The TRT Blog - Testosterone Replacement Therapy

Menopur - An alternative to TRT for men with secondary hypogonadism?

Two Alternatives to TRT for Secondary Hypogonadal Men

As I posted before, I have secondary hypogonadism. Read more about the difference between primary and secondary hypogonadism here if you don't already know what that means. Basically, if you have primary hypogonadism (testes are not producing enough testosterone) what you would probably end up doing is taking testosterone for the rest of your life. If you have secondary hypogonadism (testes are fine; problem is elsewhere, such as LH and FSH), taking testosterone will give you primary hypogonadism. However, that doesn't stop doctors from prescribing testosterone to treat secondary hypogonadism. They are comfortable with the medications available; have seen them work wonders for hypogonadal men; and have probably noticed relatively few side-effects for a huge improvement on quality of life.

But there ARE other options. I'm not talking about taking tribulus or zinc supplements; I mean real treatment alternatives that have been anecdotally shown to help some men return their system to its proper balance. The two I have been reading about are listed below....

#1 - Block Estrogen Production
What I'm doing is taking a drug called Arimidex, which was designed to reduce estrogen in women at risk of, or for early treatment of breast cancer. One of the places on which I've found a lot of anecdotal information are the various steroid forums frequented by amateur and professional bodybuilders. A lot of bodybuilders take this drug to combat the side-effects of juicing up with ten times or more of the "natural" levels of testosterone men are supposed to have. The body responds to this much testosterone by making more estrogen (or estradiol to be more precise). I am not doctor, but my understanding is that the male body turns some of the excess testosterone into estrogen. This is called aromatization. Aromatase inhibitors like Arimidex keep that aromatization from happening.

It has been theorized by many in the bodybuilding community, based on limited studies and decades of personal experience, that estradiol is more to blame for shutting down the natural production of testosterone than the actual testosterone that is being injected. It has also been theorized that bringing your body's estradiol levels to near-zero will stimulate your body to produce more testosterone so that it can aromatize it and make estradiol. Although I'm not going to link out to online steroid conversations, there are lots of threads on bodybuilding forums outlining some of the concept and sharing some anecdotal evidence as to the efficacy of this approach. Use Google and I'm sure you'll find them. But keep in mind this approach is using a medication for purposes other than what it was intended for, and for purposes which the medication was not tested for.

With full understanding of the above, I am currently trying this alternative with the knowledge and support of my primary care physician. If it doesn't work within 6 months I will move on to the second alternative below. By the way, an endocrinologist isn't going to want to let you try this approach. He will claim it has to do with these medications not being tested on men, but given the relatively low risk of side effects (when compared with permanent testosterone replacement) of temporarily taking aromatase inhibitors - my guess is it has more to do with the fact that this could FIX your problem. Then your endo would be out of a job. ;-)

#2 - Treat the Problem, Not the Symptom
One of the readers here pointed me to a drug called Menopur. Again, this is a drug for women. It is a fertility drug used to induce the development of multiple eggs and pregnancy in women who are able to produce and release eggs (ovulate). In other words, this is the kind of stuff to blame for Octamoms. But really the active ingredients are two hormones that are produced in men called follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These two hormones are responsible for telling your testes to make testosterone. In my case, as is often the case with secondary hypogonadal men, my body is not producing enough of either of these hormones. So why not take THIS drug instead of taking testosterone? Why not replace what I'm missing instead of replacing the hormone that what I'm missing is supposed to be producing?

If one of the two above alternatives to permanent testosterone replacement therapy (TRT) works for me I'll let you know, at which point I'll probably give up the blog. If neither works for me I will resign myself to a life of testosterone injections (I'm done with the creams; they give me terrible chest acne, and sometimes boils, not to mention the danger of contaminating surfaces like the faucet and towels, which my wife also touches) and you will have an author here at the testosterone replacement therapy blog for a long, long time...

Mail Order Testosterone: Legal TRT?

Looking for an online TRT clinic? Check out these options.

Being an American, the first thing I worried about when my doctor said I needed to be on TRT (testosterone replacement therapy) for the rest of my life was: How is this going to affect my health insurance costs?

Maybe you have health insurance, but they won't cover testosterone injections unless the doctor gives them to you. Since most people can't afford to take time off work every week to visit a doctor's office, they're stuck taking either Testim or Androgel or getting testosterone by other means.

Some choose to contact a mail order compounding pharmacy, get some independent lab tests done, and have a "phone consultation" with one of their doctors.

The Nuts and Bolts of DIY Testosterone Injections

If you think you might need TRT and haven't been officially diagnosed as hypogonadal by a doctor yet there is an option that doesn't involve the record-hungry healthcare system: Get the test done privately and pay in cash. You don't need a doctor to read the test results. If your testosterone is low, contact a compounding pharmacy or hormone replacement / anti-aging clinic that doesn't take health insurance. You can take the shots yourself in the privacy and comfort of your own home; it won't be on your medical records; and you won't end up spending much more than you would with co-pays to the doctor and pharmacy if you'd gone the traditional route.

The Legality of Mail Order Testosterone:

This is a gray area. Testosterone is a schedule III drug and is illegal to obtain without a prescription. The compounding pharmacies and male HRT clinics (also many anti-aging clinics) often have a doctor in-house that will interpret your test results and have a phone consultation with you. That doctor, who you never see in person, will prescribe your testosterone (as well as growth hormone, which is an even grayer area) and any other ancillary drugs (such as Nolvadex or Arimidex to prevent side effects like gynecomastia). They usually don't accept insurance and will ship your HRT drugs out by mail within one week. SO... technically, you're getting your drugs from a legal pharmacy, which also happens to have a doctor on staff to provide the prescription. I don't think you'd have anything to worry about in court. The HRT or Anti-Aging clinic, on the other hand, might have some legal questions to answer should the DA or DEA ever decide to pay them a visit, which has happened in the past.

Tips on Ordering Testosterone Online
If you order testosterone online, follow these tips to stay as close as you can to being "legitimate" in the eyes of the American court system...

Never order from overseas
Always obtain test results from a legitimate lab showing abnormally low testosterone and/or growth hormone
Never deal with a compounding pharmacy, HRT or Anti-Aging clinic that does not have a legitimate doctor on staff. Get the doctor's name, find out what medical school they attended, and verify that they are still recognized by the appropriate boards.
Never send cash in the mail. A legitimate HRT clinic will usually accept credit cards, but if you feel uncomfortable with that you can send a check, cashier's check or money order.

Please read this disclaimer: I am not a doctor. I am not an attorney. I am not qualified to dispense legal or medical advice. The information above are only my opinions and should not be taken as legal or medical advice. Always speak to a qualified attorney when you have legal questions. Always see a qualified health professional when you have medical questions.

ERT Vs TRT: The Great HRT Double Standard

Why is it ok for post-menopausal women to take estrogen, which is known to increase the risk of breast cancer, but it is taboo for men to take testosterone? What is the difference between estrogen replacement therapy (ERT) and testosterone replacement therapy (TRT)? They are both forms of hormone replacement therapy (HRT) designed to return hormone levels to the normal range for someone of a certain age and gender.

Do we care more about creating a "level playing field" in baseball than we do about our own health and wellbeing? The word "steroids" has been victim to so much stereotyping, so many unfounded rumors and quick-science, that the mere mention that you're taking testosterone sends friends and family members into a panic - as if you're setting out to destroy your life and become some gigantic freak bodybuilder.

Speaking of gigantic freak bodybuilders, I don't see anything wrong with that either. If an adult wants to risk their own health to change the way they look, what business is that of federal, state and local governments? Are they going to make plastic surgery illegal? It is essentially the same issue (risking your health to look "better") with the only difference being that many, MANY more people die, are disfigured permanently, and are permanently disabled due to plastic surgery every year than those who take steroids.

But back to the point at hand... It is a double standard, a downright sickening hypocrisy, that HRT for women is almost universally accepted as "healthcare", while HRT for men is almost universally rejected as "steroid abuse". As this website matures I will be further elaborating on this issue, as it is one that happens to be of great interest to me.

Primary Hypogonadism VS Secondary Hypogonadism

Most men who require hormone replacement therapy with testosterone have some form of testicular injury or primary hypogonadism. In other words, the problem is all in their balls. Those of us who have secondary hypogonadism often have perfectly functioning testes, but the problem lies elsewhere in what's known as the Hypothalamus Pituitary Testicular Axis (HPTA), which is responsible for keeping our male hormones in proper balance.

The problem with secondary hypogonadism, is that the treatment actually CAUSES primary hypogonadism by introducing exogenous (external) testosterone into the system. To understand that, first let's go over some basics...

Hypothalamus:
Among other things, this part of your brain sends GnRH (gonadotropin releasing hormone) down to instruct the pituitary gland to create more LH and FSH.

Pituitary Gland:
Among other things (like growth hormone), this gland at the base of your brain secretes LH (luteinizing hormone) and FSH (follicle stimulating hormone), which travel down to the testes / gonads to instruct them to create more testosterone.

Testes / Gonads:
Endocrinologists might get upset that I use these terms interchangeably. Oh well, screw 'em. You get the point. Your "balls" get the message from your pituitary gland to make more testosterone.

The Axis:
The important thing to remember about the hypothalamus pituitary testicular axis (HPTA), also sometimes called thehypothalamic-pituitary-gonadal axis (HPG), is that it does not run only in one direction. The body tries to reach homeostasis - a healthy balance of these hormones - and the entire system can fall out of whack once you start introducing any of these hormones from outside sources. Which brings me to...

The Problem With Taking Testosterone to Treat Secondary Hypogonadism:
First of all, let's be clear - I take testosterone to treat my secondary hypogonadism. That's because there is currently no choice. Why "cure" something when you can have a customer for life? Why treat my body's inability to create enough GnRH when that would require research money and you already have a product that fixes my "symptoms" ?

Digression aside, the problem with introducing an external source of testosterone is that eventually your gonads see that they are no longer needed. They pack their bags, or - rather - pack INTO their bags, and practically disappear over time. Now guess what? Not only do I have secondary hypogonadism, which might have been made even worse, but I now have a classic case of primary hypogonadism to deal with if I the medical community should ever find a treatment for secondary hypogonadism.

Here's an idea - Why don't pharmaceutical companies make GnRH and market that to the endocrinologists so they can treat the source of my problem? Am I being naive here? Is there more to it than my not-medically-trained mind understands?

All gripes aside, I do feel great. Sure I'll be tied to this drug like a prisoner for the rest of my life, but I feel ten years younger. I'm happy, confident, strong, lean, sharp, motivated, and a lot more fun in the bedroom. And I've yet to see any CONVINCING studies about the long-term health dangers of testosterone replacement in hypogonadal men. Heart disease? Prostate cancer? Show me the studies? These are often-quoted side-effects, but all I hear are doctors "deducing" them because, for instance, taking away a man's testosterone seems to help with pre-existing conditions of prostate cancer. But that is not a cause-and-effect relationship. Just because removing testosterone helps treat or minimizes the recurrence of prostate cancer, doesn't mean it causes prostate cancer. Does it? OK, ok, that's anothe post entirely...