TRT and Anabolic Steroid Side Effect Management Table

[Nelson Vergel]

It is suggested that you talk to your physician about the need for proper blood tests before and during testosterone.

Read this first since it is the most common testosterone side effect: High hematocrit

Problem	Solution and Comments
Acne/oily skin Caused by Dihydrotestosterone (DHT) effect on increased oil production	· Accutane– a powerful prescription item - 40 mg/day for one week sometimes stops acne if started at the first sign or as directed by your doctor. Accutane is potentially highly liver toxic and can lower testosterone. Do not use unless as last resort. · Sporanox – Effective for some acne-like eruptions that are caused by fungi. Some doctors also prescribe antibiotics, like tetracycline, for acne with good results. . Minocycline . Shower with Nizoral shampoo· Anti-bacterial soaps - Use a scrubbing brush and wash twice a day, especially after sweating during a workout. · UV light or sunlight with moderation. . Zinc/copper supplements or zinc soaps may help some men with acne. . Other options: How to treat and prevent acne
Hair loss Caused by DHT effect on hair follicles	· Nizoral shampoo– Available by prescription and over-the-counter as a lower dose product. · Rogaine – Available over the counter · Propecia (finasteride) - Available by prescription. A few males experience decreased erections with finasteride. Do not use.
Increased sex drive	· A problem? Sex drive is part of quality-of-life. This is not necessarily a bad side effect. Enjoy it.
Unresolved erectile function	· Viagra, Cialis, Levitra – Available by prescription; enables robust erections. If you have sinus congestion or headaches/backaches (Cialis) take non-drowsy allergy medication and ibuprofen. ED drugs can be combined with alpha-blockers and/or nitric oxide precursor amino acids (arginine or citrulline) · Yohimbine (Yocon) - Available by prescription; increases sex organ sensitivity. Can increase heart rate and blood pressure · Muse - Available by prescription; pellet inserted into the urethra to produce an erection. Unpopular · Trimix – Available by prescription from compounding pharmacies. The best and cheapest formula for injection into the penis for lasting erections. · Caverject - Available by prescription. An injection into the penis that produces an erection that can last 1 to 2 hours. Be careful with injecting too much since it can produce dangerously ling erections that need to be treated in emergency rooms! Follow instructions from your urologist. · Papaverine – An older injectable medication, less expensive than Caverject. · Wellbutrin – Prescription at 300 to 450 mg/day; increases dopamine. · Human chorionic gonadotropin (HCG) – First dose is 2,000 IU, then 250-500 IU twice or three times a week. No protocol has been proven in controlled studies yet. When Testosterone Replacement Doesn’t Lead to Better Erections
Insomnia Usually, this is caused by dosages that are too high. Find the least amount that gives you a good result.	· Sleeping medications – e.g. Ambien, Sonata, Lunesta, Restoril · Melatonin- 1 to 3 mg before bedtime. If you wake up groggy after 6 hours your dose should be lower. · Avoid working out too close to bedtime. · Limit caffeine, especially after 3 pm. · You may want to try a sleep formula with tryptophan, melatonin, and magnesium. Nutrients do not work as well as drugs, but they can help some people. Article: How to protect your circadian rhythm
Sleep Apnea	· Have your doctor prescribe a sleep study if you snore and wake up tired even after 7 hours of sleep. Some people may have to wear a C-PAP machine to breathe at night. Visit Home - SleepApnea.org for more information. There are also oral devices for those people who fail CPAP. Fatigue- When Testosterone Is Not Enough
Testicular atrophy	· Human Chorionic Gonadotropin (hCG)– One 2,000 unit injection per week for 2 weeks, followed by maintenance of 350-500 IU twice a week. For men who want to remain fertile while on TRT, 500 IU every other day has been studied. Watch this video on hCG and men
Enhanced assertiveness or reactivity.	· Make sure you are getting enough sleep. . Count until 10 and be aware of your interaction with others. · Decrease caffeine. · Meditation, mindfulness, yoga, breathe from your belly for a few minutes when overreacting. · The testosterone dosage may be too high. · Ask yourself: Do I need to always be right? . Vent extra energy at the gym, sex, and sharing with your buddies at www.excelmale.com
High blood pressure/water retention	· Caused by sodium retention in the kidneys. Usually it has nothing to do with high estradiol. Blood pressure medications - Elevated blood pressure may be transient or not. Try ACE or ARBs since they seem to have fewer sexual dysfunction related effects. · Magnesium (600 mg/day); vitamin B6 (100 to 200 mg/day); may help reduce water retention. · Water - Drink extra water every day to help flush the kidneys. . Make sure you are doing cardio exercise at least 3 times a week for 30 min. Sweat and lower your salt intake since TRT increases sodium retention in some men.
Gynecomastia- RARE in TRT (male breast development) Caused by overproduction of estrogen in the presence of low testosterone and high IGF-1	· Caused by low testosterone in the presence of high estradiol, IGF-1 and genetic predisposition. Rare in men on TRT. - If needed, Arimidex (anastrozole) inhibits estrogen production. Available by prescription. 0.5 mg/week max. Ensure that your estradiol is never under 20 pg/ml (by sensitive test) since it is needed for bone, skin, brain, lipids, libido, good lipids and hair health. Only 0.3-0.4% of testosterone is aromatized to estradiol. Current lab ranges were derived from men not on TRT. Most men on TRT do not need anastrozole. Be careful not to crash your estradiol. · Nolvadex (tamoxifen)– Competes with estrogen for receptors. Available by prescription, 10 to 20 mg/day. Use of Nolvadex during a steroid cycle may reduce the net anabolic effect, as it decreases the production of GH and IGF-1. . Severe cases may require removal of the breast tissue by surgery. · DHT cream- Some people have obtained great results by rubbing a 10% DHT cream on their nipples. Not available in the US but some people order it online from Germany . Read about medications/foods to avoid if you have gynecomastia. . Those who do know to respond to the above, check other reasons Watch this video about estradiol in men Check your estradiol with the right sensitive test.

To find out how long it takes testosterone replacement to potentially show benefits, read this article.


For affordable blood tests in most cities in the U.S. (Prescription provided): DiscountedLabs.com

We also highly recommend reading this and other articles from our friend Lee Myers from peaktestosterone.com : Testosterone Risks

Metzger, DL, et al. Estrogen receptor blockade with tamoxifen diminishes growth hormone secretion in boys: evidence for a stimulatory role of endogenous estrogens during male adolescence. J Clin Endocrinol Metab (1994) 79(2):513-518.

[ii] el-Sheikh, MM, et al. The effect of Permixon (saw palmetto) on androgen receptors. J Acta Obstet Gynecol Scand (1988) 67(5):397-399.

[iii] Suzuki, K, et al. Endocrine environment of benign prostatic hyperplasia: prostate size and volume are correlated with serum estrogen concentration. Scand J Urol Nephrol (1995) 29:65-68.

[iv] Gann, PH, et al. A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia. The Prostate (1995) 26:40-49.



BLOOD TEST TARGETS FOR TESTOSTERONE REPLACEMENT THERAPY

 

[Nelson Vergel]

• Sticky: How to Manage Increased Blood Thickness (Hematocrit) Caused by Testoste
• Sticky: Does Testosterone Cause Prostate Cancer? Can Men Treated for Prostate Cancer Use TRT?
• Sticky: Role of Estradiol in Men and Its Management
• Sticky: The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility
• Sticky: Water Retention Caused by Testosterone May Have Nothing to Do with Estradiol
• Sticky: Gynecomastia: Clinical evaluation and management
• Sticky: Effect of DHT on Prostate and Sexual Function: Review of Studies
• Sticky: TRT & Swelling: Understanding and Managing It
• Sticky: Bloated and Swollen on Testosterone: What Tests to Run
• Sticky: Can Testosterone Induce Blood Clots and Thrombosis? Interview with Dr Charles Glueck
• Sticky: Testosterone Decreased HDL: What Can I Do?
• Sticky: Getting Off Testosterone or Anabolics? You May Want to Read These PCT protocols
• Sticky: Testosterone and Acne: What You Need to Know
• Sticky: Does your doctor prescribe testosterone plus HCG?
• Sticky: Testosterone, BPH and Lower Urinary Track Symptoms
• Sticky: What high blood pressure meds are the most erection friendly?

 

[Nelson Vergel]

water retention excelmale.com site:www.excelmale.com - Google Search

Gynecomastia Associated with a Combination of High IGF-1 and Estradiol In Adolescents

 

[Nelson Vergel]

PRINT TABLES: Blood Test Targets and How to Manage Side Effects of TRT

 

[Nelson Vergel]

Dr Morgentaler Clarifies Misperceptions of Testosterone and Heart Disease Risk

 

[Nelson Vergel]

 

[Nelson Vergel]

Testosterone Replacement Blood Test Targets

 

[Nelson Vergel]

Controversies in Testosterone Replacement Therapy (TRT)

Controversies in Testosterone Therapy ABSTRACT Introduction: Testosterone prescriptions have increased dramatically in recent years, largely because of changes in expert guidelines. Concerns have been raised that testosterone therapy (TTh) may be associated with an increased incidence of...

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[Nelson Vergel]

Recommended Lab Tests Before Starting and While on TRT​

Free Download of Attached File (For registered members)

Testosterone Replacement Therapy (TRT) has changed the lives of many men around the world. Like any therapy, it can have great benefits if properly managed but negative side effects if not monitored. This article will briefly and simply review the different TRT tests that most physicians use to monitor your progress while minimizing potential side effects.