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Testosterone Therapy Side Effects vs Benefits Overview

Testosterone Therapy Side Effects vs Benefits

As with any medical treatment, including testosterone therapy, there are potential side effects. These side effects are uncommon during testosterone therapy and, certainly, as good physicians we want to minimize any negatives while enhancing the positive benefits.

Every patient is different so it is important to individualize the low testosterone treatment. This requires the guidance of a license physician.

Alert! Learn more: Testosterone & Heart Disease, Heart Attacks, & Stroke Risk

Positive Side Effects of Testosterone Therapy in Men

The technical term for low testosterone is hypogonadism. This means the testicles, for whatever reason, are producing too little testosterone and you are at risk for other health problems. Low testosterone causes your body to deliver less oxygen to your cells, increased risks of strokes and heart attacks (the heart is a muscle), bone loss, muscle loss, and, in many patients but not all, erectile dysfunction.

“Male hypogonadism is characterised by androgen deficiency and infertility. Hypogonadism can be caused by disorders at the hypothalamic or pituitary level (hypogonadotropic forms) or by testicular dysfunction (hypergonadotropic forms). Testosterone substitution is necessary in all hypogonadal patients, because androgen deficiency causes slight anemia, changes in coagulation parameters, decreased bone density, muscle atrophy, regression of sexual function and alterations in mood and cognitive abilities.”1

Here is a brief list of the well-known benefits of testosterone therapy that most men experience in our treatment program:2

  • Improved sexual desire, function and performance
  • Improved bone density
  • Increased muscle mass and strength
  • Decreased body fat
  • Better mood and quality of life
  • More energy and better sleep
  • Improve brain function and reduced risk of Alzheimer’s
  • Better blood sugar regulation and decreased risk of diabetes
  • More nitric oxide production and more oxygen delivered to cells

“Restoring testosterone levels to within the normal range by using testosterone replacement therapy can improve many of the effects of hypogonadism. Most importantly, these include beneficial effects on mood, energy levels and patients’ sense of well-being, sexual function, lean body mass and muscle strength, erythropoiesis and bone mineral density (BMD), cognition and some benefits on cardiovascular risk factors.”2

“Testosterone is well known to help in libido, bone density, muscle mass, body composition, mood, erythropoiesis, and cognition. All these benefits made testosterone replacement therapy in the United States increase substantially over the past several years, with an increase of more than 500% in prescription sales of testosterone products since 1993.”2

There are many more potential benefits such as increased confidence, improved work performance, and women finding you more attractive. Testosterone therapy can also help improve growth hormone levels and decrease bad cholesterol levels.

While testosterone therapy is not a “cure-all”, in our opinion, the benefits of testosterone therapy when done correctly greatly outweigh any potential risks. If side effects do occur, which is very rare, we are available to help you address them so you can continue to receive the benefits of optimal testosterone levels.

Potential Negative Side Effects That We Help You Prevent & Treat

There is a myth that testosterone causes breast enlargement, prostate problems, and mood swings. This is false. Estrogen, in excess, causes breast enlargement, prostate problems, and mood swings.

The side effects of excess estrogen can be treated and prevented. Testosterone can convert to estrogen and this is normal. As we age, testosterone declines and estrogen production increases. This is also considered normal. However, it is far from healthy unless you want to get in touch with your feminine side and have your chest muscles turn to fat and your prostate swell. In addition, “grumpy old man syndrome” is low testosterone and increased estrogen.

Elevated estrogen levels are also highly correlated with erection problems. Most guys will notice an insidious decline in their penis size as they get older. This is from less testosterone and too much estrogen. This can be very severe in men with diabetes who tend to convert very high amounts of their testosterone to estrogen.

Testosterone Converts to Estrogen and then feeds back to the brain to reduce Testosterone Production

Testosterone Converts to Estrogen and then feeds back to the brain to reduce Testosterone Production

By measuring your estrogen levels and using the proper doses of anti-estrogen medications we can prevent and treat any symptoms related to excess estrogen and this is relatively easy to do. In the past, inexperienced physicians would “freak out” if the patient reported breast enlargement (gynecomastia) and discontinue testosterone therapy despite the fact that estrogen is easy to reduce.

“Gynecomastia is an unusual side effect associated with testosterone replacement therapy (TRT) that has been traditionally treated with surgery, radiation, or discontinuation of testosterone supplementation. We report here our experience with two cases of gynecomastia in men undergoing TRT who were successfully treated with the aromatase inhibitor anastrozole.”1

Another potential side effect of testosterone therapy is testicular shrinkage. This happens when your body sees that you have enough testosterone due to testosterone therapy and begins to make less which causes the testicles to get smaller. This can easily be treated with HCG or clomid because these medications increase your natural production. HCG and clomiphene stimulate your body to produce more testosterone.

“If patients with hypogonadotropic hypogonadism wish to father a child, spermatogenesis can be initiated and maintained by gonadotropin therapy (conventionally in the form of human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) or, more recently, purified or recombinant follicle stimulating hormone (FSH)).”2

“No adverse effect was identified after treatment. We conclude that hCG injection may be considered as a treatment for PADAM [partial androgen deficiency].”3

Testosterone Cypionate Injections

This medication is used in men who make too little of a natural substance called testosterone. In males, testosterone is important for maintaining normal body functions, such as genitals, muscles, and bones. Testosterone belongs to a group of hormones known as androgens.

How to use testosterone cypionate IM

Watch the video: how to inject testosterone intramuscularly

Testosterone can be taken as an injection, a topical cream, as a tab under the tongue, or can be improved by increasing natural production with medications such as HCG. Testosterone cypionate is given by injection into the buttock or thigh muscle as directed by your doctor, usually once to twice weekly. Do not inject this medication into a vein (pulling back on the plunger before injecting to make sure no blood comes into the syringe will help prevent this). Your dosage is based on your medical condition, testosterone blood levels, and response to therapy.

If you are giving this medication to yourself at home, we will review proper use in the clinic and if you have any questions or concerns it is important to contact us as soon as possible. Always check the vial of testosterone for particles or color change before each use. If particles or color changes occur, do not use and contact us. All needles should be disposed of in a “sharps” container that can be purchased at and returned to most pharmacies (ie Rite Aid). Unused medication should be disposed of properly (contact us for instructions).

Use this medication regularly in order to get the most benefit from it. To help you remember, use a calendar to mark the days you will receive an injection. We always give a dosing schedule to each patient but if you have any questions be sure to contact us.

If you wish to discontinue testosterone therapy we will help you do it safely. It is important to avoid abrupt discontinuation. In such cases, it may take time for your body to begin producing adequate testosterone again, and withdrawal reactions (such as tiredness, weakness, depression) may occur. To prevent withdrawal reactions, your doctor may reduce your dose gradually and use other medications to stimulate your natural production. Consult your doctor for more details, and report any withdrawal reactions immediately.

Testosterone is classified as a controlled substance because some men (ie body builders) may abuse it in an unsafe way. Always ask us before increasing your dose or using it more frequently. Excessive (abuse) use of testosterone may increase serious side effects (such as increased risk for heart disease, stroke, liver disease, ruptured tendons/ligaments). Bodybuilders who abuse testosterone use levels 10x higher than we would ever prescribe for therapeutic benefits.

Possible Side Effects of Testosterone Therapy

WebMD lists a number of possible side effects from testosterone cypionate injections.5 The majority of these side effects are very rare when testosterone is used properly and estrogen levels are being addressed. In our effort to deliver the highest quality to you, we ask you to review the possible side effects and ask us any questions so we can ensure you understand how we are addressing these issues for you.

Some side effects that we have NEVER seen but are theoretically possible include:

  • Nausea and/or vomiting
  • Headache
  • Skin color changes (this may happen if you have liver problems)

We commonly see this side effect:

  • Increased sexual interest (libido)

We rarely see these side effects and have ways to address them:

  • Decreased sexual interest
  • Oily skin
  • Hair loss
  • Acne
  • Pain and redness at the injection site may also occur

If any of these effects occur please tell your doctor at Innovative Men’s Clinic promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is much greater than the risk of side effects and has created a plan to reduce any possible side effects and will help you address any side effects that may occur. Most people using this medication are free of side effects when it is used at normal doses as prescribed by your doctor.

Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as anxiety, depression, increased anger), trouble sleeping/snoring, signs of serious liver disease (such as persistent abdominal pain/nausea, unusual tiredness, yellowing eyes/skin, dark urine). Most men using testosterone therapy notice a slight increase in their aggressiveness but because these side effects were found in men taking oral testosterone (causes liver problems which leads to skin color changes) or abusing testosterone, it is unlikely these will be an issue for you.

Tell your doctor immediately if any of these unlikely but serious side effects occur: trouble urinating, breast swelling/tenderness (too much estrogen), too frequent/prolonged erections.

Rarely, males may have a prolonged erection lasting 4 or more hours that can cause discomfort. If this occurs, call us at (425) 455-1700 or seek immediate medical attention, or permanent problems could occur.

This medication can decrease sperm production, an effect that may lower male fertility. Consult your doctor for more details about how hCG can be used to help maintain your fertility (see additional handout).

This medication can cause your body to hold on to extra body water (edema). Some men experience this with testosterone injections and there are ways to address this as it is due to either too much estrogen or from the cypionate. Generally,switching to topical testosterone will resolve this issue.

Excess water retention can increase your risk of heart failure. Tell your doctor immediately if any of these unlikely but serious signs of water retention or heart failure occur: decreased exercise ability, hands/ankles/feet swelling, unusual tiredness, shortness of breath while lying down.

In reality, research support the use of testosterone therapy in heart failure as it improves heart function:

“Heart failure is a chronic clinical syndrome with very poor prognosis. Despite being on optimal medical therapy, many patients still experience debilitating symptoms and poor quality of life. In recent years, there has been a great interest in anabolic hormone replacement therapy – namely, growth hormone and testosterone – as an adjunctive therapy in patients with advanced heart failure. It has been observed that low levels of growth hormone and testosterone have been associated with increased mortality and morbidity in patients with heart failure. Animal studies and clinical trials have shown promising clinical improvement with hormonal supplementation.”

“Growth hormone has been shown to increase ventricular wall mass, decrease wall stress, increase cardiac contractility, and reduce peripheral vascular resistance, all of which might help to enhance cardiac function, resulting in improvement in clinical symptoms. Likewise, testosterone has been shown to improve hemodynamic parameters via reduction in peripheral vascular resistance and increased coronary blood flow through vasodilation, thereby improving functional and symptomatic status. To date, growth hormone and testosterone therapy have shown some positive benefits, albeit with some concerns over adverse effects. However, large randomized controlled trials are still needed to assess the long-term safety and efficacy.”4

Allergic reactions to testosterone cypionate injections are very rare. Our testosterone cypionate is typically in an base of grapeseed oil or sesame oil. Get medical help immediately if you notice any signs of a serious allergic reaction, including: rash,itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your Innovative Men’s Clinic doctor immediately.

Before using testosterone, tell your doctor if you are allergic to it, grapeseed, or sesame seed; or if you have any other allergies. This product may contains inactive ingredients (sesame oil or grapeseed oil), which can cause allergic reactions or other problems in some men.

This medication should not be used if you have prostate or breast cancer.

Before using this medication, tell your doctor your medical history, especially of: heart disease (such as heart failure, chest pain, heart attack), liver problems, kidney problems, other types of cancer, high cholesterol, high blood pressure, enlarged prostate, sleep apnea, or diabetes. This will help your doctor determine the safest approach to balancing your hormones.

If you have diabetes, this product may decrease your blood sugar levels, which is usually a good thing but we want to prevent your blood sugar from decreasing too much. Check your blood sugar levels regularly to make sure your blood sugar is not going too low. Tell your doctor immediately if you have symptoms of low blood sugar, such as increased hunger, dizziness, or unusual sweating. Your diabetes medication may need to be reduced.

If you use coumadin or warfarin to thin your blood, this product may increase the effectiveness of your blood thinner. Check your protime and INR regularly and advise your cardiologist that you may need to reduce your coumadin/warfarin dose. Tell your doctor immediately if you have symptoms of increased bruising.

References on next page

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{ 231 comments… read them below or add one }

Teddy April 6, 2014 at 5:22 pm

Dr. Barry,

I’m a 50 year old male who has just started back on testosterone cyp injections. I’m taking 100mgs once a week and have had a couple of Afib episodes that have lasted for about 10 seconds each and have left me feeling weak and anxious. I would then take my ativan .50 mgs to calm me down. Do you think that I’m having a side effect to my shots? I find the shots have me feeling way better than not having them but I’m still a little anxious about these Afib attacks. What do you suggest?

Reply

Dr. Barry Wheeler May 22, 2014 at 5:28 pm

Teddy,

Please discuss this with your doctor. Anything is possible so a more thorough work up is important to determine what is going on with you.

Cheers,
Dr. Barry

Reply

khadfie April 2, 2014 at 4:29 am

Hi Dr. Barry.
My boyfriend is a 38 year old male who has been administering RD testosterone shots via intra-muscular injections every 10 days for some time. About 6 months ago, his Dr. decreased his dosage and he started to feel slow and sluggish throughout the day. Two weeks ago, he saw a specialist who increased his prescription and advised him to take switch to subcutaneous injections. About 3 days after his first sq shot, he developed a very large, painful knot at the site that was red and burning hot. The following week, he was much more careful about cleaning and sterilizing everything, believing that he could avoid the same reaction (which he believed to be an infection) but to no avail. 3 days and a second knot developed. He seems to think that antihistamines are helping quell the reaction a bit but I’m worried about the consequences of continuing to take it without knowing what it is. Other than an increase and admin method, his prescription didn’t change. Should he switch back to iM injections? Is it an allergic reaction?

Reply

Dr. Barry Wheeler April 4, 2014 at 8:59 pm

Hi Khadfie,

Testosterone and the other components in the medication, such as benzyl alcohol and the oil base, are likely irritating the skin. I have seen this happen before but he should visit his doctor to make sure it is not an infection or a problem with the testosterone medication. It could be a “bad batch”.

Only his doctor can determine what to do so its important for him to contact his doctor. In addition, I have seen this happen often with subcutaneous testosterone injections. Testosterone should really only be injected into muscle in my opinion. I have had patients doing intramuscular injections who injected subcutaneous on accident and had this sort of reaction but to be safe he should see his doctor.

Best of luck,
Dr. Barry

Reply

damien March 16, 2014 at 6:54 pm

Hi dr. Barry,

I have been reading your comments here and I appreciate the help u give us.

I’m a 33 year old musician chronic pain patient who is has been on r oxycodone 15mg 3 times a day for more than 5 years.

Within the last 6 months I stopped getting rigid boners. I also gained some weight. I recently got tested and had low t 198. I went and got on T and started a new diet. I weighed 209 and I’m down to 196 in my last bathroom weighin. I’m have taken 2 100mg test cup shots a week apart w 2 days before shot on 25mg of hcg. After this 3rd shot I got scared cuz the day after my bp felt high. The next day I took it in walmart when I felt fine and it was 143 over 88. The next day I felt fine and I still feel fine. When it was high I was telling myself screw this I don’t wanna die I’m quitting everything tomorrow and just suffer it out. But I feel like it’s helping me lose weight and I been doing pushups my muscles feel bigger. I still can’t get a rigid erection. What should I do the stress of it adds to all of it. What is the golden path I will follow your advice.

Reply

Dr. Barry Wheeler April 4, 2014 at 8:52 pm

Hi Damien,

Sounds like you need to get more closely monitored by your doctor. You should be monitoring your red blood cell levels (testosterone increases them), estradiol (testosterone increases), and blood pressure (testosterone can be dehydrating for some men). There are actually a number of studies showing that testosterone can improve blood pressure (reduce) and help with weight loss.

Only your doctor can advise you. You’re welcome to visit one of our clinics as well. I recommend you tell your doctor about your blood pressure concerns and ask them to check your estradiol (estrogen) and red blood cell count.

Best of luck,
Dr. Barry

Reply

Gordon March 6, 2014 at 8:26 pm

I am a 54 year old male that has been diagnosed with low T. I had been using 200 mg/ml a month, weekly injections of 50mg/ml. My general health improved, my energy and strength at the gym. I have used the T cypionate off and on for 8 years now while taking medicine for HPB and high Cholesterol. Lately, even with vigorous exercise and weight loss, my blood pressure has elevated to borderline (on meds) and I have been to the ER and hospital 3 times over the past year with Afib. I was able to convert naturally all three times after about 12 hours, but now need medication for this too. My cardiologist has taken me off the T all together feeling this could be a contributing factor. I have not been able to pinpoint the trigger. Meanwhile, I am now feeling lethargic, fatigued, tired and my low energy has impact my trips to the gym. Where I was considered a gym rat, I now feel horrible. I don’t know what is worse. The low T or the Afib. It has only been about 6 weeks since stopping my treatment and I am really thinking about starting it again at a lower dosage. The cardiologist told me just to wait it out for a few months until I produce again, but the low T was the issue to begin with? May I have your opinion to the T treatment and Afib?

Reply

Dr. Barry Wheeler March 9, 2014 at 11:28 pm

Hi Gordon,

There is some research showing that low testosterone increases the risk of atrial fibrillation:

“Sex hormones play an important role in the development of cardiovascular disease. Testosterone and estradiol have been reported to be down-regulated in subjects with coronary artery disease and heart failure, but has not been studied in atrial fibrillation (AF).”

“CONCLUSION: Reduced testosterone levels may be associated with susceptibility to lone AF in men.”1

However, every patient is different and while I have seen many patients benefit from testosterone therapy our goal is always to minimize any potential side effects. Weekly injections of 50 mg is a very conservative dose. Did they check how low your levels are dropping at the end of the week? Were they monitoring your estradiol and red blood cell levels?

Also, with optimal hormone levels there is a greater demand for optimal nutritional levels. For example, magnesium deficiency can increase the risk of several health problems, including atrial fibrillation:

“Recently there has been an increased interest in the role of magnesium deficiency in chronic kidney diseases. Magnesium intake is inversely associated with the incidence of type 2 diabetes, but interventional studies are inconsistent to date. The use of magnesium in acute asthma and hypertension has also been reported, but definitive trials are lacking. In contrast, the use of magnesium as adjuvant therapy for ventricular arrhythmias, and atrial fibrillation may be beneficial although long term benefit remains unclear.”2

All treatments should be supervised by your doctor. I suggest you ask your doctor for a referral to a nutritionist.

Best of luck,
Dr. Barry

  1. Reduced testosterone levels in males with lone atrial fibrillation. Lai J1, Zhou D, Xia S, Shang Y, Want L, Zheng L, Zhu J. Clin Cardiol. 2009 Jan;32(1):43-6. doi: 10.1002/clc.20423.
  2. Disorders involving calcium, phosphorus, and magnesium. Moe SM. Prim Care. 2008 Jun;35(2):215-37, v-vi. doi: 10.1016/j.pop.2008.01.007.

Reply

Matt March 6, 2014 at 5:07 pm

Dr Wheeler,

Great website and practice.

I am a Type 1 diabetic and have been for 28 years, currently 38 years old with no diabetic complications. Well, not counting low vitamin D and low T.

My T levels were in the 250 range in my late 20′s but my Endo at the time said I was low normal. New insurance, new Endo, new labs, and at 30 I was sub 200. I tried gels which actually made my T levels lower. I tried Testopel and while that brought my levels up to mid 300 I would have to fall back to low 200 before they could be replaced. I did nit enjoy the experience and finally new insurance would nit cover them. Now I am on Test-C 100 mg a week. I feel great, no negative sides. Mood is stable, energy stable…just great and my levels test out between upper 300 to mid 400.

The problem is my doctor hates Test C and says that out of all of the TRT it is the one that causes all of the negative side effects. That it is not safe long term. He is constantly trying to get me to switch to some other method.

Is this true? I can’t seem to find any information to support or contradict this.

My endo is fantastic for my diabetes but I don’t have enough information to engage in a serious discussion.

Thank you.

Reply

Dr. Barry Wheeler March 9, 2014 at 11:12 pm

Matt,

One of the problems with topical testosterone is that much of the testosterone applied travels through the lymphatic system and not the blood vessels so we don’t really see what is going on in the body with regular blood testing. Testosterone injections on the other hand show increased in blood levels that correlate better with symptoms and the dose used.

The body only produces about 5-10 mg per day. I have found that for many men 100 mg of testosterone cypionate injected weekly is a sufficient dose but some men ened more and some men need less. In testosterone cypionate there is about 70 mg of testosterone left after the cypionate molecule is cleaved off slowly over a week.

Many topical testosterone medications range in doses from 50-200mg. There is debate about whether topical testosterone is fully absorbed or not and this leads to further confusion about how best to manage patients using topical testosterone. Not to mention the risk of transfer to others.

Another issue is that in patients with diabetes we tend to see a lot of conversion of testosterone to estrogen (estradiol). I suggest you ask your endo to check your estrogen levels. In younger men the ratio of testosterone to estradiol is about 40:1 and as we age, especially in the case of diabetes, the ratio can as low as 10:1 or less.

The two biggest risks I see in men on testosterone are due to lack of monitoring. With any treatment there are potential side effects but there are also risks to not receiving treatment. Our goal is always to minimize risk and increase benefits.

Read more: Testosterone Heart Disease, Heart Attacks, and Stroke Risks

Best of luck,
Dr. Barry

Reply

Gene March 3, 2014 at 6:01 am

Hello DR,
I have a quick question for you. I’m doing home injections of testosterone E. Of 200 mg/ml once a week. Every time I inject in my glute (butt), by the 2nd day afterwards the injection site swells under the skin pretty large. It’s hard underneath and slightly red on the serface. It’s sore but not debilitating, what could be causing this? My injection techniques are good and very steril. Thanks. Gene

Reply

Dr. Barry Wheeler March 9, 2014 at 10:59 pm

Hi Gene,

I have had this happen from time to time with patients but generally it only happens once in a while. If it happens every time there be a sensitivity to the benzyl alcohol or benzyl benzoate preservatives in the medication. Sometimes when the medication gets under the skin instead of all in the muscle it will cause irritation that can last for days.

It is important you follow up with your doctor ASAP to review your options and make sure there is no infection. Furthermore, if you are using compounded medications its possible that the medication can be made with less of the benzyl alcohol or benzoate or in a different base such as sesame oil or cottonseed oil.

Best of luck,
Dr. Barry

Reply

Abe February 22, 2014 at 1:17 pm

Dr. -

You have a great website, very informative.

I’m a 32 yr old white male. 6′ @ 195lbs. I hit the gym 5 days a week with a mix of high intensity cardio and weight training. 2 years ago I noticed that I felt “off”. I had a lack of motivation, felt tired all the time, and had a depressed out look on my job and the overall state of the economy.

I decided to go to my doctor who is a internal medicine doctor. Told him all about it, he did a full blood panel and sure enough my Total T level came back at 291, everything else was normal with Cholesterol being a few points high (family history) He said it was border line and recommended evaluating my diet, exercise, stress, potentially take some vitamins, and reevaluate in 3 months. I maintained diet, exercise, job induced stress remained high, and I began taking zinc, B, D, B12 in addition to my regular Alive multi vitamin.

3 months later the total T came back at 298.

We continued to draw, track and monitor these levels for the next two years. The total T levels always came in between 270 and very low 300. I have been trying to fix this with a holistic approach.

My Dr. decided to send me to a Urologist for a second look. He did his labs as well along with checking Free T. The brain MRI was decided against based on blood work, and the Free T has been averaging 9 to 10. He said I was a candidate for T replacement but since my wife and I wanted another child he recommended trying to get pregnant first.

So, it took about 3 months to get pregnant, our second baby arrived healthy 5 months ago, I decided to have a vasectomy in Nov 2013, and now I’m ready to take the next step towards fixing why I still feel off. My latest Total T from this weeks apt with the Urologist is 215 ( this was drawn at 2:00pm- all others where 8:00am). Dr recommended either 1cc every two weeks to get started with T shots, or Clomid once a day– My choice.

My Chiropractor says I’m crazy to take T replacement and he believes I’m experiencing Pregnenolone Steal Syndrome and wants me to start taking Pregnenolone 25mg supplements everyday and is confident it will remedy the problem. Have you ever sen success with this?

What are your thoughts on all these options based on my past. I feel that being 32 I’m too young to need T, but obviously the numbers have been consistent for quite some time. Thanks for taking the time to read this. Just want to make a informed decision. And more importantly I want to feel good. I’m sick of feeling off, tired, slightly depressed, and foggy. Thanks again.

Reply

Dr. Barry Wheeler February 23, 2014 at 7:23 pm

Hi Abe,

There are ways to increase fertility and your testosterone levels simultaneously. I suggest you ask your doctor about HCG as an alternative to clomiphene. He should also check your LH, FSH, prolactin, and estradiol levels as these are important factors in assessing fertility and potential risks and benefits of different treatments. Taking HCG or clomiphene may increase estrogen (estradiol) levels too much and require a medication such as anastrazole (low dose) to reduce this conversion.

When testosterone levels are low it is important to look for the cause of the problem. It is unlikely taking pregnenolone would address a pregnenolone steal as the reason pregnenolone gets “stolen” is due to increased demand from the adrenal glands to produce cortisol. In addition, the pregnenolone is not being “stolen” from the testicles. With chronic stress there may be an increase in cortisol which leads to a decrease in other hormones such as testosterone. We often see an increase in estradiol (estrogen) production in this case. The estrogen then feeds back to the brain and decreases the signal from the brain to the testicles.

When guys are younger the ratio of testosterone to estradiol is about 50:1 and then as we age this ratio reduces and we begin to experience symptoms of low testosterone. When the levels of estrogen increase above 35 pg/mL there are increased risks of breast development, prostate enlargement, heart attack, stroke, and ankle swelling:

Testosterone and Heart Disease, Heart Attacks, and Stroke Risk

Testosterone may make your sperm less motile but with HCG or clomid in combination with testosterone injection my patients are usually able to maintain fertility. In general, testosterone injections tend to be more effective at lower doses taken every 7 – 10 days. Bigger doses tend to give high levels for a few days and a big drop off following with poor testosterone to estrogen ratios.

Be sure to talk to your doctor before taking any new medications or changing your treatment. You may want to get a second opinion from a doctor more experienced in testosterone therapy and ferility.

Best of luck,
Dr. Barry

Reply

Dewan February 16, 2014 at 2:19 pm

Dr,
I too am 44. I first was getting 200mg injection every 10 days and had great results. I ended up like Dana….waking up gasping which was actually “trouble breathing while sleeping” which ended me in hospital with severe lower extremity adema and sleep deprivation halucinations all because my doctor didnt recognize text book symptoms. Careful Dana you may find like me your oxygen levels get near zero when sleeping or trying too. They wanted to call it sleep apnea but when testosterone was stopped so did it shortly thereafter.
Well i need some T and i think forewarned is forarmed although it got pretty bad before but only due to doctors inability to recognize cause.
2 days ago we decided 100 injection as he is resistant to topical for some reason. Well, waking up with light gasping has returned but so has russel the one eyed love muscle.
I just need help getting past this “trouble breathing while sleeping” which will lead to adema due to lack of oxygen and i guess potential other problems caused by not getting enough oxygen (fuel) for the various important “pump motors”, as one doctor put it.
I NEED THE T. MY MARRIAGE NEEDS THE T.
Sleeping in my recliner seems to alleviate the gasping. If this is the case (should it be for some reaso?) , then should i reasonably expect that i am getting enough oxygen and if i see no adema develop that I am overcoming that particular side effect which i believe caused the others (adema and severe sleep deprivation) “dear, the doctor dipped me in water so i wouldnt be cold….he was riding his horse”.
Should i be pushing my doc for topical? Should i maybe push for 50 every 5 days or 300 every 10 days to boost my immunity? It seems my doctor will not have the answers here, i will have to educate him.
I want to be clear that i am pleased with my doctor and i think there has to be a first for any of them. He says he has always used this treatment and i am the first with this reaction.
Not willing to give it up just need more O2 in PM OK?

Reply

Dr. Barry Wheeler February 23, 2014 at 6:53 pm

Hi Dewan,

I have found daily low dose propionate (10 mg – 20 mg) to have less risk of ankle swelling or sleep apnea in patients who are sensitive. I have also had good success having patients take 25 mg progesterone by mouth before bed to improve sleep and ankle swelling while on testosterone. Another important aspect is making sure the ratio of testosterone to estradiol (estrogen) is not too low. I generally like to see estradiol between 20 and 30 pg/mL and testosterone around midrange.

You may want to get a second opinion from another doctor in your area. The only way to know for sure what’s going on with your sleep is a sleep study. Your doctor should be able to refer you to a sleep study center and they even have devices you can use at home to monitor your sleep.

I wish you the best of luck. Be sure to talk to your doctor about your concerns and don’t change any of your treatments without discussing with your doctor first.

Cheers,
Dr. Barry

Reply

Rob February 16, 2014 at 6:16 am

Hi Dr. Wheeler,

I am a 40 year old male. I am currently taking about 22.5 mg of oxycodone for DDD and a whole host of other back issue as a result of a back injury after weaning down from 90 mg. Since September, I have developed near daily migraines. Most start late afternoon. I’m currently taking 100mg Topomax daily and 100mg Immitrex at onset for migraine treatment. I recently read that low T can cause migraines and that opiates can reduce the body’s ability to produce testosterone. I had my testosterone checked and it was 220 with the free T at 3.9. I wonder how much of this might be caused by the Oxycodone vs being 40. Should I start treatment and see if I can get relief or do I finish weaning off Oxy and see if the migraines get better before going the route of testosterone injections at this juncture?

Thanks for your insight!

Reply

Dr. Barry Wheeler February 23, 2014 at 6:23 pm

Hi Rob,

The cause of your low testosterone is likely a combination of the oxycodone and your age but there are other possible causes as well. I suggest you get a consult form a doctor experienced in testosterone therapy in your area to review your options.

Best of luck,
Dr. Barry

Reply

khan February 9, 2014 at 2:28 pm

i have 3 male kids,older one is 13 years now, all of my kids have small penis this is because,when i was a kid in age of 14, i use to wear underwear always,even when i sleep.. The result my penis didn’t grow enough and i got about 4 and half inch erect…
my question is can my son get Testosterone Therapy to grow his penis well..
i get some information from this source.
http://www.aafp.org/afp/1999/0401/p1956.html
waiting for a reply

Reply

Dr. Barry Wheeler February 16, 2014 at 8:30 pm

Hi Khan,

I suggest you take your child to a pediatrician to determine the correct diagnosis and best treatment. In younger boys the treatment of choice will really depend on the cause of the problem. For example, in boys with constitutional delayed puberty injections of HCG may be effective (I suggest you ask the doctor to check estrogen levels as well). However, in boys with beta-thalassemia major, a genetic condition affecting red blood cells leading to iron overload, may require treatments to reduce iron levels in the blood to improve testicular function. I highly doubt that wearing underwear can cause a reduced penis size.

“We studied 12 adolescent boys with beta-thalassemia major and delayed puberty (age, 15.8 +/- 1 years) with Tanner I sexual development treated with a long-term low-transfusion regimen. Ten nonthalassemic adolescents (> 14 years) with constitutional delay of growth and puberty (CDGP) served as controls.”1

“In summary, hCG therapy was effective in treating 7 of 12 (58%) of thalassemic adolescents with delayed puberty. In the rest of patients (5/12, 46%) with significantly higher iron overload, hCG therapy failed to stimulate testicular growth and adequate T. Proper iron chelation appears to protect against testicular dysfunction. In the first group of patients, hCG therapy can be used for the treatment of their hypogonadism, whereas T replacement remains the therapy of choice for the second group.”1

Best of luck,
Dr. Barry

  1. Human chorionic gonadotropin therapy in adolescent boys with constitutional delayed puberty vs those with beta-thalassemia major. Soliman AT, Nasr I, Thabet A, Rizk MM, El Matary W. Metabolism. 2005 Jan;54(1):15-23.

Reply

Brian February 6, 2014 at 9:48 pm

Hi,

Im a 30 year old man about to start T treatment. 4 years a go my pysical and mental helth started to decline. Anxiety, low energy, feeling weak etc. In addition my sperm quality is very poor. 4 years a go my T level was measured (measured due to my sperm quality) to 5.2 nmol (SHBG 30 nmol). New test some weeks a go shows the same values (and several tests in between the last 6 months). My testies are normal in size and the MR of my brain showed no unregularities. My endo say they dont know why my T levels are so low and that it might just be my “normal” level. All other (they have teste all sorts of things) test shows normal levels, exept that the LH level was just on the lowest reference level.

Have the doctores missed anything that can explain my low T levels?
Can I use HCG treatment in sted of T?

Reply

Dr. Barry Wheeler February 16, 2014 at 8:10 pm

Hi Brian,

I suggest you ask them to check your blood estradiol (estrogen) and FSH levels and do a 4 point salivary cortisol test. Too much estradiol can feedback to the brain and decrease the signals from the brain to the testicles reducing the signals for sperm production (FSH) and testosterone production (LH).

Chronic stress can affect cortisol (stress hormone) patterns and lead to over-conversion of testosterone to estrogen.

When the LH level is low normal there are two approaches that may be effective:

  • Daily oral clomiphene (25 – 50 mg)
  • HCG injections, 500 IU 2 – 3 times per week

These treatments should be supervised by a licensed physician. Clinically, I have found testosterone injections to be the most effective at improving symptoms but HCG and clomiphene can certainly improve levels but you should have your testosterone, estradiol, and other blood levels monitored regularly by your doctor.

Cheers,
Dr. Barry

Reply

Jeff February 5, 2014 at 3:22 am

Hello Doctor Barry,

I’m 44 years old and based upon my typical Low T symptoms believe I have had low-normal T my entire adult life. However, in recent year, or two, my symptoms worsened to the point I could no longer have sexual intercourse at all.

I’ve spent the last year educating myself about Low T and TRT and decided I wanted to try Testopel. My endo tested me at 320 Total T. He wanted to ensure pellets would be safe for me so he administered trial T injection of 300mg to see how my blood and PSA were affected after two weeks. We did three of these injection tests over three months and determined I was a good candidate for pellets. I felt great about five days after each injection, with associated decay following thereafter. I was excited about the prospect of pellets providing this improvement on a more continual basis.

Four weeks ago he implanted 10 Testopel Pellets near my hip area. He said I should feel improvement within a week-to-two weeks. I have no improvement at all, just irritability. Today I just got my 4-week Total T result of 1200. My endo is surprised I don’t feel better. I asked if my T-to-E conversion might be the problem. He said it is possible but didn’t order the test yet. He says maybe I will feel better as the pellets decay back down through the normal range. However, I didn’t feel improvement on the way up. I’m wondering why the pellets don’t have the effect on me that the trial T injections did? What should I do?

FYI- prior to my endo, I had a complete lab work performed at my own expense. My E2 was 26. I have other numbers as well but am away from home without the report.

Thank You,

Jeff

Reply

Dr. Barry Wheeler February 9, 2014 at 10:08 pm

Hi Jeff,

If your estradiol was 26 pg/mL at baseline and your total testosterone was 320 ng/dL and now your total testosterone is 1200 ng/dL that means you testosterone has been increased by 400%. Testosterone converts to estradiol and if your estradiol increased by 400% it would be 104 pg/mL. The “normal” range for estradiol is about 8-40 pg/mL so 104 pg/mL would be quite high. The over-conversion of testosterone to estrogen is called hyper-aromatization because the enzyme that converts estrogen to testosterone is aromatase.

The medication most commonly used to treat hyper-aromatization is anastrozole. Too much estrogen could make a man feel irritable but there are other possible things going on here and you should work with your doctor and consider a second opinion to get this figured out. You should only change your treatment under the supervision of a licensed physician.

The problem with testosterone pellets is if you have a problem it can take months for the testosterone to leave your system. I’m a fan of low dose weekly testosterone injections because if there’s a problem the testosterone medication will dissipate within 1-2 weeks.

Best of luck,
Dr. Barry

Reply

Jeff February 12, 2014 at 12:11 am

A follow-up question for you, Dr. Barry,

My E2 level at 4.5 weeks on Testopel is 37.9 pg/mL coupled with total testosterone of 1208 ng/dL. I have no improvements since being on Testopel for 5 weeks now.

Why did the trial testosterone injections work but the Testopel does not? Is my E2 too high or could the high testosterone be the culprit?

Thanks again,

Jeff

Reply

Dr. Barry Wheeler February 16, 2014 at 8:37 pm

Hi Jeff,

Did they check your free testosterone level and sex hormone binding globulin (SHBG)? If free testosterone is too low or SHBG too this can limit your benefits.

It is also possible that your levels are too stable causing down-regulation of receptors. Your body may be “getting too used” to the constant high normal levels with no fluctuation. There are ways to increase testosterone receptors, such as l-carnitine, procaine, and others. Procaine is presciption only and should be supervised by your doctor. In Europe there is a medication called Gerovital (oral procaine) that people take for ant-aging.

I usually try to get my patient’s estradiol level between 20 and 30 pg/mL. I suggest you ask your doctor about taking a low dose of anastrazole – maybe 0.25 mg by mouth twice weekly. Anastrozole is prescription only and should be supervised by your doctor.

Cheers,
Dr. Barry

Reply

Dana February 4, 2014 at 2:34 am

I am 44 yrs old, started testosterone shots every week about two months ago, I started having severe anxiety attacks 2 weeks ago. They feel like they will never stop. My wife started reducing the amount she gives me a little at a time to see if the attacks subside. I have had them in the past (attacks) but never like this. I feel like I cant breathe, I wake up out of a dead sleep and have to go outside to calm down. The doctor gave me Buspirone and it helps a little. Should I stop the treatments cold turkey?

Reply

Dr. Barry Wheeler February 9, 2014 at 9:47 pm

Hi Dana,

You should work with your doctor to discontinue your testosterone treatment if so desired. Panic attacks may be related to adrenal exhaustion and testosterone tends to lower cortisol levels and blood sugar. Testosterone also stimulates red blood cell production but if you have iron deficiency it could make the red blood cells more iron deficient. Iron deficiency can cause panic attacks.

Never change your treatment without talking to your doctor first. Please tell your doctor about what is going on and ask him to test you for iron deficiency and do an insulin glucose tolerance test. A 4 point salivary cortisol test would also be helpful.

“In patients of all ages, many disorders labeled as psychiatric may actually be due to hormonal insufficiencies. For example, cortisol deficiency is rarely taken into account in a medical or psychiatric work-up, so persons with mild to moderate cortisol insufficiency are for the most part relegated to receiving a psychiatric diagnosis when, in fact, the same disorder is represented. However, the symptoms of cortisol insufficiency appear to closely parallel such psychiatric disorders as post traumatic stress disorder (PTSD) and addictions. There has been some question of whether substance abuse causes a hypocortisolemic state. In reviewing the literature and obtaining detailed histories of addicted patients, it appears that childhood trauma, also known as “early life stress” (ELS), instead may elicit a hypocortisolemic state. This leads some to self-medicate with an addictive substance to quell the pain of a cortisol insufficiency, both physical and emotional. In fact, the literature supports the concept that addictive substances increase cortisol in predisposed patients. Patients with a variety of psychiatric disorders including addictions were found to have signs and symptoms of mild or moderate hypocortisolemia. Generally, an appropriate comprehensive examination supported a diagnosis of cortisol insufficiency. For the most part, these patients were successfully treated with physiologic doses of bio-equivalent hydrocortisone, along with replacement of any other deficient hormone. By correcting underlying hormonal insufficiencies, many patients improved, with some patients having a total reversal of psychiatric symptoms. It is therefore reasonable to evaluate and treat hormonal insufficiencies with hormones prior to using psychotropic medication.”

“Patients undergoing a panic attack (PA) or a hyperventilation attack (HVA) are sometimes admitted to emergency departments (EDs). Reduced serotonin level is known as one of the causes of PA and HVA. Serotonin is synthesized from tryptophan. For the synthesis of serotonin, vitamin B6 (Vit B6) and iron play important roles as cofactors. To clarify the pathophysiology of PA and HVA, we investigated the serum levels of vitamins B2, B6, and B12 and iron in patients with PA or HVA attending an ED. We measured each parameter in 21 PA or HVA patients and compared the values with those from 20 volunteers. We found that both Vit B6 and iron levels were significantly lower in the PA/HVA group than in the volunteer group. There was no significant difference in the serum levels of vitamins B2 or B12. These results suggest that low serum concentrations of Vit B6 and iron are involved in PA and HVA. Further studies are needed to clarify the mechanisms involved in such differences.”

Best of luck,
Dr. Barry

  1. Low serum concentrations of vitamin B6 and iron are related to panic attack and hyperventilation attack. Mikawa Y, Mizobuchi S, Egi M, Morita K. Acta Med Okayama. 2013;67(2):99-104.
  2. Stress-induced hypocortisolemia diagnosed as psychiatric disorders responsive to hydrocortisone replacement. Schuder SE. Ann N Y Acad Sci. 2005 Dec;1057:466-78.

Reply

Wayne February 3, 2014 at 4:30 am

Good evening Dr.
I am 44 yrs old and have been on and off testosterone treatment for the past 2 years. I never lasted as long as I am on it now which is 7 weeks and counting. Before my test came in at 250, now I take .4cc twice a week of 150mg test cyp. I started to take test because I started getting anxiety almost out of the blue. The issue is; now that I am taking test and why I kept quitting is my anxiety has gotten worse. My test now comes back around 600-700 and the estrogen is between 31-36 when I get blood work done. Also since starting test I feel mild depression for the first time in my life. and gets worse if I take the estrogen reducer (forgot the name of the prescription). So here I am 7 weeks in and still not sure if I should continue. Am I not giving my body enough time? I thought for sure I would see benefits by now. Also I put on weight (just a few pounds). I work out 4 times a week and eat as clean as I can. Please help

Reply

Dr. Barry Wheeler February 9, 2014 at 9:29 pm

Hi Wayne,

It sounds like your situation is a little more complicated than just low testosterone. If you were to come to my clinic here are a few things I would consider:

  • When you take the anti estrogen pill (anastrazole most likely) your estrogen either goes too low causing side effects or your testosterone goes too high
  • Anxiety is often related to blood sugar problems – low and/or high
  • Testosterone can cause low blood sugar is susceptible individuals and low blood sugar can cause anxiety
  • Testosterone stimulates red blood cell production but if there’s not enough iron you could get iron deficient red blood cells and this could cause anxiety
  • Chronic stress can lead to low cortisol levels and cortisol is highly correlated with anxiety (stress reponse) and depression in some men
  • Testosterone tends to reduce cortisol production

I suggest you talk to your doctor about doing salivary 4 point cortisol testing and doing a 3 hour glucose insulin tolerance test. Checking your thyroid (TSH, Free T3, Free T4, Total T3, Total T4, Reverse T3) and other hormone levels would be useful as well.

Always talk to your doctor before changing any of your treatments and make sure you tell him immediately about your concerns.

Best of luck,
Dr. Barry

Reply

Wayne February 15, 2014 at 1:39 am

Thank you very much for your reply. Just out of curiosity. Do you normally treat most men with low testosterone with injections or creams / gels?

Aslo my doctor told me if I didn’t mind the needles then start to divide my weekly does into three. Inject example on Monday, Wed and Friday. He believes I can avoid the spikes better that way over time. Just wanted to know your thoughts?

Reply

Dr. Barry Wheeler February 23, 2014 at 6:12 pm

Hi Wayne,

Over the years I have become more of a proponent of more frequent and lower doses of testosterone cypionate and propionate blends. However, topical testosterone creams and gels certainly have their place as well. The challenge with topical testosterone is that the levels in blood rarely increase with lower doses of testosterone like they do with lower dose injections.

It sounds like your doctor is helping you try some different approaches that may be effective. Just make sure he is checking your estrogen (estradiol) as well. I have found insulin needles to be an option when the doses are low enough as well so ask your doctor if he can prescribe them for you.

Best of luck,
Dr. Barry

Reply

Jack January 30, 2014 at 5:08 am

Dear Dr. Barry:

I am a 54 yr old male that enjoys generally excellent health. I have been an avid bodybuilder for 32 years. I recently got my total testosterone checked and it was 455ng/dl and my free testosterone came back low at 7.0 pg/ml. I am very interested in starting a low dose (.25cc every 5 days) therapy regiman of Test Cypionate. I currently use 1.25 mg of Finestaride every day to control a slight hair loss problem. My question to you is “What do you think the chances are (based on your experience with previous patients) that a TRT program would accelerate a hair loss situation”. I had lost some hair about 15 years ago and then it seemed to slow/stop about 3 yrs after it started. I have only been on Finestaride for about 6 months.

Thank You very much for your anticipated reply.

Jack

Reply

Dr. Barry Wheeler February 9, 2014 at 9:05 pm

Hi Jack,

Finasteride is a medication that reduces the conversion of testosterone to dihydrotestosterone (DHT). DHT is about 4 times as potent, in terms of androgenic activity, as testosterone. Thus, by decreasing your DHT in your entire body with finasteride you have greatly reduced your male hormone activity in your body so that you will need much higher testosterone levels to overcome the loss caused by the finsteride.

Testosterone actually stimulates hair growth on the scalp. It is only when testosterone converts to DHT in the hair follicle that it causes hair loss as the follicle swells from the DHT. Thus, a more advanced approach is to target the conversion of testosterone to DHT in the hair follicles without shutting down the DHT production in the entire body. There are ways to do this using topical medications and other treatments. I have heard some positive results from shampoo containing saw palmetto extract.

Thierry Hertoghe, MD, who wrote The Hormone Handbook, always optimizes testosterone levels before considering the use of finasteride due to its potential side effects. Some men have serious side effects from finasteride which can continue even after stopping the use of finasteride:

“Subjects reported new-onset persistent sexual dysfunction associated with the use of finasteride: 94% developed low libido, 92% developed erectile dysfunction, 92% developed decreased arousal, and 69% developed problems with orgasm. The mean number of sexual episodes per month dropped and the total sexual dysfunction score increased for before and after finasteride use according to the Arizona Sexual Experience Scale (P<0.0001 for both). The mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date."1

All treatments should be supervised by a licensed physician and you should only change your medications after speaking with your doctor. Topical treatments sohuld be used with caution as there is a risk of transfer to others.

Best of luck,
Dr. Barry

  1. Persistent sexual side effects of finasteride for male pattern hair loss. Irwig MS, Kolukula S. Sex Med. 2011 Jun;8(6):1747-53. doi: 10.1111/j.1743-6109.2011.02255.x. Epub 2011 Mar 18.

Reply

Jack Suser July 10, 2014 at 4:23 pm

Dear Dr. Barry:

Thank you so much for your reply to my question. Your absolutely right! I have been feeling even more lethargic and unable to recover from my workouts than usual. I could not pinpoint the reason, but if my overall male hormone levels have dropped from my 1.25mg dose of Finesteride that would explain a lot. My only question then would be “In your clinical experience, what % of your patients have experienced an increase in hair loss on a (low) replacement dose of Testosterone Cypionate, and do you feel I should be overly concerned about this problem as my initial hair loss seems to have stopped about three tears after it started at 40 yrs of age.

Thanks again Dr. Barry,

Jack

Reply

Kelly January 24, 2014 at 11:02 pm

I am a 51 year old male and T therapy has been recommended by my Dr. I consider myself to be healthy 5’9″ 160 lb and have been exercising for 30 years. I requested my levels be checked due to low energy levels and no sex drive. Testing revealed total T level of 313 and free was 4.5. He has prescribed Androgel .25 mg daily. I have done much research and have mixed emotions regarding T therapy as the research is all over the board! I have also experienced prostrate issues (swollen) in the past. My insurance has approved the prescription. I want to feel better and enjoy a healthy sex life with my wife but, I also want to live a LONG healthy life. Your opinion would be much appreciated.

Regards,

Reply

Dr. Barry Wheeler February 4, 2014 at 4:30 am

Hi Kelly,

I suggest you read this book to learn more about how testosterone and estrogen effect your body:

The New Testosterone Treatment: How You and Your Doctor Can Fight Breast Cancer, Prostate Cancer, and Alzheimer’s

Cheers,
Dr. Barry

Reply

DAN January 23, 2014 at 2:54 am

Im a 57 year old male, I have been taking the shots for about 8 years now. Back in october I started having anxiety/panic attacks/ loss of wanting to do pretty much anything, all the typical symptoms of low T.
Had my levels checked and they were 420, not too bad. Well i kept getting worse, and went back to the doctor got rechecked and my levels had dropped to 211, Dr. advised me to double up on the dose from .4 to .8. This concerned me but I did like he said. I took the dosage he requested two days ago. I fell horrible now. Bad anxiety and panic attacks, all the classic other signs. Im at a loss on what to do and need some advise. Should I continue like he said or go back to the dose I use to take ? Thyroid was a little elevated but he said it was nothing to worry about. Am I having an allergic to the higher dosage or what? Im so tired of dealing with this.
Best.

Reply

Dr. Barry Wheeler February 4, 2014 at 4:28 am

Hi Dan,

Sound like you should get a second opinion from a doctor more experienced in testosterone therapy. Has he ever checked your estrogen levels? If you’re converting too much of your testosterone to estrogen increasing the dose is unlikely to help.

Also, it sounds like you may be having adrenal deficiency (cortisol deficiency) which requires salivary (4 point) testing. When you say your thyroid was a little elevated I assume you are referring to thyroid stimulating hormone (TSH) which is, in my opinion, one of the most worthless tests out there. It is the signal from the brain to thyroid. A better test would be t measure Free T3, the actual thyroid hormone.

I suspect it is more complicated than just increasing your testosterone dose as you have found out. Without seeing you in my clinic I can’t give you any advice so I suggest you find a doctor in your area and tell you doctor what’s going on immediately.

Sometimes taking a break from testosterone therapy can be helpful to regain the initial benefits you may have felt but you should only change your medications under the direction of your doctor.

Best of luck,
Dr. Barry

Reply

Andy January 22, 2014 at 11:49 am

Thanks for the info Dr. Barry!!

I am a 37 year old male who just received his first 200mg injection today. My numbers are as follows Component Your Value Standard Range Units
Tot Testosterone,Male 192 NG/DL
Sex Hormone Binding Globulin 9.8 NMOL/L
Free Testosterone 61 PG/ML
% Free Testosterone 31.8 %

My doctor said to come in once a month for 200 mg injection. Everything I’ve read suggests that 2 weeks should be max, and I see you support that. I emailed my doctor and asked him about this. Do you know of any doctors that successfully treat low T with one injection a month?

Thanks!

Reply

Dr. Barry Wheeler February 4, 2014 at 4:21 am

Hi Andy,

I suggest you ask your doctor to repeat your test and include estradiol (estrogen) and ask why your sex hormone binding globulin (SHBG) is so low. Your free testosterone is also calculated incorrectly (http://www.issam.ch/freetesto.htm), it should be 6.10 ng/dL = 3.18 %

In my opinion testosterone injections should be done at lower doses and more frequently to prevent side effects. 200 mg of testosterone will likely last you about 2 weeks and then your levels will be low again. The testosterone to estrogen ratio is also important and in my opinion it is impossible to maintain a healthy ratio with monthly or even biweekly testosterone injections.

Best of luck,
Dr. Barry

Reply

EManuel January 17, 2014 at 1:30 pm

Dr Barry,

My Husband rather stupidly decided to self-medicate an injury with cycles of M1T and anabolic mass. He used the M1T for approximately six months – initially taking it in three weeks on and two weeks off cycles, he would use anabolic mass for the two weeks he was off. He did this 2-3 times and then switched to taking M1-T every other day for approximately 3 months. As soon as I discovered what he was doing he stopped taking these ‘supplements’ and my question is, how long would it take for his testosterone levels to drop to normal after such a prolonged period of use, factoring in a possible reduction in liver metabolism due to the effects of the methylated form of testosterone. I ask this as he seems to have continued to experience significant hypersexuality for quite some time since stopping. Thanks

Reply

Dr. Barry Wheeler February 4, 2014 at 4:13 am

Hi Emanuel,

It is difficult to say as this is a poorly studied methylated testosterone (M1T refers to methyl-1-testosterone). It will really depend on his liver function. I suggest he go see his primary care doctor to get checked out as oral steroids such as M1T can be toxic to the liver. It could take weeks for his levels to return to “normal”.

Best of luck,
Dr. Barry

Reply

Dewey January 10, 2014 at 5:15 am

Hello Doctor,

I am a 49 year old, fairly healthy male with low T. I live a very sedentary life style and am about 30-40lbs overweight. My GP put my on a patch. After a couple of days I began having heart palpitations. Ceased testosterone and scared me enough to go to a cardiologist and have a complete workup including stress test and 2 week heart monitor. All test came back fine. Heart monitor recorded some palpitations but within normal levels. A few weeks after discontinuing T therapy and no more heart palpitations.

GP and cardiologist dismiss the idea that testosterone replacement can cause heart palpitations. Long story short, no heart palpitation without testosterone replacement and I get them while using the patch or Axiron. I have halved the dose of Axiron – 1 pump vs. 2 pumps a day and still have very mild palpitations. I am taking it again due to any benefits possible healing a broken bone. Improved libido doesn’t hurt either.

Have you heard of testosterone causing heart palpitations and is taking it doing me more harm than good?

Thank you.

Dew

Reply

Dr. Barry Wheeler January 30, 2014 at 2:56 am

Hi Dewey,

Testosterone can improve blood sugar regulation and can lower blood sugar levels. I suggest you ask your doctor to check you for hypoglycemia using a glucose insulin tolerance test. This is the most effective way to rule out reactive hypoglycemia which could certainly cause palpitations in sensitive individuals.

“After glucose intake, seven patients had symptoms (palpitations, headache, tremor, generalized sweating, hunger, dizziness, sweating of the palms, flush, nausea, and fatigue), whereas in the control group, one subject reported flush and another palpitations, tremor, and hunger.”

Cheers,
Dr. Barry

  1. Suspected postprandial hypoglycemia is associated with beta-adrenergic hypersensitivity and emotional distress. Berlin I, Grimaldi A, Landault C, Cesselin F, Puech AJ. J Clin Endocrinol Metab. 1994 Nov;79(5):1428-33.

Reply

Kelvin January 9, 2014 at 1:44 pm

Dear Dr.
Kindly advise me on the possible side effects of Testosteron. I was advised to take enjections of sustaton Testosteron injections without proper determinations of the levels of testosteron in my body. After was injected 3 times once every after a day, I decided to discontinue the treatment for my heartbeat rose up to 104 per minute on one day. Before this medications, I did took some tests and the results showed that testosteron level in my body was 21.7. This test was done in 2009 and the enjections were taken from 10 – 15 December 2013.
What are the possible side effects in administering testosteron in a man that has testosteron level of 21.7?
I usually feel hot in my stomach after and pain when i hold the skin of my belly, can this be some symptoms of liver function?
Please advise me Dr.

Reply

Dr. Barry Wheeler January 30, 2014 at 2:51 am

Hi Kevin,

I’m assuming you are referring to a level of 21.7 nmol/L which is about 600 ng/dL total testosterone level. Without knowing your free testosterone level it is hard to say if you had a form of testosterone deficiency or not. There is something called Partial Androgen Deficiency of the Aging Male (PADAM) and men with this may have “normal” total testosterone levels and low or low normal free testosterone levels. If you know you sex hormone binding globulin (SHBG) level you can calculate your free testosterone here: http://www.issam.ch/freetesto.htm

Sustanon is a very potent form of testosterone that contains different forms of testosterone esters. It is possible you were sensitive to one of those and it is possible a different form of testosterone (ie testosterone cypionate) would have a better effect. However, you should only take testosterone under the supervision of an experienced and licensed physician.

Liver problems from testosterone injection are rare and are much more likely to occur with oral testosterone (ie testosterone pills). I suggest you see a doctor ad get your liver etc evaluated as its tought to say what’s going on without seeing you in my clinic.

Cheers,
Dr. Barry

Reply

Alan January 9, 2014 at 9:12 am

Hi I’ve just found your site. I’ve had my first injection (250m) to day,the next one will not be for a month. I have testicular cancer and have had both of my testicles removed. I may get patches if I need them, but there seems to be very little monitoring of my case. What changes will I notice and how soon will I notice any change. Ie sweating shortness of breath general fatigue. Thank you for your help.

Reply

Dr. Barry Wheeler January 28, 2014 at 9:08 pm

Hi Alan,

Some men notice immediate improvement and for other men it may takes several weeks or months. The human body naturally produces 5-10 mg of testosterone per day and testosterone cypionate (200mg/mL) contains about 140mg of testosterone and 60mg of cypionate. Also, the body will clear the testosterone fairly quick in many cases so lower dosing, about 100-200 mg testosterone cypionate injected per week, tends to give more consistent levels. Monthly injections will often be ineffective and lead to a poor testosterone to estrogen ratio in my experience. If your doctor is unwilling to switch you to weekly or every 10 days injections then patches may give more consistent levels. Always ask your doctor before changing your treatment. Topical testosterone and patches have more risk of transferring to others.

Also, I suggest you ask your doctor to check your estrogen (estradiol) levels and be sure tell him about the shortness of breath and sweating immediately. You may want to get a second opinion as well from a doctor more experienced in testosterone therapy.

Best of luck,
Dr. Barry

Reply

Carl January 7, 2014 at 1:00 pm

Dear Dr. Barry

I am a 73 year old male and have been doing trt for several years. I take 250 mg of enanthate every other week. I recently had a blood test on my T and it came back at 14.9 when normal is 7-8. What could possibly cause this kind of spike?

Thank you

Reply

Dr. Barry Wheeler January 13, 2014 at 12:17 am

Hi Carl,

Did they do the test on a different day of the week than they normally do? If they always check it the day before your injection and then this time checked it the day after that would change the results. Testosterone levels are highest for the first few days after its injected and then begin declining. I suggest you talk to your doctor and ask him about switching to a lower, weekly dose of testosterone enanthate or cypionate. Weekly injections tend to cause less spikes and less drop off as well.

Another possibility is lab error. Perhaps they should repeat the test.

Cheers,
Dr. Barry

Reply

Michael January 7, 2014 at 3:38 am

Hi Dr Barry,

I have recently had by blood tests done and hoping you could offer advice.
I am 45 years old. Was born with only one testicle, have 2 daughters (4 & 2), no problem with erections although libido has decreased slighlty of late, no fatigue symptoms or depression. I have always had problems putting on muscle, and do work out regularly weight training. I can be quite moody and have started feeling ‘my age’ these past few months (hence my blood work)

Lutropin 4.6 IU/L (1.5-9.3)
Follitropin 3.3 IU/L (1.4-18.0)
Oestradiol 118 pmol/L (<146)
Testosterone 16.3 nmol/L (8.0-26.0)
Free Testosterone 198 pmol/L (225-725)
Dihydrotestosterone 2.0 nmol/L (0.7-3.1)
SHBG 71 nmol/L (13-71)
DHEA 12.1 nmol/L (4.5-48)
Glucose fasting 4.6 mmol/L (3.0-5.4)
PSA 0.78 ug/L (<2.50)
Thyrotropin 1.364 mU/L (0.300-4.000)

My free test levels are very low, and SHBG is high.

Do you think I would be suitable for TRT? and would this change by free test levels or would SHBG bind most of it? Should I be trying to lower SHBG initially?

(I fear my GP is not going to relate to any of this, as he couldn't understand why I wanted my estrogen levels checked when I requested it!)

thanks for your time.
michael

Reply

Dr. Barry Wheeler January 13, 2014 at 12:14 am

Hi Michael,

Based on your labs it looks like you have a deficiency of free testosterone but of course only a doctor who sees you in person can make a diagnosis or advise you.

Free testosterone tends to decline as we age and can certainly cause symptoms of irritability. Sex hormone binding globulin (SHBG) increases as we get older causing our testosterone to get “bound up” and inactive. After puberty, symptoms of low testosterone “include sexual dysfunction (erectile dysfunction, reduced libido, diminished penile sensation, difficulty attaining orgasm, and reduced ejaculate), reduced energy and stamina, depressed mood, increased irritability, difficulty concentrating, changes in cholesterol levels, anemia, osteoporosis, and hot flushes.1

Your total testosterone (units converted) is about 470 ng/dL. Many doctors feel that total testosterone less than 350 ng/dL is required for diagnosis, however, in many ways free testosterone levels are more important than total testosterone. Using this free testosterone calculator we get 5.7 ng/dL for your free testosterone level and generally I feel that any level less than 10 ng/dL could benefit from some sort of treatment is a patient is experiencing symptoms of low testosterone.

You may want to get a second opinion from a doctor more experienced in testosterone therapy.

“The treatments were: (i) intramuscular injection of 250 mg mixed testosterone esters at 2-weekly intervals, (ii) oral testosterone undecanoate 120 mg bd, and (iii) subcutaneous testosterone pellets (6 x 100 mg). Pellet implantation gave the most prolonged effect with free and total testosterone levels being elevated for up to 4 months. This was accompanied by prompt and sustained suppression of plasma LH and FSH, an increase in plasma levels of oestradiol but no change in SHBG levels. In contrast, intramuscular injections induced marked but reproducible week-to-week fluctuations in free and total testosterone, which resulted in a small decrease in plasma SHBG levels, less marked suppression of LH and FSH and a smaller increase in plasma levels of oestradiol. Oral testosterone undecanoate produced the most variable plasma levels of free and total testosterone with a peak in the first treatment week and a fall thereafter and, despite maintenance of testosterone levels within the physiological range, there was no significant suppression of plasma levels of LH and FSH, and oestradiol levels were unchanged but levels of SHBG and total cholesterol were decreased. Free testosterone levels were increased disproportionately during testosterone treatment as the proportion of unbound testosterone was increased by all three treatments. All three testosterone preparations lowered plasma levels of urea and all were without biochemical or haematological toxicity. Reported sexual function was better maintained and side-effects were fewer with parenteral compared with oral treatments.2

In addition, there are other ways to reduce SHBG levels but all should be supervised by an experienced doctor and monitored with regular lab testing, otherwise you may end up wasting your time or money, or end up with side effects. I have had good success reducing SHBG with testosterone injections but every patient is different.

Be careful with “natural supplements” unless your working with a doctor: “Mass Destruction, a product marketed online and in retail stores as a dietary supplement for muscle growth, has been associated with at least one reported serious illness, reports FDA. The agency urges consumers to not purchase the product, and to stop use immediately.3

Best of luck,
Dr. Barry

  1. Male hypogonadism: Symptoms and treatment. Peeyush Kumar, Nitish Kumar, Devendra Singh Thakur, and Ajay Patidar. J Adv Pharm Technol Res. 2010 Jul-Sep; 1(3): 297–301.
  2. Randomized clinical trial of testosterone replacement therapy in hypogonadal men. Conway AJ, Boylan LM, Howe C, Ross G, Handelsman DJ.Int J Androl. 1988 Aug;11(4):247-64.
  3. FDA Warns Consumers Not to Use Mass Destruction, a Dietary Supplement Sold Online and in Retail Stores. January 8, 2014 7:00 PM. http://www.nabp.net/news/fda-warns-consumers-not-to-use-mass-destruction-a-dietary-supplement-sold-online-and-in-retail-stores

Reply

Carl January 6, 2014 at 12:49 am

Dr. Wheeler,
I just ran across your website and I want to compliment you on the immense amount of info and time you put into this. We all appreciate it.
I have just a quick question. I am 62 years old and have been on Testosterone cypionate injections through my urologist for over ten years. I give myself 100mg. every five days or so (no more than 200 mg every ten days). My doctor has done a seven day Total Test on serum and it ranges from about 1000 (on day one after a shot) to about 350 after 6 or 7 days. I’m happy with the current treatment. However, I have been fighting prostatitis for the past 2 years, on and off Levaquin for an average of 30 days at a time. My question is whether the testosterone injections are having anything to do with the recurring prostatitis. Also, my doctor says he doesn’t like to use finastride because of the studies showing an increase in more aggressive prostate cancers. He says my prostate is moderately enlarged. Can you also please address that.
Thank you again for everything.

Reply

Dr. Barry Wheeler January 6, 2014 at 7:02 pm

Hi Carl,

Thanks for the feedback. Help others improve their lives is what it’s all about!

I agree with your doctor that finasteride has some risks associated with it and that there are likely better approaches, such as saw palmetto, progesterone (low dose), and anti-estrogen treatments. Frequent use of antibiotics can cause the good bacteria in your intestine to die off and then bad bacteria and yeast may take hold. I suggest you ask your doctor about probiotics, saw palmetto, and low dose progesterone, as well as checking your estrogen levels.

Has you doctor ever checked your estradiol (estrogen) levels? In my experience, and research supports this, too much estrogen leads to swelling of the prostate and increases the risk of other prostate problems. I imagine you are not trying to get in touch with your feminine side either. Low estrogen can cause problems as well – it’s all about balance. As we age we typically convert more of our testosterone to estrogen and as the ratio of testosterone to estrogen gets worse we see an increased risk of prostate problems, including prostatitis and prostate cancer. When do we get prostate cancer? When we’re old and have low testosterone, but also this is when our estrogen to testosterone ratio gets “way out of whack” as well.

Taken together, these data link estrogens to prostatitis and premalignancy in the prostate, further implicating a role for estrogen in prostate cancer.1

Benign prostatic hyperplasia (BPH) is a common disease of men over 50, and its incidence goes up with advancing age. Statistics shows that BPH is hardly found in men less than 30 years old, but in 88% of autopsies BPH were found in men aged above 80, with compatible symptomatology reported in nearly 50% of men aged above 50 in the general population. The phenomenon maybe correlated with changes of sex hormone in serum of elderly population. One clinical study reported that there were low free testosterone concentrations with relative rise in serum estradiol levels in patients of BPH.2

Best of luck,
Dr. Barry

  1. Increased endogenous estrogen synthesis leads to the sequential induction of prostatic inflammation (prostatitis) and prostatic pre-malignancy. Ellem SJ, Wang H, Poutanen M, Risbridger GP. Am J Pathol. 2009 Sep;175(3):1187-99. doi: 10.2353/ajpath.2009.081107. Epub 2009 Aug 21.
  2. Possible mechanism of benign prostatic hyperplasia induced by androgen-estrogen ratios in castrated rats. Xiang-Yun L, Ying-Wen X, Chen-Jing X, Jiu-Jiu W, Qi P, Bo G, Zu-Yue S. Indian J Pharmacol. 2010 Oct;42(5):312-7. doi: 10.4103/0253-7613.70397.

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Carl January 9, 2014 at 12:42 am

Thank you so much Dr. Barry for the info.
After your suggestions I had my total test level and estradiol done along with psa and cbc. My test level was 1036 (normal value 241-827), estradiol was 40.0 (normal value less than 52.5), and PSA was 0.81 (normal value 0.00 -3.90) and cbc was all normal values. One thing to note, three days before these tests were drawn, I injected 1 cc testosterone cypionate. So I’m assuming my test values were around the 1500 range the day after the shot. And another note here, the day after the injection and for about 72 hours afterwards, I was urinating at least once an hour. Now it’s about 4 days after the shot and my urinating is almost back to normal. Do you see anything going on here? You previously commented on the problems out-of-wack ratios of test to estrogen could cause. I am a slim person and in otherwise good health. But thinking back (and maybe I’m chasing symptoms here) I almost think my shots might have something to do here with my ongoing prostatitis episodes.
If I wasn’t on the east coast I would certainly be in your clinic. Thank you again for any help you can offer. I see my urologist in about 3 weeks and I’m on day 32 of 42 days on Levaquin.
Regards,
Carl

Reply

Dr. Barry Wheeler January 13, 2014 at 12:32 am

Hi Carl,

I suggest you discuss reducing your dose with your doctor and addressing you estradiol level. Estradiol over 35 increases the risk of prostate and other health problems. We typically prescribe low dose anastrazole to keep estrogen levels in check. For most guys, 0.5mg anastrazole by mouth weekly is sufficient but this shoull be supervised by your doctor.

Progesterone supplementation may be helpful as well and I have had some success in patients with prostate problems. Only low doses are required (10-25mg by mouth daily before bed) and this treatment should be supervised by your doctor as well.

Best of luck,
Dr. Barry

Reply

Carl February 6, 2014 at 2:05 am

Dr. Barry, I had my urologist read our communications as you suggested. He took it very well and was actually very interested in your treatment protocols. He suggested I ask you what testosterone medication to use that I might give myself daily or every other day injections and what dosage you would suggest. I think he was looking for short-acting test. He said I am overly sensitive to medications. Also, he wanted me to address my estrogen level with you. He was somewhat hesitant to treat my estrogen level with a value of only 40. He thought 40 was not high enough to treat but I should address this also with you?
I think as a urologist he is not as well-versed in the hormone aspects as you are and is very open to your suggestions and experience.
Thanks again Dr. Barry for the continued support. I’m sure you are aware how prostate issues can affect our quality of life.
Regards, Carl

Marvin January 4, 2014 at 12:01 pm

Dr. Wheeler,
I’m 83 and have Prostrate Cancer for over 10 years. I’ve been on Paroxetine for Depression for over 20 years… I have decided to stop taking Paroxetine, and I’m completely of it now for 3 weeks and sleeping well…
I believe that testosterone treatment will help me in so many ways…
Your repose would be welcomed…

Reply

Dr. Barry Wheeler January 7, 2014 at 12:51 am

Hi Marvin,

Please remember it is important to talk to your doctor before changing any of your medications. If you haven’t told your doctor that you stopped the paroxetine please do so.

You would need to get the approval of your urologist before starting testosterone replacement therapy. This is important because different grades of prostate cancer have different risks and you want to make sure the benefits outweigh the risks.

I suggest you have your doctor read this:

“The increasing population of elderly men means there is also an increase in those suffering from late-onset hypogonadism and testosterone deficiency, with all its attending consequences such as reduced libido, erectile dysfunction, metabolic disturbances, cardiovascular disease, decreased bone density and reduced quality of life. The use of testosterone replacement therapy may benefit such patients but remains controversial, especially with regard to the risk it may have on prostate cancer. However, there is no conclusive evidence that testosterone therapy increases the risk of developing prostate cancer nor is there any evidence to suggest that it can convert subclinical or indolent prostate cancer into a clinically significant one. In fact, a number of recent reports have shown that it is safe to give testosterone therapy in patients who have been successfully treated for early prostate cancer. Therefore, the purpose of this review is to discuss the role of testosterone replacement therapy, focusing on those with prostate cancer, as well as the risks and benefits that every physician must consider before commencing treatment.1

In my opinion, every patient is different and and treatment should be individualized. However, if a patient has a history of prostate cancer I always get a second opinion from a urologist before beginning treatment.

Best of luck,
Dr. Barry

  1. Testosterone replacement therapy in prostate cancer patients: is it safe? Umbas R, Sugiono M. Acta Med Indones. 2010 Jul;42(3):171-5.

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John December 31, 2013 at 5:43 am

I am a 37 yo man with secondary hypogonadism due to idiopathic hyperprolactinemia. The presumed onset was during college, gradually my personality changed from outgoing and athletic, to anxious and depressed. Things were rough for a while, and luckily a doctor through to check my testosterone last year (my thyroid had always been normal) , and it was 182, FSH/LH low normal (i.e. not compensating) and prolactin 66 (other hormone tests normal). MRI brain normal, DEXA osteopathic, and I started therapy with Cabergoline. This only raised my Testo to 432, and I was feeling miserable, so Clomid was added over the summer. Long story short, I have had a :normalization: in Testo to 900′s, and while my depression has gone away, I now experience intense burning headaches and at times cognitive difficulties (slowness). There symptoms occurred while trialing Clomid, then Hcg, and finally topical Axiron, send the symptoms worsened as my Endocrinologist titrated up each medication. I started arimidex (estrogen was 56), and while this helped somewhat, these troubling symptoms persist. Even worse, the symptoms have a situational content, and worsen when I’m stressed. Is there a there a known reason for these symptoms, and would you recommend any further testing and/or change in treatment? Thank you very much.

Reply

Dr. Barry Wheeler January 7, 2014 at 12:25 am

Hi John,

I assume you have already told your doctor about the burning headaches and cognitive difficulties but please go ahead so again immediately. I’m not sure what doses of medication you are taking but Clomid® or cabergoline could potentially be causing your headaches or it could be something else entirely, ie dehydration, so be sure to discuss your headaches further with your doctor. The fact that the headaches started with the clomid and then continued makes me wonder if it wasn’t dehydration or blood pressure related, as blood pressure would go up under stress.

You may want to ask your doctor to check your stress hormone, cortisol, using a 4 point saliva test. I suggest you ask your doctor to check your estrogen and testosterone again as well now that you’re on a new therapy and still having these symptoms. The doses you are taking may be too high but make sure you talk to your doctor before changing your treatment. Perhaps titrating up the medications is not the solution as often times lower doses work best as long as your patient.

Best of luck,
Dr. Barry

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Joe December 30, 2013 at 9:39 am

Very helpful info

Thank-you

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David December 17, 2013 at 6:25 pm

Hello Dr. Wheeler,

I am 53 years old and exercise daily. I have had a low sex drive for years and started taking Testosterone 250mg/ml 3 months ago and increased it to 400mg/ml this past month. I feel great and my libido is back. In fact I haven’t woke up with an erection in the morning for years, but now I do. Now I must admit I have not had any test done due to no Health Insurance, but from what I have read it appears that Testosterone Therapy is safe for me and I have no side effects what-so-ever. Is the dose ok I am taking 400mg/ml 1cc per week? And do I continue taking my injections or do I need to cycle this as some suggest. Also should I take clomid or another to avoid gyno? Thank you and yes as soon as my insurance kicks in I will have any test done but I feel great after only 3.5 months.

David Autry

Reply

Dr. Barry Wheeler December 22, 2013 at 11:20 pm

Hi David,

I have never seen any testosterone that concentrated before (400mg/ml). Are you sure that is correct? You should definitely find a doctor to supervise your treatment for a number of reasons, including legal and safety. Your medication could be contaminated with who knows what and just because you are not experiencing side effects now doesn’t mean you won’t in the future. The dose, 400mg per week, is very high and will stimulate too much red blood cell production possibly. Without monitoring your levels (including red blood cells and estrogen) you may be increasing your risk of a stroke significantly. Too many red blood cells will thicken your blood causing turbulence and damage to your blood vessels and too much estrogen will change how your blood clots increasing the risk of blocking an artery somewhere in your body (ie heart, lungs, brain).

A recent study at the VA showed the unsupervised testosterone therapy increases risks, while other studies that were done under proper supervision (lab testing and folow ups) showed improved health and wellness. Read this article about why you should have an experienced doctor supervise your treatment (avoid the VA): Testosterone and Heart Disease, Heart Attacks, and Stroke Risk

The reason some men cycle their testosterone injections is often because they are taking too much and after the body gets “used to” these high doses they start to feel less benefit. High doses of testosterone cause too much estrogen which is bad for the prostate and can cause increased breast growth (gynecomastia). Again, you need to see a doctor asap to get checked out.

Clomid® is used to block estrogen feedback to the pituitary gland and help maintain the signal from the brain to the testicles. This medication requires doctor supervision. Also, it will have very little to no effect on preventing breast growth. There are other medications that do that but also require doctor supervision. If you take too much or too little of these medications there can be side effects (ie hot flashes and bone loss from estrogen becoming too low).

Best of luck,
Dr. Barry

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Lynn December 17, 2013 at 3:24 pm

My husband is on bi-weekly testosterone therapy injections. He is now experiencing muscle issues, he ruptured a ligiment in his shoulder recently. He used to be on the testosterone gel but now they moved him to injectable. Is the increase in the level of tesosterone in his body causing the muscle/tendon issue?

Reply

Dr. Barry Wheeler December 22, 2013 at 11:09 pm

Hi Lynn,

It could be unrelated but he should definitely talk to his doctor about this issue. There is some research showing that when testosterone levels are too HIGH it can cause problems with tendons and ligaments. This is why we typically use smaller and more frequent doses to prevent the levels from peaking, and from dropping too low as well. This is also why we d frequent lab testing as what some doctors consider a good dose for one man may be too much or too little for another man. I have never had this problem with any of my patients but it anything is possible.

Best of luck,
Dr. Barry

Reply

Tim December 15, 2013 at 10:48 pm

Hi Dr. Barry,

22 Year old male, hypogonadism, have undergone several treatments, I think with each one the hope was the because I was young my own endocrine system would kick in. It didn’t. A couple months after discontinuing most recent TRT, 200 m/g every two weeks Testosterone cypionate, my levels plummeted to 234. My endocrinologist at the time (who I am replacing) decided that was close enough, and put off seeing me next until May, no TRT in the interim. After speaking to an endocrinologist who is a friend of my dad’s, it seems that I absolutely need to be on TRT, and I am seeking a new endocrinologist to do so.

While in retrospect it was foolish, while between endocrinologists I injected myself with 300 mg Testerone Cypionate two weeks ago and one week ago. I was frustrated with the fact that my physique had gone to hell due to the rapid decline in testosterone I experienced over the past three months, and felt I had been wasting a lot of hours at the gym. I know that that was foolish, but my question is, what do I do now until my next endocrinologist appointment? Is it better to just leave things alone, or am I going to experience too much of a plummet if I don’t administer another (smaller) dose? Is there anything I can do in the interim to combat the aromatization that has likely occurred from the excessive dose?

Putting my more recent actions aside and looking forward to my ongoing treatment, I am weary at this point of not getting the proper TRT. Will a competent endocrinologist put me on treatment permanently at this point? What are the typical doses, and what are the relevant concerns for each dose? Will I need to be on an anti-estrogen? Also, how long after starting treatment will my levels increase, and where would they typically settle?

Thanks.

Reply

Dr. Barry Wheeler December 22, 2013 at 10:46 pm

Hi Tim,

Without seeing you in my clinic I am unable to advise you on any specifics. You could call around and see if you could get in to see someone right away or call your doctor and request to see him asap. You should only use medications under a doctor’s supervision. If you lived in the Seattle area I’d invite you to come into one of our clinics.

Endocrinologists treat diabetes mostly so many are inexperienced in testosterone therapy. There are certainly some good endocrinologists out there. I have even met some gynecologists who are well versed in testosterone therapy. It really just depends on the doctor. In my opinion, a competent doctor will listen to your concerns and advise a number of options. If you came to one of my clinics we may offer a number of treatment options, including HCG, Clomid®, anastrazole, testosterone injections or topical testosterone, and nutritional and lifestyle approaches. At your age you will typically have more options. If you have never tried Clomid® or HCG we would likely recommend trying those first to see if we can restart your natural production. All these treatments require a doctor’s supervision.

Every person is different so doing proper lab testing to get baselines on estrogen and testosterone is essential. Certainly, testosterone injection will increase your levels within 24 hours but finding the proper dose and approach to managing estrogen production is different for every patient. Some patients produce too much estrogen and we use medications to reduce their conversion of testosterone to estrogen. On younger men we typically recommend they use HCG in conjunction with the testosterone to maintain better testicle size. Your fertility may be reduced if you use testosterone but studies show it usually returns to normal after discontinuing testosterone for a few months.

In my opinion, testosterone injections every two weeks is less effective than smaller more frequent doses. Personally, I have found 20mg of testosterone cypionate/propionate (blend) injected daily to be most effective for myself but I have had many patients see a big improvement in their symptoms from 100mg injected weekly. An experienced physician will help guide you through this process.

Best of luck,
Dr. Barry

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Maria & Luis December 15, 2013 at 6:14 pm

Hello,
My husband is a biweekly injections and although there is an increase in his sexual and overall health he has an increase in the amount of sweat he produces. We can just be hanging out and he begins to break out in sweats as if he was working out. I’ve tried researching it but haven’t come across anything about it. Is that a side effect that you are aware of?

Reply

Dr. Barry Wheeler December 16, 2013 at 12:18 am

Hi Maria and Luis,

I that he contact his doctor to discus this as it sounds like hot flashes. It could be due to fluctuation in his estrogen levels. The body gets use to a certain level of estrogen and if it is dropping or going to high it could lead to bouts of sweating similar to hot flashes that women experience during menopause. Estrogen can be measured in the blood easily.

There are certainly other possible causes so it is important he discuss this with his doctor.

Cheers,
Dr. Barry

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joe December 14, 2013 at 9:18 pm

Dear Dr Barry:
I am trying to find details about a recent study that showed an increase in strokes and heart attacks in men 50+ old ,with existing heart conditions , who take testosterone injections.
I unfortunately do not know who did the research . I am 73 years old and take an injection of testosterone cypionate [20 mg ] once a month,
Any and all information that you can furnish would be greatly appreciated.
Much thanks, Joe

Reply

Dr. Barry Wheeler December 16, 2013 at 12:15 am

Hi Joe,

You can find a link to and read all about the article you are looking for here: Testosterone and Heart Disease, Heart Attacks, and Stroke Risk. It is an article published in the Journal of the American Medical Association (JAMA) and was done by reviewing data from patients of the Veteran Administration’s (VA) medical system. It is difficult to make any conclusions based on the study because there are a number of serious flaws. It does seem prudent to avoid receiving testosterone therapy from the VA though.

I suggest you discuss your dosing with your doctor more. Monthly injections of testosterone cypionate tend to cause higher levels the first week and much lower levels for the rest of the month. Also, this approach often leads to increased estrogen levels, in my experience, so asking him to check your estradiol (estrogen) levels may help. Always talk to your doctor before changing your medications.

Cheers,
Dr. Barry

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Rob December 10, 2013 at 8:43 pm

I am a 37 year old male who has been on Caduet 5-80, Toprol 50mg, and Cozaar 50mg for the past 6 years. Since being on these medications, I have noticed a decrease in Muscle mass and strength. My libido is fine and I have normal energy.
I have worked out for 20years and never had this much problem gaining muscle or lossing body fat. Every year my doctor ask hows my energy because the drugs I am on can reduce my testosterone. I have a yearly follow up in a week. Should I ask my doctor to do a blood test to check my T-levels?

Reply

Dr. Barry Wheeler December 16, 2013 at 12:01 am

Hi Rob,

Yes! I recommend any man who is concerned about their testosterone levels to get them checked, rather than wait until they’re really suffering. Even if you’re testosterone level comes back normal at least you’ll know where you stand. Many men experience low testosterone in different ways, and some men may only have one symptom. Statins and losartan, in particular, are known to lower testosterone levels. Always talk to your doctor before changing any of your medications.

Learn more: Low Testosterone Symptoms and Lab Testing

Cheers,
Dr. Barry

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Rob December 16, 2013 at 2:00 pm

I went to the doctor and described my fatigue and he ordered blood test for thyroid stimulating hormone. Whould this show test levels? The other blood test were for Lipid, Hepatic, and Metabolic panel.

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Dr. Barry Wheeler December 22, 2013 at 10:51 pm

Hi Rob,

Thyroid stimulating hormone (TSH) by itself is one of the most worthless tests in the world, in my opinion. TSH is the signal from the brain to the thyroid. It tells the thyroid to produce thyroid hormones. If your TSH level is low or high it may be useful but most often it comes back “normal”.

Low thyroid hormone (T3 or T4) can certainly cause fatigue but in my experience, is more commonly a problem in women. In addition, he didn’t even measure the thyroid hormones themselves, only the signal. Interestingly, when most doctor check for low testosterone they measure the total level of testosterone, called total testosterone. The signal form the brain to the testicles is luteinizing hormone (LH) but doctors would never measure this only and for some reason they think its okay to only measure the signal in the case of the thyroid.

Long story short, none of those tests will tell you anything about testosterone levels.

Read this article: Low Testosterone Levels Test & Symptoms

Best of luck,
Dr. Barry

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Darrell December 7, 2013 at 6:35 pm

Im 66, have serious heart issues and am taking weekly injection of .5 IM T shots for low T, hypogonadism, ED (among other things). Only been taking for 4 weeks. Haven’t seen any change in symptoms however I have developed a rash on chest, back and groin and have tender nipples. After reading your responses I believe my estrogen levels maybe high and/or I am converting much of my T to estrogen. I will check with my doc on Monday and suggest we do another blood test to see where I’m at. I think your responses are very helpful and a vary impressive marketing strategy. Helping people while making money is the best of both worlds. Thanks

Reply

Dr. Barry Wheeler December 8, 2013 at 11:08 pm

Hi Darrell,

It is important to tell your doctor right away about your rash and nipple sensitivity. He should definitely consider checking your estrogen levels. The rash may be unrelated but its still important to tell your doctor about it immediately. Rash, as you can imagine, is much more common in men using topical testosterone.

Some men notice little benefit from testosterone therapy during the first few months while others notice immediate improvements in their symptoms. I suggest you talk to your doctor about switching to topical testosterone (low dose) or get a second opinion from another doctor more experienced in testosterone therapy.

Best of luck,
Dr. Barry

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Greg December 7, 2013 at 4:46 pm

I have been on topical TRT for almost 12 months. I feel great, have gained 20lbs of muscle and am more “ripped” and healthy looking than when I was 20. All is great except I have really bad acne on my back and shoulders. I have cut out DHEA and tried a Dermotologist prescribed Doxycycline with no positive results. What would you do with a client that is having this problem?

Also…my wife is now having acne breakouts and is blaming my treatment??? I am very careful to avoid contact with her after I apply the T. We have now begun separating clothes in our hamper, etc. as precaution. Is this founded.

Thanks

Reply

Dr. Barry Wheeler December 8, 2013 at 10:56 pm

Hi Greg,

It is certainly possible you’re accidentally transferring testosterone to her. If she is washing your clothes she may be getting exposed. Some women are sensitive to very small amounts of testosterone and get acne. It could also be totally unrelated. You should both talk to your doctors to get this figured out. Lab testing with your doctor’s help could get to the bottom of this quickly.

The problem with topical testosterone is that a lot of it converts to dihydrotestoterone (DHT) and DHT can certainly increase acne. The conversion of testosterone to DHT is increased if you are applying to hairy areas of the body, such as arm pits or chest. Testosterone gels may also cause more DHT versus testosterone creams.

There are several ways to reduce the conversion of testosterone to DHT:

  • Applying testosterone to less hair areas can help, such as inner thighs and sides of abdomen.
  • Applying testosterone to the rectal mucosa can help. Mucosal membranes have no hair and tend to absorb better allowing lower doses in smaller amounts.
  • Prescription medications such as spironolactone and dutasteride decrease DHT but may be too potent.
  • Vitamin D decreases the conversion to DHT and tanning increases DHT and kills bacteria on the skin. Ask your doctor before tanning.
  • Essential fatty acids (EPA, DHA, GLA) all decrease DHT production and can help decrease acne.
  • Saw Palmetto is an herbal supplement that decreases DHT production and is good for the prostate.
  • Zinc decreases DHT and has been shown to decrease acne and improve immune function.

Another option to discuss with your doctor is switching to testosterone injections. In my experience, 100mg (or less) testosterone cypionate injected weekly rarely causes acne and has NO risk of transfer to your wife or others.

All treatments should be supervised by a licensed physician and be sure to talk to your doctor before changing your treatment.

Best of luck,
Dr. Barry

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Josh December 3, 2013 at 3:44 pm

I have been getting injections for 4 months now – 2cc every 2 weeks. My level increased from 250 to 780 after 7 injections. My doctor is happy with the number and suggests to continue the same treatment going forward. I feel great and agree. However, I ran into an issue that was addressed on this website – edema. There have been 2 instances where my ankles and feet have swollen. The first time wasn’t bad and it was quick to go away in about 1-2 days. The 2nd time was much worse and the swelling moved into my calves. It took about 3-4 days for the swelling to be completely gone and I was “unusually tired” during these days. It has been about 10 days since the 2nd instance of swelling and everything is back to “normal” and I feel great. While this swelling side effect has only happened twice (really only once that was bad) in the past 4 months I am concerned that it will become more of the norm rather than a one-off here and there. I see that it is suggested to switch to the topical cream but I have 2 young daughters at home. Is this is a concern? Please help…thank you so much.

Reply

Dr. Barry Wheeler December 8, 2013 at 10:36 pm

Hi Josh,

Please be sure to tell your doctor about the ankle swelling right away if you haven’t already. I totally understand your concern about transferring the topical testosterone to your daughters.

The dose you are taking may be too large. Assuming you are taking 2cc of a 200mg/mL testosterone cypionate, means youare taking 400mg of testosterone cypionate every two weeks. It is likely that your levels are VERY high the first week after your injection and then begin to decline. This may be part of the reason you are having ankle swelling. In addition, a large portion of this testosterone will convert to estrogen, which is likely contributing to the ankle swelling.

In general, lower more frequent doses are less likely to cause side effects in my experience. I suggest you talk to you doctor about switching to 100mg injected weekly. You should also ask him to check your estradiol (estrogen) levels.

Testosterone propionate is another option to discuss with your doctor. Testosterone propoionate is faster acting and must be injected daily using an insulin syringe but I have never had a patient get ankle swelling from testosterone propionate.

Best of luck,
Dr. Barry

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Josh January 29, 2014 at 3:29 pm

After posting my issues/questions to you back in December I continued to do research on my problems and decided to switch to the topical gel. In short, the research I found basically said that most of the problems I was experiencing should diminish or be eliminated with the topical gel. I just made sure I took every precaution in eliminating transfer to my daughters and wife (long sleeve shirts, separate laundry bins, etc). So, I did a 30-day treatment of 1.0% Androgel. Moving closer to the 2nd month of gel treatment my doctor wanted to check my T level to see how the gel was working. My gut told me that the number would be low…probably really low because I had been feeling like I was back before I even started T injection treatment. Below are my levels and how they changed with the T injections and then with my first month of T gel.

injection every 2 weeks:
8/23: 293 T
10/8: 518 T
11/26: 786 T (bio available 401)
30-day gel:
1/25: 273 T (bio available 79)

As you can see my level fell off the face of the earth…lower than what it was back when I first started. Not exactly sure what the bio available component means but I figured I’d include it because of the noticeable correlation. When I speak with him I will be asking about propionate vs cypionate and the lower dose more frequent injections. But I have a feeling I should probably be seeking a more experienced doctor in testosterone therapy. In general, I am not excited about going back to injections because of the previous issues I had but the injections worked and I felt great. Issues aside I guess I would be willing to try the injections again on a different dose and “ionate” agian. So, I guess my question is: have you seen this sort of thing before – where the T gel has no effect whatsoever? Also, I would like to say that I think what you are doing is great – it really helps a lot of people. So, thank you.

Reply

Dr. Barry Wheeler February 9, 2014 at 8:49 pm

Hi Josh,

One of the problems with topical testosterone is that it is very difficult to monitor with blood testing. Topical testosterone seems to travel more through the lymphatic system and spend more time inside of the cells. You were applying 1 mL of topical testosterone which is 10mg of testosterone which is mostly absorped rapidly throught the skin, especially in the gel form. It is possible it was leaving your system too fast.

The lack of correlation between topical testosterone blood levels and dosage applied is well known in the anti-aging medicine field. Many doctors use saliva tests to monitor testosterone levels but this also an unproven method and the levels may poorly correlate with a patient’s symptoms. The most effective may to increase blood levels with topical testosterone is to use a concentrated cream form and apply it to the rectal mucosal membrane – “butthole”. I patients with poor skin absorption a small amount (0.10 mL 20% testosterone cream) applied to the outside area of the anus (not inside the rectum) will tend to increase blood levels much higher with less testosterone required. The biggest challenge I’ve had with this approach is that when a person has a bowel movement you cream is removed and it can get tiresome applying cream to that area everyday for some men.

Women who apply topical hormones to labial mucosa tend to get better absorption as well. Hormones applied to the skin tend to build up in the layers of the skin and this can lead to excess hormone in the lymphatic system. Mucosal membranes transfer the hormone more directly into the blood stream.

Some doctors actually believe taking a shower before bed to wash it off actually causes the body to produce more testosterone during the night and maintains natural production but this is far from reality as most of that testosterone has already been absorbed by the body. There is likely some testosterone still on the skin and even small amounts of testosterone can affect children and women but washing off testosterone before going to bed to maintain testicular function is a fairy tale. There are oter more proven ways to maintain testicular function (HCG, anastrazole, clomiphene).

Always ask your doctor before changing you medications or starting a new medication. All treatments should be supervised by a licensed physician.

Best of luck,
Dr. Barry

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jeff November 21, 2013 at 1:07 am

I was switched to Testosterone Cypionate a few months ago because of shortage of Enthanate. 120 mg/week. Felt great at first. Gained a bunch of strenght and libido was higher with this as compared to Enthanate.
The last few weeks I feel sort of like I’m not feeling so great.
Had labs done on day before next thigh injection. Figured the numbers would be low because I remember feeling sort of “crappy” that day. Well the numbers were really high on the trough day. 837 was my T reading. Not even in range.
My Dr said that right after injection that my level may be 2000. She decided that I should cut dosage in half to 60 mg / week.
any thoughts?
thank you very much
pretty concerned and just want to feel good again. Is T levels so high that I’m manufacturing Estrogen possibly?

Reply

Dr. Barry Wheeler November 29, 2013 at 9:22 pm

Hi Jeff,

It sounds like your doctor made the right decision. Most guys notice little difference between testosterone cypionate and testosterone enanthate. It is possible your body processes the enanthate faster or differently. I wonder if your doctor didn’t get confused on the dosage. Testosterone enanthate or cypionate can come in 200 mg/mL and 100 mg/mL. So you may want to double check with your doctor what doses you were doing. My first thought is that you were doing a higher dose than previously.

I doubt your testosterone level was 2000 after you injected 120 mg testosterone cypionate but the only way to know for sure would be a blood test. You should also ask your doctor to check your estrogen (estradiol) and free testosterone levels. 60 mg is a pretty low dose so you may want to ask your doctor about doing two doses of 50 mg per week. Typically, low doses divided up reduce the chances of levels being too high or low. Reducing the dose and or dividing the dose and addressing over conversion to estrogen will typically help bring back the benefits you were feeling previously but it should be done with your doctor’s supervision. If your doctor is unaware of the fact that testosterone converts to estrogen you want to get a second opinion from a doctor more experienced in testosterone therapy.

Cheers,
Dr. Barry

Reply

david November 17, 2013 at 3:46 am

Dr. does hcg cause cancer?

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Dr. Barry Wheeler November 19, 2013 at 12:10 am

David,

No. HCG does NOT cause cancer. Some forms of testicular cancer produce HCG but there is no evidence HCG causes cancer and in fact there is research showing it may reduce the risk of cancer when used in women. HCG stimulates the testicles to produce testosterone. I have had patients with history of testicular cancer and their oncologists have always given them the green light to use HCG for improving testicular function. Always ask your doctor before taking any medication.

As an aside, marijuana has been shown to significantly increase the risk of testicular cancer.

Cheers,
Dr. Barry

Reply

David November 16, 2013 at 8:03 pm

Hi Dr,

Please excuse my ignorance on some of this. I had my Testosterone tested last year and was told by my Dr that I was low. Less than 300. I started taking monthly shots, and these shots were originally 200 (however T is measured). My Testoterone was checked again after several months, and my level was still less than 300 – there had been almost no improvement. At that time he increased my shot from 200 to 300, and from once a month to twice a month. So my anount was tripled.

Almost immediately, my BP began to rise and I started having swelling all over, but most noticably in my legs and joints. I also had a 30 lb weight gain in less that 3 months (some of wchich I am sure can be sttributed to eating more once I stopped smoking).

My Dr referred me to a vascular specialist because of the swelling in my legs, but the ultrasound proved to be normal. My Testoterone was also retested and this time it was above 1100. So I was changed from getting a shot twice a month to once every 3 weeks.

At that time, I did not get my usual injections. I wanted to see if my swelling and other symptoms lessened. And after almost 6 weeks, they did. They weren’t gone by that time, but they had decreased CONSIDERABLY.

I got another injection.

Within a week my legs were swollen, I gained 6 lbs and my BP was up again.
My Dr conceded that it was probably the testosterone shot that was giving me the swelling, weight gain, and possibly even anxiety. So now I am currently on Testim 1%. My questions are:

Is the Testim different than the injection concerning side effects?
And considering that I went almost 6 weeks with no injections before the side effects began to leave, how long will it take for them to leave now that I went from an injection and one week later began the testim?

Because frankly, I am miserable. I can’t exercise like I used to because of the swelling in my legs, and my joints are swollen and any repetitive task (exercise, playing guitar, as examples) is impossible for me to do sufficiently.

Thank you for your time.

Reply

Dr. Barry Wheeler November 26, 2013 at 12:40 am

Hi David,

I have noticed that some men tolerate topical testosterone better than testosterone injections but most often the swelling is from too much conversion of testosterone to estrogen or too high of doses of testosterone. The problem with getting higher dose shots, in some men, is that your levels go too high and then they go too low. When men are having trouble getting their testosterone levels up I typically consider switching them to a lower dose and having them inject it more frequently, say 50mg twice a week.

Like I said, some men seem to tolerate the topical testosterone better than the testosterone injection but it goes both ways. Some men feel worse on topical testosterone vs testosterone injections. It really just depends on the person. The problem with topical testosterone, in my opinion, is that its difficult to monitor. Most the topical testosterone applied to the skin travels through the lymphatic system so its tough to measure in the blood. This can lead to guys applies very high doses and never seeing their blood levels increase that much.

I suggest you ask your doctor to check your estradiol (estrogen) levels as increased estrogen may contribute lead to swelling in the ankles. Beyond that, you may want to get a second opinion from another doctor in your area more experienced with testosterone therapy. You should also be sure to tell your primary care doctor about the swelling.

Best of luck,
Dr. Barry

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Randy November 30, 2013 at 5:38 pm

Ask your Dr. about spironolactone. I am on T therapy and my Dr. gave it to me for increased acne, which I have always had, but got worse on T therapy. When I started taking it, I started to loose weight. I believe I had gained about 6 to 10 pounds when I started taking T. I am pretty sure it was water retention as sometimes my ankles would swell. I lost the weight and never had ankle swelling again. Recently I stopped the spiranolactone for a week to see what would happen. I gained back 6 pounds rapidly. I started back on the spironolactone yesterday, and I bet the weight drops off again. It is a blood pressure med with off label use for acne, primarily in teen girls. But I am sure it works for water retention also. Believe it or not, to keep estrogen at optimum levels, I take progesterone.

Reply

Dr. Barry Wheeler December 8, 2013 at 10:15 pm

Hi Randy,

Thanks for your comment. I have used similar approaches to hormone balancing on my patients. One word of caution, if your doctor is using saliva or urine testing to monitor your hormone levels they should also be doing blood testing. I had a patient come to my clinic whose doctor only was doing urine testing and said their levels were perfect. When I checked their estrogen levels in the blood it was about 8 times higher than is considered optimum and twice the upper limit of the range.

Spironolactone is a diuretic that works by blocking the actions of aldosterone, hormone that causes our bodies to retain sodium and water. Spironolactone also decreases the conversion of testosterone to dihydrotestosterone (DHT). Too much DHT in the skin can cause acne and increases body hair. It can also cause hair loss on the scalp. Medication like Propecia® used for to treat male pattern hair loss are designed to decrease the conversion of testosterone to DHT.

The nice thing about spironolactone is that its less potent than Propecia® so that it is less likely to shut down all production of DHT, which we need (read Topical Finasteride for Hair Loss).

Hair follicles in the skin convert testosterone to DHT. This is why men using topical testosterone (vs testosterone injections) may have more conversion of their testosterone to DHT.

Progesterone also decreases the conversion of testosterone to DHT. It also helps our body process estrogen by preventing it from staying in the cells too long. Progesterone can also help improve sleep. Believe it or not, men naturally produce a little progesterone and estrogen. Its all about balance.

Be sure to talk to your doctor before changing or discontinuing your medications.

Cheers,
Dr. Barry

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Derek November 12, 2013 at 4:39 pm

Greetings,

I am 40 yrs old and have been on pain medications for over 5 yrs now for trauma to my leg. I suffer from severe post-trauma arthritis and need the meds to walk basically(30 mg oxycontinin 2/day, 15 mg morphine immediate release as needed). I also recently gone through a bad divorce and some job stresses whereas my GP prescribed Klonopin for(1 mg 2/day). I have very low T, 165 at last check, low vitamin D and recently found high uric acid. Been prescribed Allopurinol (100 mg once) and Indomethacin for a gout break out. I started Testosterone compound cream(100 mg, 2 pumps daily) and have been recommended to take DHEA (50 mg/day) and 5 HTP for mood enhancement. I was very ill for 8 days recently, intense vomiting for 2.5 days, doc says I had a stomach virus and was dehydrated. I am feeling better now, still not normal, but my feelings of depression have been decreasing since the compound cream, but I have a new problem … Very little semen upon ejaculating. When “getting there” it feels “normal,” but there is very little discharge and “globby” in consistency. I am under a lot of stress and anxiety and learning more about Klonopin, been decreasing the use of that drug, but it feels as if either the reduced amount of ejaculate correlated with either my uric acid treatments, testosterone use or post being very ill. Can any of these drugs or combinations of them affect semen production/limited ejaculate? Suggestions?

Reply

Dr. Barry Wheeler November 18, 2013 at 11:36 pm

Hi Derek,

Pain medications, such as morphine, are well know to decrease testosterone production. Most of the semen produced by the body comes from the prostate. If you are ejaculating more often that can cause less volume with each ejaculation. You should talk to your doctor about your concerns.

You should also ask your doctor to check your estrogen levels as this can sometimes increase the prostate size and sometimes cause problems such as difficulty urinating. Dehydration may be a factor as well. Some of the semen is produced by the testicles and when we take testosterone we make sometimes make less sperm/semen. There are ways to stimulate the testicles to produce more sperm and maintain their function better while taking testosterone. Simply reducing the conversion of testosterone to estrogen can have an effects as the estrogen will feedback to the brain and reduce the signals from the brain to the testicles (FSH and LH).

You should talk to your doctor before changing any of your medications.

Best of luck,
Dr. Barry

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Drex November 9, 2013 at 2:35 pm

I was diagnosed with secondary hypogonadism after several tests for low total T, low normal LH and low normal FSH. E2 was normal before starting TRT, however total estrogen was a little high. I have been on Testim 1% 50mg for a month now and while I have had some ups and downs on it, I am having one serious side effect that I don’t understand and that is digestive upset and nausea. I know that nausea and vomiting are listed as potential side effects, but can’t find out why. It’s becoming bad enough that I think I may have to quit the Testim, and am thinking of asking for Clomid. Any thoughts on what may be causing the digestive problems ?

Reply

Dr. Barry Wheeler November 10, 2013 at 11:17 pm

Hi Drex,

I have treated hundreds of men with low testosterone and have never had any report increased nausea of digestive upset. However, I rarely use Testim® as it has some added chemicals, such as pentadecalactone, to improve penetration of the testosterone that may lead to side effects. I suggest you tell your doctor about your symptoms and ask to try another form of testosterone such as a compounded topical cream of low dose testosterone injection.

Testosterone can lower cortisol hormone production which may cause nausea possibly. Without seeing you in my clinic its hard to say. I suggest you also ask your doctor to check your estrogen levels again as they may be much higher. Also, topical testosterone travels through the lymphatic system rather than the blood and can be difficult to monitor. Low dose testosterone injections are one alternative to discuss with your doctor as well.

HCG and anastrazole are other options that can be effective when LH and FSH are low especially when there is a concern about fertility. HCG helps improve fertility. Another hormone to ask your doctor to test is prolactin. Sometimes high prolactin will suppress LH and FSH levels.

Please tell your doctor right away about your symptoms.

Clomid® (clomiphene) is worth a try but can lead to difficult to manage estrogen levels. Clomiphene blocks estrogen negative feedback at the pituitary to cause an increase in the signal to the testicles to produce testosterone. However, clomiphene can block estrogen in other parts of the body which long-term may lead to problems such as decreased bone mass. Its all about balance. Short-term it is unlikely to have any side effects but should still be supervised by a licensed physician.

Cheers,
Dr. Barry

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Khan November 1, 2013 at 1:41 am

Hello Dr Barry

I’m 45 years old, and my sexual life was pretty normal, the libido, erection, ejaculation, sperm count, all went well. I started to feel declined in these factors gradually in 2013. During the summer I started to have a serious ED, and lost of libido, fatigue, and loss of focus and concentration. I went to see a doctor last week, and he asks me to do the testosterone hormone blood test. The result was: Total is 170 .
The doctor told me that I need to start a therapy right away. He is not specialist but just a general family doctor.

What do you advice me to do ? In particular,

1) Shall I begin the therapy or just wait ?
2) Is it fine and safe to make it with a family general doctor, or I need to see a specialist ?
3) How long is the therapy going to take ? How to speed up the process ?
4) Do I need to take the treatment for ever and the rest of my life ?

Any help or advice will be appreciated.
Thanks

Reply

Dr. Barry Wheeler November 6, 2013 at 5:51 pm

Hi Khan,

There are many general medicine doctors who do testosterone therapy, some better than others in my opinion. First, let me respond to your questions and then I’ll give you a few tips on finding the right doctor.

  1. Without seeing you in my clinic I cannot give you advice. Only your doctor can advise you as to the best options and then it is up to you to make the decision.
  2. Many general medicine/family medicine doctors treat their patients for low testosterone, some are more experienced and some more comprehensive than others. Any treatment has potential side effects and benefits and only your doctor can discuss them specific to your situation. If you are unsure how to proceed get a second opinion from another doctor in your area or ask for a referral to a specialist. Getting more information can be useful. Ask your doctor why you have low testosterone in the first place.
  3. Every patient is different. Some patients notice immediate benefits like the lights just got turned back on while others notice no benefits ever. Some symptoms such as erectile dysfunction may not significantly improve for months or even up to a year. Most guys notice improvements in energy levels, mood, and libido during the first few months, in my experience. In general, taking a holistic approach to balancing hormones can reduce the risk of side effects and enhance the benefits. This may include monitoring and reducing estrogen production as needed and using additional medications such as HCG to reduce testicular shrinkage.
  4. Typically, as we get older our testosterone levels will continue to decline but it really just depends on your specific situation. Most men, in my exsperience, who discontinue testosterone replacement after a year will likely just return to the levels they had before they started and sometimes their testosterone levels are a little better and sometimes they are a little worse. It is important to discuss this with your doctor and ask how they can help you maintain or improve your natural testosterone production.

Based on your comment it is unclear if your doctor has determined the cause of your low testosterone. This is an important topic to bring up with your doctor.

Best of luck,
Dr. Barry

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John Doe October 26, 2013 at 3:33 pm

Hello Dr. Barry,

I am actually one of your current patients who is very satisfied with the attention to detail and great service from your clinic. Your staff is excellent especially in terms of speed and follow ups. I have a couple questions that may not have been addressed yet.

It seems that TRT may cause low ferritin, do you suggest actively checking these levels? Also, I donate blood every 56 days because my hemoglobin and hematacrit increased with TRT, 50 and 17.7 respectively. Since donating blood lowers iron as well, is there a potential for problems here? How can we go about solving it?

I also use Zoloft not for depression, but anxiety, is there any issue with trt and SSRIs?

Lastly, I noticed when first began trt my libido was great, however, now I can still easily keep an erection but drive is much lower, this was before I took Zoloft too.

Thank you.

Reply

Dr. Barry Wheeler October 29, 2013 at 12:22 am

Hi John Doe,

Please contact our clinic to discuss how we can help you improve your libido by calling (425) 455-1700. Also, we would be happy to measure your iron levels for you. Most guys have plenty of iron and do better with a little less but let’s check it anyways. Typically, we would suspect low iron levels if your red blood cell size is small so that is one way we monitor it. Taking too much iron can be dangerous so please talk to us before taking any iron supplements. We get lots of iron by eating meat and seafood but if you’re vegetarian you’re more at risk.

Generally, when testosterone levels increase then libido will increase. Sometimes guys notice more libido when first starting treatment and then it seems to taper off either due to their body adjusting or just getting used to more libido. Interestingly, many guys with low libido are unaware they have low libido until their libido improves with treatment.

One of the potential side-effects of Zoloft® (sertraline) is low libido. There are also cases where it increases libido. In my experience, patients on SSRIs often benefit from TRT and a review of research supports that they are safe to use in conjunction.1

Cheers,
Dr. Barry

  1. Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. NICE Clinical Guidelines, No. 91. National Collaborating Centre for Mental Health (UK). Leicester (UK): British Psychological Society; 2010. http://www.ncbi.nlm.nih.gov/books/NBK82914/

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Chris October 23, 2013 at 2:23 am

Sir,

I am a 38yr old male 6’2 230 lbs moderately muscular.

A year prior to TRT my Testosterone levels were in the 700s, and was doing ok physically. I went through a lengthy/nasty divorce/custody litigation and was awarded full custody of my children. I am sure the stress has caused some of my following medical problems.

In June of 2012 I began TRT (Pellets) I do not remember the exact dosage I was given, but I also received a shot of Test Cyp on the day the placed the pellets into my hip. After a few days I felt better. July and August 2012 I developed severe insomnia. I went to my Dr. and advised him of how I was feeling. He ordered blood work requesting Total Test, Free Test, estradiol, and several others. The following results are from what I remember and notes: Total test high 800′s, Free Test 50s, Estradiol in the 600s. Rest of my blood work was within range. My Dr. was floored by my estrogen level and remarked that he could do a case study solely on my hormone problems.

As a side note as a pre- teenager (mildly overweight) I developed bad gynecamastia and did not get rid of it until I was 28yrs old via plastic surgery. At the age of 28yrs old I was diagnosed with Pappillary Thyroid Carcinoma, and underwent a complete thyroidectomy and RAI 131 treatment. Since then I have been cancer free and have battled to feel normal regardless of what Thryoid supplementation I take.

After my high estradiol levels I then began taking Arimidex 1mg daily. I did this for 2 months. During the 1st month of Arimidex I received my second round of Pellets. During the next couple months of my life I would consider this to be the worse I have ever felt in my life. My insomnia was so severe that I could not function. I decided to immediately stop the arimidex and the pellets once they were all absorbed. I went cold turkey with no HCG, Clomid, Nolvadex, and/or supplements. I felt better than I did on the pellets, but I still felt really bad.

December 2012 I finally decide to switch my Endocrinoligists and my TRT Drs. My wife a Dr. found me a Endo who does TRT. I figured great this Dr. can monitor my thyroid and my TRT. At my first visit with the new Endo, he orders full blood panel, Total Test, Free Test, Estradiol, Psa, thyroid, etc. A few days later I had my bloodwork done and received the following results Total test 300′s, Free test 20′s, and my estradiol was 238. A few weeks later I go back to my new Endo and he reviews my blood work with me. He advised me that he believes I need to start TRT

My new Endo wants me to begin TRT and prescribes me Test Cypionate 100mgl/weekly. He then advises me he is not worried about my Estradiol. Which should of been my first clue to leave his practice.

During January, Feb, March, April, and May of 2013 I feel better, but I am having typically problems that someone with high Estradiol would have chest tenderness, poor sex life, etc. I contact my new Endo he advises me that he will check my levels since I begged him. My Total Test was in the 600′s, Free test 30′s, and Estradiol in the low 300′s. My Dr. consult he advised me once again that he was not concerned with my Estradiol levels.

June 2013 I finally realize that the new Endo has no clue how to manage a complex patient as my self. I then start looking for Drs. out of network and find a cash pay TRT Dr. I give the Dr. my recent blood work and advise him that I am currently under the new Endo and I am taking 100mgl/weekly of Test cyp. The new TRT Dr. advises me to start taking my shots bi-weekly, increase my zinc intake, and he prescribed me Arimidex EOD and clomid daily. Due to me stating that I wanted to attempt to kick start my own natural Test production. A few months go by and I am still feeling tired, fatigue, moody, increased sex drive, but very emotional.

July/ August 2013 I have another appointment with my new TRT Dr. I advise him of my concerns. He pulls blood work again and my Total T was in the 700′s, Free T 50′s, and Estradiol 328. My new TRT is highly concerned with my Estradiol levels being so high. He then prescribed me Arimidex daily.

At this point I stopped taking Clomid, but continued to take the Arimidex. After a few weeks I still fell horrible. The new TRT Dr. requested labs once again. My Total Test and Free test stayed about the same, but my Estradiol levels actually increased to 328.

September 2013 I return to my New TRT Dr. I adivse him that I want to stop TRT. He prescribes me Clomid and HCG. I began a standard PCT and still felt horrible.

I then had my blood work done again once again Estradiol levels were in the 300s. I stopped TRT in end of August 2013. Had my blood work done again at the beginning of September 2013. My Total T was 230′s and Estradiol was in the low 300s. I then begin clomid and Nolvadex daily. My blood work was done again in the end of Sept 2013 my Total T was high 300′s and my Estradiol was mid 300′s. My wife does not take any estrogen supplementation. I need your help please advise. Thanks in advance.

Reply

Dr. Barry Wheeler October 28, 2013 at 11:36 pm

Hi Chris,

What is the units of measurement for those estradiol levels? For an adult male the range at Labcorp is 7.6-42.6 pg/mL. For an adult female the range goes up to about 500 pg/mL. If they are measuring your estradiol in another unit that would change things.

Typically, when estradiol is that high in a male, I think the highest I’ve seen is about 150 pg/mL, we will see very high levels of sex hormone binding globulin (SHBG). I also don’t see that anyone is checking your luteinizing hormone (LH) levels. LH is the signal from the brain to the testicles to produce testosterone. It may also be helpful to check follicle stimulating hormone (FSH) as well. FSH stimulates sperm production and is often reduced when there is too much estradiol.

I suggest you contact an endocrinologist to help you determine why you are producing so much estrogen. I think it is important to determine. Unfortunately, I cannot give you any advise without seeing you in my clinic. There are more tests that you could ask your doctor to order, such as 24 hour urine hormones and salivary hormones. Still, ask all your doctors why you are producing so much estradiol and if they can’t tell you I suggest you find a doctor who can tell you.

Best of luck,
Dr. Barry

Reply

Allen October 22, 2013 at 1:33 am

I started taking testosterone injections 3 months ago and my T level made a strong improvement. I have been injecting weekly per instructions of my Dr.
Went back to my regular doctor this week and he became very concerned about a serously irregular heartbeat. Concerned enough that he would not let me leave until we had an appointment with a cardiologist (tomorrow). It just so happens that I had a complete physical 3 months before with this Dr and my heart was fine. Is there a connection between the injections and this cardiac issue that I have now? Please advise.

Reply

Dr. Barry Wheeler October 28, 2013 at 10:51 pm

Hi Allen,

The research related to heart health generally supports the treatment of low testosterone. I am unable to give you advice without seeing you in my clinic. Hormones can certainly affect a number of functions in the body so it is important to ask your doctor to measure them, including testosterone, estradiol (estrogen), and thyroid hormones. Every patient is different so it is important to work with your doctors to determine the best treatment for you.

A study done at Boston University School of Medicine that watched men on testosterone therapy (testosterone injections) over 5 years did not find any increased incidence of irregular heart beats.

“These findings suggest that long-term treatment of men with TD restoring physiological levels of T produces important clinical benefits. This study differs from previous studies in that it followed men with TD for a period of 5 years, which is the longest reported duration of treatment to date.”1

Another study published in 2010 in the International Journal of Andrology concluded, “a high number prolonged QT interval measurements was observed in hypogonadal men who may therefore be at increased risk for cardiac arrhythmias. This observation reveals an additional feature of male hypogonadism, which may benefit from testosterone replacement therapy.”2

However, every patient is different. Your doctor may ask you to discontinue your testosterone to see if it affects your heart rhythm. It is important to do this under the supervision of your doctor and not without talking to them about it first.

Cheers,
Dr. Barry

  1. Long-term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long-term registry study. Traish AM, Haider A, Doros G, Saad F. Int J Clin Pract. 2013 Oct 15. doi: 10.1111/ijcp.12319. [Epub ahead of print]
  2. Increased prevalence of prolonged QT interval in males with primary or secondary hypogonadism: a pilot study. Pecori Giraldi F, Toja PM, Filippini B, Michailidis J, Scacchi M, Stramba Badiale M, Cavagnini F. Int J Androl. 2010 Feb;33(1):e132-8. doi: 10.1111/j.1365-2605.2009.00985.x. Epub 2009 Sep 11.

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rakesh October 20, 2013 at 10:19 am

dear dr barry
i am on testosterone replacement therapy since childhood (i guess since i was 10 yrs old)…now i have very less control over my anger….before i was very calm about everything but now i do get depressed full negativity for myself and yes i get angry very easliy on everyone…..is this because of my therapy?? And if it is because of that then please tell me what to do?? I myself is a doctor
thank you

Reply

Dr. Barry Wheeler October 22, 2013 at 12:23 am

Hi Rakesh,

I would need a lot more information to be able to help you effectively. I suggest you find yourself a good doctor or refer yourself to a specialist. Ask your doctor to check your testosterone, free testosterone, and estradiol levels. There may be other tests that they’ll want to do as well.

Even if your doctor you still need a doctor to supervise your care. In the United States doctors are unable to prescribe themselves testosterone so I suspect you are in another country. You could be getting receptor down-regulation. If you were my patient I would consider putting you on daily testosterone propionate injections or daily topical testosterone. Sometimes its good to switch things up. Find yourself an experienced doctor or come into our clinic.

Based on your symptoms of depression and anger its very important to see a doctor right away. If you’re having any suicidal thoughts you should seek immediate medical attention.

Cheers,
Dr. Barry

Reply

arthur October 20, 2013 at 5:55 am

Hello Dr. Barry,

I am a 30 year old male. Experiencing low sex drive past few years and very bad memory.

My test results are as follows.

Estradiol at 31.6 pg/mL

Free Test at 12.7 pg/mL

Total Test 653 ng/dL

Do my results say that I should consider testosterone and see a doctor?

Arthur

Reply

Dr. Barry Wheeler October 22, 2013 at 12:14 am

Hi Arthur,

I suggest you read the book, “The New Testosterone Treatment: How You and Your Doctor Can Fight Breast Cancer, Prostate Cancer, and Alzheimer’s”, by Edward Friedman, PhD. Your free testosterone level is “low normal” while your total testosterone level is mid-range. Your estrogen is on the upper end of the range but likely still “normal”. I can’t say for sure without seeing the lab results and the ranges that the lab uses. Every lab has its own set of “normal” ranges for the levels.

If you came into our clinic would want to repeat the tests for your testosterone levels and estrogen levels. It is possible your levels have declined further since this test was done or your symptoms are caused by something else. We always discuss your symptoms with you and try to match them with your lab tests to make sense of what is going on. Lab testing is not perfect and depending on the lab and day you do the test you can get different results. That’s why its important to have a doctor guide you through the process to help you figure out what’s going on.

I suggest you come into our clinic or contact your doctor, if you’re not local, to make an appointment to repeat the lab tests and look for other possible causes. Sadly, as you get older you testosterone levels will likely continue to decline so looking for the cause of the problem is important.

Cheers,
Dr. Barry

Reply

Jerry October 17, 2013 at 4:11 am

Dear Dr Wheeler,
I placed testosterone pellets since a year ago. Just a month ago I noticed that I acquired clubbing nails in my fingers and toes. They have a estranged yellow color curved like claws and separated from the nail bed. What do you think this is caused by? It situation happened after I started the testosterone pellets implants. Please tell me what to do?
I appreciate your response.
Jerry

Reply

Dr. Barry Wheeler October 18, 2013 at 7:36 pm

Hi Jerry,

I cannot find any research that shows that testosterone pellets can cause clubbing of the nails. Clubbing of the nails can be caused by a number of health problems so it is important to contact your primary care provider immediately and discuss this with him/her.

Best of luck,
Dr. Barry

Reply

Darrel October 15, 2013 at 4:28 am

Dr. Wheeler, I’m currently a well-satisfied patient of yours. However, I had been taking dutasteride .5mgs/day for its effects on preventing hair loss, without side effects. I stopped taking the dutasteride when I started TRT, and the shedding (MPB, to be sure — familial) became noticeable rapidly. I came across this description of a study:

http://www.medscape.com/viewarticle/759769

As a lay person, I think I have a general idea of the conclusions of the study, but you’re the expert and I wanted to check with you. Can I resume dutasteride, receive the benefits of its DHT-suppressing functions regarding hair loss, and continue TRT? Thanks for everything — you have a great team!

Reply

Dr. Barry Wheeler October 22, 2013 at 12:06 am

Hi Darrel,

Thanks for the feedback! Helping men improve their lives is why we do it.

I had my staff contact you but if you still have questions please give us a call at (425) 455-1700. In general, we find that dutasteride has LESS risk for side effects when guys are on testosterone therapy. DHT is about 4x as potent as testosterone so when we have low testosterone and then take dutasteride to reduce DHT even further we often see more side effects. When testosterone levels are optimal, however, dutasteride is less likely to cause those side effects.

Any patients considering changing their medications should always as their doctor first, or if you’re one of our patients just give us a call or come into the clinic. Some medications, such as blood pressure medications, should be not be discontinued without supervision of the doctor who prescribed them.

Cheers,
Dr. Barry

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Alvin October 13, 2013 at 4:25 pm

Sir,

What do you think about clomid to help with low T if primary or seconday hypogonadsm has not been determined. I’ve been on T treatment for 2 yrs with little success and used all three methods. Considering Clomiphene.

Thx

Reply

Dr. Barry Wheeler October 19, 2013 at 5:14 pm

Hi Alvin,

Without more information it is difficult to say. I would need to know more about what you’ve tried with respect to testosterone and more about your health history. To give any advice I’d have to see you in my clinic. By all 3 methods I suspect you mean testosterone injections and topical, but am unsure what the third method is that you’re referring to. Many guys get poor results because they convert too much of their testosterone to estrogen so I suggest you ask your doctor if he has ever tested your estradiol levels. There other factors as well such as dosage and frequency.

To determine if you had primary or secondary hypogonadism your doctor should measure your luteinizing hormone (LH) level. With supervision by your doctor you could take a break from testosterone therapy and then test this level. Clomid works by increasing the LH signal to the testicles. If you LH level is already high when you’re off testosterone therapy it is unlikely clomid would be helpful. Also, clomid requires doctor supervision as there are some risks if not used properly (ie overstimulating the pituitary gland).

You need to discuss your concerns with your doctor and consider getting a second opinion from another doctor in your area.

Cheers,
Dr. Barry

Reply

Sophie October 11, 2013 at 4:24 pm

Brother is on testosterone therapy (injections every two weeks) because of secondary hypogonadism due to prolactinoma (for which he takes a low dose of cabergoline). He has developed bad acne on his back and shoulders and a bit on his chest, which he never had before. Doe this mean the dose of testosterone is too high? Suggestions for treating the acne–ritalin, acutane?
Thanks

Reply

Dr. Barry Wheeler October 12, 2013 at 12:16 am

Hi Sophie,

Testosterone injection can certainly promote acne outbreaks. It doesn’t necessarily mean his testosterone is too high but it does mean that he may be converting too much of his testosterone to dihydrotestosterone (DHT). He should discuss this with his doctor as there are other potential causes and contributing factors.

Ritalin® does not treat acne but is used for ADD, just fyi. Accutane® might help but isn’t treating the cause of the problem. Again, he should discuss all this with his doctor first.

If he came into my clinic I would likely reduce his testosterone dose and have him do it weekly instead of twice a month so he gets more stable levels. I also usually recommend men take fish oil, go tanning, eliminate fried foods, take vitamin D, and take a good multivitamin with zinc. I can’t recommend anything to your brother without seeing him in my clinic though. He needs to talk to his doctor about the acne. In some cases prescription medications for acne are necessary but always require doctor supervision. Any changes to his treatment should be discussed with his doctor first.

Best of luck,
Dr. Barry

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Eric October 10, 2013 at 6:49 pm

I am 28 years old and I have been using topical creams and none of them made my levels go up. I’m at 220 for my testosterone levels. Now I have been taking Test. cypionate injections 200MG/ML. I take 1 ML every 2 weeks for 4 months now. I am on my feet a lot but I am completely exhausted by 4pm. I do have mood swings and anxiety problems. About 2 months ago I went off of Effexor so I figure that was the cause of mood swings and depression. I am 235lbs and 6ft. 1 inch. I don’t always eat the best either. Do I need to get my testosterone increased, obviously diet would help what would be a good diet to follow?

Reply

Dr. Barry Wheeler October 12, 2013 at 12:08 am

Hi Eric,

Topical testosterone can be tricky to measure in some men. It seems to concentrate in the lymphatic system sometimes and can have poor absorption if applied in the same spot daily.

Make sure you are discussing your anxiety and mood swings with your doctor. It is important to discuss any medications with your doctor (ie effexor). Discontinuing medication on your own can be dangerous and have rebound effects.

In men who come to my clinic on twice monthly injections I usually find that by the second week their testosterone has become too low and their estrogen level has increased too much. This leads to a poor testosterone to estrogen ratio. A recent book called “The New Testosterone Treatment: How You and Your Doctor Can Fight Breast Cancer, Prostate Cancer, and Alzheimer’s” by Edward Friedman, PhD. In the book he discusses how too much estrogen can increase the risk of breast and prostate cancer. Testing for estrogen levels (estradiol) in the blood is easy to do and there are ways to decrease the conversion of testosterone to estrogen.

I suggest you ask your doctor about switching from 200mg every two weeks to 100mg once a week. Also tell him you stopped the effexor if you haven’t already.

In general, we recommend the paleo diet to our patients but everyone is different. I suggest you ask your doctor what diet he recommends for you. The conversion of testosterone to estrogen is generally made worse by eating to many carbs or sugar because insulin resistance somehow promotes this conversion.

There are certainly other things that may be going so I suggest you talk to your doctor about your symptoms and consider getting a second opinion.

Cheers,
Dr. Barry

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Shamron October 9, 2013 at 4:30 am

Dear sir
How will I be able to know if my testosterone level is low and this affects my fertility as we had been trying to have a child and my wife did not conceive ,she is diabetic and is on her tablets to control it, does this mean she has a problem or do I have a problem, I do not see and dysfunctions in me and looks like normal, please advice what can be done in this case, Thank you

Reply

Dr. Barry Wheeler October 11, 2013 at 11:58 pm

Hi Shamron,

It is impossible to advise you without doing some lab testing and seeing you in my clinic. I suggest you find a fertility doctor in your area. Your fertility is determined by your sperm count and sperm health (like mobility). The more swimmers and the faster they are the more likely you are to be successful. There are ways to stimulate both sperm production and testosterone production. All treatments should be supervised by a licensed physician.

I cannot comment on your wife’s fertility.

Best of luck,
Dr. Barry

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joy October 4, 2013 at 8:21 am

Hello sir,I am 23 years old.my lab test r as below
Serum testosterone-300.48
LH-3.29 mlu/ml
FSH-2.17 mlu/ml
Serum prolectin-4.65
My doctor suggested me to take testosterone depot-250mg/week for 1 yr,temoxifen-10mg daily..
I asked him about hcg but he told me its not needed…i dont want to decrease size of my testes..What should i do??i had my first day yesterday..
Should i go only for hcg??

Reply

Dr. Barry Wheeler October 5, 2013 at 5:39 pm

HI Joy,

In my experience, when LH is on the lower end and testosterone is low there may be too much estrogen. Tamoxifen blocks estrogen but I don’t see that you’ve had that checked. Estrogen feeds back to the brain and reduces LH. Also, I prefer clomid over tomoxifen.

Typically, I use HCG and anastrazole on my younger patients and get good results and our goal is always to fix the problem so after a year they don’t need it anymore. I rarely need to use testosterone injections on men under 25 years of age and if I do its because we’ve already tried many other treatments.

I suggest you talk to your doctor again and ask him why you have low testosterone in the first place and consider getting a second opinion.

Cheers,
Dr. Barry

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chester September 29, 2013 at 6:05 am

I have been own testosterone injection for 2 years went from 1cc month now 1cc week .wife wanting baby stopped taking testosterone injection body started hurting sleeping all time bones acking. Order clomid.hadnt had levels checked since beginning of summer.do I need to keep taking injection with clomid for pregnancey.does clomid reverse the effects of estrogen. Will clomid help with the down fall if stop taking injection for pregnancey.what would you suggest. What symtemes am I going to witness. Will I need viagra for sex.does clomid stop the body from production of estrogen .I need answers? ????????

Reply

Dr. Barry Wheeler October 5, 2013 at 5:20 pm

Hi Chester,

You need to find a doctor experienced in fertility treatments. Every patient is different. Doing proper lab testing to check testosterone, estrogen, and LH (luteinzing hormone) levels is important. Other lab tests for follicle stimulating hormone (FSH) are important as well. LH is the signal from the brain to the testicles that says to make more testosterone. FSH is the signal from the brain to the testicles to produce more sperm.

Research is showing that to produce a healthy amount of sperm LH and FSH can both be important. The mechanism of action for clomid is to increase the LH signal by blocking estrogen’s negative feedback in the brain (pituitary gland) by blocking estrogen receptors. Clomid is a selective estrogen receptor modulator because it only blocks certain estrogen receptors in the body. Without doctor supervision it can be dangerous and cause damage to the pituitary and other parts of the body by blocking too much.

There are other approaches as well that use medications that decrease the conversion of testosterone to estrogen rather than just blocking the receptors. Typically this is done in combination with human chorionic gonadotropin (HCG). HCG mimics the LH signal. Other medications that are identical to or mimic FSH can also be used.

I suggest you discuss all this with your doctor and find a doctor experienced in fertility treatments.

Best of luck,
Dr. Barry

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John September 25, 2013 at 6:00 am

Hello doctor

I am 19 years old and I have been having this problem ever since I can remember. While my height is completely normal for this part of the world (173 cm or 5.67 ft) I am extremely skinny. Being a boy this is a huge problem. Right now I am at 53 kg or around 116 pounds. My wrist for instance is thinner than that of a girl’s, and thus I am forced to wear long sleeved shirts during summer, which is awkward to say the least. Needless to say that I have tried pretty much everything to put on some weight. For instance I would eat 3 times everyday with meat at every table, usually ending up feeling sick given how much calories I eat. I have tried slacking it off hoping that by not being physically active I will gain some weight. I also went to the gym for 6 months a year ago, but if anything I was loosing weight. Three months ago I started going to the gym every 5 days lifting extremely heavy weights but this does little as well. I do not have a genetic disease and my testosterone, according to not one but many doctors over the years have been ok. Pretty much everything is normal with my blood samples if not very good as some doctors said. Do you have any idea what is it the troubles me? I will start law school within a week and I cant say that I am looking forward to meet my new colleagues with me having the physique of a 14-15 year old. Thanks

Reply

Dr. Barry Wheeler September 29, 2013 at 5:28 pm

Hi John,

Many doctors get confused about what lab tests to do and how to interpret them properly based on the symptoms that a patient is having. The test your doctors likely performed was your total testosterone level. The “normal” range for total testosterone is determined by taking the entire population, old and young, and arbitrarily making the top 2.5% high and the bottom 2.5% low.

How are reference ranges determined: http://labmed.ucsf.edu/sfghlab/test/ReferenceRanges.html

A more specific test for testosterone in a younger male would be free testosterone levels and to be as accurate as possible there is a test called free testosterone equilibrium dialysis that should be considered. This test is more expensive but may be the most useful. The free testosterone reference ranges are also age adjusted which will help your doctor interpret them more easily. In older patients these age adjusted ranges actually confuse their doctors.

There are certainly other possible causes of your inability to gain muscle and small frame. Growth hormone levels should be assessed whenever there is a concern about development in my opinion. Dihydrotestostorone (DHT) is about four times as potent as regular testosterone and some males may not convert testosterone to DHT properly so this is another test to discuss with your doctor. There is another factor that blood tests cannot measure and that is the receptors on the cells. Testosterone has to activate these receptors and if there are not enough receptors then “normal” levels of testosterone are inadequate.

I suggest you request a referral to a specialist (endocrinologist) as they are typically able to do growth hormone stimulation tests to better identify growth hormone deficiencies. We do all the above mentioned tests at our clinic as well.

Cheers,
Dr. Barry

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JB September 24, 2013 at 10:34 pm

Hello, I am 1.5 ML Depo Testost every three weeks and have been doing this for about a year and have not had any ill side effects until today. As the nurse was doing the injection in my back side it was the most painful injection I have ever had. Almost immediately I developed a strange tickle in my chest and started coughing. This last for a approx. 5 minute I also started to sweat and thought I was going to pass out. The injection site also bleed abnormally and I soaked at least 5 bandages. It has been about two hours since the injection and I still have a tickle in my chest if I breathe deeply and start coughing. However, It is much better than it was. What could have happened?

Reply

Dr. Barry Wheeler September 29, 2013 at 5:10 pm

Hi JB,

I have heard of this happening to patients but have never seen it myself and I’ve done thousands of testosterone injections on patients. You need to discuss this with your doctor but I’ll explain my understanding of why a testosterone shot can cause a coughing episode.

Testosterone is supposed to be injected in the muscle. There are a number of blood vessels in and around muscles. When a person gets a testosterone injection the need is inserted into the muscle but the tip of the needle may be in a blood vessel. That is why it is important to pull back on the plunger to look for any blood coming into the syringe. If blood comes into the syringe then you’re in a blood vessel and the needle needs to be adjusted so that the testosterone injection goes into the muscle and not the blood vessel.

If some testosterone is injected into a blood vessel it will go in the vascular system and through the heart and lungs. My understanding is that this is what causes the coughing. This typically resolves on its own with some time based on what I have heard from others. It is important to tell your doctor and keep an eye on things. I have personally been doing testosterone injections on myself for years and have never had this happen.

You can watch a video here: How To Inject Testosterone Intra-Muscularly

Cheers,
Dr. Barry

Reply

Anthony September 24, 2013 at 12:20 am

Doctor,

Currently, I am a 22 year old, 6’3″, 170-lb male. Since January, I have pretty much changed my lifestyle by eating healthier and going to the gym 4-5 times a week (weight lifting). In the last few months, my diagnosed OCD has kicked in and now I see myself obsessing about what I’m eating and when. I do eat a lot of food, but I balance my carbs/protein/fat (40/40/20) daily and do not eat ANY junk foods. I have lost 12 pounds since January.

On a more serious note, I have noticed my libido has decreased since June as well as my available energy. I used to be so happy and stress free, but now I am more irritable and sense a decrease in energy. I still manage to go to the gym 4-5 times a week, so I guess the lack of energy isnt too much.

Anyway, I have had my T levels checked and my T levels are 18 (ng/ml) Total. This number has surprised my doctor and he is unaware what could be causing this. My thyroid numbers are fine, and everything else he has checked has been okay. This is SUPER low, and 2 tests confirmed the number. I was wondering if you have seen this before in a 22 year old before and what could be causing this.

Thank you

Reply

Dr. Barry Wheeler September 29, 2013 at 5:00 pm

Hi Anthony,

I hope you’re talking about your concerns about being OCD with your primary care doctor. If you haven’t discussed it with him please do so. Oxytocin is a hormone produced in the pituitary and deficiencies of oxytocin have been linked to increased risk of being obsessive compulsive. I can’t say if this is a factor for you or not but interestingly oxytocin is made in the same area of the brain the signal, luteinizing hormone, is produced.1 Luteinizing hormone (LD) is the signal from the brain to the testicles. LH tells the testicles to produce more testosterone. Thus, you should ask your doctor to check your LH levels.

An MRI can take a picture of the area of the brain where important hormone production signals like LH are produced. Ask your doctor for a referral for imaging to help rule out any problems in this area.

Here is some discussion about testosterone ranges on WebMD: http://men.webmd.com/testosterone-15738?page=2

I think there is a problem with your units. You wrote “18 (ng/mL) Total” testosterone which is 1800 ng/dL and the normal range most labs use is about 300 – 1200 ng/dL. If you intended to write ng/dL then 18 would be considered quite low. I suggets you double check your units dL or mL with your doctor. I actually had a patient one time who’s doctor wrote female by accident on the lab requisition and then when the levels came back high on the female range the doctor wanted to lower his levels.

Assuming your levels are 18 ng/dL and the normal range is 200 – 1000 ng/dL there are a number of potential causes. If testosterone converts too much to estrogen it can feed back to the brain and shut down testosterone production. This may be the body’s way of preventing femininization. Thus, I suggest you ask your doctor to check your estrogen (estradiol) levels in your blood. Too much estrogen and not enough testosterone can certainly cause irritability.

You may want to get a second opinion from another doctor in your area if you feel your concerns are not being addressed fully.

Best of luck,
Dr. Barry

  1. Oxytocin and the anterior pituitary gland. Samson WK, Schell DA. Adv Exp Med Biol. 1995;395:355-64.

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Charles September 22, 2013 at 2:58 pm

I hv taken sustanon 250mg injection up to 6 or 7 at the interval of every 3 weeks! But it seems as if the injection is not working for me! My sexual life is poor, quick ejaculation, low sperm count, weak erection and all worth not. And, if i may ask, does varicocele of the testis inhibits the production of natural testosterone? Pls, i need an answer because my Dr. is demanding for a varicocele surgery. Although, i was earlier diagonised to hv low testosterone before embarking on sustanon injection. I hv a boy of almost 13 yrs and since them we hv not gotten another one! Pls, i need your medical advice on my fertility issue because am eager to father more children.

Reply

Dr. Barry Wheeler September 26, 2013 at 1:05 am

Hi Charles,

In response to your question about vericocele and low testosterone:

“Accumulating evidence suggests that varicocele, long associated with male infertility, is also a risk factor for low testosterone levels. The exact pathophysiology of the negative effects of varicocele on testicular function is not well understood, but theories include venous stasis, increased testicular temperature, oxidative stress, and resulting toxic environment. While prior studies report conflicting effects of non-microsurgical varicocelectomy on testosterone level, recent literature demonstrates that microsurgical varicocelectomy improves testosterone levels in men with varicocele and low testosterone preoperatively.1

Has anyone checked your estrogen levels? Remember, testosterone can convert to estrogen and some men convert too much testosterone to estrogen and this will reduce benefits and increase risks of side effects. I suggest you talk to your doctor about your symptoms and ask to have your estrogen (estradiol) levels checked.

In terms of your sperm count, this could be due to the vericocele but testosterone injections can also reduce sperm counts. We typically use HCG to stimulate more sperm production and I suggest you talk to your doctor about this as well.

There are other ways to stimulate more sperm production including clomid. Perhaps you should get a second opinion from a fertility doctor in your area. I typically advise my patients to use surgery as a last resort after they have tried all other options.

Best of luck,
Dr. Barry

  1. Varicocele and hypogonadism. Dabaja A, Wosnitzer M, Goldstein M. Curr Urol Rep. 2013 Aug;14(4):309-14. doi: 10.1007/s11934-013-0339-4.

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Jack September 21, 2013 at 9:49 pm

Hi, I am 28 years old(M).
My test results are as follows:
DHT – 468
Testosterone – 523
TSH – 1.530

After a month, I went again to get myself tested.
Testosterone – 683
Estradiol – 33

This time, I got myself tested for estrogen too.

My issue is, I have a good mustache and beard on the chin but not on the cheeks and a frail line along my jawline. I need more facial hair.
My doctor suggested two options:
1) Testosterone injections
2) DHT cream

Please advice me how to proceed doctor.

Thank you.

Reply

Dr. Barry Wheeler September 26, 2013 at 12:17 am

Hi Jack,

Sorry for the delay in responding to your question. I have been in Canada taking some continuing medical education.

I suggest you ask your doctor to check your free testosterone levels. Some DHT tests are inaccurate so ask your doctor what test he did for your DHT. Also, you should have your LH levels checked as this is the signal from the brain to the testicles and at your age there are ways to increase this signal. If the signal is low or high your doctor will also want to look for the cause.

Some guys have a limit to how much beard they can grow due to genetics. In my experience, increasing testosterone will increase DHT as long as estrogen levels are prevented from increasing too much and you are already on the higher end of the estrogen range I suspect so be sure to talk to your doctor about this.

You must not be in the United States as DHT is not allowed for use here on patients. There are some potential risks such as acne, hair loss, and prostate enlargement. I know they do use DHT in Europe. One nice thing about DHT is that is doesn’t convert to estrogen at all.

Without having you come into my clinic to do some labs and take a look at you I am unable to advise you. It sounds like you are doing a lot of testing on your own. I suggest you find a doctor with experience who can supervise your treatment and look for the cause of your concerns.

Cheers,
Dr. Barry

Reply

Joe September 21, 2013 at 4:53 am

I actually grew in height 2 inches after I started T replacement, has this happened before?

Reply

Dr. Barry Wheeler September 26, 2013 at 12:08 am

Joe,

That would be quite unusual. Perhaps you are just standing taller? Testosterone does support growth hormone production and the guys that get the “hunch” on their upper back often times have low testosterone and low growth hormone (see “The Atlas of Endocrinology for Hormone Therapy” by Thierry Hertoghe, MD).

I suggest you ask your doctor about it as it is quite unusual as growth plates close after puberty.

Cheers,
Dr. Barry

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MJ September 19, 2013 at 10:29 pm

I have been using Androgel 1% gel, 5 g/daily dosage, as prescribed by my primary care physician for a couple of years. At varying times, over the course of treatment, I have complained about edema and some associated pain in my feet, ankles and lower legs. We’ve discussed the edema and looked into excessive sodium intake, NSAID usage and even tried the infamous prescription water pills. The possibility of an Androgel side effect has never come up. I’m now confident that the swelling is related to the TRT, since it stops by the next day when discontinuing the Androgel. Is it possible that I might be able to control this problem merely by reducing the daily dosage? I would do this in concert with my primary if you think there is a potential benefit.

Reply

Dr. Barry Wheeler September 26, 2013 at 12:05 am

Hi MJ,

Has he ever checked your estrogen levels? I suggest you ask your doctor to check your estradiol levels and refer him to this research article and vascular insufficiency:

“Our data support the hypothesis that the steroid environment, in particular estradiol level, can influence venous vascular tone (via VEGF or NO), thus affecting venous leakage dysfunction.1

  1. Increased estradiol levels in venous occlusive disorder: a possible functional mechanism of venous leakage. Mancini A, Milardi D, Bianchi A, Summaria V, De Marinis L. Int J Impot Res. 2005 May-Jun;17(3):239-42.

The above article is mainly about erectile dysfunction but vascular insufficiency can certainly occur in other parts of the body. There are other possible causes as well, such as low thyroid so it is important to ask for a referral to cardiologist if your doctor is unable to find the cause of your edema (ankle swelling).

Also, are you rotating the locations where you are applying the topical testosterone? Often time I have patients come in and they’ve been using the testosterone for years and their levels were good at first but then when we check them they are low and their estrogen is quite high. This, in my experience, is often due to the hormone building up in the skin and after a while it just stops absorbing. Rotating the locations where they’re applying the topical testosterone cream often helps address this.

Please ask your doctor about reducing your dose as well as this may help but you should also ask to get your levels checked (testosterone AND estrogen).

There are other forms of topical testosterone that may work better for you as well that you can get from compounding pharmacies with a prescription from your doctor. My favorite is testosterone in a PLO gel or cream.

Best of luck,
Dr. Barry

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MJ October 2, 2013 at 11:57 am

Thanks for the input, Dr. Barry. I’ll print this out and bring it to my Primary’s attention next visit. I’ll report back to you with results, but it probably will be a few weeks.

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Jodie September 19, 2013 at 6:34 pm

Dr. Wheeler,

My boyfriend is 43 and type 2 diabetic. When we first started dating, he could not get an erection at all, but was able to ejaculate with oral stimulation. Over the course of the last six months, we have tried several things. An over the counter testosterone boosters/supplements, along with L-arginine. Other various supplements that promise to increase libido and sexual performance. Some increase in erection, but not significant. Viagra and Cealis – increased the erection…..so close but not hard enough for stimulation.

He is a very gentle, very romantic and a very sensitive man. I can tell his body mass is older looking than his age, specifically his chest area and arms – which are less muscular and evidence of increased breast tissue.

This week he had his testosterone levels checked and began his first testostrerone injection today, which he will repeat every two weeks. He is uncertain as the dosage of the injection or the exact testosterone reading, although they told him he was on the very low end of low.

My question is – what is the likelihood that his “low end of low” testoserone levels could be causing the erectile dsyfunction? Should we try using the Cealis too now that he is taking the testosterone injections and if not, how long should we wait to see if the injections fix the issue before adding the Cealis again?

Additionally, I have read that low testosterone can have adverse effects on insulin resistance and therefore be a contributing factor to the onset of type 2 diabetes. If this is true, can the testosterone injections possibly reverse the diabetes?

Reply

Dr. Barry Wheeler September 25, 2013 at 11:26 pm

Hi Jodie,

Men with type 2 diabetes often convert too much of their testosterone to estrogen. This can become a downward spiral for some men. Blood sugar regulation problems increase the conversion of testosterone to estrogen and testosterone is necessary to maintain good blood sugar regulation. As the testosterone decreases the blood sugar regulation (ie insulin resistance) gets worse and this causes the body to convert even more testosterone to estrogen. There is a picture of this process further up on this page showing the aromatase enzyme converting testosterone to estrogen.

I have found in many of my patients, and this is what the research shows as well, is that l-arginine, Viagra®, Levitra®, and Cialis® are much less effective or not effective at all when testosterone is too low. Many of the testosterone boosters can just make the problem worse because if you boost testosterone without decreasing estrogen you may just end up with more estrogen and not much more testosterone.

Symptoms of being overly sensitive (ie crying during movies) and increased breast tissue are often related to too much estrogen in men. Too much estrogen in men can also increase the risk of a venous leak in the penis. A venous leak is basically like a balloon that you fill with air, or in this case a penis you fill with blood, but it just can’t maintain the pressure and the blood leaks back out causing the penis to become soft. I have had good results treating erectile dysfunction using hormone balancing but I always monitor both testosterone and estrogen levels and balance both levels simultaneously.

One of the biggest risks of testosterone therapy is too much conversion of testosterone to estrogen and I often see this happen in patients with type 2 diabetes. many doctors with less experience treating low testosterone never even think to do lab tests to check estrogen (estradiol) levels. This can often be one of the barriers to getting benefits from testosterone therapy and can certainly increase risks if not being monitored properly.

Many patients with type 2 diabetes and low testosterone when properly treated with testosterone therapy will need to decrease their diabetes medications (ie metformin) and this should be done under supervision of their doctor.

Cheers,
Dr. Barry

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Pete September 16, 2013 at 9:34 pm

Dr. Barry, I’ve had my testosteron tested twice, first was collected at 10:46 am and results were 228 L ng/dl, the 2nd was collected at 7:58 am and the results were 530 L ng/dl. My personal Dr said your levels are higher in the morning, but decrease during the day which are shown in my tests. Now I’m a fireman so my sleep patterns change due to work, and also have mild sleep apnea, but I’m still tired durning the day. Still on the fense about starting testosteron therapy and the side effects. Do you think my levels are low to start taking testosteron?
Thanks,
Pete

Reply

Dr. Barry Wheeler September 25, 2013 at 11:15 pm

Hi Pete,

Correct, testosterone levels are higher in the morning and then decline throughout the day. If you came into my clinic I would also want to check your free testoterone level. Often times our total testosterone level looks “normal” but the bio-available or “free” portion is too low. This is something you could ask your doctor to check for you. I generally try to match a patient’s symptoms to their testosterone levels.

Some doctors think that testosterone therapy can make sleep apnea worse. If I am concerned about this with patients at my clinic I generally ask them to get a sleep study so we can have a better idea of what’s going on. I suggest you talk to your doctor about your sleep apnea as this may be part of what is causing your low energy.

As a fireman, you need to be in top performance so looking for the cause of your problem and finding effective and doable solutions is important. The more active someone is the more testosterone they typically need. Every patient is different so without seeing you in my clinic, doing some exams, and some more lab tests its impossible to say if testosterone therapy is right for you or not.

Something to keep in mind is that by night time your testosterone levels are even lower. Consider asking your doctor this, “is it okay to have low normal testosterone in the morning and low testosterone in the evening?” Sometimes treating sleep apnea can improve testosterone levels and I have had some patients with sleep apnea who still have low testosterone after the apnea has been treated.

Best of luck,
Dr. Barry

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Greg September 16, 2013 at 7:52 pm

Hi doctor,

I have a few questions. First, my info: 43 years old, 50 ng/dl (now 800), Axiron 1x/day.

1. I’ve had three bouts of severe enlarged prostate in the four months I’ve been on TRT. My primary and urologist both said to keep using the Axrion anyway. Sound right?

2. I had severe hot flashes before TRT. They seem to be fewer now, but I still sweat a lot when others are cold. Do low T or TRT cause hot flashes?

3. I grew a spotty beard (patches of hair) that grew just 1/2 inch in a month. It’s was spotty and not like others. I seem to shave a lot now (twice a day) since TRT. I also had a normal penis up until puberty, but it grew very little during puberty. I measure a girthy but short 4.5 inches. Any chance for growth there.

4. It seems I’m gaining hard muscle without working out. Is that possible?

5. Finally, I’m getting lots of night cramps all over my body. Could this be a side effect?

Reply

Dr. Barry Wheeler September 16, 2013 at 8:36 pm

Hi Greg,

1. Its possible you have a prostate infection or are converting too much of your testosterone to estrogen. Both of these, in my experience, can cause enlarged prostates. I suggest you discuss this with your urologist again. Also, topical gel testosterone often converts too much to dihydrotestosterone (DHT) and this can sometimes increase prostate size. Many of my patients have taken saw palmetto with good success to reduce estrogen and DHT in the prostate and reduce its size. Saw palmetto is used in Europe by doctors for prostate health.

2. Most guys who get hot flashes before starting testosterone have low estrogen levels. Low estrogen can cause hot flashes because estrogen helps control our internal thermostats in the brain. If you are converting too much of your testosterone to estrogen you may sweat more. Many doctors never think to check a man’s estrogen level but I think it is very important.

3. Its tough to make the penis longer but you can work to prevent it from shrinking. Make sure you ask about checking your estrogen levels. Too much estrogen may shrink the penis. Also, use it or lose it. Keeping active sexually can help maintain penis function. Ask your doctor about a penis pump to improve girth. Penis pumps should only be used under a doctor’s supervision.

4. Testosterone supports muscle health. Most guys with low testosterone get a 15% increase in muscle mass when they receive testosterone replacement therapy.

5. Too much estrogen can increase the risk of peripheral artery disease (PAD) and men and lead to cramping. There are other possible causes so be sure to discuss all your concerns with your doctor.

“This cross-sectional study shows for the first time that low serum testosterone and high serum estradiol levels associate with lower extremity PAD in elderly men. Future prospective and interventional studies are needed to establish possible causal relationships between sex steroids and the development of lower extremity PAD in men.1

  1. Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men. The MrOS Study in Sweden. Tivesten A, Mellström D, Jutberger H, Fagerberg B, Lernfelt B, Orwoll E, Karlsson MK, Ljunggren O, Ohlsson C. J Am Coll Cardiol. 2007 Sep 11;50(11):1070-6. Epub 2007 Aug 24.

Cheers,
Dr. Barry

Reply

mehdi September 16, 2013 at 2:40 am

Hi Doctor

im really desesperate as im 33 years suffering from low testosterone since 2011 but to get it prescribed here in canada is rare i think
my level is 9nmol and doctor said normal
but i really feel low testo no libido no sex with my wife or once every 3 weeks, breast enlargement ,fat ,loss of muscles even if i workout
any help doctor ?

Reply

Dr. Barry Wheeler September 16, 2013 at 8:24 pm

Hi Mehdi,

Using this tool I converted your testosterone from nmol/l to ng/dL and got:

  • 9 nmol/L = 259.366 ng/dL

I suggest you find another doctor and/or ask to have your levels rechecked. I suspect the range your doctor is using is about 9-25 nmol/l. As a doctor experienced in testosterone therapy I always match symptoms to testosterone levels and if things don’t connect I usually repeat the test on another day and check for other possible causes such as low growth hormone, low thyroid, and high estrogen. If you’re level had come back one point lower at 8 nmol/l he would likely have said you were low.

“The reliability of interpreting results also depends on the reliability of the reference range provided by the laboratory. Guidelines on the production of reference ranges have been published by the International Federation of Clinical Chemistry.1

  1. Measurement of testosterone in the diagnosis of hypogonadism in the ageing male. Wheeler MJ, Barnes SC. Clin Endocrinol (Oxf). 2008 Oct;69(4):515-525. doi: 10.1111/j.1365-2265.2008.03325.x.

Best of luck,
Dr. Barry

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Mark September 15, 2013 at 3:25 pm

Hi!

I am 23 years old man (63kg, 169cm) and I just got my testosterone results from a lab:

Free Testo 196 pmol/L (range 200-550)
Total Testo 12 nmol/L (range 10-38)

The reason I started to check my levels was my symptoms: sleep problems (I have restless sleep, waking up every hour or two) “brain fog”, mild gynecomastia and fatigue. And these problems I have had as long as I can remember. I think I have have pretty OK libido, but I really need to like a girl a lot to be able to have sex. Otherwise I don’t feel for sex. That’s why I never have one night stands. And relatively small amount of alcohol makes me so fatigued that I can’t have erection and my libido is really low. During the sleep I notice usually multiple erections. I also have pretty good muscles and I got them almost too easily without going to gym.

I’m worried to start any testosterone treatment because of the side effects. I have also read that lack of good quality sleep can also alter testosterone levels so I don’t really know is low testosterone just result of a bad quality sleep.

Do you think that my testosterone levels could be the root of the problem even though I have pretty OK libido, multiple erections during the night and good muscles (but fat tissue on my chest, gynecomastia)? I’m missing the most obvious symptoms I think.

Reply

Dr. Barry Wheeler September 16, 2013 at 8:04 pm

Hi Mark,

There are a number of other lab tests that you need to talk to your doctor about. The most important being luteinizing hormone (LH) and estrogen (estradiol). These are both blood tests. You may not even need testosterone replacement therapy because at your age it is often effective to use medications like HCG to stimulate testosterone production. Sometimes just reducing the conversion of testosterone to estrogen can be helpful as well. Most commonly in guys your age I do both.

Gynecomastia is caused by too much estrogen and you haven’t even had your estrogen levels checked yet.

In terms of your sleep, you should ask your doctor about getting a sleep study. Growth hormone is produced at night so getting a good night’s sleep is very important. I have used a number of approaches to improve sleep in patients. Many patients have blood sugar problems (low or high) and this can certainly effect sleep. Also, most guys, in my experience, who convert too much testosterone to estrogen have blood sugar regulation problems. Converting testosterone to estrogen is what causes your breasts to get bigger (gynecomastia).

Please discuss your concerns with your doctor.

Best of luck,
Dr. Barry

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Angie September 13, 2013 at 7:32 pm

Hi Dr. Barry,

My 38 yr old husband has been on 100mg weekly injections of testosterone for the past 3 months due to low T and I have noticed a change in his temperament. He is definitely more quick to anger with me and our 2 young sons. He has always had a “strong” personality however this is a bit much. He doesn’t seem to notice the temper change and says the only side effects he can see are the increased energy and decreased ED problems. Is the temper issue normal? Something that will get better with time? Thanks so much for the info!! Angie

Reply

Dr. Barry Wheeler September 13, 2013 at 11:30 pm

Hi Angie,

When I have this situation with my male patients I usually check their estrogen levels because testosterone converts to estrogen. In my experience, too much estrogen can cause irritability in men. Testosterone can also reduce empathy if used in excess in some men. If he was my patient I would also check his testosterone level and consider reducing his dose or dividing his dose into two shots per week so there is less of a peak after each injection.

I suggest you ask to go with him to see his doctor to discuss the issue or call his doctor and ask what you should do. If he is physically abusive in any way you need to contact the police, of course.

Testosterone can definitely make guys more aggressive and sometimes I need to reduce a patient’s dose if it is causing problems. Most commonly we can address this by reducing and dividing up his doses and using medications to reduce the conversion to estrogen.

Dr. Barry

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Archit September 10, 2013 at 12:53 pm

Hi Doctor,
I m a 27 year old single man
History how i developed ED
“When i was 16 year old i used to masturbate a lot 2 to 3 times a day and i continued the same for 4 years so when i was 20 one day i felt my penis not getting erected even when i felt excited and then i went into depression some how i controlled my self moved on but the problem of low libido, quick ejaculation ,high hanging testicles that to small size persisted ” also i am fit used to gym and go for 3 km running infrequently and have a athletic frame no too thin and not too fatty
Currentweight- 77kg, height 5’8 so go to gym thrice per week and do cardio in between gym off’s
When i became 27 year old my family pressurized me to get married and search on net for cure and hence went to a doctor for treatment
Six months back my blood test showed
free Tlevel 11.74 pg/ml
total Tlevel 371.80 ng/dl
Sperm test – Sperms are good(my night fall period is only once in a month)
Doctor First Priscription for 1 month
VAIO NEURON,Gold CalD3, and Fludac 20 mg but nothing much happened
2nd month
Andriol 2 tablets thrice a day,VAIO NEURON,Gold CalD3, and Fludac 20 mg
I felt some improvement and i started running 3 km with ease and started having some morning(out of 30 day – 20 day morning erecsion) erecsion’s.
3rd month
he reduced the androl tablets
Andriol 2 tablets twice a day,VAIO NEURON,Gold CalD3, and Fludac 20 mg
results : all things started falling back :- Harder to run 3 km less than half day of morning erecsion than earlier.
4th month
got my t levels checked
free t level – 14.3 pg/ml
S. tlevel (total)- 493 ng/ml
Prescription changed
Sustanon- 250 one in 10 days same continued for 2 months i.e 4 and 5 month
4 month i feel average effects having morning erections, but it helped me dramatically with my gym now my body is growing and shaping faster than before.
5 month same dosage i started running in evening most stress on sprints and 1.5 km normal running. 5 month i felt decrease in effects less morning erections than before, increased in body hair..
6 month my doctor reduced the injection:-
Sustanon 100mg per week for a month this cycle has just started but feeling not much difference morning erection almost nil,

I tired to give u clear picture about my case doubts.
1. I don’t know where i m heading some times its good some times its not.
2.As i already mentioned my testicles size is small it has not reduced after treatment but also has not gained much. is that a worry.
3.I don’t know i will be cured or not or it may lead to a disaster marriage.
Please suggest

Reply

Dr. Barry Wheeler September 13, 2013 at 10:52 pm

Androl is an anabolic steroid that is taken orally and can cause severe liver problems: WebMD: Androl-50

Any oral testosterone has to go through the liver first and that is why it is why we only recommend topical testosterone or testosterone injections. Testosterone taken as an injection or topically will have its effects on the body before being processed by the liver. Anything you put in your mouth has to be processed by your liver before effecting the rest of your body.

I’m not a huge fan of sustanon as it has very long acting testosterone in it (testosterone undecanoate). Most guys, in my experience, feel good at first and then notice a declining benefit. When this happens, at my clinic, we typically switch to daily testosterone propionate or daily topical testosterone. If you came into my clinic I would try to determine why why your testosterone was low in the first place and check the signal from your brain to your testicles (LH). If you’re concerned about fertility I would also consider checking your FSH level, which signals the testicles to produce sperm.

I’m excited you’re seeing benefits from testosterone injections (sustanon). Your testosterone levels are on the lower end of the range for your range and you may be converting too much of your testosterone to estrogen. You may also want to ask your doctor about taking HCG to maintain your natural production of testosterone and improve your fertility.

Without seeing you in the clinic I can’t say much more. Best of luck. I hope the above information helps you have a more informed discussion with your doctor.

Cheers,
Dr. Barry

Reply

Greg September 5, 2013 at 10:10 pm

Is DIM (Diindolylmethane) safe to take with Testosterone cypionate? Also, I just took my first injection in my left thigh. I had slight pain that started around my left knee that has moved to my left ankle? Is this a normal side effect?

Reply

Dr. Barry Wheeler September 13, 2013 at 10:41 pm

Hi Greg,

You should tell your doctor right away about any side effects that may be occurring. You may be experiencing irritation from the testosterone injection but you should discuss this with your doctor immediately. This is a rare side effect in my opinion but you may be getting irritation from one of the compenonents of your testosterone injection (preservatives, base oil, etc.). Infection from injections is rare but you should have your doctor take a look to be on the safe side.

Some guys get some water retention of swelling from the cypionate itself. Every patient is different and that’s why doctor supervision is so important.

DIM assists with the breakdown of estrogen and can be helpful but you should still ask your doctor to monitor your estrogen levels. Only your doctor can decide if DIM is safe for you or not. In my opinion it is more important in women. In men, we just want to make sure we’re not producing too much estrogen and eating broccoli, which contains substances similar to DIM, is a good idea. Eat cooked broccoli as raw broccoli is difficult to digest.

Cheers,
Dr. Barry

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Mark September 5, 2013 at 11:43 am

Hi Doc, I am almost 18 and will be going to my doctor shortly. I believe I have low testosterone as I have very little body hair and a small build, usually not seen as a problem but my dad is big with large hands body hair and a full beard, i am the opposite. I am quite small down there as well. I also have what some would call a muffin top after losing 10 kgs to a normal weight, but the stomach fat was still there so I lost another 8 kgs but still there. My brother is 15 and already quite bigger than me and almost as big as my father. What do you thinks wrong doc ?

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Dr. Barry Wheeler September 13, 2013 at 10:34 pm

Hi Mark,

It sounds like you may be converting too much testosterone to estrogen but without lab testing it is impossible to know. There are also genetic conditions that may be considered but again you need to discuss this with your doctor. A common cause is testicular trauma or an undescended testicle. If these are missed by doctors at your yearly exam they can effect you while you’re developing. Increased body fat is often a sign of too much conversion of testosterone to estrogen in my experience.

I suggest you discuss checking your estrogen (estradiol) level with your doctor. Many doctors are unaware of this problem and if you come back in the “normal” range of testosterone they may just assume you’re normal. That’s the best I can do without seeing you in my clinic.

Cheers,
Dr. Barry

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Wayne September 2, 2013 at 5:47 pm

Ever since I turned 60 (6 years ago) I have felt my energy, strength and motivation diminish. I competed in college gymnastics and have been athletic all my life. I used to do weights 3 days a week and the elliptical 6 days. I used to feel great after getting off the elliptical after 40 minutes (6 yrs ago). On 6/6/13 after dropping my elliptical workout to 4 days at 20 minutes per day I had to be taken to the ER after 14 minutes 36 seconds with a HR of 136. The symptoms were the same as adrenal failure. Things just started shutting down. None of the docs found anything other than a low pulse. It was 44 in the ER. Have done 2 stress tests and the only thing we can come up with is dehydration and stress. After a month of proper hydration and several antistress herbs each day I at least am able to do aerobics but I keep injuring muscles during weight workouts and still get very tired after workouts. Last night I ate too much Carrot cake loaded with sugar and my 20 minute cardio was absolutely the worst. My sex life has not changed much since I was 20. I live with a woman who has just entered menopause and we make love 1 or 2 times a week. In between I masturbate 4 or 5 times. I have no problem with my sex drive or equipment. Could I still have low T? I am supposed to get a scrip from my doc to get tested soon. Very frustrated.

Reply

Dr. Barry Wheeler September 5, 2013 at 4:12 pm

Hi Wayne,

My first thought is that sounds like a blood sugar crash and you’re right that adrenal problems could cause that problem and response. Cortisol rises during exercise to maintain our blood sugar by signalling the breakdown of glycogen (glucose storage) in the liver. When you work out you use up your blood sugar and if it drops too low your body tries to produce more cortisol and if this doesn’t work it produces adrenalin and adrenalin can certainly increase the pulse. There are other conditions such as cortisol deficiency and adrenal deficiency that are more in the “grey area” and often overlooked by doctor because they see most health problems are very black and white. Saliva testing is one way to measure cortisol that you might want to have your doctor look into for you.

There is also a test called the insulin glucose tolerance test which measure your response to sugar over a period of time. Some men will have a spike in blood sugar and then respond too strongly by producing too much insulin and this leads to a blood sugar crash. This can help diagnose insulin resistance more effectively.

Some men can have low testosterone and still have a good libido. Every man will experience low testosterone in his own way. Connecting the dots, low testosterone can actually cause insulin resistance. I have a number of patients whoa re pre-diabetes and with testosterone therapy done correctly their blood sugar regulation improves and they sometimes no longer need their medications such as metformin. If you haven’t had your testosterone levels checked then I suggest you ask your doctor. With any luck he’ll help you get it checked. Some doctors who are less experienced may think that only guys with ED and low libido have low testosterone. This is a myth.

The nice thing about low testosterone treatment, when done correctly, is that it helps improve blood sugar regulation and with a healthy diet and exercise can help improve adrenal function, in my experience.

As always, these are just some thoughts for you to bring up with your doctor. Any low testosterone treatment should be supervised by a licensed physician.

Best of luck,
Dr. Barry

PS. Congrats on staying active with your partner! The research shows the more sex you have the longer you’ll live so keep up the good work. My favorite prescription to write is “More Sex!”

Reply

Wayne September 22, 2013 at 11:37 am

Hi Dr. Barry, Thank you for your reply. It turns out that my T level is 307. My doc also told me during our meeting that if I stopped taking injections after a year or so my testes would not resume making any T on their own. When I left his office I went to my favorite health food store and talked to my guy there about alternatives. 2 1/2 months ago I started taking NewChapter Prostate 5LX and it took my PSA from 4.0 to 2.7 to 1.7. Nature’s Plus Ultra T Male was recommended to help with my fatigue. Can you comment on the discontinuance of injections after a few years and do you know of any natural oral products that may help me before I try injections? I still cannot build muscle mass and am tired after 8 or 9 hours of sleep. Thanks, Wayne

Reply

Dr. Barry Wheeler September 26, 2013 at 12:58 am

Hi Wayne,

I suspect that in a year your testosterone will be lower even if you don’t take any testosterone. In my experience, most men resume making about the same amount of testosterone they did before starting testosterone injections after they stop and if there is aa concern we typically use medications that stimulate more natural testosterone production and verify the results with lab testing.

We do take a more holistic approach and we use conservative doses of testosterone. Every patient is different. There are ways to stimulate natural testosterone production, but just like with herbal ad natural testosterone boosters, these approaches in and of themselves become less and less effective as we get older and I have found that most guys need the real thing to get the best results, testosterone.

Whatever you do, whether natural supplements or testosterone injections, its important to monitor your treatment with lab testing (estrogen, testosterone, psa, etc) and have it supervised by an experienced doctor. Read my article to learn more about our approach: testosterone therapy.

The supplement you’re taking for your prostate has Saw Palmetto in it and I;ve had good results reducing prostate sizes and decreasing PSAs in my patients with it. It is always important to tell your doctor about what you’re doing and about a high PSA as well so they can help monitor your treatment, which I assume is what you’re doing. Herbal testosterone boosters are often times, in my medical opinion, a waste of money and they become less effective as we get older. I have used a number of herbal supplements on my patients and sometimes they make the problem worse. That’s why its important to have a doctor’s supervision and get proper lab testing. Without seeing you in my clinic I can’t say what supplement may be helpful.

There are other hormones that you may want to have checked, such as thyroid, and be sure that your doctor is checking for diabetes.

Here is a quote from a study done in 2010 that I like:

“Testosterone replacement in intermediate-frail and frail elderly men is associated with preservation of muscle thickness. The results suggest that testosterone mitigates sarcopenia by improving muscle tissue to maintain a state of normality in aging men.1

  1. Effects of testosterone on skeletal muscle architecture in intermediate-frail and frail elderly men. Atkinson RA, Srinivas-Shankar U, Roberts SA, Connolly MJ, Adams JE, Oldham JA, Wu FC, Seynnes OR, Stewart CE, Maganaris CN, Narici MV. J Gerontol A Biol Sci Med Sci. 2010 Nov;65(11):1215-9. doi: 10.1093/gerona/glq118. Epub 2010 Jul 2.

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Keith September 2, 2013 at 6:21 am

Hi Dr. Barry,

I have been on testosterone therapy for 10 months. I experienced almost all of the symptoms of low T last year: fatigue, depression, low libido, poor erections, and inability to climax with my partner. I am 36 and had a level of 234 prior to treatment. I am now in the 500 range and have been receiving injections since January (I started with the gel, but got very little response for such a high cost). I take one CC of 250 mg Testosterone Cypionate bi-weekly.

I feel great, but have noticed that although my erections seem to last longer, they do not get as hard as they did before therapy. Does TRT reduce blood flow to the penis since the testes typically shrink? Mine are maybe 3-5% smaller than before.

Also, I’ve noticed my normally thick hair has thinned noticeably. Can this be halted? If so, with what? I do not want to try propecia as I have read that medications such as these cause ED. Will my hair continue to thin or will this process stop? I would be okay with this problem if I knew that it had a finite conclusion. Thank you for your info and this web stream. It has been very informative.

Reply

Dr. Barry Wheeler September 5, 2013 at 3:58 pm

Hi Keith,

I assume you’re saying that your level is 500 2 weeks after your testosterone shot. There are a few things that may be happening that you should discuss with your doctor.

Just to be clear, testosterone increases the blood flow to the penis by increasing the production of nitric oxide and supporting smooth muscle function. The reduction in your testicle has nothing to do with blood flow but is a sign of decreased natural testosterone production and there are a number of ways to address this including HCG, clomid, and taking a break from testosterone, which should all be done under supervision of your doctor.

The first problem I see is that you are doing biweekly doses of testosterone injections. This means that after your injections your levels will rise very high and then by the second week you are beginning to drop your level. Also, I see no mention of your free testosterone or estrogen levels and these may be part of the problem. The hair loss may be genetic or it may be due to increased conversion of testosterone to dihydrotestosterone (DHT). DHT increases when testosterone goes too high the first few days after your injection and may remain high for the remainder of the two weeks depending on the person.

Propecia®, or finasteride, can have severe side-effects in some men. There are other ways to reduce the conversion of testosterone to DHT such as vitamin D, omega-3 fatty acids, and zinc. These should all be supervised by a doctor. I have found topical spironolactone compounded with minoxidil to be a safer option when prescription medications are needed. Again, these should be supervised by your doctor.

Typically, we have our patients do lower doses of testosterone more often. Some patients do two injections per week but most do weekly testosterone injections. This way there is less of a surge of testosterone the day after the injection and the level remains more optimal the rest of the week before the next injection. Some doctors consider 800-1000 to be optimal and I tend to agree. Every patient has their “sweet spot” where they feel the best and side effects are minimized.

The problem with your erections losing firmness is possibly due to your body “getting used to” the testosterone surges after your injections. This may be causing a decrease in the receptors that are activated by testosterone. Without confusing you too much let me just say that this can happen over time and there are ways to fix it (read my article about L-carnitine and Testosterone Therapy). A doctor experienced in testosterone therapy should have some ways to address this issue. I have seen “testosterone resistance,” aka “getting used to it,” occur in combination with too much conversion of testosterone to estrogen. With our patients we typically switch them to daily injections using insulin syringes and low dose testosterone propionate and adding a medication, such as anastrozole, to block the conversion of testosterone to estrogen be helpful.

There are certainly other possible causes of your concerns and without seeing you in my clinic and knowing all your medical history its impossible to give any advice. Please be sure to follow up with your doctor.

Cheers,
Dr. Barry

Reply

Keith September 8, 2013 at 7:16 pm

Thank you for the info Dr. Barry. I do not know what my free testosterone or estrogen levels are, but I will ask my doctor about them. He asked that I be tested 7 days after the injection, which yielded the 500 level at that time. He tested me twice after therapy began, and both times I was in that 500 range.

The hair loss surprised me because there is no family history of baldness from either side of my family. I am going to read your article you linked to and talk to my doctor some more. I almost wished I would have tried to produce more testosterone naturally before beginning TRT. I do feel better though.

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tom September 2, 2013 at 4:41 am

I have been taking 250mg test cyp per week for the past 3 years without doctor supervision. I started taking it because I was working out and wanted to get bigger and stronger which I did but now I am afraid to discontinue. I am 37 years old. Is it still possible for my body to naturally produce testosterone after this long or will I have to be on trt for life? Btw, I feel great but I know that I cannot continue taking that dosage any longer or I might have problems down the road.

Reply

Dr. Barry Wheeler September 3, 2013 at 3:15 am

Hi Tom,

There are a number of ways to improve your natural production of testosterone. I have been taking testosterone since I was 27 years old and it has changed my life. I have some patients who do it for a few years and then wish to discontinue for whatever reason and we have different approaches to making sure their natural production returns.

Most of our younger patients who are taking testosterone also use HCG to help maintain their natural testosterone production. Taking a break for one month a year can also be helpful – we call it a T vacation and have a special approach so levels maintain during this time.

I suggest you discuss this with your doctor so he can help you find a solution.

Cheers,
Dr. Barry

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Mark September 1, 2013 at 3:46 pm

I have low T 323 is what came back from blood work. Are there loading doses when you first start taking the injections or is it a standard dose that doesn’t change unless you need to go higher to bring the T-levels into normal range? I ask this because I started at one place and they gave large doses called Loading Doses and after my 2nd shot I would have a day or two of slight shortness of breath then it would go away until my next shot. I left there and am Just now starting at a new place that said they start low and work up if needed. I am 43 yo, no health issues , BP is normal, Cholesteral normal. Thanks for any information.

Reply

Dr. Barry Wheeler September 3, 2013 at 3:07 am

Hi Mark,

There are a number of possible reasons you were getting shortness of breath and that is something you need to be sure to discuss with your doctor.

Some guys retain water because of too much conversion of testosterone to estrogen or they are sensitive to the cypionate ester that is attached to testosterone in testosterone cypionate injections. Typically we find that guys who want to do injections but get side effects do best with a daily testosterone propionate. Starting low can be good depending on the person. Starting too low can also backfire especially if estrogen isn’t being monitored because the low dose can over-convert to estrogen and then decrease your natural production so you have low testosterone and increased estrogen, the opposite of what you’re wanting.

Topical testosterone may be a better options for you but you need to discuss all this with an experienced doctor who is willing to take the time to help you figure this out and who knows all the options.

Cheers,
Dr. Barry

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Mark October 21, 2013 at 10:28 pm

Do you put anyone on anastrozole for high estrogen? Just curious because they gave that to me because my estrogen went up. I guess that means I am converting too much over to estrogen?

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Dr. Barry Wheeler October 28, 2013 at 9:53 pm

Hi Mark,

I sometimes prescribe anastrazole to my male patients who convert too much of their testosterone to estrogen. It is important to use the correct dose so you still produce some estrogen and avoid shutting down your estrogen production. Make sure your doctor is going to test your estrogen levels again and make sure everything is balanced and verify with them that you are taking the correct dose.

Dr. Barry

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Tony August 29, 2013 at 3:24 am

Dr: my t-levels just tested at low 300′s, I just turned 50, is this number low?

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Dr. Barry Wheeler September 3, 2013 at 3:02 am

Hi Tony,

It depends on the range that the lab that did your testosterone test uses. Some labs have a range of 200 to 800 and others 350 to 1200. We always check free and total testosterone levels as well as match up symptoms such as decreased libido, fatigue, etc. Everybody has a sweet spot where they feel best. Most likely you are low and certainly you’re lower than when you were 25 years old but that is a conversation that needs to be had with your doctor.

Also, some guys will have all the symptoms and still have “normal” testosterone levels. Most often I find that these guys are on the verge of having a drop in their levels and their bodies are working on overdrive.

Again, you need to discuss this with your doctor or come into our clinic.

Cheers,
Dr. Barry

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Dave August 29, 2013 at 1:41 am

I am 57 years old and just had my T level checked and it was 475. ( I am told for my age 400-900 is normal ) I am at the low end. I am in good health but , I have low energy , an enlarged prostate , ED ( staying erect but not for a long period of time to complete intercourse. )focus or lack of concentration at times. I have talked to my doctor about a 3 month program of 4 shots ( 1 every 7-10 days ) and a gel for the full 3 months. I worry about some of the side effects. Shutting down what I produce and if I start , can I stop or switch to something else so I won’t stay dependent on injections or cream. Your insight would be helpful. Thanks

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Dr. Barry Wheeler September 3, 2013 at 2:58 am

Hi Dave,

In my experience it is good to try several different testosterone replacement options to help find the one that works best for you. I hope your doctor also checked your free testosterone, LH, and estrogen levels because these are all relevant to your concerns.

If your total testosterone is “normal” your free testosterone may be very low or optimal. Based on your symptoms it is likely to be on the lower side.

Your estrogen is likely too high or will become too high when you take testosterone. Most guys with enlarged prostates tend to have too much estrogen in my experience. Testosterone can be protective for the prostate but if you are converting too much of your testosterone to estrogen this can be a problem. It is all about balance. Men with too much estrogen may also notice more breast tissue than when they are younger. The prostate and breasts both respond to estrogen by growing. The good news is that an experienced doctor will be able to monitor your estrogen and use appropriate medications to reduce the conversion of testosterone to estrogen and this can help reduce side effects.

Luteinizing hormone (LH) is the signal from the brain to the testicles. It can be helpful to get a baseline on this level because if you ever want to stop testosterone this is the signal that I would check to make sure you’re trying to produce your own natural testosterone again. There are other ways to stimulate natural production of testosterone such as clomid and HCG and these are options we may give to our patients based on their goals and medical history.

I suggest you discuss your concerns with your doctor or find a more experienced doctor to help you get the results you’re looking for in the safest way possible(minimize side effects). Consider coming to our clinic if you’re in the Seattle area.

Cheers,
Dr. Barry

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Dennis August 25, 2013 at 11:02 am

Hello my name is Dennis, and I have been diagnosed with low T and have had Testicular cancer back in 1989, I have used Androderm patches as well as Androderm gel, and prefer the gel, I will have insurance within a week or two, just need a Doctors Presciption to get the Gel. My PCP is actually my Oncologist in Seattle, let me know if you can help me?

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Dr. Barry Wheeler August 28, 2013 at 10:40 pm

Hi Dennis,

Please call our testosterone clinic in Seattle at (206) 329-2000 to discuss our insurance policy. We don’t accept insurance but we do provide superbills that you can submit to your insurance.

Cheers,
Dr. Barry

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Amman August 17, 2013 at 8:45 pm

Amman.
Hi Dr.

i am 41 years old and i so weak in sexual affairs. i cant satisfy myself as well as the apposite.
all the time i feel weak and sometimes my blood pressure gets low. i do fitness, but after 30 minutes i feel so weak.
i have a history of anxiety as well as asthma. my size is small.
please advise me to use testosterone or not . if yes would you please tell me the doze .
regards

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Dr. Barry Wheeler August 20, 2013 at 5:57 pm

Hi Amman,

There are other possible causes of your problems and without doctor supervision taking testosterone would be dangerous. One possibility is you are converting too much of your testosterone to estrogen which would lead to reduced penis size. I’m not sure if you are saying your penis is small or your body is small.

Anyways, you should go see a doctor and get some lab testing done to look for the cause of your problems or come into our clinic.

Best of luck,
Dr. Barry

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Naru August 16, 2013 at 9:40 pm

I have been diagnosed with low T and my numbers are 150. I am 44 yrs male.
Please tell me if T injections are better or gel for T replacement therapy.

What will be the most long term serious side effect of TRT?

Please suggest me

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Dr. Barry Wheeler August 17, 2013 at 5:10 pm

Hi Naru,

Every treatment should be individualized to the patient and without knowing more about you and having you here in the clinic it is impossible to say which is better. They both have their pros and cons. Some guys feel more benefit from testosterone injections and some guys do better on topical testosterone.

In my experience there is a little more risk of side effects from testosterone injections but topical testosterone has the risk of having little to no benefits at all and can be transferred to others through touching them. Women and children can get little mustaches if you aren’t careful and they are not going to be happy about it. All joking aside there is some risk that topical testosterone can have negative effects on others with the highest risk related to transferring to pregnant women and children.

In terms of long-term serious side-effects, again, it is almost impossible to say without knowing your medical history. There are long term serious side effects from NOT doing TRT as well. It is all about balance. The biggest risk for most guys who get treated by inexperienced doctors is related to the conversion of testosterone to estrogen as this can increase the risk of prostate problems and growing breasts. Also, without the use of hcg or some other approach to maintaining natural testosterone production and testicular function you may become dependent on testosterone or reduce your fertility.

We use the “trifecta approach” which is all about the following three elements:

  1. Optimize Testosterone Levels (Free and Total)
  2. Maintain Natural Testosterone Production
  3. Optimize/Reduce Estrogen Levels (without shutting them down)

Note: guys naturally produce a little estrogen, its all about balance

Please discuss your options with your doctor, get a second opinion, or come into our clinic.

Cheers,
Dr. Barry

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kevin August 15, 2013 at 12:55 am

I just want to say that I am 47 and have a 300 testosterone count. I started injections 1 a week for 4 weeks, then once a month. This past week I was feeling like I did before, extremely tired, forgetting things, etc. I went and had the nurse give me another shot, since the dr said if 1 a month wasn’t enough, then every other week would be good. Oh by the way I get a 200 mg shot, testosterone cypionate. Well, the nurse who has every degree except Dr, (she’s going for it)realized the doctor was putting it in the wrong spot. He was injecting me in the back of the arm in the fat, not the muscle. 2-3 hours after the shot I felt like a new man again. I personally will take the risk of any side effects from this to feel this much better. Quick question, 400 mg a month, what do you think??

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Dr. Barry Wheeler August 15, 2013 at 5:01 pm

Hi Kevin,

I’m glad you finally figured out they were giving you the testosterone shot incorrectly. We generally give patients their testosterone injections in their thigh muscle or buttocks muscle. We also have most of our patients doing their testosterone injections on their own at home and we teach them how to do the injection properly. This allows them to inject lower doses more frequently.

The problem with one BIG testosterone injection monthly (400mg is a large amount to at once) is that you get really high levels for about a week and then you are low for the second half of the month. I personally inject myself daily with a very small amount of testosterone propionate using an insulin syringe. However, most guys do just fine with about 100-200mg testosterone cypionate once weekly as long as we are managing their estrogen levels and keeping an eye out for increased red blood cells.

As always, testosterone therapy should be supervised by an experienced physician and you should talk to your doctor before changing your treatment.

Cheers,
Dr. Barry

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Mark September 1, 2013 at 3:55 pm

Has the daily injections with insulin syringes worked out well for you? Something I might need to discuss with my MD. Would 3-4 days work as well?

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Dr. Barry Wheeler September 3, 2013 at 3:09 am

Mark,

I personally love daily testosterone propionate and most of my patients who use them feel the same. Testosterone propionate typically causes less water retention but must be done daily or at least every other day. Testosterone cypionate at low doses can be done every four days but can still lead to too much water retention in some men. Be sure to discuss your concerns with your doctor.

Dr. Barry

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Tim August 13, 2013 at 9:02 pm

Thank you
Can you recommend a similar Clinic like your’s in the Orlando to Melbourne, FL area?

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Dr. Barry Wheeler August 15, 2013 at 4:54 pm

Hi Tim,

I’m not familiar with any clinics in the Melbourne or Orlando areas but I imagine if you bing “men’s clinic Orlando” you’ll see several. I suggest you call around and talk to the staff at several clinics before making an appointment. I hope that helps. If you’re ever in the Seattle area please consider coming to our clinic.

Cheers,
Dr. Barry

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Brian August 13, 2013 at 1:58 pm

Dr. Barry,

I have been receving T injections for 38 weeks now. I had many of the symptoms that led my Dr. suggesting I start, such as ED, memory loss, extreme fatigue, etc. In the beginning I could feel a change for the good, but in the last month or so it feels like I’m tired again and spontanious errections have been difficult. My original T levels and free T was very low. I’m getting 150 T injection as well as starting HCG about 4 months ago. My therepy Dr. did start prescribing anastrosal to be taken at the time of the shot, plus two follow up pills each 48 hours after the injection, but those are at half doses. Could there be something with my therepy that is causing my onset of ED and fatigue?

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Dr. Barry Wheeler August 13, 2013 at 5:58 pm

Hi Brian,

Some guys feel good with testosterone therapy initially and then notice a declining benefit. This can be due to a number of different possible reasons. Switching to daily low dose injections of testosterone propionate or daily topical testosterone is what we usually consider. It is also possible your estrogen is now TOO low. Without seeing your lab results its hard to say and I suggest you bring this up with your doctor as there are many possible causes of your fatigue and ED.

Supplements that are supportive during testosterone therapy can be helpful also, such as l-carnitine and chromium. These should be supervised by an experienced physician. Also, some guys feel good taking a break for a month and we often use clomid during the one month “t vacation” to support natural production and prevent levels from dropping too much. Again, this needs to be supervised by an experienced physician.

There is also something called hyper-excretion where guys will lose a lot of their testosterone in their urine. The only way to detect this is with a urine test but checking testosterone levels in the morning before you do your t shot can be helpful (measures the low point).

I suggest you bring all this up with the doctor who is prescribing your testosterone and if you’re still not satisfied come into our clinic or get a second opinion from another doctor in your area.

Cheers,
Dr. Barry

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francisco August 22, 2013 at 5:52 am

My doctor told me. If I get the injection. That I could have cancer is that. Ture

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Dr. Barry Wheeler August 28, 2013 at 10:45 pm

It is a myth that testosterone therapy causes prostate cancer. In fact, low testosterone is associated with more aggressive prostate cancer. Abraham Morgentaler, MD, a Harvard urologist, explains “as clinicians, it is our duty to take into account the whole person, and to make treatment decisions based on an evaluation of risks and benefits. With appropriate medical monitoring, TRT appears to be safe for the prostate, and can be an effective treatment for
many hypogonadal men.” Hypogonadism means low testosterone.

“Testosterone replacement therapy and prostate risks: where’s the beef?” Morgentaler A. Can J Urol. 2006 Feb;13 Suppl 1:40-3.
Division of Urology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

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dr praba August 11, 2013 at 3:35 pm

this is a very informative dialogue between dr. Barry and the questioners .the finding on Atrial Fibrillation in patient on testoteronr therapy must be investigated further.,normally low levels can produce At Fib.

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Josh August 6, 2013 at 6:11 pm

I enjoy reading your response to all of the questions here on your site. I am starting testosterone therapy and just wanted to ask a quick question about hcg. For you patients that are on testosterone therapy and hcg, do you usually have them cycle on and off the hcg(ex. 2 months on , 1 month off)?

In addition, do you recommend an estrogen blocker (like estradiol) during your testosterone treatments most of the time?

Thanks

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Dr. Barry Wheeler August 6, 2013 at 9:23 pm

Hi Josh,

Thanks for the feedback!

Yes. The newer approach with HCG is to cycle it 2 months on and 1 month off. Some doctors think this helps maintain the benefits of the HCG better.

The estrogen “blocker” we typically use is anastrozole. It actually reduces the conversion of testosterone to estradiol (estrogen). Many of the side-effects of testosterone therapy are related to over-conversion of testosterone to estrogen. On the flip side, some doctors over-use estrogen blockers and this can lead to too little estrogen . It is all about balance. Not all guys need estrogen “blockers” but all guys should have their estrogen levels monitored.

Dr. Barry

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Brent July 31, 2013 at 8:39 pm

Hello Doctor,

At the suggestion of a friend I went to my doctor and had my T levels tested, they came back at 64 which I am told is very low for a 41 year old male. My doctor started me on 120 cc injections of Testosterone Cypionate every week for the past four weeks. I must say that life is wonderful now, I am far more alert and focused at work, my sexual desire is starting to come back, I sleep better, and my energy levels are through the roof.

I recently started working out again and it feels great, I am wanting to start taking some over the counter nutrition supplements. One of the supplements that I am wanting to take does state that it will increase your body’s production of Testoserone, is it okay for me to take this supplement while getting Testosterone Cypionate injections?

Thanks Brent

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Dr. Barry Wheeler August 7, 2013 at 7:10 pm

Hi Brent,

I’m glad to hear you’re seeing good benefits from your testosterone therapy. We have seen many of the benefits you mention and that is why we are so passionate about helping men optimize their testosterone levels in a safe way.

There are many different supplement that claim to increase your body’s production of testosterone. Without knowing the specific supplement and what’s it contains it’s difficult to comment. I suggest you take it to the doctor who prescribed your testosterone so he can take a look at it or bring him some info about it.

Some supplements increase your body’s testosterone production by reducing the conversion of testosterone to estrogen. Some supplements increase free testosterone levels. And other supplements have different mechanisms. Depending on the supplement it could enhance the benefits of your testosterone therapy or increase the risk of side effects, especially if your doctor isn’t experienced or monitoring other levels such as estrogen and free testosterone.

I hope that helps.

Cheers,
Dr. Barry

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Den July 31, 2013 at 7:27 pm

Hello my wife and I were TTC but ended up having to do Ivf do to her having blocked tubes from endometriosis but when I gave my sperm analysis I came up azoospermia do to Testosterone replace therapy. He has since placed me on 25 mg clomid ED and 500 HCG EOD but from the studies I have read online those medications are not given together. Just wondering if that is a treatment option or possibly if I need to look for another DR that is more knowledgeable in male infertility from TRT. TYVM

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Dr. Barry Wheeler August 7, 2013 at 6:47 pm

Hi Den,

I have gotten good results just using HCG by itself. Perhaps your fertility doctor considers the combination of clomid and HCG to be more aggressive. The newer approach that many doctors are using with TRT patients is HCG 500IU twice a week for 2 months and then take a month off to maintain sperm counts. However, you were not using HCG in the past so it is likely he is trying to be more aggressive. Every patient is different. Many men have trouble with fertility who have never even used testosterone.

Getting a second opinion is generally a good idea when you have concerns and there is no risk in doing so as long as you communicate with all your doctors well. I suggest you ask your doctors these questions and consider a second opinion just to see what another doctor may suggest who can review your medical history and meet with you in person.

I had a patient who refused to use HCG while on testosterone therapy because wanted to reduce his fertility. When he and his partner decided to have a baby he used HCG for one month and was successful. Again, every patient is different.

Best of luck,
Dr. Barry

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Keith July 29, 2013 at 1:19 am

I was injecting cypionate from a doctor for about a year. I felt like a new man from it. I cannot tell you the difference it made in my mood and how much better I performed physically. I was tested over and over to make sure I was a good candidate for this by two different doctors and everything was right in the middle of normal.

But after around a year, all of a sudden I started going into atrial fibrillation at night while I slept. It was the scariest thing I could imagine and it happened constantly. A couple times it landed me in the ER because I would lose consciousness and fall down going to the bathroom to vomit. When the doctors studied me in a myriad of ways they could not find anything wrong with me. According to the numbers I should still be running through walls.

I laid off the injections to see if that would help and sure enough they went away! However, all the things I was trying to deal with also came back like the mood issues, weight gain, body pain…etc. Have you ever heard of something like this related to testosterone injections? I wish I could restart the regime again but I not without understanding what is going on with the strange health issues.

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Dr. Barry Wheeler August 6, 2013 at 11:43 pm

Hi Keith,

I haven’t heard of this specific scenario but I have seen many unusual responses to all sorts of treatments.

I hope someone was monitoring your estrogen levels. It is also possible the symptoms you were experiencing were unrelated. If you came into my clinic I might suggest trying topical testosterone first as it an be a little less aggressive. It sounds like they never really diagnosed you with atrial fibrillation. You might want to ask about getting a sleep study as its possible your were having sleep apnea which could cause symptoms similar to atrial fibrillation or panic attacks from the lack of oxygen. I suggest you find a doctor who has a more holistic approach as there are other ways to increase testosterone besides testosterone cypionate.

Cheers,
Dr. Barry

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himanshu July 28, 2013 at 5:11 pm

dear sir…..
i have a problem of ; less beared & less moustache problem…i m suffering from hypogonadism my dr ,… is also advice to take 250 mg of testosrtome injection and tamoxifen 10mg dear sir is it right for me …is there any side to my body i m 21 year old man…..after 2 year my marriage is also i.e 2015 is also done after my marriage life is there no any side effect to pregnant problem to my wife……plz give me right suggestion

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Dr. Barry Wheeler August 6, 2013 at 9:29 pm

Hi Himanshu,

It sounds like your doctor may want to measure your dihydrotestosterone (DHT) level. Some men just don’t grow very much beard due to genetic reasons. I generally wouldn’t use tamoxifen but perhaps your doctor has something specific in mind. My question would be why are you not producing testosterone. In 21 year old men we generally get good results with clomid or HCG but that is something you need to discuss with your doctor. Perhaps you can come into our clinic or get a second opinion. Self treating can be dangerous, especially if you are not looking for the cause of the problem.

Be well,
Dr. Barry

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Jeihind July 25, 2013 at 7:54 pm

Hello dr..
i am hypogonadism patient.i am under treatment about 15 months.i have a side effects thats is my face color is changed into black.now i am looking bad.so any chance to regain my lost skin color and what should i do…?and also give some suggestions to avoid these kind of side effects like heart ,liver damages….please help me sir :-)

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Dr. Barry Wheeler July 27, 2013 at 10:42 pm

Hi Jeihind,

There are a number of potential causes of darkening skin and it is important for you to see a doctor to determine the cause. This is an important question that needs to be answered by the doctor who prescribed your testosterone. If it is somehow related to your testosterone therapy it is most likely due to too much conversion of testosterone to estrogen. Increased levels of estrogen have been shown to increase skin pigmentation and can make your skin look darker.1 This is why it is important to measure estrogen (estradiol) levels when receiving testosterone therapy. There are other possible causes but this is the first one that popped in my mind. You need to contact your doctor and discuss this further.

Testosterone therapy is more complicated than just taking testosterone. Liver damage is more commonly caused by oral testosterone. There are many ways to support liver health such as taking milk thistle. Heart health is more complicated and the best way to avoid side effects is to find a doctor experienced in testosterone therapy who will fine tune your treatment to enhance the benefits and reduce the risks. I wish I could be of further help but am unable to give any medical advice unless you come into one of our clinics.

Cheers,
Dr. Barry

  1. Debabrata Bandyopadhyay. Topical Treatment of Melasma. Indian J Dermatol. 2009 Oct-Dec; 54(4): 303–309. doi: 10.4103/0019-5154.57602 PMCID: PMC2807702

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Arjun July 25, 2013 at 7:37 pm

Hi Dr…
I am 21 years old male and suffered by hypogonadotropic hypogonadism .For the past 1 year i am taking TRT by Testosterone 250 amp injection.After treatment my penis size increased about 1 inch and i get facial hair.And i couldn’t control my sexual thought.so per week i masturbate more than four times..is it any wrong?

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Dr. Barry Wheeler July 27, 2013 at 5:38 pm

Hi Arjun,

Those are really questions you need to be asking the doctor who prescribed your testosterone. I’m assuming amp refers to ampule but I’m unclear on how often you are doing this injection. It sounds like you could reduce your dose but that is really a conversation to have with the doctor who prescribed your testosterone.

Hypogonadotropic hypogonadism, if that is truly what you have, is caused by a lack of signal from the brain (pituitary) to the testicles. The signal from the brain to the testicles is luteinizing hormone (LH). It is always important to look for the cause of low LH and again that is an important conversation you need to have with your doctor or come into our clinic. Low LH can be treated in a number of ways depending on the cause. We often get good results with HCG injection or sublingual tablets, which are both prescription medications and require a doctor’s supervision. If you get HCG on the internet it is likely to be ineffective or possibly even dangerous as you don’t know what’s really in it.

The benefit of using HCG and something to reduce estrogen or clomid is that it maintains your fertility better. If you were my patient that is what I would likely recommend instead of taking testosterone injections. Again, you need to have this conversation with your doctor as self-treating is dangerous and illegal as testosterone is controlled substance. I hope that helps give you some things to talk about with your doctor.

Cheers,
Dr. Barry

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Usman July 14, 2013 at 10:18 pm

Dr,
I’m a 27 year old male and athletically built. I’m looking to gain another 10lbs of lean muscle mass. I’d been looking into androgenics but due to the side effects I’ve heard if I was skeptical. Someone recommended I give pure test a try. However, from what I understand, testosterone shots could shut down my natural testosterone levels and could shrink my testicles. What would possible remedies be to that and could such side effects be permanent?

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Dr. Barry Wheeler July 17, 2013 at 4:35 am

Hi Usman,

We generally use HCG in younger guys and get good results. This, however, would depend on the cause of your problem. The first step would be to check your testosterone and related levels in the blood, such as estrogen and LH (signal from brain to testicles). There are other factors that could be limiting your success. Taking testosterone would decrease your natural production and that is why we use HCG in combination with testosterone, typically.

You need to see a licensed physician to get your levels checked and discuss your options. The last thing you want to do is shoot your estrogen levels through the roof because no one is monitoring your treatment. Testosterone converts to estrogen and this can get out of hand if its not being addressed. There are all kinds of ways to increase testosterone and the most effective treatment is one individualized and supervised by an experienced physician.

There are other medications such as clomid that stimulate testosterone production in the testicles and this can be helpful for guys who are trying to restart their natural testosterone production after discontinuing testosterone therapy or when taking a break. I suggest you discuss this with your physician or find a doctor exprienced in men’s health.

Cheers,
Dr. Barry

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John July 11, 2013 at 11:48 pm

Is it safe for someone who has normal testosterone levels to take testosterone injections? I want to lose some body fat and tone up and a friend said it would be a good course of action but I have no health problems relating to natural testosterone production Im a healthy, little bit overweight 24 year old just wondering if its safe

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Dr. Barry Wheeler July 12, 2013 at 10:00 pm

Hi John,

Just to be clear, “normal” is a very broad range and free testosterone levels are sometimes more important than total levels. At age 24 you’re at your peak testosterone production and around age 30 levels start declining for most guys.

At your age you need to have a doctor’s supervision. Testosterone injections would not be safe if your testosterone levels are already optimal and if you don’t do it correctly you may affect your sperm production. There are other ways to increase and optimize your total and free testosterone levels and this can assist in losing excess body fat and increasing muscle mass. We’ve had good success using HCG on younger guys but it really depends on their lab levels.

No easy answer to your question. Taking testosterone injections just to tone up without any medical need would be wrong and dangerous. Taking testosterone without symptoms of low testosterone is called abuse because you have to take an unsafe amount of testosterone to notice any difference. On the other hand, optimizing testosterone and estrogen levels with other medications and therapies can improve quality of life in a safe way. Come into our clinic or find a doctor who knows what they are doing. Do NOT take testosterone injections without a prescription from a licensed doctor.

Cheers,
Dr. Barry

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Darwin July 10, 2013 at 1:37 am

Hi Dr Barry Wheeler

Is it advisable for me to have testosterone therapy to increase my muscle mass and have a lean (and sexy) body, like a model? I am male, 26 years old and would like to have a lean body and increased in muscle mass. I consider my self physically fit, average body size and I do work out (the gym stuff, for about 3 months already) and currently, I just see little progress in my goal.

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Dr. Barry Wheeler July 12, 2013 at 10:09 pm

Hi Darwin,

The first step would be getting your testosterone levels checked and discussing your symptoms and medical history with a doctor. If your local come into our clinic. There are a number of ways to increase your testosterone levels safely at your age without even taking testosterone.

Cheers,
Dr. Barry

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GERALD July 1, 2013 at 3:24 am

I am a 76 year male taking injections for low testosterone levels and have noticed swelling of the feet and ankles. Is this normal? Never had this problem before getting the injections.

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Dr. Barry Wheeler July 1, 2013 at 8:47 pm

Hi Gerald,

You need to contact your doctor immediately to tell him about the swelling in your ankles.

Often the swelling is from too much conversion of testosterone to estrogen but there are other potential causes of swelling in the ankles and it is important to rule out any serious conditions, such blood clots. Hot weather can also increase swelling in the ankles. Some men are predisposed to get swelling in the ankles from testosterone injections and may do better on a topical cream.

Please contact your doctor immediately. This is not medical advice but you should seek advice from the doctor that prescribed your testosterone or your primary care physician.

Cheers,
Dr. Barry

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julio June 30, 2013 at 7:32 pm

I am 87 yrs old. As expected my libido is practically gone.I also have sporadic atrial fib controlled by propafenone.Would testosterone help my libido.My prostate is free of nodules and slightly enlarged.

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Dr. Barry Wheeler July 1, 2013 at 9:10 pm

Hi Julio,

You should come into our clinic or consult your cardiologist.

Testosterone therapy can certainly help improve libido a lot! The important part is finding an effective and safe way to increase your testosterone levels and minimize any potential side effects.

There is some research (2009) that shows sporadic afib is related to low testosterone:

“Conclusion: Reduced testosterone levels may be associated with susceptibility to lone AF in men.”
Reduced testosterone levels in males with lone atrial fibrillation. Lai J, Zhou D, Xia S, Shang Y, Want L, Zheng L, Zhu J. Clin Cardiol. 2009 Jan;32(1):43-6. doi: 10.1002/clc.20423.

A big review of research published in The Journals of Gerontology Series A: Biological Sciences and Medical Sciences found that patient receiving testosterone therapy had the same rate of atrial fibrillation as people receiving placebos in controlled studies.

“Cardiovascular event rates did not differ significantly between testosterone-treated and placebo-treated men”
Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. Calof, Olga M., et al. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60.11 (2005): 1451-1457.

Testosteone therapy can increase red blood cell production so it is important to monitor blood CBC levels regularly. Testosterone can also increase the effective of warfarin so it is important to tell your doctor about all the medications your taking when you discuss testosterone therapy with your doctor or at our clinic.

The above comment is not medical advice and is for information purposes only. All testosterone therapies should be done with supervision from a licensed physician.

Cheers,
Dr. Barry

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Mrs K June 29, 2013 at 8:45 pm

Hi,
my husband has 8 weekly nebido injections, due to primary hypogonadism caused by chemotherapy. So far it is the best replacement therapy he has used, but he has azoospermia because of the testosterone. Is there any way of returning his fertility? We have 2 children from before his cancer treatment, and his fertility was ok before the chemo,
Thanks
Mrs K

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Dr. Barry Wheeler July 1, 2013 at 9:30 pm

Hi Mrs K,

Nebido® is testosterone undecanoate. I am confused on the number of injections he is receiving as generally they are given less frequently than weekly but perhaps they are trying to build up his levels or something and then cut back or maybe you are saying he gets them every 8 weeks. I’m always very cautious recommending longer acting testosterone medications because once they are in the body it is tough to get them back out.

My favorite is actually testosterone propionate because it allows men to inject a very small daily dose using an insulin needle and then they get that nice daily rise and fall of testosterone levels. With undecanoate the levels rise and remain elevated for several weeks to months and then gradually decline. Typically guys will do okay on the longer acting testosterone medications for a while and then may start noticing decreased benefit despite good testosterone levels on lab tests.

Testosterone cypionate and testosterone enanthate are considered medium acting and can be used for weekly injections or injections every 10 days or so. These forms of testosterone are the most widely used of all the testosterone injections and work well for most guys in my experience.

Fertility is something he should discuss with the doctor prescribing his testosterone. We generally use HCG injections, a prescription medication, to help improve fertility. With more aggressive treatments of HCG to improve fertility and testicular function we are starting to recommend 2 months on and 1 month off to prevent declining benefits that we have noticed sometimes. Clomid® (clomiphene) is another medication that can help improve fertility along with anastrazole depending on his estrogen levels.

This comment is for information purposes only and is not medical advice. He should discuss this with his oncologist, primary care doctor, and the doctor who prescribed his testosterone.

Cheers,
Dr. Barry

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scott June 26, 2013 at 8:45 pm

I just started my andro gel 1.6 and have a little girl and new baby boy on the way. Will the gel leach through a t-shirt if holding either infant? Why isn’t HCG or Clomid used for the increase in testo? but they put me straight to the gel. Should i ask about a combination therapy? I just want to increase my health and create issues down the road. I would rather live with my low testo issue than risk my life or effect those around me. Any input would be great thanks for your time.

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Dr. Barry Wheeler June 27, 2013 at 12:25 am

Hi Scott,

I totally understand your concerns and would be concerned myself. There is a risk that the gel will transfer to others. In this situation where there is so much concern over transfer we usually recommend testosterone injections. Of course, this is a conversation you need to have with the doctor who prescribed your testosterone gel. We usually recommend HCG, especially on our younger patient. Please contact your doctor to discuss testosterone injections and other alternatives to the gel (there are also more concentrated testosterone creams). An experienced doctor should be able to customize your treatment to address your concerns and increase safety while still improving benefits.

Cheers,
Dr. Barry

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adam June 19, 2013 at 10:09 pm

Is TRT normally a long-term or life long treatment or is is something that can be done until levels are back to “normal”

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Dr. Barry Wheeler July 1, 2013 at 8:37 pm

Hi Adam,

Generally, testosterone therapy is a long term solution to a problem, low testosterone aka hypogoandism, that is unlikely to get better any time soon. However, depending on your age and the cause of the problem it may only be necessary for a short period of time and not everyone needs testosterone injections or creams as there are other ways to increase testosterone. It just depends on what is causing your low testosterone.

In a perfect world we could live our entire lives with perfect hormone levels without any testosterone replacement therapy. Unfortunately, the world is becoming more and more stressful and polluted so the problem, low testosterone, is only going to get worse. Not everyone has or will get low testosterone. Research shows that low testosterone is becoming a greater problem for men at all ages. Your peak testosterone level is around age 25 years old. We should be checking everyone’s testosterone at age 25 so we can compare this level to their testosterone levels as they age.

Long story short, it depend. Please contact your doctor or make an appointment at our clinic if you live near Seattle and we will be happy to assist further. The above comment is not medical advice.

Cheers,
Dr. barry

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Allen June 17, 2013 at 10:04 pm

Consumer Reports, WebMd and others don’t brush off side effects as glibly as you do. How do you respond to their concerns regarding prostate issues, heart problems and a host of side effects. And they are not selling testosterone like you are.

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Dr. Barry Wheeler June 18, 2013 at 7:51 pm

Hi Allen,

Did you read the article you’re commenting on? All your requests have already been addressed above and beyond that it really depends on the patient as the treatment should be customized to the individual. Treatments with a one size fits all approach will likely lead to more side effects. I think you are confusing “brushing off” side effects with our approach that finds ways to reduce the side effects of testosterone therapies.

This article discusses how we address the side effects listed on WebMD as most doctors are unaware of the different ways to reduce side effects and increase benefits. Also, we have many other ways of increasing a man’s testosterone level without using testosterone. We provide a medical service that is based on an individual’s goals, medical history, physical exam, and lab results.

Cheers,
Dr. Barry

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Elana June 15, 2013 at 12:24 pm

Husband on testostorone shots has no libido for last 2 years. Said his levels are good. Do not understand!

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Dr. Barry Wheeler June 15, 2013 at 8:09 pm

Elana,

Have they checked his estrogen levels? Most doctors rarely check estradiol (estrogen) levels or free testosterone levels. Both these could give further insight. He should ask his doctor about checking these.

Cheers,
Dr. Barry

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Dr ahmed May 6, 2013 at 11:23 am

The suppression effect of prolonged testosterone therapy as used by athletes,on sperm production, please comment the best mode of administration and duration of therapy , thanks

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Dr. Barry Wheeler May 7, 2013 at 4:49 pm

Dr. Ahmed,

There is sufficient evidence that the use of hcg in combination with testosterone helps maintain natural production and prevents testicular shrinkage. I recently assisted a patient improve his fertility successfully after using testosterone for years. He had not used hcg in the past and when we added hcg to his treatment he was able to get his wife pregnant. Of course, infertility is a big problem and many men have this problem who have never used testosterone in the past. Thus, there are no guarantees but in my experience, every male patient who asked for my help to improve their fertility was successful with the addition of hcg.

“Exogenous testosterone supplementation decreases sperm production. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. Clomiphene citrate is a safe and effective therapy for men who desire to maintain future potential fertility. Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment.”

Read article: Exogenous testosterone: a preventable cause of male infertility

Cheers,
Dr. Barry

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Greg January 15, 2014 at 3:20 am

I am 42 years old and have 2 test over the past 2 months for testosterone and the results were 150 and 205 ng/dl. My doctor has prescribed 200mg of testosterone cypionate every 4 weeks. Based on the research I have done over the past 2 weeks, I am concerned about 2 things. Is it enough to make an impact in a 6′ 4″ 290 pounder? Will there be peaks and valleys?

Mikmac

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Dr. Barry Wheeler January 30, 2014 at 3:09 am

Hi Greg,

The human body naturally produces 5-10 mg testosterone per day. Testosterone cypionate 200 mg/mL contains about 140 mg testosterone and 60 mg cypionate. For a guy your size I would expect you to “use up” most of that testosterone in about 10 days so, yes, I would expect that your levels would be high for the first few days, then be in the normal range for a few days more days and then be low for the rest of the month.

I suggest you ask your doctor about injection 100 mg testosterone cypionate weekly as I have found this approach to be more effective with less peaks and troughs. You should also ask him to check your estrogen levels.

Best of luck,
Dr. Barry

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Dr. Barry Wheeler February 16, 2014 at 8:03 pm

Hi Carl,

The daily testosterone we typically use is either testosterone propionate 50 mg/mL or a blend of testosterone propionate and testosterone cypionate. Both of these are not commercially available so need to be custom made by a compounding pharmacy. These medications can be injected in the muscle (ie deltoid) with an insulin syringe because only 0.1 – 0.3 mL are typically used daily. They are prescription medications and should only be used under the direction of a licensed physician.

In general, I like to see estradiol levels between 20 and 30 pg/mL. However, estradiol may become more active inside the cells if there is too little progesterone present. Men produce small amounts of progesterone, and just like in women, progesterone reduced the effects of estrogen on our bodies by kicking estradiol out of the cells. In some men with borderline estradiol levels but are having symptoms of too much estrogen I usually prescribe an oral dose of 25 mg before bed every day.

The testosterone to estrogen ratio is very important as well. My goal is usually about 40:1 testosterone to estradiol. There is a significant amount of research showing this ratio can help improve prostate health and that progesterone can also improve prostate health.

“The association between plasma androgens and prostate cancer remains contradictory and mostly not compatible with the androgen hypothesis. Similar evidence apply to estrogens, although the ratio of androgen to estrogen in plasma declines with age. Apart from methodological problems, a major issue is to what extent circulating hormones can be considered representative of their intraprostatic levels. Both nontumoral and malignant human prostate tissues and cells are endowed with key enzymes of steroid metabolism, including 17betahydroxysteroid dehydrogenase (17betaHSD), 5beta-reductase, 3alpha/3betaHSD, and aromatase. A divergent expression and/or activity of these enzymes may eventually lead to a differential prostate accumulation of steroid derivatives having distinct biological activities, as it occurs for hydroxylated estrogens in the human breast. Locally produced or metabolically transformed estrogens may differently affect proliferative activity of prostate cancer cells.”1

“Although progesterone has shown promising role in various non-hormonal benefits, further clinical studies are needed to prove its usefulness in conditions like stroke, traumatic brain injury, neuropathy and crush injury. In male related illnesses like BPH and prostatic Ca, it may prove a boon in near future. New era of hormonal male contraception may be initiated by use of progesterone along with testosterone.”2

Best of luck,
Dr. Barry

  1. Estrogen and prostate cancer: an eclipsed truth in an androgen-dominated scenario. Carruba G. J Cell Biochem. 2007 Nov 1;102(4):899-911.
  2. Novel actions of progesterone: what we know today and what will be the scenario in the future? Kaore SN, Langade DK, Yadav VK, Sharma P, Thawani VR, Sharma R. J Pharm Pharmacol. 2012 Aug;64(8):1040-62. doi: 10.1111/j.2042-7158.2012.01464.x. Epub 2012 Feb 21.

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