The TRT Blog - Testosterone Replacement Therapy

What to Do About High Red Blood Cell Count while on TRT

Testosterone replacement therapy can increase hemoglobin and hematocrit production beyond normal/safe levels, a condition known clinically as polycythemia. If you are on TRT it is important to be regularly tested for this condition, as it may increase the risk of thrombosis and stroke.

Hemoglobin is an iron-containing biomolecule that can bind oxygen, and is responsible for the red color of blood cells. Hematocrit levels refer to the percentage of blood volume occupied by red blood cells. The test I get is a red blood cell (RBC) count, which measures the number of red blood cells per volume of blood and includes readings for both hemoglobin and hematocrit.

How to Lower RBC while on TRT

If your RBC test results come back abnormally high, treatment options given by the doctor might involve lowering your testosterone dosage or discontinuing your hormone therapy. Personally, neither of these is an acceptable option so I opt for a third: Donating Blood. The doctor could theoretically prescribe a therapeutic phlebotomy (draining some of your blood, which would be destroyed instead of donated). However, it is not a widely adopted practice and is unlikely to be prescribed. Besides that, I'd rather my blood be donated to someone in need.

Can You Donate Blood if You Take Testosterone?
The Red Cross form you fill out will ask if you take any injectable drugs, and may even specifically mention testosterone, but the fine print says "Without a prescription" so you can answer "No" to that question. As long as you are taking doctor prescribed testosterone for hormone replacement (Not 500mg + every week like a bodybuilder) it should be OK to donate because there is only a normal amount of testosterone in the blood stream.

I donate blood to the Red Cross about once every three or four months. If they have the facilities at the donation center I'll even opt for a Double Red Blood Cell Donation, and it feels much like I'd imagine an oil change might feel to a sentient vehicle.

Click Here to find a Red Cross blood donation opportunity near you.

Does TRT Improve Sex Drive?

As any guy who has been struggling with low T for a long time will tell you, the difference testosterone makes for your sex drive is profound.

I'm just happy that my mojo is back.

Over the years I've heard some great stories by people who profess that testosterone replacement has replenished their sex drive, or even saved their marriage. Some used to have problems with ED, while others just couldn't be bothered to deal with all the foreplay involved after a long day at work and an evening dealing with the kids. Sound familiar?

Does TRT improve your sex drive? In short, hell yes! And there are many studies and news stories that you can trust to back up that statement.

Studies on TRT and Male Libido

Cleveland Clinic Journal of Medicine: Andropause, testosterone therapy, and quality of life in aging men

The Journal of Clinical Endocrinology & Metabolism: The Relationship between Libido and Testosterone Levels in Aging Men

The Los Angeles Times: Drop in testosterone can affect sexual desire in men and women

The American Journal of Psychiatry: Age-Associated Testosterone Decline in Men: Clinical Issues for Psychiatry

Department of Medicine, University of Mississippi Medical Center: Considerations for the Diagnosis and Treatment of Testosterone Deficiency in Elderly Men

The International Journal of Clinical Practice: The evolving role of testosterone in the treatment of erectile dysfunction

Learn more in our TRT eBook!
Chapter 10: Testosterone and Restoring Your Libido

No News is Good News RE: Testosterone Replacement Therapy Update

I just had my testosterone levels checked again and am at 1,151 Total. I've seen "normal range" scales say different things, usually from about 240 - 250 on the low end to anywhere from 800 - 1,080 on the high end. I like to be on the high end most of the time, but will occasionally lower the doses for awhile if I feel like I'm getting too much for too long. Lately I've been feeling good with my testosterone levels, as well as my thyroid levels now that we have that dialed in (I had my thyroid removed a couple of years ago during a cancer scare).

One thing I've learned this year is that if I feel a bit of gyno come on reducing the testosterone dose is NOT the answer, especially without some nolvadex or an aromatase inhibitor. I had this self-fulfilling crisis in which I lowered the testosterone because I felt a little bit of gyno and thought that would make it go away. But that only served to create a further imbalance (in favor of estrogen), which caused the symptoms to get worse. I called the doctor and asked for some Nolvadex and he said I should up the dose back up to what I was taking (200 mg per week) normally and if it didn't go away in a week he'd prescribe me some. Well it went away in a few days. However, I would very much like some Nolvadex on hand in case it pops up again (no pun intended).

The problem with aromatase inhibitors is that they suppress the conversion of testosterone into estrogen, which is good for "cycles" but maybe not for long-term HRT. The more suppressed your estrogen levels become (below normal) the more signals are sent to convert more testosterone to estrogen. Then when you stop taking an aromatase inhibitor (e.g. Arimidex) your body will be producing WAY more estrogen than it would have otherwise. That is, at least, how my endocrinologist explained it to me. He likes tamoxafin citrate (i.e. Nolvadex) because it just blocks the parking spot (receptors) that the estrogen would normally bind to, rather than keeping it from being produced in the first place.

At any rate, I don't currently have any gyno symptoms, my sex drive is great, I'm in awesome shape and I feel good. It has been like this for several months straight now so It's All Good!

How has your therapy been going lately?

4-chloro-17a-methyl-androst-1-4-diene-3b-17b-diol

How Some Health Supplements Can Drop Testosterone Levels

I was going to title this post:
How So-Called "Natural" Testosterone Boosters, Prohormones and Other Over-The-Counter Health Supplements for Building Muscle May Cause Hypogonadism

But that's a little long ;-)

While the FDA does a pretty good job of regulating "medicines" they don't do such a good job of regulating health supplements, which generally fall under "food" guidelines, which are much more lenient than what prescription-grade pharmaceuticals have to deal with (e.g. years of laboratory testing, human trials, etc...). The FDA has tried several times to expand the definition of pharmaceutical drugs and thus their jurisdiction over health supplements. Some see this as a good thing; others see it as a bad thing. I'm going to stay out of that argument. But I will say this: There's a big difference between something like vitamin B, whey protein, or acai berries and things like 3,17-keto-etiocholetriene and 4-chloro-17a-methyl-androst-1,4-diene-3b,17b-diol.

Have you ever taken an over-the-counter, legal supplement - like pro-hormones - only to find out afterwards that you have low testosterone?
Did you gain lose fat while taking a supplement, only to gain all of it - and more - back when you stopped taking it? Did you get steroid-like side effects (e.g. gynecomastia, hair growth...) from legal bodybuilding supplements? You may be surprised to find out that many of those so-called supplements actually break down into the same ingredients found in "real" illegal or prescription-grade steroids, aromatase inhibitors, estrogen blockers, erectile dysfunction drugs and other pharmaceutical substances. If you find this difficult to believe, just read some of these recalls, which are just the tip of the iceburg (those that got busted) when compared to how many are still out there:

Recalled Health "Supplements":

Gaspari Nutrition Recalls Novedex XT, Marketed as a Dietary Supplement Containing ATD
(AKA 3,17-keto-etiocholetriene, an anti-aromatase used to lower estrogen-related side-effects in men taking steroids.)
iForce Nutrition Recalls Reversitol, a Dietary Supplement Containing ATD
(See above description RE: ATD)
Bodybuilding.com Supplements Recalled: May Contain Steroids
(Big recall in 2009 involving dozens of supplements that the FDA said should have been classified as steroids like Trenbolone, Androstenedione and Turinabol.)
Good Health, Inc. Recalls Vialipro – Contains Prescription-Only Ingredients
(These recalls in which sexual enhancement drugs sold at gas stations, truckstops and online contain real erectil dysfunction medications like sildenafil -aka Viagra - or substances like Sulfoaildenafil, that break down into Sildenafil, are quite common.)
IDS Sports Conducts a Voluntary Nationwide Recall of Bromodrol, Dual Action Grow Tabs, Grow Tabs, Mass Tabs, and Ripped Tabs TR
(Similar to the Bodybuilding.com recall, there were several supplements that were found to contain ingredients the FDA deemed should have been classified as steroids.)

Want to see hundreds more like this? Check out US Recall News' Dietary Supplement section

If something is being marketed in the back of a bodybuilding magazine with steroid-sounding names like Bromodrol, Dbolz, Testosterone Booster Tripple X... you should think about what that marketing is trying accomplish. I'm not anti-steroids when it comes to adults making their own health decisions. And I certainly don't think the government should be telling us what vitamins we can take without a prescription. But neither should teenagers, women or unsuspecting male athletes be conned into taking health risks and job risks under the false pretense that they are taking "legal" supplements that don't have any side effects.

So if you've ever taken a health supplement that produce too-good-to-be-true results, only to find that you crashed when you came off, or that your testosterone levels were low after long-term use of these drugs, you may have actually been taking steroids, or something analogous to them in effects and side-effects. It makes me wonder how many guys end up on lifelong testosterone replacement because of these supplements, especially since they probably didn't take appropriate post-cycle-therapy precautions.

Stockpiling Testosterone and Thyroid Medications

I'm the type that plans for the worst and hopes for the best. We have a pantry full of canned food from the garden, a gas generator for power outages, and long-term supply of clean drinking water and several first-aid kits throughout the house. That's why I read this blog, which inspired me to write my own post about stockpiling medication. I don't think the zombie-apocalypse is coming and I'm only half-sure that we could face some kind of long-term economic meltdown. I'm not a conspiracy nut and I don't have a bomb shelter. I'm a pretty normal guy, actually. But in the event that something catastrophic does happen - economically, socially or environmentally - I wouldn't want to be put in the situation where I only have 1-3 months worth of medication on-hand. In my case, I depend on testosterone and thyroid hormones. Without them life gets pretty bleak for me. With them I not only feel "normal" - I feel great.

All of this is to bring up the topic of stockpiling testosterone, thyroid hormone and any other medication you have to take long-term. Here are some options we can consider:

Ask your doctor if he/she would prescribe you enough to last a year. I don't mean enough "refills" but enough at once. A refill does precious-little if the pharmacies have all been pillaged. Pro: It is perfectly legal. Con: Fat chance you'll get them to agree, and it would be very expensive if you did because insurance is unlikely to cover that.
Head down to Mexico or another country that has cheap meds and shady doctors who will prescribe you whatever you want. Pro: It comes with a vacation. Con: Crossing the border with a year's worth of any medication is going to be risky - especially controlled substances like testosterone.
Find a compounding pharmacy or HRT clinic (if hormone meds are what you need) and ask for the year's supply. Pro: They tend to be a little more understanding than the average endocrinologist and, when it comes to uninsured meds, a little cheaper than the local pharmacy. Con: You have to find one you can trust.
Start skipping a dose now and then, or taking less for awhile, and gradually build up a stockpile. Pro: Easy, cheap and legal. Con: It would take a very long time and I don't like the idea of skipping doses.
Tell your doctor you're on vacation and forgot your prescription next time you're out of town. Pro: They'll usually write you a new prescription, which is often covered by insurance. Con: You can only use this trick once or twice a year without raising suspicions.

In the end I think I'm going to combine several of the options above for a multifaceted approach to stockpiling my meds in case of a long-term shortage or emergency. Hopefully it will never come to the point where I'd not be able to obtain my medications, but I'd rather be safe than sorry when it comes to something as important as access to my thyroid medication or testosterone.

A note about expiration dates: The pharmaceutical companies like to make money. That much is obvious. One way they generate more revenue is by making expiration dates much sooner than they need to be. This keeps them safe from lawsuits regarding under-dosed meds (they start gradually losing potency after expiration, but don't just suddenly become "no good") and keeps you buying more medication. The best thing to do once you build up a stock-pile is to rotate your meds so you are using the oldest from the shelf and replacing them with the ones you just got from the pharmacy. In this way you'll never be using expired medication, and will always have a surplus to cover you for long-term shortages and emergency situations.

Anyone have any better ideas about this topic, or anything else to ad?

How Much Is Gynecomastia Removal Surgery?

Luckily mine isn't so bad that I would consider gynecomastia removal surgery at this point, but I do get the "sensitive" and "itchy" nipple feeling from time to time and I can feel a pea-sized bit of tissue on the right side. It comes and goes. Sometimes I'll take some Nolvadex if I happen to have any on hand. I've asked my doctor about prescribing me Arimidex or some other aromatase inhibitor but he maintains that they are not needed at my dosage. He also doesn't want to test me for estrogen levels because he says what really matters is that the balance is in favor of testosterone. So, meh... I have some good and bad things to say about my endocrinologist.

The average amount charged by the plastic surgeons is about $2,000 - $3,000 for both sides. I also found out that some doctors recommend getting both sides done even if your problem is in one side since eventually you'll probably have to deal with the other side anyway. Of course, they may just be wanting more of your money.

I guess I could afford $3,000 at the high end of the range if it came to that. I've heard that it's a one-time surgery because they take out the tissue and it doesn't grow back. I'm not sure how true that is. Anyone know? For now I'll just try to keep it from getting worse. It's not anything anyone would be able to see at this point, even with my shirt off.

Got a gyno-related story? I'm sure the other visitors would love to hear about this topic that affects a lot of guys, especially those with endocrine problems, but one which we are unlikely to be able to talk about to our friends and family.

Three Month Update on TRT

I'm not sure exactly how long I've been on TRT now, but I think it's been about three months. I haven't done the blast-cruise thing because I ran into some other health problems (benign thyroid tumors that my doctor thought "could be" malignant at the time) that took awhile to figure out, and longer to heal from surgery. I figured it would be pointless to take more than prescribed if I can't make the best of it in the gym. Also, the wife is pregnant (WAY pregnant) so having a better libido is kind of superfluous unless I feel like jerking off more often. TMI? IDGAF.

I've been taking 100mg per week of testosterone enanthate and feel pretty good. I don't feel like I do when I take 200mg per week, but I don't feel like crap - which is how I feel when I'm not on TRT. The only problem is I think I'm developing a small case of gynecomastia. It's nothing you can see, but I can feel it under my skin and sometimes that area is itchy or sensitive. The doctor assured me that this wouldn't happen on normal doses - which was his reasoning for refusing to prescribe me Nolvadex or an aromatase inhibitor like Arimidex - so it should be an interesting conversation when I go in for my appointment in a few weeks and he feels the lumps.

I'm not all that concerned though. A: It's easily taken care of with a relatively simple surgery and B: I can probably keep it from progressing as long as I start taking Nolvadex or Arimidex.

Having been on just "normal" levels of testosterone, and having been out of the gym for several months, I'm not feeling in the greatest shape. The fact that your thyroid is responsible for your much of your metabolism (and mind has been completely removed) probably doesn't help matters. There's one more medication that I'm on for life, and that I haven't fully dialed in the dosage on yet. But I'm confident that I will be able to get the dosage right with time, afterwhich I look forward to getting in the best shape of my life by the age of 36. :-D

So that's my update. How are YOU doing?

502 – My Lucky Number

After one month of testosterone injections of 100mg per week (.5 mil of 200mg/mil injectable oil) using testosterone enanthate my test levels are at 502. I wanted to take what was prescribed for awhile to see where that would put me. This was also near the end of the week so I'm guessing that is the lower end of the spectrum, although when injecting enanthate (generic form of Delatestryl) every week the spectrum probably isn't too wide. My guess is I'm anywhere from between 500 and 800 ng/dl. The government website Medline Plus puts the "normal" range for men at 300 to 1,200 ng/dL. Given that this includes 25-year-old guys at the peak of their physical condition, I think maintaining somewhere between 500 and 800 is going to work out well for me healthwise. I feel good in this range.

Now... with that said, I am hereby embarking on the "Blast" phase of my year, where I will be taking double that amount for several months before tapering back down to 100 mg per week. I believe at 200mg per week I will still be within safe-enough levels to avoid any major side effects (hopefully) associated with steroid use, as bodybuilders frequently start at a minimum of 500mg per week (up to more than 2 grams in some cases) in addition to several other androgenic / anabolic steroids like nandralone, stanozolol, dianabol and equipoise. At this point one needs to take a whole host of other medications to combat the side effects, both during the "cycle" and during the post-cycle-therapy (PCT) phase, including things like tamoxifen citrate (generic Nolvadex), clomophene (Clomid), and anastrozole (Arimidex). Since I don't plan on having any more children, I am not even taking HCG. Right now it's just testosterone, although I do plan on having some Nolvadex and/or Arimidex on-hand just in case I feel any estrogen-related side effects.

So that's the plan. If I'm going to be on testosterone for the rest of my life, I might as well enjoy the benefits of being able to have a great sex drive and physique for the rest of my life without having to hassle with the crashing testosterone levels experienced at the end of normal testosterone cycles for men who aren't on lifelong TRT.

Please keep in mind that A: I am not interested in being a bodybuilder and do not need to take 500mg of testosterone to be "in good shape". B: I want to avoid as much ancillary medication as I can without experiencing estrogen-related side-effects. C: I do plan on tapering from 200 mg/week, to 150 mg/week for one month before going to the normal 100 mg/week to give my body time to metabolize some of the estrogen and catabolic hormone build-up while staying in the proper balance of having more testosterone in relative amounts to the other hormones.

I'd appreciate any feedback you might have on this, especially if it sounds like something you have tried yourself in the past.

Two Ways to Save on Testosterone Medication

So I've been taking testosterone enanthate for a few weeks now and feel good. I have another appointment with the endo tomorrow that I will update you on, but I'm hoping it checks out. They did an ultrasound on my thyroid because the doctor said it was swollen. I also have some symptoms of hypothydroidism (nervousness, trouble sleeping, twitching eyelid...) but that could all be stress. I'll get the pre-testosterone blood tests back, and I'm hoping he'll order another one to see where I'm at now - but that probably won't happen for a few more months, as I think he'll just want me to "stay the course" for awhile since I feel better.

But that's not what this post is about. I wanted to compare prices on the three options I had for buying my testosterone medication (200mg / mil bottles of testosterone enanthate for injection) so you can see how much money can be saved when you shop around.

Option #1 ($210 for 10mil) was going through the regular pharmacy, and that was after insurance coverage.
Option #2 ($75 for 5mil) was going through my insurance company's pharmacy, or at least one that they have some sort of monetary relationship with. I'm not sure how it all works, but this is a mail order deal and they usually send you three month's supply up front for most drugs, but will only do 1 month at a time for controlled substances like testosterone.
Option #3 ($100 for 10mil) from a mail order HRT clinic (the kind I discussed in this post about if you order testosterone online and whether that is legal) and this place didn't take insurance.

I'm going to take 150mg per week of testosterone. The doctor prescribes 100mg, but I have a some left over from when I tried to get off TRT and, frankly, I feel better on 150mg per week while still being in the normal range. I need to get another blood test done, but I've been on this roller coaster long enough to know my body and I'm feeling in the mid-to-upper ranges of "normal" at this dose. I will give you hard numbers when I get another blood test done. What I'm getting at is how much this costs per week for each option:

#1 = $31.50 (CVS, Walgreens, Etc...)
#2 = $22.50 (Medco via my health insurance company)
#3 = $15.00 (Online HRT clinic)

Clearly the HRT clinic is the better option for those without health insurance (or without insurance that will cover TRT), or who don't want to go through their health insurance, or who have high deductables and copays, etc... It is just cheaper, and my experience has been that it can be very reliable if you find the right place.

HOWEVER - if your insurance covers testosterone injections that you can do at home and your deductible is low enough that you're going to meet it ever year - option #2 (if something similar is offered by your provided. You should ask.) is actually the better option in the long run. This is what I'm probably going to end up going with, although I may use the HRT clinic from time to time.

Option #1, unfortunately, is what most Americans tend to go with. Don't ask me why. I guess we've just been conditioned to accept our lot as having one of the worst healthcare systems in the developed world. I don't mean to bitch or be unpatriotic here. I'm not trying to get into a discussion about the Big Healthcare Debate. All I want to say is that you have other options and exploring them could save you hundreds, possibly thousands, of dollars every year over the course of the rest of your life. It's worth making a few phone calls.

I guess there's a fourth option: Drive down to Mexico. But I'm not so sure I'd trust a pharmacy like the one pictured in the photo above when it comes to something I'm injection into my body ever week. ;-)

Good luck!

Getting Back on Track – Testosterone Enanthate Here I Come!

After a three-month waiting list (I live out in the boonies) I finally got to see the only endocrinologist within 50 miles. We did some blood work that I haven't gotten back yet, and he said my thyroid was swollen so I have to get a sonogram done on that in a couple of weeks. Those two things aside, we're going ahead with testosterone replacement therapy and I'm looking forward to getting life back on track again and settling into some kind of rhythm.

While my primary care idiot physician was only prescribing me one 200mg shot of testosterone cypionate every month (fucking moron! Sorry, couldn't help it.) and made me come into his office for it (so they could charge me $85 and wait an hour to get stuck.) this new endo is prescribing 200mg of testosterone enanthate every other week, and is letting me take it from home. He said if I'd rather take 100mg every week and don't mind the shots then he's all for it. I get a three-month supply for under $100 and even that is tax-free since it gets paid out of my health savings account.

He said he wanted to try just the testosterone for six months and then do some blood work. His hope, and mine, is that I can just take the test without any other drugs (estrogen blockers, aromatase inhibitors, HCG...) I know my boys will shrink away without the HCG, but my wife is pregnant now and we were only planning on having one kid. I have some "spares" in the sperm bank just in case.

So that's that. Hopefully there'll be no more bitching and whining from me about having to take testosterone for the rest of my life. I'm pretty sure I've accepted it, at least for now. You have to understand that the last few months of posts have been while I'm trying to function without much testosterone (hovering around 200 +/-) so if I've been acting like a little bitch it's because I've been feeling like one too.

No more. Today I got my first 200mg shot of test in awhile, and will be on TRT regularly. Acceptance is a good thing. I feel good.

I'll keep posting updates; will let you know if any health issues pop up that other TRT guys should think about. I might even use the TRT dose as a "cruise" does and go up to 500mg per week for a few months out of the year. My HPTA is already all fucked up, so I might as well have the advantage of not crashing out after a cycle. The only immediate problem I can see is how to get my wife's libido on the same track as mine is going to be. Something tells me that won't be easy. ;-)