I have heard of so many mistakes being made by people taking testosterone replacement therapy. Some mistakes seriously impacted their quality of life, or resulted in men stopping testosterone prematurely. Here are a few of the biggest errors I've witnessed:
Using “street sources” of testosterone: I have met many men whose doctors do not support their use of testosterone, so they buy it on the black market or from some guy 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 without a prescription. Be aware that the buying or the using of testosterone without a 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 that justifies their use (e.g. anemia, wasting, hypogonadism). If you still decide to get testosterone in the black market, be aware that you could set up by informants who may alert the DEA of your purchase. Also, importing testosterone even if you have a prescription is not legal. In a nutshell: only use testosterone after a physician gives you a prescription 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 grape-seed oil. You also run the risk of exposure to contaminants that could cause infection.
Not having a doctor follow-up your blood work is a sure way to get in trouble! If you have low testosterone, there are hundreds of doctors who will prescribe testosterone replacement therapy. If you are using testosterone to increase muscle mass or to improve athletic performance even though you have normal testosterone levels, be smart and research all you can. And please, read the information in the book about how stopping testosterone can cause health problems (if you are using black market testosterone, chances are that your source will eventually run out).
2. Not exploring what testosterone option is best for you: Since there is an assortment of options for testosterone replacement, it's important that you take the time to really find out what's 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 stick to a strict daily schedule, fears of needles, and physician familiarity of the different products. For instance, some health management organizations (HMOs) programs only pay for testosterone injections since they are the cheapest option. However, some men have needle-phobia and dislike weekly or bi-weekly injections that may require them to go see their doctors that frequently (some doctors do not teach their patients to self inject at home). Other men are prescribed daily gels even if their busy lives make it difficult to be perfectly compliant to daily therapy. Some men without insurance or financial means decide not to seek help since they do not know that there are patient assistance programs set up by manufacturers, or the fact that compounding pharmacies can make cheap gels and creams with a doctor prescription. Every testosterone option has advantages and disadvantages that may be more suitable for one person over another, so read the following section on treatment options.
3. Not using the right dose: Men who start testosterone need to have their testosterone blood levels rechecked two weeks or one month after they start therapy (depending on the testosterone formulation), right before they administer the corresponding dose for that day or week. This is critical since these results are essential to deciding if the dose is right for you. Total testosterone blood levels under500 ng/dL that are not improving your sexual desire and energy should be increased to 500 to 1,000 ng/dL by increasing the frequency of injection or the dose. Some doctors fail to retest after they get a patient started on testosterone since they assume most men respond to 200 mg bi-weekly injections or 5 grams per day of gels. The reality is that many men require higher doses to reach total testosterone levels above midrange of normal. Those men tend to stop testosterone early because they perceive no benefits at “average” doses. Incorrect frequency of injections is a common mistake and is actually worse than not getting treatment at all.
4. Cycling on and off testosterone: Testosterone replacement is a life-long commitment in most cases. Once you start you should assume that you will 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 do not know is that during the time that you are taking testosterone, your testicles stop producing it. When you stop replacement therapy you are left with no testosterone in your system for weeks while your HPG hormonal axis normalizes. Depression, weight loss, lack of motivation, and loss of sex drive can appear rapidly and with a vengeance. A few men never have their hormonal axis return to normal after stopping testosterone (especially if they were hypogonadal at baseline).
5. 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 the new medications that someone might have started. I have seen people suffer because of 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.
6. Not knowing how to manage potential side effects: Luckily, this will not happen to you after you finish reading this book. I know men who stopped testosterone due to swelling in their nipple area, acne, moodiness, perceived lack of benefit, hair loss, or a prostatic specific antigen (PSA) increase that was due to a prostatic infection. Knowing how to manage these side effects is essential to long-term success. If you know what side effects may occur and how to deal with them, you are less likely to prematurely stop therapy. You may just need to readjust the dose, change the delivery method, or take a medication to counteract the potential problem. Only the best physicians, who do not overreact to a side effect, know how to do this.
7. Having a lifestyle that is not “testosterone friendly”: If you smoke, drink more than two drinks a day, smoke too much pot, are overweight, do not exercise, do not keep your blood sugar or lipids in control, and do not show up to doctor's appointments, you do not have a testosterone-friendly lifestyle. Studies have shown that these factors may influence your sexual function and long-term health. Excessive alcohol can decrease testosterone. Exercise can increase it if done properly or decrease it if overdone. You can read more about this in my book.
8. Not reading or staying “networked” with other patients: Being in isolation about information makes you a less effective patient. There are online groups of men who discuss testosterone and other issues (see the Resource section in the book Link RemovedLink Removed). Sharing your experiences and learning from others are keys to being an empowered and proactive patient. It's the only way to maximize the benefits of any therapy you are using. Many of the practical “tricks” that I have learned have been obtained via this method. The collective wisdom of other people with similar issues is more powerful than just relying on everything your doctor tells or does not tell you. Besides, most doctors treat educated patients a lot better than those who are timid about sharing and asking questions.
9. Not switching doctors when you have to: Changing doctors can be difficult, especially if you are not a networked patient who reads a lot about your condition. Many people do not have options and have to see a certain doctor in a health management organization (HMO) setting. But most of us have the option of searching for educated doctors who are not condescending and who treat you as an equal. Your doctor should be your partner in your health and not just an unquestioned authority. Although 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 myths and misconceptions similar to ours I have heard the most irrational things from doctors about testosterone replacement that make me question how unfortunate their patients may be. Be sure to do your homework and find a doctor who supports you in your search for optimum health.
10- 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 up to send me text messages to my phone as reminders. Avoid the yo-yo effect that poor compliance causes! Testosterone replacement is a lifetime and lifestyle commitment that should be explored with care.
Using “street sources” of testosterone: I have met many men whose doctors do not support their use of testosterone, so they buy it on the black market or from some guy 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 without a prescription. Be aware that the buying or the using of testosterone without a 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 that justifies their use (e.g. anemia, wasting, hypogonadism). If you still decide to get testosterone in the black market, be aware that you could set up by informants who may alert the DEA of your purchase. Also, importing testosterone even if you have a prescription is not legal. In a nutshell: only use testosterone after a physician gives you a prescription 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 grape-seed oil. You also run the risk of exposure to contaminants that could cause infection.
Not having a doctor follow-up your blood work is a sure way to get in trouble! If you have low testosterone, there are hundreds of doctors who will prescribe testosterone replacement therapy. If you are using testosterone to increase muscle mass or to improve athletic performance even though you have normal testosterone levels, be smart and research all you can. And please, read the information in the book about how stopping testosterone can cause health problems (if you are using black market testosterone, chances are that your source will eventually run out).
2. Not exploring what testosterone option is best for you: Since there is an assortment of options for testosterone replacement, it's important that you take the time to really find out what's 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 stick to a strict daily schedule, fears of needles, and physician familiarity of the different products. For instance, some health management organizations (HMOs) programs only pay for testosterone injections since they are the cheapest option. However, some men have needle-phobia and dislike weekly or bi-weekly injections that may require them to go see their doctors that frequently (some doctors do not teach their patients to self inject at home). Other men are prescribed daily gels even if their busy lives make it difficult to be perfectly compliant to daily therapy. Some men without insurance or financial means decide not to seek help since they do not know that there are patient assistance programs set up by manufacturers, or the fact that compounding pharmacies can make cheap gels and creams with a doctor prescription. Every testosterone option has advantages and disadvantages that may be more suitable for one person over another, so read the following section on treatment options.
3. Not using the right dose: Men who start testosterone need to have their testosterone blood levels rechecked two weeks or one month after they start therapy (depending on the testosterone formulation), right before they administer the corresponding dose for that day or week. This is critical since these results are essential to deciding if the dose is right for you. Total testosterone blood levels under500 ng/dL that are not improving your sexual desire and energy should be increased to 500 to 1,000 ng/dL by increasing the frequency of injection or the dose. Some doctors fail to retest after they get a patient started on testosterone since they assume most men respond to 200 mg bi-weekly injections or 5 grams per day of gels. The reality is that many men require higher doses to reach total testosterone levels above midrange of normal. Those men tend to stop testosterone early because they perceive no benefits at “average” doses. Incorrect frequency of injections is a common mistake and is actually worse than not getting treatment at all.
4. Cycling on and off testosterone: Testosterone replacement is a life-long commitment in most cases. Once you start you should assume that you will 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 do not know is that during the time that you are taking testosterone, your testicles stop producing it. When you stop replacement therapy you are left with no testosterone in your system for weeks while your HPG hormonal axis normalizes. Depression, weight loss, lack of motivation, and loss of sex drive can appear rapidly and with a vengeance. A few men never have their hormonal axis return to normal after stopping testosterone (especially if they were hypogonadal at baseline).
5. 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 the new medications that someone might have started. I have seen people suffer because of 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.
6. Not knowing how to manage potential side effects: Luckily, this will not happen to you after you finish reading this book. I know men who stopped testosterone due to swelling in their nipple area, acne, moodiness, perceived lack of benefit, hair loss, or a prostatic specific antigen (PSA) increase that was due to a prostatic infection. Knowing how to manage these side effects is essential to long-term success. If you know what side effects may occur and how to deal with them, you are less likely to prematurely stop therapy. You may just need to readjust the dose, change the delivery method, or take a medication to counteract the potential problem. Only the best physicians, who do not overreact to a side effect, know how to do this.
7. Having a lifestyle that is not “testosterone friendly”: If you smoke, drink more than two drinks a day, smoke too much pot, are overweight, do not exercise, do not keep your blood sugar or lipids in control, and do not show up to doctor's appointments, you do not have a testosterone-friendly lifestyle. Studies have shown that these factors may influence your sexual function and long-term health. Excessive alcohol can decrease testosterone. Exercise can increase it if done properly or decrease it if overdone. You can read more about this in my book.
8. Not reading or staying “networked” with other patients: Being in isolation about information makes you a less effective patient. There are online groups of men who discuss testosterone and other issues (see the Resource section in the book Link RemovedLink Removed). Sharing your experiences and learning from others are keys to being an empowered and proactive patient. It's the only way to maximize the benefits of any therapy you are using. Many of the practical “tricks” that I have learned have been obtained via this method. The collective wisdom of other people with similar issues is more powerful than just relying on everything your doctor tells or does not tell you. Besides, most doctors treat educated patients a lot better than those who are timid about sharing and asking questions.
9. Not switching doctors when you have to: Changing doctors can be difficult, especially if you are not a networked patient who reads a lot about your condition. Many people do not have options and have to see a certain doctor in a health management organization (HMO) setting. But most of us have the option of searching for educated doctors who are not condescending and who treat you as an equal. Your doctor should be your partner in your health and not just an unquestioned authority. Although 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 myths and misconceptions similar to ours I have heard the most irrational things from doctors about testosterone replacement that make me question how unfortunate their patients may be. Be sure to do your homework and find a doctor who supports you in your search for optimum health.
10- 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 up to send me text messages to my phone as reminders. Avoid the yo-yo effect that poor compliance causes! Testosterone replacement is a lifetime and lifestyle commitment that should be explored with care.
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