Testosterone Side Effect Management Table

Table of Contents

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

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
  Video on testosterone and acne
  Article: Acne treatment options

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 (finesteride) - Available by prescription. A few males experience decreased erections with finesteride. Do not use.
• Prescriptions gels from compounding pharmacies

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/back aches (Cialis) take an non-drowsy allergy medication and ibuprofen. ED drugs can be combined with alpha blockers and/or nitric oxide precursor aminos (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 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 gonadatropin (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 comprehensive sleep formula with tryptophan, melatonin and herbs. Nutrients do not work as well as drugs, but they can help some people.
  Article: How to protect your circadian rythm

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 http://www.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 250-500 IU twice a week. Decrease testosterone dosage accordingly after starting hCG to reach levels around 500-1200 ng/dL while keeping all other lab work monitored
Video on HCG

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 over reacting.
• 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

• 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.
• Supplements – Magnesium (600 mg/day); vitamin B[SUB]6[/SUB](100 to 200 mg/day); may help reduce water retention.
• Water - Drink extra water every day to help flush the kidneys.
• Check your estradiol to make sure it is not over 45 pg/ml. Treat if high.
• Make sure you are doing cardio exercise at least 3 times a week for 30 min.

Gynecomastia(male breast development)

Caused by overproduction of estrogen, which can happen when is there is too much testosterone. (Testosterone converts into estrogen.)

• Arimidex (anastrozole)-- Inhibits estrogen production. Available by prescription. 1 mg/day until sensitivity stops, then ½ mg per day. Some people take .25 mg two to three times a week for maintenance. Ensure that your estradiol is under 45 pg/dl but do not go too low (under 20 pg/ml) since it is needed for bone, skin, brain, lipids, libido, good lipids and hair health.
• 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 avoidif you have gynecomastia.
  
• Those who do know respond to the above, check other reasons
  Video on estradiol and testosterone

Check your estradiol with the right sensitive test.

Virilization

(body hair growth, deepened voice, clitoral growth in women)

• Women with this problem should ensure that they are using the lowest possible dosage
• Testosterone replacement in men seems to exacerbate body hair growth.

Benign Prostate enlargement (diagnosed by digital rectal exam and/or ultrasound. Symptom: frequent urination and not voiding urine completely)

• Proscar - Available by prescription. For men, 1 to 5 mg/day. (Note:Can cause decreased sex drive and erections in some men.)
• Hytrin, Flomax and other alpha blockers - Available by prescription. Can improve ED when used with ED drugs
• Saw palmetto extract – May be effective for reducing prostate problems, but one study suggests that this herb may reduce the effects of testosterone, too.[ii] Contradictory data.
  
• Cialis has been approved for BPH at 5 mg/day
• Estrogen inhibitors like Arimidex -  Estrogen dominance appears to increase prostate growth.[iii] [iv]
• Check your prostate-specific antigen and have a digital rectal exam before starting any TRT program, to detect the potential for prostate cancer, especially if you are over 35 or have a family history of prostate problems, and discuss with your doctor who frequently monitors in the future since guidelines have changed.
  Video on testosterone and the prostate

Polycythemia

(Elevated hematocrit over 53, which means there are too many red blood cells that can increase blood viscosity and cardiovascular risks)

• Therapeutic phlebotomy or blood donation: It means to have a pint or more of blood removed, usually 1 pint every 2.5-3 months. (1 pint usually will lower hematocrit by about 3 points. You may hematocrit to be under 50). Polycythemia is a compelling reason to avoid using higher TRT doses than are necessary. Taking the lowest effective dose or injecting lower doses more frequently reduces the risk of over-production of hemoglobin (red blood cells). If you are healthy you can donate blood every 2.5-3 months to keep hematocrit under 54
• Although not proven - there is some evidence that grapefruitmay lower hematocrit. However, grapefruit increases blood levels of many medications and cause increased side effects due to that,so talk to your doctor. WARNING: Donating blood too frequently can decrease ferritin and iron and cause fatigue. Check those two blood tests. If low, short term iron+vitamin C supplementation may be required.
  Video on testosterone and hematocrit

Check your hematocrit cheaply here.

Low Sperm Count that Prevents Pregnancy

Decreased HDL (high density lipoprotein- good cholesterol under 40 mg/dL)

• Talk to your doctor (or ask for a referral to a fertility doctor) about the findings of these studies using HCG or Clomid (clomiphene). No need to stop or avoid TRT if you want to have kids!
• Decreases in HDL occur when higher doses of testosterone are used (100-200 mg per week are standard). This side effect is not easy to manage. Some people respond to Niacinbut many have skin flush no matter what type of Niacin they use. Exercise,fiber and diet can increase HDL but they may not compensate for the effects of higher than normal (supraphysiologic) doses. A small study showed that NAC can increase HDL. Note: Testosterone decreases triglycerides and LDL. More information

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 : http://www.peaktestosterone.com/testosterone_risks.aspx

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




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