Starting testosterone next week. What should I expect?

[Nelson Vergel]

Starting testosterone next week. What should I expect?

Nelson, I know you wrote the book "Testosterone: A Man's Guide". I was diagnosed with low testosterone and do not know if I should do injections or gels. Also, what should I expect when it comes to sex drive and energy, etc? Thanks for your great work educating us in simple terms we can understand. Ah, my friends also told me I should be careful with heart attacks while on testosterone. Is that true? I do not want to screw myself up, just want to feel better since I have been tired and sex sounds impossible for me. My bf thinks I am not interested in him but I am really attracted to him but just lost my mojo and motivation.

Response from Nelson:

I hope getting your testosterone blood level up will help you regain your mojo and stamina. But testosterone replacement therapy (TRT) is no magic solution and a cure-for-all. Some men expect huge differences right away and get easily discouraged.
To answer the question about how long TRT, a group of researchers reviewed a lot of the TRT studies published to date. Here is what they found:

Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, no further increments beyond.

Changes in erections/ejaculations may require up to 6 months.

Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer.

Effects on depressive mood appear after 3-6 weeks with a maximum after 18-30 weeks.

First effects on erythropoiesis (increased red blood cells) after 3 months, peaking at 9-12 months.

Prostate-specific antigen and volume rise, marginally, plateauing at 12 months; further increase related to aging rather than therapy.

Effects on lipids appear after 4 weeks, maximal after 6-12 months.

Insulin sensitivity may improve within a few days, but effects on glycemic control become evident only after 3-12 months.

Changes in fat mass, lean body mass, and muscle strength occur within 12-16 weeks, stabilize at 6-12 months, but marginally continue to improve over years.

Effects on inflammation occur within 3 to 12 weeks.

Effects on bone detectable after 6 months but continue at least for 3 years.

Source:

Onset of effects of testosterone treatment and time span until maximum effects are achieved - PMC

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects ...

www.ncbi.nlm.nih.gov

So, as you can see, you have to be patient.

The decision of whether to use gels or injections is a personal one based on several factors:

- Cost and insurance coverage. Injections are cheaper by far but less convenient than daily gels. For best results, weekly injections of 100-150 mg of testosterone are better than 200 mg every two weeks since there are less pronounced peak and valleys.
- Fear of transferring testosterone to female sexual partners or kids by contact (gels). For many *** men, this is not an issue unless you have kids.
- Personal commitment. Are you OK with daily application? Are you afraid of needles?

You can read more about how to chose the best testosterone replacement options and how to prevent potential side effects on my new education website:
ExcelMale.con

Good luck in your new journey.
In health,
Nelson

 

[Nelson Vergel]

Often Overlooked Factors Before Starting Testosterone Replacement


How long does testosterone take to show effects?

 

[Larr8162]

Starting testosterone next week. What should I expect?

Nelson, I know you wrote the book "Testosterone: A Man's Guide". I was diagnosed with low testosterone and do not know if I should do injections or gels. Also, what should I expect when it comes to sex drive and energy, etc? Thanks for your great work educating us in simple terms we can understand. Ah, my friends also told me I should be careful with heart attacks while on testosterone. Is that true? I do not want to screw myself up, just want to feel better since I have been tired and sex sounds impossible for me. My bf thinks I am not interested in him but I am really attracted to him but just lost my mojo and motivation.


Response from Nelson:

I hope getting your testosterone blood level up will help you regain your mojo and stamina. But testosterone replacement therapy (TRT) is no magic solution and a cure-for-all. Some men expect huge differences right away and get easily discouraged.
To answer the question about how long TRT, a group of researchers reviewed a lot of the TRT studies published to date. Here is what they found:

Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, no further increments beyond.

Changes in erections/ejaculations may require up to 6 months.

Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer.

Effects on depressive mood appear after 3-6 weeks with a maximum after 18-30 weeks.

First effects on erythropoiesis (increased red blood cells) after 3 months, peaking at 9-12 months.

Prostate-specific antigen and volume rise, marginally, plateauing at 12 months; further increase related to aging rather than therapy.

Effects on lipids appear after 4 weeks, maximal after 6-12 months.

Insulin sensitivity may improve within a few days, but effects on glycemic control become evident only after 3-12 months.

Changes in fat mass, lean body mass, and muscle strength occur within 12-16 weeks, stabilize at 6-12 months, but marginally continue to improve over years.

Effects on inflammation occur within 3 to 12 weeks.

Effects on bone detectable after 6 months but continue at least for 3 years.

Source:
http://www.eje-online.org/content/early/2011/07/13/EJE-11-0221.full.pdf

So, as you can see, you have to be patient.

The decision of whether to use gels or injections is a personal one based on several factors:

- Cost and insurance coverage. Injections are cheaper by far but less convenient than daily gels. For best results, weekly injections of 100-150 mg of testosterone are better than 200 mg every two weeks since there are less pronounced peak and valleys.
- Fear of transferring testosterone to female sexual partners or kids by contact (gels). For many *** men, this is not an issue unless you have kids.
- Personal commitment. Are you OK with daily application? Are you afraid of needles?

You can read more about how to chose the best testosterone replacement options and how to prevent potential side effects on my new education website:

Best of ExcelMale.com

About your question on heart attacks: Two studies were published in the past 6 months that suffer from the same flaws of lack of monitoring. I reviewed them here:

Nelson Vergel Asks for Change in Testosterone Guidelines After Another Negative Study

So, you can see that the conclusions of those studies are not what I would consider "clean". I am amazed how some researchers are eager to publish data that does not even meet minimum criteria on monitoring!

I am here to answer any questions you may have as you get more deeply educated about hormones and your health, so do not shy away from sending me updates and questions.

Good luck in your new journey.
In health,
Nelson

Nelson,
First, thanks for all you do.
I am a 66 year old male, I was on Testosterone Cypionate for about 2 years and had been loving it, but noticed my libido started to suffer recently, I spoke to urologist and he suggested a change, was on 2 pumps daily of Androgel 1.62% for 2 months. He did testosterone and free testosterone tests and said, my levels were still low, so he increased it to 4 pumps daily last month. I still don't have my libido back yet, it's better, but not where it was 6 months ago.
Is there something else I should get tested for? I see him next Thursday for a class in moving towards injections instead of Viagra, as the Viagra has seemed to be less effective lately. I can get an erection, I just can't seem to maintain it.
Oh yeah, 3 years ago, I had penis surgery for a bent penis, Peyronies Disease. That's another issue, my penis is straight again, but I lost about 2 inches in length and about 1/2 inch in girth. I am trying to live with this too.
My depression has subsided with the TRT, so I am happy with that. I just wonder why the TRT is not as effective as it was for over a year and a half.
Thanks

 

[Nelson Vergel]

Hi Larr8162

I would suggest that you switch back to injections (100-200 mg per week). Some like the libido boosting effects of HCG (500 IU twice per week) and boost their erections with 5-10 mg per day Cialis.
It would also good to see your blood work including total and free T, sensitive estradiol, prolactin and DHT 8 weeks after you start the injections.
Most of us now inject subcutaneously or shallow IM by splitting T dose in two (50-100 mg per shot- twice per week)

 

[Brandon360]

I am a 48 yr old and been diagnosed with low t and my endocrinologist said he was gonna start me with injections of 200mg of Testosterone cypionate once every 2 weeks. I saw him and said i was concerned because i heard that wasnt a very good protocol and he told me he always starts his patients on that to see how they will be because everyone is different and after a month or so they will test my blood and if its still low then they adjust.I don't know if i should do it his way or find someone else?

 

[Sean Mosher]

See if he'd compromise with maybe 100mg every week starting out......
Every 2 weeks isn't going to help you at all.

 

[Brandon360]

See if he'd compromise with maybe 100mg every week starting out......
Every 2 weeks isn't going to help you at all.

I tried and he told me he wanted to do the 200mg every 2 weeks,maybe i should find another dr.

 

[Sean Mosher]

Sorry to hear that.
Unfortunately it's probably your best solution to find someone else.

 

[Rockyo317]

Good morning everybody and Nelson maybe you can answer this question for me or anybody else! If you're on testosterone I've been on it say 9 months again and you get your totals done say it's 500 how long does it take wear your numbers drop drastically when you stop taking testosterone injections every week? How long would it take for the numbers to go down 1 wk 2 weeks 3 weeks please anybody has any info on that or they can advise please do thank you so much

 

[Vince]

Good morning everybody and Nelson maybe you can answer this question for me or anybody else! If you're on testosterone I've been on it say 9 months again and you get your totals done say it's 500 how long does it take wear your numbers drop drastically when you stop taking testosterone injections every week? How long would it take for the numbers to go down 1 wk 2 weeks 3 weeks please anybody has any info on that or they can advise please do thank you so much

Testosterone half life table

 

[Rockyo317]

Vince thank you for the reply! I'm on the T Cypinate just trying to figure how fast the total T numbers goes down and how long it takes to drop the numbers as far as days wks? Then going for your labs to do totals and free? Thank any other input please anybody shout out thanks

 

[Vince]

Vince thank you for the reply! I'm on the T Cypinate just trying to figure how fast the total T numbers goes down and how long it takes to drop the numbers as far as days wks? Then going for your labs to do totals and free? Thank any other input please anybody shout out thanks[/QUOTE

How often do you need to inject, higher shbg fewer injections, low shbg more frequent injections. Always do Labs on injection days before you inject.

 

[Rockyo317]

Vince thank you for your reply but I guess you're misunderstanding me what I'm asking or I didn't put it out there right I want to know if you're on testosterone cypionate and say your numbers are 500 total when you do your laps say you don't do no injections for a week 2 weeks 3 weeks how much do your numbers drop as far as when you get your labs and they do the total testosterone just want to know how quickly the numbers go down if you didn't do testosterone for a week 2 weeks 3 weeks do the numbers go down drastically I'm trying to figure out the time frame thank you please advise if you have any information or anybody else

 

[Vince]

Vince thank you for your reply but I guess you're misunderstanding me what I'm asking or I didn't put it out there right I want to know if you're on testosterone cypionate and say your numbers are 500 total when you do your laps say you don't do no injections for a week 2 weeks 3 weeks how much do your numbers drop as far as when you get your labs and they do the total testosterone just want to know how quickly the numbers go down if you didn't do testosterone for a week 2 weeks 3 weeks do the numbers go down drastically I'm trying to figure out the time frame thank you please advise if you have any information or anybody else

If you have lower shbg your testosterone goes down faster. If you have higher shbg testosterone stays higher. Is harder to get good levels and to feel good with low shbg.

 

[Vince]

Low SHBG and controlling E w/Dr Crisler

 

[madman]

Vince thank you for your reply but I guess you're misunderstanding me what I'm asking or I didn't put it out there right I want to know if you're on testosterone cypionate and say your numbers are 500 total when you do your laps say you don't do no injections for a week 2 weeks 3 weeks how much do your numbers drop as far as when you get your labs and they do the total testosterone just want to know how quickly the numbers go down if you didn't do testosterone for a week 2 weeks 3 weeks do the numbers go down drastically I'm trying to figure out the time frame thank you please advise if you have any information or anybody else

If you are planning on stopping trt than:

It will take a few weeks for the exogenous testosterone to clear your system due to the ester.

I would wait 4 weeks after your last injection than have blood work done..... LH and FSH /TT/FT/e2 (sensitive assay)

 

[Rockyo317]

thank you mad man the reason why I'm asking is for insurance purposes and I just wanted to know if say your total testosterone was 500 when you did your labs and if you didn't inject for say one week 2 weeks 3 weeks how much as far as numbers your total testosterone drop? Would it go down a 100 or go down 200? That's what I'm trying to figure out hopefully I put it out there correctly so see you or anybody else understands it I just trying to figure out if you just stop injecting how fast and how much would your numbers decrease and total testosterone please advise thank you

 

[madman]

thank you mad man the reason why I'm asking is for insurance purposes and I just wanted to know if say your total testosterone was 500 when you did your labs and if you didn't inject for say one week 2 weeks 3 weeks how much as far as numbers your total testosterone drop? Would it go down a 100 go down 200 but it go down? That's what I'm trying to figure out hopefully I put it out there correctly so see you or anybody else understands it I just trying to figure out if you just stop injecting how fast and how much would your numbers decrease and total testosterone please advise thank you

When one uses exogenous testosterone (trt) and stops their injections levels will decline as the T ester clears the system.

Once the ester clears your system.....roughly 2 weeks after your last T cypionate injection your testosterone levels will be sub-par.

Seeing as your HPTA is shutdown due to exogenous testosterone it will take time for endogenous production to resume and will return to your baseline (pre-trt) levels.

Exactly what level that will be exactly no one can say.....if your TT levels pre-trt were 200-300 ng/dL than your levels will be around that.

Regardless I would still wait a full 4 weeks after your last injection before retesting your baseline levels.....TT/FT/e2 (sensitive) and you definitely want to see where your LH and FSH levels sit.

 

[madman]

If you are just looking into how quickly your testosterone levels will drop after your injection
aside from the T ester used ones SHBG levels/injection frequency will dictate how fast your testosterone levels decline.

What are your SHBG levels and what is your injection protocol (dose/injection frequency)?

Was your TT 500 ng/dL tested at trough.

 

[Rockyo317]

Good morning Madman I'm just seeing this message from a wk ago thanks for reaching out happy New year! I figured it out it was for insurance purposes but ounce your approved with low low T from the beginning your doc just needs to send a Pre Auntherzation form in after a yr with detailed needing this every wk! I think I have it and thank you for the help!!! Ps I May Need some Other Help with my trt therapahy stuff never got it right for awhile now just want to feel good thanks again thank Rocky