I have heard of so many mistakes made by people taking testosterone replacement therapy. Some mistakes seriously affected their quality of life or caused men to stop taking testosterone prematurely. Here are some of the biggest bugs I’ve witnessed:
- Use of “street sources” of testosterone: I have met many men whose doctors do not endorse the use of testosterone, so they buy it on the black market or from some sort at their gyms. This is illegal. Testosterone is classified as a controlled substance under the Anabolic Steroids Control Act of 1990 and has been assigned to Schedule III. It is regulated by the Drug Enforcement Agency (DEA). A doctor can legally prescribe it, but it is illegal to use it without a prescription. Please note that the purchase or use of testosterone without the proper prescription may have legal consequences. The use of testosterone and its cousin molecules (anabolic steroids) is illegal in the United States for those without a medical diagnosis justifying their use (eg, anemia, emaciation, hypogonadism). If after reading this book you still decide to obtain testosterone on the black market, be careful because you could be tricked by informants who could alert the DEA to your purchase. Also, importing testosterone even if you have a prescription is not legal. Bottom line: only use testosterone after a prescription is given by a doctor and do not import it from other countries.
- The use of “street” testosterone is also dangerous. No one knows what those products may contain. Some so-called testosterone products may simply contain peanut oil, sesame, or grapeseed oil. You also risk exposure to contaminants that could cause an infection.
- Not having a doctor keep track of your blood work is a sure way to get yourself into trouble! If you have low testosterone, there are hundreds of doctors who will prescribe testosterone replacement therapy (see Appendix section for directories). If you are using testosterone to increase muscle mass or to improve athletic performance despite normal testosterone levels, be smart and do as much research as you can. And please read the information in this book on how stopping testosterone can cause health problems (if you’re using black market testosterone, chances are your supply will eventually run out).
- Not exploring which testosterone option is best for you: Since there are a variety of options for testosterone replacement, it is important that you take the time to really figure out what is best for you. Several factors are involved in deciding what would be the best testosterone replacement option for you. Among them are cost, insurance coverage, convenience, preference for daily versus weekly use, lack of time to adhere to a strict daily schedule, fears of needles, and physician familiarity with the different products. For example, some health management organization (HMO) programs only pay for testosterone injections, as they are the cheapest option. However, some men have needle phobias and don’t like the weekly or bi-weekly injections that may require them to visit their doctors so often (some doctors don’t teach their patients to self-inject at home). Other men are prescribed daily gels even if their busy lives make it difficult for them to perfectly adhere to daily therapy. Some men without insurance and financial means choose not to seek help because they are unaware that there are patient assistance programs set up by manufacturers, or that compounding pharmacies can make cheap prescription gels and creams (details of this information are available at Appendix section). Each testosterone option has advantages and disadvantages that may be more suitable for one person than another, so read the next section on treatment options.
- Not using the correct dose: Men starting testosterone should have their blood testosterone levels rechecked two weeks to one month after starting therapy (depending on the testosterone formulation), just prior to administering the corresponding dose for that day or week. This is critical as these results are essential in deciding if the dose is right for you. Total testosterone blood levels below 500 ng/dL that do not improve your sexual desire and energy should be increased from 500 to 1000 ng/dL by increasing the frequency of injections or the dose. they assume that most men respond to biweekly injections of 200 mg or 5 grams per day of gels. The reality is that many men require higher doses to achieve total testosterone levels above the normal mid-range. These men tend to stop testosterone early because they don’t see benefit at “average” doses. Incorrect injection frequency is a common mistake and is actually worse than no treatment at all. See the following sections for more details on this.
- Cycling On and Off Testosterone: Testosterone replacement is a lifetime commitment in most cases. Once you start, you should assume you’ll stay on it unless you have an unmanageable side effect. Some patients think that “giving the body a break” once every few weeks is a good thing. What they don’t know is that during the time you are taking testosterone, your testicles stop producing it. When you stop replacement therapy, you are left with not testosterone in your system for weeks while your HPG hormonal axis normalizes. Depression, weight loss, lack of motivation, and loss of sex drive can come on fast and hard. Some men never return to their normal hormonal axis after stopping testosterone (especially if they were hypogonadal to start with). Read more details about this in the section titled “HPGA Dysfunction.”
- Stopping testosterone abruptly due to an unrelated signal: Some of us may be taking medications for other conditions along with testosterone. Sometimes new medications can increase cholesterol and triglycerides and/or liver enzymes (I call these “signals”). Some doctors prematurely blame testosterone instead of new drugs someone might have started. I have seen people suffer from this poor judgment of their doctors. Weeks later, they learn that stopping testosterone did not improve any of these problems, but by then they feel tired, depressed, and asexual.
- Not knowing how to handle possible side effects: Fortunately, this will not happen to you after you finish reading this book. I know men who discontinued testosterone due to swelling in the nipple area, acne, moodiness, perceived lack of benefit, hair loss, or an increased prostate-specific antigen (PSA) due to a prostate infection. Knowing how to manage these side effects is essential for long-term success. If you know what side effects can occur and how to manage them, you are less likely to stop therapy prematurely. You may just need to readjust the dose, change the method of delivery, or take a medication to counteract the potential problem. Only the best doctors, who don’t overreact to a side effect, know how to do it.
- Having a lifestyle that is not “testosterone friendly”: If you smoke, have more than two drinks a day, smoke too much marijuana, are overweight, don’t exercise, don’t control your blood sugar or lipids, and don’t show up for medical appointments, you don’t have testosterone. -friendly lifestyle. Studies have shown that these factors can influence your sexual function and long-term health. Too much alcohol can lower testosterone. Exercise can increase it if done correctly or decrease it if done excessively. You can read more about this later in this book.
- Do not read or remain “networked” with other patients: Being isolated about information makes you a less effective patient. There are online groups for men who discuss testosterone and other topics (see the Resources section). Sharing your experiences and learning from others are keys to being an empowered and proactive patient. It is the only way to maximize the benefits of whatever therapy you are using. Many of the practical “tricks” I have learned have been obtained through this method. The collective wisdom of other people with similar problems is more powerful than just trusting everything your doctor tells you or doesn’t tell you. Also, most doctors treat polite patients much better than those who are shy about sharing and asking questions.
- Do not change doctors when you have to: Changing doctors can be difficult, especially if you’re not a networked patient who reads a lot about your condition. Many people have no choice and have to see a certain doctor in a health management organization (HMO) setting. But most of us have the option of seeking educated doctors who won’t patronize and treat you as an equal. Your doctor should be your partner in your health, not just an unquestioned authority. Even though they are saving lives and have spent hundreds of hours in school and practice to do so, they are human beings who are exposed to similar myths and misconceptions as we are. I’ve heard the most irrational things from doctors about testosterone replacement that make me wonder how. unfortunate as their patients may be. Be sure to do your homework and find a supportive doctor. you in your quest for optimal health. See the Resources section for directories of physicians trained in the management of testosterone replacement.
- Poor compliance: Forgetting when to inject or apply gels is a common complaint. Good time management and reminders are key. Find reminders that work for you. I use Google calendar, which can be set to send me text messages on my phone as reminders. Avoid the yo-yo effect that causes poor compliance! Testosterone replacement is a lifetime and lifestyle commitment that should be carefully explored.
