to the lack of peer reviewed research data advocating it for this specific reason.

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,"5 -*5,)&85goom5 /(:kfBkC9khl7n8 oh5 3*,*,)&.#('#5(5,.#&53- /(.#)(8505,)&65hfff5#(.,65hBgC9io@jh6 oi5 ,)&.#(5(5.-.)-.,)(95."#,5,)&5#(5'&5-2/&5 /(.#)(85,(#5g65,(.5
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78

CHAPTER 9

Th5 /."),5 ) 5 ."#-5 ))%5 "-5 (5 *,7 -,#5(5/-5&')-.50,35 5B&7 .#05 -.,)!(5 *.),5 )/&.),C5 (5
5 B
,)'.-5 ("##.),C50#&&85
.,5'(353,-5) 52*,#(65 ]05")7 -(5B1".5 5 &C5,5."5
5(#&&,35 '#.#)(-5 ),5 *"3-##(-5 .)5 .,.5 (5 - 7 &35 ),,.5 *).(.#&5 5 -#5 Ŀ.-85 )'5 '(65/5.)5."5/(#+/(--5) 5."#,5#)"'#&5#(#0#/&#.3651#&&5(5 -.,)(!,5-#5Ŀ.5'#.#)(5."(5).",-8 Because these SERM’s and AI’s have not been FDA approved for use in males, TRT physicians prescribe them ‘off-label’. Due to the fact that some of them are now manufactured as generic medications in most markets, it is unlikely a drug company would pursue FDA approval CAUTION for use in men now because of limited profit incentive, mostly due to the relatively small market potential (for now at least). It is important to understand these medications were designed to treat breast cancer in women and as such they must be closely monitored when used in male endocrine systems. They are usually well tolerated and a progressive and experienced TRT physician should be quite familiar with their pharma dynamics. A progressive TRT-prescribing doctor will analyze your lab work and symptoms and prescribe you ancillary medications recommended in the chart below (when your symptoms and/or blood values warrant it necessary) and will PRO TIP discuss these potential side effects and their ramifications beforehand. This will make them easier to identify for both of you. It is even more important you are also learned in understanding and dealing with them as well. Again, do your homework and know thyself.

79

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

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80

CHAPTER 9

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81

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

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82

CHAPTER 9

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83

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL


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84

CHAPTER 9


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85

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL


]-5 B
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,#'#28

86

CHAPTER 9

TABLE FOOTNOTES g5 /,,5 65 ),(55BgonjC85ZTh5*",')&)!35(5&#(#&5/--5) 5 .')2# (Z85",')&85Th,85hk5BhC95ghm@hfk85)#9gf8gfglIfgli7mhknBnjCoffji7i h5 #'658865.5&865Th5.,.'(.5) 5"3*)!)(#-'5#(5'(5) 5,*,)/.#05 !85,.#&5.,#&65hfgi85ooBiC95*85mgn7hj85 i5 (65:5-/0(6585B (5hffiC85Z-5) 5&)'#*"(5#.,.5.)5,0,-5 *,'./,5(,)*/-5-)(,35.)5-.,)#5/-Z85,.#&5.,#&5mo5BgC95hfi@k8 j5

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5#.,85hffj5 /&:gjkBgC9mg7l85( #&5Ŀ.-5) 5,&)2# (5(5 .')2# (5#(5."5.,.'(.5) 5*/,.&5!3()'-.#8 1,(565/!".5
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/!:jhBn5/**&C95iihm-7iiii-8

87

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

THE USAGE OF AROMATASE INHIBITORS (AI’S) AND SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERM’S) AS TESTOSTERONE REPLACEMENT THERAPY (TRT) .5 #-5 )'#(!5 '),5 )'')(*&5 ),5 *"3-##(-5 .)5 /-5 5  5 B-&.#05 -.,)!(5 ,*.),5 ')/&.),C5 -/"5 -5 &)'#65 )&025 ),5 ),'# (65),50(5(5
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855 5 &#(5(),#()&5 .85hffk5 (:ofBgC9hgg7n85*/5hffj5.5gi8

88

CHAPTER 9

TRT protocols are inaccurate when AI’s and SERM’s are dosed without any corresponding elevated blood values or noticeable symptoms to indicate the patient needs either medication. There are *sometimes* exceptions to this rule. Older men (usually over 50) and men with high CAUTION body fat percentages (for reasons previously discussed) can reasonably start a TRT protocol with an AI such as Arimidex dosed at 0.5 mgs every other day (EOD). After 21-30 days, if a patient starts to exhibit symptoms of unbalanced T and E, prescribing a SERM or modulating the therapeutic dosage of an AI is warranted until balance is achieved. And obviously vigilant observation of further lab work is necessary.

There are no hard and fast rules in regard to dosing the aromatase inhibitors (AI’s) and selective estrogen receptor modulators (SERM’s) medications. The dosing of these PRO TIP medications is highly variable. All men are biochemically different and why it is crucial to have a competent TRT prescribing doctor who can evaluate lab assays and attend to symptoms when the need arises. Again, ongoing and regular blood draws and patient feedback are crucial for both patient and doctor to achieve and maintain balance. With some men, balance can take time to achieve.

89

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

METABOLIC SYNDROME, OBESITY, AROMATASE AND ESTROGEN -.)-.,)(5&0&-5,5&)1,5 Increased #(5 '(5 1#."5 )-#.365 '.)&#5 Obesity -3(,)'5 (5 .3*5 h5 #7 .-ol85
-50#(535$/-.5&))%7 Increase in #(!5 ,)/(65 )-#.35 #-5 #(,-7 muscle Increased mass and Aromatase Obesity #(!5.5,'.#5,.-5#(5')-.5) 5 increase in fat Estrogen ."5 -.,(5 (5 )(7-.,(5 Cycle 1),&855&&5%()15."5,-)(-85 )),5#.65(55&%5) 52,#-5 ,5."5"# 5/&*,#.-85 Converting Icrease in Testosterone (.5 -./#-5 #(#.5 Estrogen into Estradiol 5 #(5 '(5 1#."5 .3*5 h5 #.-5 "-5 ( ##&5 Ŀ.-5 )(5 #(-/&#(5 ,-#-.(5 (5 0#-,&5 #*)-#.3om85 )-.5 &#(##(-5 ,5 1,5 #(-/&#(5 ,-#-.(5 (5 0#-,&5 .5 *&355%35,)&5#(5,#)0-/&,5#--855 -.)-.,)(5 ,*&'(.5 .",*35 "-5 ,(.&35 (5 *,)0(5 .)5 #(,-5&(5)35'--5B  C65,/5 .5'--5(5*,)/5-/-.#(5 (5-#!(# #(.51#!".5&)--65,/.#)(5#(51#-.5#,/' ,(5(5 on85 )/&(].55#(5)-5'(51#."5.-.)-.,)(5 ##(3555/(#+/5 (5 Ŀ.#05 .",*/.#5 **,)"5 .)5 ."5 '(!'(.5 ) 5 )-#.3>5  5 )/,-5#.51)/&8 )/&(].5#.5&-)5'%55&).5) 5."),.#&5-(-5 ),5'(51#."5.3*5h5 #.-5(5'.)&#5-3(,)'5.)5)(-#,5"0#(!5."#,5.-.)-.,)(5 &0&-5'-/,>5 5 )/(5.)55&)15),5&)15(),'&651)/&(].551&&5 -#!(55*,).))&5B&)(!51#."55*,)*,5#.5(52,#-5*,)!,'5 /&&35-.,/./,5.)5,/5)35 .C5)Ŀ,55,-)(&5-.,.!35.)5 )*.#'#45."#,5"&.">5
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90

CHAPTER 9


,)'.-5B-5*,0#)/-&35#-/--C5#-5'),5/((.5#(5 .5.#--/8oo5 Th5 "#!",5 3)/,5 )35 .5 *,(.!65 ."5 '),5
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91

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

.-.)-.,)(5 #(.)5 -.,#)&5 BhC85 -*#&&35 #(5 ."5 -./),(5 )35 .gff5 *).5,-5B
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PRO TIP

If your body fat is above 20%, (and to make every effort to minimize potential aromatization and estrogenic side effects) you should prioritize losing body fat101 while undergoing TRT. I discuss strategies to optimize your fitness while on TRT in Chapter 12.

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92

CHAPTER 9

CHAPTER 9 READER QUESTIONS I’ll appreciate any advice. Curiosity led to blood work, which revealed: Test total: 156 (late afternoon test) Test free: 5.7, LH: 4.4, FSH: 2.6 I’m 32, and obese, 5’7 285. I’ve always been heavy set dude but these past three years were stupid, 60+ pounds gained. I’m seeing an endocrinologist in a few days but I don’t expect much. What are the options? What should I read up on? I’d still like to have kids. Thank you.

#(!5
5B)-C51#&&5&#'#.53)/,5)3]-5#&#.35.)5,#05)*.#'&5 ,-/&.-5 1"#&5 /-#(!5 85 ))5 '(35 '(5 ."#(%5 ."35 (5 �5 5 
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5 !))55#-*(-#(!5).),51#&&55"05(35'(5#(5."5if7kf5 !5 ,(!5 -.,.5 5 )/,-5 ) 5 5 B().5 /(.#&5 ."35 "05 *,)*,&35 2*&),5 3)/,5 #&#.35 .)5 *,)/5 3)/,5 )1(C5 # 5 3)/,5 †g5 -#,5 #-5 "0#(!5 "#&,(85 "#-5 *"3-##(5 -")/&5 -.,.5 3)/5 )(5 5 )/,-5 ) 5 #.",5 hCG5 ),5 &)'#5 ')().",*385)."5) 5."-5'#.#)(-51#&&5-.#'/&.53)/,5&3#!5&&-5.)5 #(,-5 -.)-.,)(5 *,)/.#)(5 0#5 /.#(#4#(!5 ),')(5 B C5 1"#&5 &-)5&&)1#(!53)/5.)5,'#(5 ,.#&85 DO YOU HAVE ANY QUESTIONS ABOUT YOUR SPECIFIC SITUATION?

/-.5)(..5/-5350#-#.#(!5."#-51-#.95 1118 -.,'#(8)'

93

MONITORING TRT FOR OPTIMUM HEALTH CHAPTER 10



53)/,5!)&5#-5&# &)(!55'#(#-.,.#)(5B# 5."#-5))%5"-5./!".53)/5 (3."#(!65#.5-")/&5C53)/,50#-#)(5(50#!#&(5,!,#(!5')(#.),#(!5 3)/,5 &))5 1),%5 -")/&5 ()15 !#(5 #(5 ,(-.85 .5 #-5 &-)5 ) 5 ,/#&5 #'*),.(5 .)5 1),%5 1#."5 5 7*,-,##(!5 *"3-##(5 1")5 !(/#(&35 "-5 3)/,5 &)(!7.,'5 !)&5 ) 5 )*.#'&5 "&."5 (5 - .35 .5 ",.85 .5 #-5 &-)5 #'*,.#05 3)/5 '#&#,#45 3)/,-& 5 1#."5 ."5 )&&)1#(!5 #)',%,-5 (5 ")15 ."35 '35 5 #'*.5 35 &# &)(!5 5 '#(#-.,.#)(85 )/5 -")/&5 )'5 /.&35 1,5 (5 /.5 )(5 "5 -)5 )."5 3)/5 (5 3)/,5 ).),5 (5 '#(#'#45 ),5 0)#5 #--/-5  ),5 ."35 ,#-85 %#(!5 (35 '#.#)(5 (5 0,-&35 #'*.5 )(]-5 )35 "'#-.,35 (5 #!(),#(!5 #.5#-5 ().50#-&8

CAUTION

There is no reason to become overly paranoid or concerned about monitoring your blood work. A good TRT physician should alleviate most if not all of your worries. It is their job to observe and act when necessary. For those of you living where it is legal to be your own doctor, you must research and become intimately aware of your body’s individual biochemical response to TRT.

94

CHAPTER 10

UNDERSTANDING YOUR BLOOD PANELS AND LAB ASSAYS
.,5!.",#(!53)/,5'#&5"#-.),365(5#( ),'5 7*,-,##(!5 *"3-##(5 1#&&5 '-/,5 3)/,5 &))5 1),%5 35 ,/((#(!5 ."5 )&&)1#(!5 ,#.#&&35#'*),.(.5--3-8 R R R R R R R R R R R R R

-.)-.,)(65,5(5).& 5-*#fi&&35')!&)#(I'.),#. 25),')(5#(#(!5&)/&#(5BC )')3-.#( -.,#)&5B(-#.#05),5("(C #.'#(565hk73,)23 ,)&.#( 7.#05,).#(5/(. Th3,)#5(& -#5 .)&#5(& #*#5(& 
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"#&5&&5) 5."'5,5#'*),.(.5.)5')(#.),5 ),5)/.7) 7,(!50&/-6 ]'5!)#(!5.)5 )/-5)(51".5 5&#05,5."5--3-55/-,-5 5 %*5 5 1." /&5 35 )(5 ),5 ."5 (.#,5 /,.#)(5 B#5 &# &)(!C5 ) 5 ."#,5 .",*3855 '',5'35,)''(.#)(-5#(5"*.,5j85 (5 .5."35,5-)5 #'*),.(.5(5,&0(.5.)5."#-5"*.,77."35,5,*.#(!9

PRO TIP

For men in their 20’s and 30’s fortunate enough to be undergoing TRT, I recommend you get your blood drawn at least once a year. For those of you in your 40’s and up, twice a year is best. An Anti-Aging Panel is highly recommended for anybody 35 and up.

5 3)/5 ,5 ().5 &,35 )#(!5 -)65 3)/5 -")/&5 !#(5 ,!/&,&35 !..#(!5 3)/,5 &))5 1),%5 )(5 -)5 3)/5 (5 )'*#&5 (5 , ,(5 &&5 ) 5 3)/,5 .5 ),5&# 855 0#(!5 5 .#&5 .#'&#(5 ,)'5 3)/,5 0,35 ̑,-.I#(#.#&5 &))5 .-.)-.,)(5*(&51#&&5*,)0#52&&(.5)'*,#-)(5*)#(.-5-53)/,5 95

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

0&/-5(5#)',%,-5"(!5)0,5.#'850#)/-&353)/,5*"3-##(51#&&5 5)/'(.#(!5."#-5/.5 5&-)5,)''(53)/5%*#(!5)*#-5) 53)/,5 &))5*(&-53)/,-& 5-)53)/5(5)'5#(.#'.&351,5) 5."5"(!-5 3)/52*,#(85)53)/,5")'1),%5(5%()153)/,5)385./353)/,5 ,.#)(-5(5.%5,3-.&5&,5().-85)/51#&&5-053)/,-& 55&).5) 5.#'5 1"(5 )(0,-#(!5 1#."5 3)/,5 ).),5 # 5 3)/5 (5 -*%5 #(.&&#!(.&35 1#."5 "#'I",5,!,#(!53)/,5)1(5)35(5#.-5,.#)(-5.)58

EVALUATING BLOOD TESTOSTERONE ,5#-5(5./&52,*.5 ,)'55&))5.-.5 ,)'55"&."35(5 .5 ii73,7)&5'&51#."5&)15)35 .651")5-")%#(!&35-.#&&5-/Ŀ,-5 ,)'5 &)15.-.)-.,)(5&0&-8

96

CHAPTER 10

TESTOSTERONE FRACTIONS IN THE BLOOD Free T 2% Albumin-Bound T 38%

SHBG - bound T 60% T = Testosterone Only 2% is free Testosterone and 98% is bound

Remember from Chapter 4 total testosterone5 #-5 ."5 )((.,.#)(5) 5 .-.)-.,)(5 #(5 3)/,5 &))5 -.,'5 (5 free testosterone5 #-5 ."5 -'&&5 ')/(.5 ) 5 .-.)-.,)(5 &).#(!5 ,)/(85 -/&&365 )(&35 )/.5 hz5 ) 5 ."5 .-.)-.,)(5 )/(5#(5."5)35.5(35)(5.#'5#-5\ ,I.#0]gfh5(5bioavailable testosterone5BBioTC55#-5\.#0]5),50#&&5 ),53)/,5)35.)5/-85
&.")/!"5."5-&-50,365.-.)-.,)(5&0&-5,5!(,&&35#(55,(!5) 5 ,)/(5 ijn5 .)5 ggomA.".]-5 (()!,'-5 ) 5 .-.)-.,)(5 *,5 #&#.,5 ) 5 &))5 *,5 ),*85 Th5 -&5 0,#-5 *(#(!5 )(5 ."5 &))5 &),7 .),35*, ),'#(!5."5.-.-5(5."5,(!5#-51#853)(5,1#(!5&))65 .",5#-5()5#)"'#&5.-.5'#(#-.,&51"#"5(5*,#-&35'-/,5 .1(5 (),'&5 (5 (),'&5 &0&-5 ) 5 &))5 .-.)-.,)(85
&-)5 !7 -*# 55 ,(!-5 ,5 ().5 +/).5 /-5 ."5 0&/-5 ,'#(5 /(&,85
(5 ,'',5 ."5 '-/,'(.5 #-5 )(&35 ) 5 ."5 *,.#/&,5 .#'5 ."5 -'*&5 1-5,1(85Th#(%5) 5#.5-5-(*-").5) 5(52.,'&353('#5"),')(&5 (0#,)('(.8 (5 ."5 2'*&5 )065 ."5 -/$.5 #-5 )/.5 ) 5 ,(!5 (5 &)15 )(5 .-.)-.,)(85 /.5 1".5 # 5 -)')(5 #-5 -.#&&5 1#."#(5 ."5 ,(!65 /.5 )(5 ."5 &)15 (5 ),5 '#&5 *,.5 ) 5 ."5 ,(!5 B-)'."#(!5 &#%5 jff@lffC>5 Th5 *,)&'51#."5."5-&5#-5.".5#.]-5().5$/-.5 ),5!85(53)/5)/&5 5if53,-5)&51#."5.-.)-.,)(5&0&-5) 5iff85Th.]-5(),'&A ),55mf7 3,7)&5 '(85 /.5 #-(].5 5 if5 3,5 )&5 1#."5 ."5 &0&-5 ) 5 5 mf73,7)&5 '(5,/((#(!5)(5'*.3>5 5,!/5 #(#.#0&353-< gfh5 kj85,'/&(5
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97

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL


&-)65 ."5 -&5 #-5 -5 )(5 *,(.#&-85 .]-5 -35 hhk@ijn5 (!I&5 #-5 ."5)..)'5gf."5*,(.#&5(5ggom5(!I&5#-5."5.)*5gf."5*,(.#&85
.5 ."5 gg."5 *,(.#&65 3)/],5 (),'&85 /.5 .".]-5 -.#&&5 -#!(# #(.&3 &)1,5 ."(5 1".5 #-5 (0,."&--5 *"3-#)&)!#&&35 (),'&5 (5 ..#(&5 #(5 noz5 ) 5 ).",5 '(85 )5 0(5 # 5 3)/],5 ."(#&&35 ^1#."#(5 ,(!6_5 3)/],5 ().5 )*,.#(!5 .5 )*.#'&5 5 &0&-5 ),5 *, ),'(5 (5 1&&7 #(!85
(5/( ),./(.&35'(35).),-51)(].5*,-,#5."#,5*.#(.-5 .-.)-.,)(5/(&--5."5*.#(.5#-5."(#&&35)/.7) 7,(!85Th 5#-5'(-5 3)/5 )/&5 5 ik5 1#."5 5 &0&-5 ^1#."#(5 ,(!_5 ) 5 (5 nf73,7)&65 /.5 &)15 ),53)/,5!85"#-5#-5!#(55,'#(,5) 51"35#.5#-5#'*,.#05 ),5 *,)!,--#05 5 *"3-##(-5 .)5 -.,#05 .)5 .,.5 ."5 ./&5 -3'*.)'-5 ) 5 ."#,5*.#(.-5(5().5."5 #(#(!-5) 55&5,*),.

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In a healthy young male, 60% of testosterone is attached to Sex Hormone-Binding Globulin (SHBG).103 SHBG is produced mainly by the liver and then released into the bloodstream. Hormones bound to SHBG can’t be used by the body and lose their anabolic effect. As men age, SHBG levels rise and bind strongly to the testosterone of free NERDALERT ALERT molecule lowering the body’s absorption NERD 104 testosterone and its many benefits. Hence, we want to have as much FREE (usable) testosterone available as possible. SHBG is an important marker of insulin resistance and studies have shown it an independent predictor of metabolic syndrome and type 2 diabetes105. In aging men, the rise in SHBG and associated maintenance of total testosterone values may mask low levels of free testosterone. SHBG is a critical component of proper TRT evaluation. It is imperative your doctor is vigilant to your SHBG and free testosterone levels while on TRT.


-5 $/-.5 -..65 25 ),')(5 #(#(!5 &)/&#(5 BC5 #-5 ."5 )/(.#("5) 5*,)*,5"),')(&50&/.#)(85",5,5Ń#(.513-5.)5 '#(#'#45."5Ŀ.-5) 55(5./&&35,/5#.-5 ),'.#)(5#(5."5 &))85..&5,)).52.,.5),5 .#(!#(!5..&5)).gfl51#&&5&)1,55 /&.#'.&35 #(,-#(!5 ,5 .-.)-.,)(gfm85 .#(!#(!5 ..&5 )).5 &-)5 "&*-5))-.55&0&-535*,0(.#(!5#.-5)(0,-#)(5.)5#"3,).-.)-.,)(5 BC85 (5 .65."#-5/."),5&#0-5."#-5-/**&'(.5#-55 5
55 ),5 (35 '(5 &))%#(!5 .)5 '%5 5 5 &# 5 &)(!5 )''#.'(.85 5 ,)''(55#0#5)-!5) 5750-1000 mgs per day5*, ,&35)(5(5 '*.35-.)'"8 gfi5 '')(5 5BhfggC85^#0,-5)&-5 ),525),')(7#(#(!5&)/&#(5#(5 *,)/.#)(_85#)&)!35) 5*,)/.#)(5nk5BiC95jig@jjg85)#9gf8gfokI#)&,*,)8ggg8fohkoi8 5fffl7iili85 5hglgilih8 gfj5 kl5#.-5,85 35hffj50hm5#k5*gfilBlC65^-.)-.,)(5(5-25"),')(7#(7 #(!5!&)/&#(5*,#.5."5'.)&#5-3(,)'5(5#.-5#(5'#&7!5'(_5 gfk5 .(1),."565 )(-585-.)-.,)(5 ),5."5!#(!5'&:5/,,(.50#(5(5 ,)''(5*,.#585&#(#&5 (.,0(.#)(-5#(5
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99

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

HEMOGLOBIN AND HEMATOCRIT

Th,5 #-5 5 ().#&5 ),,&.#)(5 .1(5 "#!"5 .-.)-.,)(5 &0&-5 (5 "#!"5 "')!&)#(65 ')-.5 &#%&35 /-5 .-.)-.,)(5 -.#'/&.-5 #(,-5 ,5 &))5 &&5 ),'.#)(8gfo5 Th#-5 #(,-5 *,)/.#)(5 ) 5 ]-5B,5&))5&&-C5#-5&&5,3.",)3.)-#-85)'.#'-5.))5'(35 ,5 &))5 &&-5 /--5 *)&33."'#5 B&))5 ."#%(#(!C5 1"#"5 ) .(5 0&)*-5 /,#(!5 5 #(5 )&,5 '(5 .,.5 35 #($.&5 .-.)-.,)(5 *,*,.#)(-8ggf5Th35'/-.5!.5,!/&,5&))5,1-5.)5-#*")(5."52--5 ]-85*(#(!5)(53)/,5!65."5#!5*#./,5#-5%()1#(!5"'.),#.5 #-55#)',%,5.)5)'5%(&351,5) 8

gfo5 (!565#-"&!5651,&)Ŀ565.5&85 (0-.#!.#)(65.,.'(.5(5')(#.),#(!5) 5 &.7)(-.5"3*)!)(#-'5#(5'&-95 
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5,)''(.#)(-8/,5

5(),#()&85hffn:gko9kfm@kgj ggf5 -.)-.,)(5#(/-5,3.",)3.)-#-50#5#(,-5,3.",)*)#.#(5(5-/**,--5 "*##(950#(5 ),55(1 erythropoietin/hemoglobin set point. Bhasin S4. J Gerontol A Biol Sci Med Sci. 2014 Jun;69(6):725-35. doi: 1093/gerona/glt154. Epub 2013 Oct 24.

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Upon initial use of TRT, it is mandatory your physician monitors your hemoglobin/hematocrit levels vigilantly to make sure they stay under the range of 18 (Hemoglobin)/50 PRO TIP
(Hematocrit). If they are elevated above these reference ranges, the periodic giving of blood (phlebotomy) should lower the value and function to keep it within range.111 At my optimal dosage level of TRT, it is rare to have chronically elevated values, but it is still a crucially important biomarker for you and your physician to be pro-actively aware of and to aggressively treat with phlebotomy. Working with a knowledgeable TRT physician would ensure this never becomes an issue. Here is a short video where Dr Justin Saya discusses how elevated red blood cells are managed in men on TRT: XXXTRTRev.com/manage-red-blood

LIVER HEALTH Th ere have been no documented cases of benign or malignant hepatic tumors with injectable or transdermal 112 TRT. T"ere have been observed liver issues with long-term oral formulations of testosterone like methyltestosterone.113 After nearly 15 years of active physician-guided 65."5/."),5"-5(0,5)(5"5&0.5�,5*(&-85 .5#-5'35)*#(7 #)(5.,#'(.&5&# -.3&5"#.-5&#%5)(-/'#(!5&)")&5(5.#(!5#.-5 "#!"5#(5-./,.5 .-5-.,--53)/,5�,5 ,5'),5."(550,51#&&855 )/5-")/&5-.#&&5"053)/,5�,5(43'-5'-/,5)(553,85 5 3)/52*,#(5(35&0.#)(5 5-.,)(!&35()/,!5."5-/**&'(.53&,]-5 ggg5 #-"&!585-.)-.,)(5.,.'(.5)'-5) 5!95(15)*.#)(-5 ),5"3*)!)(&5 '(85&#(5(),#()&5B2 Chffl:lk9hmk@hng85D/  ggh5 /,%,5
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THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

Liver Detox114 to reduce risk and to lower elevated panel readings. (Also discussed in Chapter 11.)

PSA & PROSTATE HEALTH It is important to have a Enlarged Male Prostate Gland yearly PSA (prostate-specific anRectum tigen) screening while on TRT. Bladder Even with all the sensationalist Enlarged Protate claims in the media about how testosterone causes prostate canPenis cer and benign prostatic hyperplasia (BPH) there is no concluTesticles sive evidence that TRT increases the risk of prostate cancer or BPH.115In fact, in what I would call the “Holy Grail of TRT and Prostate Cancer Research Data” from ,858 85 )1,5(5,) --),5885,-)(116 regarding the traditional model of testosterone-dependent prostate cancer growth (which suggested that greater serum testosterone concentrations would lead to greater cancer growth)—their recent findings appear to disprove the theory entirely.

114 http://trtrev.com/tyler 115 Marks LS, Mazer NA, Mostaghel E, et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006;296:2351-2361. 116 )1,5 g65#'"(5 65,-)(55i,85,)-..7-* #5(.#!(5"(!-5(5 *,)-..5(,5#(5"3*)!)(&5'(5.,.51#."5.-.)-.,)(5,*&'(.5.",*385  5 (.85hffo5 3:gfiBoC9ggmo7ni

5

102

CHAPTER 10

NERD ALERT

Rather, the most plausible explanation for what is seen clinically in the current era of TRT is supported by the recently re-evaluated saturation model, which states that, secondary to limited androgen receptor binding sites, prostate cancer growth is sensitive to variations in serum testosterone levels only below castrate range.117

,85 )1,5 (5 ,) --),5 ,-)(5 !)5 )(5 .)5 -35 ."5 )&&)1#(!95 ^-5)(5&&50#&&5.65-51&&5-5)/,5*,-)(&52*,#(65#.5#-5'35 )*#(#)(5 .".5 .-.)-.,)(5  ##(35 -3(,)'5 (5 5 - &35 .,.5 1#."55 .,5-/-- /&5*,)-..5(,5.,.'(.8_ In my opinion, this positive data has not gotten the exposure it deserves and more TRT-prescribing physicians should be aware of it. The Life Extension Foundation (LEF) citing Abraham Morgentaler, MD, in his landmark PRO TIP research article “Destroying the Myth About Testosterone Replacement and Prostate Cancer118” offers this positional stance on the risks of testosterone119 and prostate cancer120.

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103

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

)15&))5&0&-5) 5.-.)-.,)(5)5().5*,)..5!#(-.5*,)-..5(,5(65 #(65'35#(,-5."5,#-%8 #!"5&))5&0&-5) 5.-.)-.,)(5)5().5#(,-5."5,#-%5) 5*,)-..5(,8 ,.'(.51#."5.-.)-.,)(5)-5().5#(,-5."5,#-%5) 5*,)-..5(,65 0(5')(!5'(51")5,5&,35.5"#!"5,#-%5 ),5#.8

&,&35 ."5 *,#!'5 #-5 -"# .#(!5 -5 ."5 '#&5 )''/(#.3]-5 %()1&!5) 5(,)!(5*"3-#)&)!35#'*,)0-85Th#-5#-51-)'5(1-5(5 /-5 ),5&,.#)(5 ),5'&5*,)-..5(,5-/,0#0),-5."51),&5)0,8

CAUTION

There is a possibility of TRT causing prostatitis or prostate infection/inflammation over long term use. While this is not dangerous, it can be troublesome causing restricted urine flow and frequent nighttime urination symptoms. There are a number of potential treatments to consider.

5-alpha reductase inhibitors such as Flomax or Uroxatral relax the smooth muscle of the prostate wall and bladder neck often improving urine flow121. A more radical but efficient approach is the /-5) 55&-,122 to eliminate any prostate tissue obstruction.123 PSA levels have been known to rise in older men at the start of transdermal T delivery systems due to them elevating DHT. Normally once testosterone levels have stabilized, PSA will drop back down into a baseline range. Recently the usage of Cialis124 (Tadalafil) (the erectile dysfunction drug) at 2.5 mgs to 5 mgs every day has also been approved for the treatment of BPH.125 121 The efficacy and safety of alpha-1 blockers for benign prostatic hyperplasia: an overview of 15 systematic review-J, Liu, Y, Yang Z, Qin X, Yang K, Mao C. Curr Med Res Opin. 2013 Mar;29(3):279-87. 122 http://www.amsgreenlight.com/HPS_intro.html 123 Photoselective laser vaporization of the prostate (PVP) for the treatment of benign prostatic hyperplasia (BPH): 12-month Results from the First United States Multi-center Prospective Trial. J Urol 2004; 172:1404-1408 ghj5 "..*9II.,.,08)'I#&#ghk5 .-.5*",').",*35)*.#)(-5 ),5(#!(5*,)-..#5"3*,*&-#852*,.5*#(5",7 ').",85hfgj5*/5hfgj5
/!5hn."8

104

CHAPTER 10

BLOOD PRESSURE

HIGH: STAGE 2 HYPERTENSION HIGH: STAGE 1 HYPERTENSION PREHYPERTENSION NORMAL

LOW

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105

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

)/5(5*/,"-55 &))5*,-7 -/,5/Ŀghm5)0,7."7)/(.,5(5)5 #.5 .5 ")'5 ),5 3)/5 (5 "))-5 .)5 0#-#.5 3)/,5 &)&5 *",'35 .)5 '-/,5 ,!/&,&35 B#(5 #.#)(5 .)5 "0#(!5 #.5 ')(#.),5 1#."5 ,!/&,5 )Ń50#-#.-5.)53)/,5*"3-##(C85
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106

CHAPTER 10

.)5-/**),.5."5-..'(.5\5/--5#(,-5,#-%5) 5",.5..%-5(5 -.,)%-]5#(5any man under the age of 6585 5#.51,5.,/650,35.(!,51)/&5"05(,5(5",.5#--85 B),5 '),5 #( ),'.#)(5 #-*/.#(!5 ."#-5 -./3]-5 .65 -5 ."5 #(.,0#15 1#."5,85,..5-),(gig5#(5"*.,5giC85 (5,()'#45*&)5)(.,)&&5.,#&-65555#(,-5 ."5 #(#(5 ) 5 ,#)0-/&,5 #--5 ),5 0(.-5 -/"5 -5 '3),#&5 #( ,.#)(65-.,)%65),5(!#(8gih55 &,5 '(5 ) .(5 5 (5 #(,-5 ,#-%5 ),5 0-/&,5 *,)&'-5 -5 #(5 '(35 ).",5 ,-5 ) 5 ."#,5 "&."85 /.5 .",5 #-5 ()5 )(&/-#05 ,-,"5 0#&&5-..#(!5."5,#-%5) 5/-#(!55 /,.",5((!,-5."'53)(5 ."#,5 (),'&5 #(,-5 ,#-%85 )-.5 ) 5 ."5 .5 0#&&5 B(5 *,#),5 .)5 ."-5 .,)&&#(!5 &--5 .#)(5 --5 )'#(!5 .)5 ."5 ),!,)/(C5 *,)0#-5 &,5 0#(5 -/**&'(.&5 .-.)-.,)(5 ,/-5 ."5 ,#-%5 ) 5 ,#)0-/&,5 0(.-5#(5).",1#-5"&."35(5(),'&5'(gii855 (5 ).",5 #)',%,5 .)5 5 1,5 ) 5 -5 5 *).(.#&5 0-/&,5 #--/5 #-5 ")')3-.#(85 5 )')3-.#(5 #-5 (5 '#()5 #5 1"(5 *,-(.5 #(5 "#!"5 )((.,.#)(-65"-5(5&#(%5.)5(5#(,-5,#-%5) 5",.5..%-5(5 -.,)%-gij85-,05(),'&5&0&-5) 5")')3-.#(5,5.1(5j8j5(5 gf8n5 '#,)')&-5 *,5 &#.,5 ) 5 &))85 &0.5 ")')3-.#(5 &0&-5 ,5 .")/!".5.)5)(.,#/.5.)5*&+/5 ),'.#)(535'!#(!5,.,#&51&&-85 5 ,)''(5-/**&'(.#(!51#."55)'*&2gik65)&#5
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107

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

LIPIDS AND CHOLESTEROL HEALTH 5 "-5 (5 -")1(5 .)5 "05 &#..&5 .)5 ()5 Ŀ.5 )(5 *&-'5  5 &0&-5 #(5 '/&.#*&5 -./#-gin85 5 "-5 (5 -")1(5 .)5 ,-5 .,#!&3,#-5 (5  5 &0&-gio85 .]-5 &13-5 #'*),.(.5 .)5 "05 3)/,5 &)17 (-#.35 &#*)*,).#(5 B  C5 (5 "#!"7 (-#.35 &#*)*,).#(5 B C5 &)(!5 1#."5 3)/,5 .,#!&3,#-5 "%5 1"#&5 #(5 5 -.5 -..5 .5&-.5)(553,85 Many TRT-prescribing clinicians believe testosterone can negatively impact cholesterol levels. This belief is not supported by any relevant data. It is assumed the excessively high doses (supraphysiologic) of testosterone and other synthetics (anabolic steroids) used by athletes and pro/recCAUTION reational bodybuilders leads to reductions in HDL (highdensity lipoprotein a.k.a. the beneficial cholesterol) and increases in LDL (low-density lipoprotein a.k.a. the negative cholesterol). There is no conclusive peer-accepted research to support these beliefs—only the elevated cholesterol values seen in the private panels of these population groups.

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Improving your cholesterol can be accomplished with diet and exercise modification. Proper eating and some form of exercise should be the established foundation prior to beginning any treatment. Chronically poor levels PRO TIP of cholesterol can increase your risk of cardiovascular disease. Sometimes medical intervention is needed to help restore a proper lipid balance. Here are three over the counter supplements which have shown to improve your lipid profile. Each nutrient works differently. 1) Omega-3 Fish Oil 2) CoQ10 3) Red Yeast Rice. Doctors sometimes prescribe Omega-3 as a blood thinner, found to be more effective than Asprin, for patients found to have high red blood cells. This can be especially beneficial to men on TRT Statin Drugs are commonly prescribed by Doctors to patients who have high cholesterol. Nearly 60 million people will be taking statin drugs this year in the United States alone. Statins have been found to significantly lower CoQ10 levels. Supplementing with Co-Q 10 can help restore depleted levels.

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THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

When exogenous (supplemental) testosterone is used, a cascade of biochemical actions take place. Your hypothalamus (the master gland in your brain) secretes GnRH (Gonadotropin Releasing Hormone), which causes your pituitary gland to secrete luteinizing hormone (LH) and folliclestimulating hormone (FSH). The increase in these hormones causes the testes to stimulate the Leydig NERD NERDALERT ALERT cells to produce testosterone (by conversion of cholesterol). Testosterone then has the ability to undergo various metabolic processes that will inhibit GnRH, which in turn inhibits the secretion of LH and FSH, bringing a halt to endogenous (natural) testosterone production. This is referred to as the negative feedback loop. Once testosterone has stopped being produced, it no longer sends this negative signal, and GnRH eventually begins to do its job again. This is how homeostasis is maintained in the human body.

All men should be fully cognizant using lifelong TRT protocols (like those found in this book) can definitely (and most likely WILL) reduce the size of your testes, interfere with fertility and suppress your HPTA (HypothalamicPituitary-Testicular Axis) also known as the HPGA CAUTION (Hypothalamic–Pituitary–Gonadal Axis) and sometimes now known as the HPG Axis. This means your natural testosterone production will be impaired if not SHUT DOWN altogether. This is nothing to worry about whether you are past your reproductive age or not. This is tackled further in the reader question and answer section later in this chapter.

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.-.)-.,)(5*,)/.#)(5/&.#'.&35&#(!5.)5(),'&5,*,)/.#05(5 -2/&5 /(.#)(gjm85 -#(!5"/'(5"),#)(#5!)().,)*#(5B"Cgjn50,35-)5 ) .(5 B#&365 1%&35 .)5 *,"*-5 0(5 0,35 ).",5 1%C5 .5 5 )-!5 ) 5 250 to 500 iu’s per injection B#($.#(!5 -//.()/-&3 #(.)5 ."5 .5 .#--/5 ) 5 &)1,5 -.)'"5 ),5 ."5 .5 *5 ) 5 )/.,5 !&/.5 1#."5 (5 #(-/&#(5 -3,#(!C 1#&&5 *,)0#53)/,5.-.#&-5(5#(,-5#(5-#45),5 /&&(--85"5 "-5 (5 &#(#&&35 *,)0(5 .)5 ,-.),5 ,.#&#.35 #(5 '(5 /(,!)#(!5gjo85)'5'(5*-3")&)!#&&35(5."#-5 )-'.#5Ŀ.5) 5 /&&5.-.#&-5.)5 &5(),'&85Th5^ )"(5 ,#-&,5 .")5) 5"5#-5#($.#(!5."5&-.5.1)53-5 ),55)(55 1%55#($.#)(5*,).))&5),5# 5#($.#(!55.1#51%&365#($.#(!5"5 )(5."535 ),5"5#($.#)(gkf85 .5#-5#'*),.(.5.)5')(#.),5"5-5#.5 L
L5&0.5-.,#)&5BhC5*).(.#&&35/-#(!5-.,)!(#5-#5Ŀ.#(5'(51#."5"#!",5)35 .5*,(.!-5(5"#!",5!(.#5*,)/.#)( ) 5,)'.-5/5.)5#.-5#&#.35.)5&0.5,)'.-5(43'-8 For those of you wishing to retain your fertility, fret not. Human menopausal gonadotropin (hMG) is a potent female fertility medication which can also increase sperm count and stimulate sperm motility in men151. hMG is PRO TIP stronger than hCG because it mimics both LH and FSH and additionally binds to receptors in the testicles hCG alone will not bind to.152 gjm5 ,-,0#(!5 ,.#&#.35#(5."5"3*)!)(&5*.#(.95(5/*.85
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#&-.)(-5/&#-"#(!5B ,"5gi65hfgkC gkg5 1(!565&.,-565 #*-"/&.45 85)(.'*),,35)(*.-5#(5."50&/.#)(5(5 '(!'(.5) 5'&5#( ,.#&#.385./,5,0#1-85,)&)!35hfgg:nBhC9nl7oj85)#9gf8gfinI(,/7 ,)&8hfgf8hif8 gkh5 .652.(.65(5')# #,-5) 5-* '.)!(#5,)0,35 .,5"),')(&5'&5)(.,7 *.#)(95(5#(.!,.5(&3-#Lancet. 2006 Apr 29;367(9520):1412-20.

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THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

5"05%()1(5'(51")51,5)(55 ),5'(353,-5-.,#!".5(5  .,5/-#(!5" 5#(5)'#(.#)(51#."5"5.550,35'#(#'/'5)-5) 5 f8mk5 #/]-5 *,5 35 ),5 k@m5 3-5 #(5 5 ,)165 !).5 ."#,5 1#0-5 ),5 !#,& ,#(-5 *,!((.5 1#."#(5 )(5 ')(."5 ) 5 !#((#(!5 '#(#-.,.#)(85 ),5 (35 ) 5 3)/5/.##(!55(5-.,/!!&#(!5.)5 .",5"#&,(5B$/-.5/-#(!5"5),5 &)'#C5!#05."#-5))%5.)53)/,5*"3-##(5-)5"5#-5#( ),'5(51,5 ) 5."#-5"#!"&35Ŀ.#05 85),5(52&&(.5)-#(!5-.,.!35/-#(!5 hCG5(5hMG5#(5)'#(.#)(655 5"-5(5 2&&(.5,.#&gki85 ,85 /-.#(535&-)5"-55!))50#)52*&(.#)(5) 5"5-51&&8gkj While some men are able to get a prescription for testosterone from their local primary care doctor, some often have trouble getting a prescription for ancillary medications including hCG. If that is the case and you
PRO TIP
want to consult with an experienced doctor, doing so via telemedicine by phone or webcam is a convenient alternative. If a prescription is written, medication can then be shipped directly to you from the pharmacy. This is a great service for men who do not have easy local access to TRT and related treatments. Visit this website to discover more: 111808)'I"!5

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Some physicians prescribe hCG and/or clomid monotherapy as a form of TRT. The premise of this protocol is to stimulate the testicles with either hCG or clomid so they increase testosterone production. Its success rate is highly dependant on how sensitive the leydig cells are in CAUTION the individual patient’s testicles. This is the PREFERRED strategy for younger men (30-50 age group) desiring to maintain fertility and higher sperm count (who are *ATTEMPTING* to NOT DISRUPT their endogenous testosterone production). There is no peer reviewed research stating hCG or clomid causes or does not cause HPTA shutdown. Again it is important to monitor blood panels of E2 (estradiol) when on long term hCG or clomid therapy due to their potential to increase aromatase activity. As already stated in Chapter 9 there are highly successful TRT physicians using Clomid as their sole form of therapy to restore T production in hypogonadal men concerned with retaining their fertility.

I highly recommend men still interested in maintaining their fertility consider visiting their urologist and getting a measured sperm count in order to understand their PRO TIP baseline values before undergoing TRT. It would also be prudent to have sperm frozen to be used at a later date as a precautionary measure.

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I can’t stress enough how important it is for every man reading this book to take control of his health while undergoing TRT by regular and methodical collection of PRO TIP blood panels. Order the Hormone and Wellness Panel for 160 Men first and if you’re already a lifelong TRT patient, get a couple of the TRT Male Hormone/Wellness Follow Up Panels161 done per year. Be proactive always and take your health into your own hands.

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117

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

,5#-55",.5),55".5".5 ),5."5')-.5#'*),.(.5#)',%,-I &5--3-5 ),5'(5.)5')(#.),5,!/&,&351"#&5/(,!)#(!5&# &)(!58 -.I2' ,+/(3I", &))5,--/,5B-*#&&35 Weekly or semi-monthly5 0#5 */,"-5 # 53)/5"05.))5'/"5)35 ) 5 (5 )0,7."7)/(.,5 /Ŀ65 ),5 .5 5 *",'35 ),5 (5 )Ń5 0#-#.5 1#."5 3)/,5 .C *"3-##(8 7')!&)#(5),5 '.),#.5BIC

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Once a year after age 455 B-*#&&35 # 5 '#&35"#-.),3C8 After a baseline is attained before and during TRT, 1-2x per year5 .)5 (-/,5 *,)*,5 &(5 *((.5 )(5 -#5  7 .-5 ),5 -3'*.)'-85 -.5 .)5 ),,5 \(7 "(]65\-(-#.#0]65),5\/&.,5-(-#.#0]5.)5 ..,5 0&/.5 '&5 -3'*.)'.)&)!35 ,!,#(!5-.,)!(5&0&-8 After baseline is attained before and during TRT, 1x per year5-5)(5*,7 #05-3'*.)'-I-#5Ŀ.-5B-/"5-55 &)--5) 5&##)5),5 &#(!-5) 5'))#(--5 ),5*,--#)(C85&0.5*,)&.#(5)0,5 iff5-")/&5,-/&.5#(5(5  5"%#(!5 ),55*#./#.,35()'8 Once a year after age 40. 2x a year.

1x a year for men over 40. %5-/,5.)5 .-.5 
75 -5 .",5 #-5 '/"5 '),5 5 #(5 ."5 )35 1"#"5 *,)0#-5 '),5 .)5 '-/,85 
5 #-5 5 .,#%35 "),')(5 /.5 #.5 "-5 5 &).5 ) 5 *).(.#&5 &# 5 ("(7 #(!5 +/&#.#-85 5 ."#-5 '4#(!5 ,.#&5 )/.5
gk5(51".",53)/5-")/&5 )(-#,5-/**&'(.#(!51#."5#.8

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CHAPTER 10 READER QUESTIONS Do I have to be on TRT forever? Do you get permanently addicted?

#(5 3)/,5 )35 1#&&5 ().5 *,)/5 ."5 )*.#'&5 &0&-5 ) 5 5 35 #.-& 5 B/*)(5&)(!5.,'5&# &)(!5C653)/5'/-.5)(.#(/55# 53)/51(.5.)5 '#(.#(5 ."5 ( #.-85 /.5 1"35 1)/&(].5 3)/5 1(.5 .)5 �5 5 &# 5 #&&5 1#."5 0#,#&#.3>5 )5 #Ŀ,(.5 ."(5 .%#(!5 5 ."I-")1,5 ),5 .#(!5 ))5 ,!/&,&385Th,5#-5()5-/"5*/,*)-5 ),53&#(!51"(53)/],5)#(!55 ),,.&35*,5'35,)''(.#)(-5(5-55&# &)(!5*/,-/#.855 ))5'(35'(5!.5/!".5/*5#(5."5'#(-.5) 5^"5()65# 5 5-.35)(5 ),0,5(5&)-5'35(./,&5*,)/.#)(65."(51".>_5&&653)/]&&5(0,5 "05 .)5 1),,35 )/.5 &)15 .-.)-.,)(5 (5 &&5 ."5 *,)&'-5 #.5 /--5 /-5."5.,/."5#-50,35-#'*&5(5-35.)5 85 53)/5)(].5'%5."5 ")#5 .)5 #'*,)05 3)/,5 &#(#(!5 (./,&5 *,)/.#)(5 B.).&5 (5 ,5 .-.)-.,)(5 5 0,35 -#(!&5 35  .,5 ."5 !5 ) 5 ifglh5 (5 *,"*-53)/(!,C51#."55,*&'(.5)-653)/]&&50(./&&352*,#(5 ."5-3'*.)'-5) 5-/Ŀ,#(!5 ,)'5&)1,5.-.)-.,)(8 Does TRT make me sterile and unable to have children?

"#-5#-55'3."5(5/(.,/85 53)/5-#,5.)5"05"#&,(65'%5-/,53)/5 &-)5-.,.!#45."5/-!5) 5#.",5"65&)'#5(I),5" 5#(53)/,5/-!5 ) 5 .-.)-.,)(85
-5 *,0#)/-&35 -..65 3)/5 -")/&5 &-)5 0#-#.5 3)/,5/,)&)!#-.5 .)5 !.5 5 '-/,5 -*,'5 )/(.5 #(5 ),,5 .)5 /(,-.(5 3)/,5 -&#(5 0&/-5  ),5 -.,.#(!5 85 5 /-/&&35 1#&&5 ().5 *,'((.&35 '!5 3)/,5 #&#.35 .)5 #'*,!(.5 5 1)'(85 (5 ."5 1),-.5 --5 5 "05 -(A 1",5 '(5 1")5 1,5 )(5 5 ),5 '),5 ."(5 gf5 3,-5 (5 1,5.).&&35 #("##.5 0#5 &/.#(#4#(!5 "),')(5 B C5 (5 )&&#&5 -.#'/&.#(!5"),')(5 BC5 0&/-65 /-#(!5 5 ,#!),)/-5 )/,-5 ) 5 "5 (I),5 &)'#5 ),5 " 5 ,-.),5 ,.#&#.351#."#(5-#25')(."-5(5-)'.#'-5#(5&--5.#'8

glh5

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(,)!(5 ##( 35#(5!#(!5'(95,)&5) 5.-.)-.,)(5 ,*&'(.5.",*385 5 5&#(5 5hfff:gik9imf7imn

120

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With all the sensationalist claims in the news about testosterone increasing the possibility of CV (cardiovascular) events like heart attacks, strokes, etc., and your book clearly dispelling them as poorly and wrongly interpreted data from older men in higher risk population groups, what is the prudent course of action knowing there is NO CONCLUSIVE longer term studies proving the safety of TRT? This a great question and one deserving of an elaborate answer.

Actually there is a myriad of studies documenting the SAFETY of T replacement (more so than those documenting the contrary). As with ANYTHING, precautions must be exercised (no pun intended) and T replacement should ONLY be pursued under the watchful eye of 5 %()1&!&5 (5 2*,#(5 5 -/*,0#-#(!5 *"3-##(. The benefits of T, as opposed to being wholly biochemical in nature, may be a function of the hormone’s effect on fatigue, secondarily increasing one’s tendency to exercise and pursue a more physical lifestyle. This by virtue confers protection AGAINST coronary disease. No one questions EXERCISE’S health improving effects, right? Assuming the WORST, the data are mixed: 50/50. In our professional opinion however, considering that the HRT-associated “risk” is likely a function of flawed study design (and therefore spurious), it is WORTH the risk. Hey Jay-Quick question

Background – I have had trouble finding a good TRT doc in Denver without spending upward of $3k just to get started. I paid for my own lab work, used the bloodwork video from you and put myself on TRT with black market test. So far everything has been great. My real point – As any good doc knows, after a period of time on TRT one’s natural production shuts off. Do you think/know of a Doctor who would work with me on this, without forcing me to go on a hormonal/ emotional rollercoaster just to “prove” that my natural levels are crap ie crashing my current test levels just to qualify for legit TRT script? This is also a great question. The Folks at Defy Medical provided me the best answer. You would not need to stop your hormone supplementation. On your initial panel they will detect you are taking

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(5(,)!(85Th351#&&5()/,!53)/5(5&&5'(5#(5-#'#&,5-#./.#)(-5 .)55")(-.85 5."35%()153)/5,5/-#(!5.-.)-.,)(65."351#&&5)(.#(/5 3)/,551#.")/.5#-,/*.#)(5/.51#&&5')# 35."5*,).))&5B)-!C&5.)5 !.5&&5(/',-51#."#(55!))5,(!85 5 3]-5).),-51#&&51(.5.)5%()151".53)/51,5/-#(!65")15&)(!65 .855 53)/5,53)/(!65&--5."(5ik53,-5)&65(5)(&35/-#(!5/(,!,)/(5

5."(5."5).),-51#&&5"053)/5-.)*5(5)5(5
5-.#'/&.#)(5 *,).))&85

122

NUTRITION AND ITS ROLE IN TRT CHAPTER 11



(5 "*.,-5 gg5 (5 gh5 5 #-/--5 )*.#'#4#(!5 3)/,5 .-.)-.,)(5 ,*&'(.5 .",*35 .",)/!"5 ),,.5 (/.,#.#)(5 (5 2,#-85 .5 #-5 ,/#&5 .)5 /(,-.(5 ."5 *)1, /&5 ,)&5 #.5 (5 2,#-5 *&35 #(5 ."5 '#(.((5 ) 5 85 )/5  5 #'*,)05 ,-/&.-5 ,'.#&&35 35 (-/,#(!5 #.5 (5 2,#-5 -.,.!#-5 ,5 #&5 #(85 ,85 ,..5 -),(]-5 ))%5 5  gli5 #-5 "#!"&35 ,)''(5 -5 (5 2&&(.5 ,-)/,5!/#5 ),5/(,-.(#(!5."5")15(51"35) 5*,)*,5(/.,#.#)(5 (52,#-8 It’s important we clarify some things for all men reading this book. If you are a man who drinks alcohol nightly and whose diet consists of fast food, sodas and other processed food, you will not experience the wonders of higher levels of testosterone. Testosterone WILL NEVER BE a magic CAUTION bullet or panacea wonder supplement when used in combination with an unhealthy lifestyle. If you eat a clean diet and use an intelligently-designed resistance and endurance training program while also being on a sound TRT regimen—your results should be outstanding.

.]-5 #,-.5#-/--5")15.)5-.5-.,/./,53)/,5#.5(5(/.,#.#)(5 .)5'2#'#45."5( #.-5) 58

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123

CHAPTER 11

CALORIC INTAKE IS DEPENDENT ON ONE’S GOAL )/,5 .).&5 ))5 B',)(/.,#(.-7 *,).#(65,)"3,.-5 (5 .-C5 #(.%5 #-5 &13-5*((.5)(53)/,5)0,&&5!)&855 "5,5 ,5 i5 #-.#(.5 *"--glj5 ),5 !)&-5 3)/5(5)-,05.5(35)(5.#'8 )&

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#(.((5 gj7gl5 &),#- *,5 hff7*)/(5 '(5 1)/&5 ) 5/,,(.5)35 *)/(5 ) 5 .).&5 )35 (5h6nff7i6hff5&),#-5 1#!". 1#!".5#(5*)/(*,5 35 .)5 '#(.#(5 "#-5 *,-(.5)(#.#)( )35 .5&)-- o7gi5 &),#- *,5 hff7*)/(5 '(5 1)/&5 *)/(5 ) 5 .).&5 )35 (5g6nff7h6iff5&),#-5 1#!".5#(5*)/(*,535.)5&)-5)35 . (5'/-&5 gm7hf5 &),#- *,5 hff7*)/(5 '(5 1)/&5 !#( *)/(5 ) 5 )35 1#!".5 (5 i6jff7j6fff5 &)7 #(5*)/(,#-5*,535.)55'/-&5 '-)/5 -")/&5 /(,-.(5 ")15 3)/,5 -*# #5)35 .3*5 B-)'.).3*C5 *,)---5(5,-*)(-5.)5#(-/&#(glk51"(5&/&.#(!53)/,5.).&5&),#5 #(.%5 B,-*.#05 ) 5 /,,(.5 !)&C85 (-/&#(5 #-5 ."5 ,!/&.#(!5 "),')(5 ,&-5 35 ."5 *(,-5 1"(5 )(-/'#(!5 ,)"3,.-85 *(#(!5 )(5 ")15 #(-/&#(7-(-#.#05 3)/5 ,65 /&.#'.&35 .,'#(-5 ."5 ')/(.5 ) 5,)"3,.-53)/5(5)(-/'51#.")/.5*)-#.#(!5)35 .85
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124

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL5

",5,5i5#Ŀ,(.5)35.3*-gll9 R .)'),*"#5B&(5(5-%#((3C R -)'),*"#5B(./,&&35'/-/&,C R ()'),*"#5B"0#,5(5"#!",5)35 .C

Ectomorph

Mesomorph

Endomorph

Most people are a combination of the 3 somatotypes. Those who are insulin-insensitive (endomorphic) will require a somewhat lower carbohydrate intake to avoid excess fat storage. This is why it is imperative to experiment on PRO TIP yourself with regard to your calorie intake and keep close records to see what works. All of the estimated calorie intakes listed above in the chart are highly variant due to biochemical individuality with regard to a person’s insulin sensitivity. If you have higher body fat levels and are looking for a solution to strip fat off fast and as efficiently as possible, consider Intermittent Fasting (IF)167.

gll5 glm5

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125

CHAPTER 11

THE SPECIFIC MACRONUTRIENTS NEEDED BY A TRT-ER PROTEIN ,).#(5 #-5 '5 /*5 ) 5 '#()5 #-51"#"5,5."5/#&#(!5&)%-5 ) 5&# 85)/5(5*,).#(5#(5),,5.)5 /#&5 (5 '#(.#(5 '/-&85 ,)7 .#(5 #-5 ."5 ')-.5 #'*),.(.5 '7 ,)(/.,#(.5 ),5 *, ),'(5 (5 *"3-#+/5 #'*,)0'(.85
5 *,).#(5 ,#"5#.5#-5--(.#&5 ),5)*.#'#4#(!5 )35)'*)-#.#)(51".",53)/,5!)&5#-5 .5&)--5),5'/-&5!#(85 )/,5 #&35 *,).#(5 ,+/#,'(.-5 ,5 -5 )(5 3)/,5 !)&-85 ./#-5 #(#.5(5#(.%5) 50.7 to 1 gram of protein per pound of body weight5 #-5,+/#,5.)5-/**),.5."5()&#5B.#--/5/#&#(!C5*,)---5#(51#!".5 &# .,-gln85"(5 /(,!)#(!5 .-.)-.,)(5 ,*&'(.5 .",*365 #.5 #-5 --(.#&5 .)5 &13-5 .,35 (5 )(-/'5 .5 &-.5 g5 !,'5 ) 5 *,).#(5 *,5 *)/(5) 5)31#!".5()5'..,53)/,5!)&855 If you’re worried that consuming high levels of protein might be detrimental to your kidneys, rest easy. The myth that high protein diets impair kidney function is based on studies carried out on those with renal disease. In otherwise healthy individuals protein intakes well in excess of one CAUTION gram per pound of bodyweight have shown no adverse effects on kidney function169,170. As long as you don’t have any pre-existing kidney disease, a higher protein diet should pose no issues to your health.

)5..,5/(,-.(5."5,)&5*,).#(5*&3-5#(5"/'(5(/.,#.#)(65(5 ."5)*.#'&5.3*-5) 5*,).#(5.)5.65,5."5 )&&)1#(!5,.#&-95 ,).#(5 gln5 '*&&565,#,55.5&855 (.,(.#)(&5)#.35) 5*),.-5/.,#.#)(5*)-#.#)(5 -.(95*,).#(5(52,#-85 5 (.5)5*),.-5/.,85hffm:5j9n glo5

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126

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

),5/''#-5,.5 gmg65,).#(5 ),5/''#-5,.5 gmh65(5,).#(5 ),5/''#-5,.5 gmi8 CARBOHYDRATES ",5)(.#(/-5.)55#.,35)( /-#)(5.".5,-5,5#(",(.&35 .,#'(.&5.)5)35)'*)-#.#)(85
-5-/"65'(35'(5"055 ),'5) 5 \,)*")#]5(5)(-/'5.))5 15,)"3,.-85
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127

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CAUTION

From a muscle building standpoint, most men seem to do best consuming 2 grams of carbs per pound of bodyweight. For endomorphic men (usually insulin insensitive) it is likely you’ll have to consume much less. As continually advised throughout this book, it is critical to establish BASELINES and self-experiment to figure out how your body type individually responds to your carb intake.

FATS (ESSENTIAL FATTY ACIDS)

LNA* + LA**

There is no more important nutrient to the human body than Essential Fatty Acids – commonly referred to as EFA’s. Without them, your brain would stop functioning and your nervous system would shut down. They are involved in cushioning your internal organs for protection, aiding in the absorption of vitamins and minerals, and facilitating the production of hormones and prostaglandins. Their consumption greatly impacts testosterone levels. Unfortunately 90% of people are EFA deficient from eating a “normal everyday diet.” Yes, you read that correctly. A diet high in essential fatty acids will help to keep your body in a state of positive nitrogen retention (anabolic) ensuring your TRT is maximally optimized. 128

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

)15 )5 3)/5 !.5 ."'5 #(5 3)/,5 #&35 #.>5
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SUPPLEMENTATION TO MAXIMIZE TRT .5 #-5 #'*),.(.5 .)5 ,5 "#!"&35 .#05 (5 #(.(-5 .,#(#(!5 #(#0#/&-5 (5 +/.5 0#.'#(5 (5 '#(,&5 ,*&(#-"'(.85 ,85 ,..5-),(5"-55 /&&5&#-.5) 5-/**&'(.-gng5"5,)''(-5#(5 5  5(5 ]'5&-)5*,)0##(!55+/#%5"#..,5&#-.5) 5--(.#&5."#(!-5 5 &#055*,.##(!57,5-")/&55.)5."#,5(/.,#.#)(&5,!#'(8 Eating broccoli, cauliflower and cabbage51#&&5"&*5,#5."5)35) 5 2--5-.,)!(gnh85

gmm5 gmn5 gmo5 gnf5 gng5 gnh5 3)/7hI

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129

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)/5 -")/&5 &,35 %()15 35 ()15 1"35 ,/#(!5 -.,)!(5 #-5 #'*),.(.85 ,/# ,)/-5 0!.&-5 ,5 "#!"5 #(5 #()&7i7,#()&5 1"#"5 #-5(5-.,)!(7&)1,#(!5 ))5)'*)/(8gni5"-50!!#-5,5&-)5"#!"5 #(5 #,gnj51"#"5"&*51#."51#!".5)(.,)&5(5)35 .5&)--gnk8 "5)35/--5Magnesium5(5Zinc5.)5'#(.#(5(),'&5(,05(5 '/-&5 /(.#)(85)."5'#(,&-5&-)5-/**),.55"&."35#''/(5-3-.'65 %*5 ."5 ",..5 -.365 (5 "&*5 )(-5 ,'#(5 -.,)(!85 Magnesium5 (5Zinc5(5&-)5-#!(# #(.&35 #(,-5 ,5.-.)-.,)(5&0&-5#(5'(8gnl5 Calcium hydroxyapatite5 #'*,)0-5 )(5 '#(,&5 (-#.35 (5 -.,(!."(-5 &#!'(.-5 (5 .()(-5 .5 ."5 -'5 .#'85
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various neurological disorders. Supplementing with it at 200-300 mgs a day is clinically proven to offer powerful anti-aging benefits190. Resveratrol191 is a compound found in the skins of red grapes. It is a potent antioxidant and especially important in helping *,0(.5 ."5 *,'./,5!#(!5) 53)/,5&&-192. Supplementing at 100-250 mgs a day is a proven anti-aging strategy. Metformin193 is a powerful blood sugar regulating medication. Metformin increases one’s insulin sensitivity194 and by virtue, lowers circulating levels of the inflammatory hormone insulin. Having less inflammation will lead to a longer life. Between 500 mgs to 1 gram AM and PM provides a wide range of therapeutic benefits including enhanced fat loss when used with a reduced calorie diet. In order to use Metformin, you MUST have a script from your doctor. 5As previously written in Chapter 9, it is rare clinical doses of TRT can put undue stress on the liver. It is important to understand men living in large population centers are under continual bombardment by a host of toxins like phytoestrogens from the air, plastics and processed food. Most people consume excess alcohol as well. Even if you just recreationally drink alcohol, detoxifying your metabolic system via a powerful liver protectant is a good protective policy. I recommend 3&,5 #0,5 .)2195 as an excellent overall detoxification supplement. As shown in Chapter 9, the prostate risks are overstated when on clinical dosing protocols of TRT. Your physician can also prescribe 190 Dhanasekaran M, Ren J. Th e emerging role of coenzyme Q-10 in aging, neurodegeneration, cardiovascular disease, cancer and diabetes mellitus. Curr Neurovasc Res. 2005 Dec;2(5):447-59. 191 http://trtrev.com/resveratrol 192 http://trtrev.com/defy-resveratrol 193 http://fabfitover40.com/2014/12/28/life-extension-bottle-use-metformin/ 194 http://fabfitover40.com/2014/05/19/eating-low-carbs-lowers-training-intensity/ 195 http://trtrev.com/tyler

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.-.)-.,)(8hfm5 .-5-/**&'(..#)(5#-5&-)5-#!(# #(.&35--)#.51#."5 .).&5.-.)-.,)(5(5hfn8 )5'%5-/,53)/5!.5()/!"5B().5#(!5&5.)5 /&&35)(.,)&5")15 '/"5 -/(&#!".5 2*)-/,5 3)/]&&5 ,#0C5 5 ,)''(5 3)/5 "05 3)/,5 *"3-##(5 .-.5 3)/,5 &))5 &0&-5 ) 5 #.'#(5 65 hk73,)235 .)5 '%5 -/,53)/5 &&5#(.)5."5/**,5(5) 5."5*.50&/5,(!5) 5if7gff85 )5 (-/,5 3)/,5 -),5 #-5 mf5 ),5 )0hfo65 5 ,)''(5 -/**&'(.#(!5 k6fff7gf6fff5#/]-5) 5#.'#(5hgf5#&38 Vitamin D is the name given to a vitally important group of micro-nutrients. When activated, vitamin D becomes a potent steroid hormone, switching our genes on or off, and instructing our cells what work to do. Vitamin D’s effects are PRO TIP varied and profound. It is structurally similar to steroids such as testosterone, cholesterol, and cortisol (though vitamin D3 itself is a secosteroid). In other words, it’s more of a hormone than it is a vitamin. Since too much vitamin D can become toxic, I recommend checking your D3 levels with a simple blood test.

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CHAPTER 11 READER QUESTIONS What do you think of injectable nutrients? Do they work? What should be avoided?

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136

TRT AND FITNESS CHAPTER 12

T

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FOUNDATIONAL ROLE OF WEIGHT TRAINING

This book was not written to discuss the science and varying modalities of modern day weight training. This chapter offers a very high level summary of the influence resistance (strength) training SHOULD play in maximizing the success of testosterone replacement therapy. Using testosterone and not performing regular weight training along with consistent endurance work (otherwise known as cardiovascular exercise) is akin to driving a Ferrari and putting water in the gas tank. Re'',5'(651],5)(&35-5)&5-5)/,5,.,#-8 5 ("(-5 3)/,5 )3]-5 #&#.35 .)5 #'*,)05 *,).#(5 -3(."-#-hgg65 #(,-#(!5 &(5 '/-&5 .#--/5 (5 ,/#(!5 )35 . hgh85 ).5 .%#(!5 0(.!5 ) 5 #.-5 *).(.5 ()&#5 Ŀ.-5 #-5 )/(.,*,)/.#05 (5 *)#(.&--85 !/&,5 (/,(5 2,#-5 &-)5 2,.-5 *,)..#05 Ŀ.-5 )(5 hgg5
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139

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CAUTION

It is CRITICALLY IMPERATIVE as an aging male you do not perform high impact endurance exercise (like running on hard surfaces, or ballistic movements such as those found in CrossFit programs etc.) in order to preserve your soft tissues and spine. The last thing you want is having your knee or hip replaced later in life because that type of activity can lead to life in a wheelchair221.

THE IMPORTANCE OF SLEEP

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140

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

CHAPTER 12 READER QUESTIONS Could you offer a Cheat Sheet or a Daily Dietary Schedule for a Man using TRT productively? It really depends on what lifestyle goal you have at the current time. In other words, are you trying to reduce body fat, maintain your present condition or gain muscle? Here is a sample daily schedule for a Fat Loss Phase.

FAT LOSS PHASE Wake Up – take 500 mgs-1 gram Metformin (rx from your doctor), Caffeine, Armour T"yroid 30-60 mgs (rx from your doctor), T"ermogenic ( h5 #-5 5 !))5 )(223), .#(!#(!5 ..&5 )).224 1-2 capsules, inject your testosterone (if applicable for that day)

15-30 Minutes Later – 30-45 minutes of Low Impact Endurance Training (preferred types listed above) – aim for 70-75% of maximum heart rate (225 – age).

Meal/Feeding 1 – 30 minutes later 35-50 grams of *,).#(5 *)1,225, minimal carbs, 2 tablespoons of 5 #&226 or )]-5 #&227. T"ermogenic 45-60 minutes later. Meal/Feeding 2 (4 Hours Later) – 30-50 grams of animal protein, green veggies, oil dressing85",')!(#545-60 minutes later. Meal/Feeding 3 (4 Hours Later) – Same as Meal 2.

Weight Training Day – Intra-workout shake with 25-50 grams of carbs and 25 grams *,).#( (depending on your somatotype), followed by post-workout shake 30 grams of protein, 25-50 grams of carbs. If you are endomorphic (insulin sensitive) just use 25 grams carbs intra – and post-workout. 223 http://fabfitover40.com/2014/06/23/fab-fit-40s-review-vpx-meltdown-2-holy-grailfat-burners/ 224 http://trtrev.com/nettle 225 http://fabfitover40.com/2014/09/29/road-warriors-protein-powder/ 226 http://trtrev.com/mct 227 http://trtrev.com/udo

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142

THE FUTURE IS NOW! INTERVIEW WITH DR. BRETT OSBORN ON TRT

CHAPTER 13



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146

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

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CHAPTER 13

are environmental factors to which the “disease” of aging (and agerelated disease) may be attributed. In fact, there is indirect evidence that aging is 75-80% environmental in etiology. Keep in mind that “environment” encompasses ALL factors to which the body is exposed: nutrition, physical and psychological stressors and toxins to name a few. That said, many conditions such as type II diabetes and obesity, both of which have their underpinnings in insulin resistance, can cause hypogonadism. The proverbial “quick fix” is to place a patient on restorative testosterone therapy, thereby correcting one’s lab values. This however is a short-sighted approach, in essence addressing the epiphenomenon, as opposed to the phenomenon (type II diabetes in this case), or treating the effect and not the cause. I wholeheartedly agree with Dr. Swerdloff in this regard and routinely screen my patients for disease risk factors. In this context, I address BOTH the low testosterone AND said risk factors concomitantly. This is my practice paradigm. One is not addressed without the other. Patients are started on a rigorous exercise program (as per the protocol outlined in 5  ), advised as to proper nutrition and supplementation, placed on medication (I utilize metformin, aspirin and antihypertensives aggressively) and counseled on the management of stress. Restorative hormonal therapy is often initiated concomitantly. The effects of the above are synergistic. Lowering disease risk factors (inflammation and insulin resistance) increases testosterone levels. Supplemental testosterone, in a reciprocal manner, reduces risk factors for disease. It’s a double whammy. JC: With the FDA’s recent ruling on adding Black Box Label Warnings to all testosterone products, is the landscape becoming better or worse for men seeking to optimize their hormones?

BO: Neutral. I believe the FDA is simply looking out for the pharmaceutical industry and the populace at large. By virtue of their labeling, the FDA is exonerating itself as a governing body by indirectly publicizing the results, albeit flawed, of the recent TRT study. This should be held in the same regard as commercial-embedded warnings issued by pharmaceutical companies. And while attorneys may be 5 148

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

chomping at the bit to vilify prescribing physicians in the wake of such labeling, this is by no means proof of danger (and likely is the opposite in fact). Answering your question, sometimes perceived “negative” publicity serves an antithetic function, and hopefully in this case will raise awareness of the health-promoting benefits of TRT in select individuals. JC: What changes do you see taking place on the testosterone front over the next five years?

BO: The acceptance of TRT will continue to lag behind the robust manifestations of its life-changing effects. Millions of men and women are successfully utilizing TRT currently and regaining their vitality and lust (no pun intended) for life. And without side effects. Properly prescribed, TRT is perfectly safe. Its acceptance is simply a matter of its gaining momentum through documented treatment successes. A revolution of thought is in order. We are fast moving more towards a preventive health care paradigm and ultimately into one of human optimization. The treatment of disease post-facto will soon be of days yesteryear. JC: Talk about your practice—where is it going relative to all of the TRT clinics springing up across the country and the globe.

BO: Continuing the thought my practice is currently a hybrid. The mainstay of my practice is neurosurgery albeit with a holistic slant. I make concerted efforts to treat all patients conservatively unless there are pressing neurologic issues which mandate surgery. Anti-inflammatory agents (high-dose omega-3 fatty acids and pharmaceuticals) are utilized as are exercise and nutritional strategies. Degenerative disease of the spine (affecting a large percentage of my patients) is an age-related disease. And herein lies the tie-in to Anti-Aging and Regenerative medicine. Treating degenerative disease of the spine is nearly identical to the treatment of all other degenerative diseases: coronary artery and cerebrovascular disease, diabetes and Alzheimer’s dementia. It’s just different geography. And the aging process itself is a degenerative disease, right?

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Th#-5().#)(51#&&5,#05."52*(-#)(5) 5'35*,.#5/&.#'.&385 (35 *"3-##(-5 "05 .%(5 ."#-5 &*5 ) 5 #."5 &,365 -5 ."5 ,1,-5 B')-.&35 #((#&C5 ) 5 *,#',35 ,5 '##(5 "05 )'5 0#,./&&35 ()(72#-.(.85
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150

CONCLUSION CHAPTER 14



"(5 ----#(!5 '),(5 35 -)#.365 '#&&#)(-5 ) 5 '(5 (&--&35 -/Ŀ,5 ,)'5 &)15 -25 ,#065 &)--5 ) 5 (,!365 (5 #(#&#.35 .)5 )/-65 soul crushing indecisiveness and a steadily diminishing enthusiasm for life—because of chronically low levels of their essential life blood— testosterone. Too many physicians who know little to nothing about TRT and even more lay people continue to be mystified by numerous misconceptions, both about testosterone’s effects on human biology and behavior, and about the role of testosterone therapy in adults. Testosterone replacement therapy is a verifiable and scientifically proven way to dramatically enhance your life. It should also be quite apparent “optimal levels” can be readily restored using the proven TRT protocols of progressive physicians. It is important to thank the small number of dedicated physicians, scientists and active researchers who have devoted their lives to understanding testosterone’s numerous effects on male life spans, and on building a factual, myth-destroying approach to TRT. This book is the result of close to 20 years of trial-and-error research, testing, refining, and a ton of blood (literally and figuratively), to deliver what I believe is THE authoritative research manual on testosterone replacement therapy. My listed and recommended TRT protocols represent efficient strategies known to bring blood testosterone values to the highest end of the range while minimizing side effects and maintaining optimal health and safety. Rest assure, I and my research confidantes will be at the forefront of learning newer and more therapeutic protocols in the hopes of continuing the betterment of all men. 151

CHAPTER 14

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152

THE DEFINITIVE TESTOSTERONE REPLACEMENT THERAPY MANUAL

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