Testosterone Basics

by West Conner · 53 comments

The goal of testosterone replacement therapy is to replace the lowered testosterone at physiologic doses.  At this proper dosing, the body's reaction to testosterone is a restored youthful response in all body tissues.  What we are trying to do is replicate the previous testosterone levels by restoring them throughout the body.  Too much, and the body responds by increasing estrogen and the protein, sex hormone binding globulin (SHBG).  Too little, and you will still suffer from low testosterone symptoms.

It should be noted that testosterone therapy will not prolong life expectancy.  It will, however, increase the quality of life.  Testosterone deficiency is the most common hormonal disorder in males.  Low testosterone is related to several preventable diseases and still remains significantly underdiagnosed.  Restoring testosterone levels quickly corrects most symptoms of deficiency as levels fall approximately 1-2% per year beginning around age 35.

When levels are restored, men report improvement in energy, well-being, psychosocial drive, initiative, assertiveness, increased libido, more frequent sexual encounters, increased muscular strength and endurance.

In men, testosterone is produced and secreted mainly by the testicles.  Starting with cholesterol, testosterone is synthesized within the 500 million Leydig cells inside the testis.  These specialized cells make up about 5% of the testis volume.  A small amount of testosterone is made from DHEA in specialized areas of the body.  This conversion accounts for a very small amount of your total testosterone.

Interestingly, giving a man DHEA at 50mg a day, will not increase his testosterone to acceptable replacement levels, but it will increase his estrogen level.  However, a woman taking this dose, will see her testosterone increase.

The pituitary secretes luteinizing hormone (LH) in short bursts to signal the production and release of testosterone.  The bursts occur every 60-90 minutes.  Releasing LH in this manner maintains the Leydig cell's sensitivity to LH and maintains the pattern of secretion.  Constant stimulation and the Leydig cells will become resistant to the signal.

Men produce between 3mg and 10mg of testosterone per day with 4% being converted to dihydrotesterone (DHT) and about 0.2% being converted to estradiol, an estrogen.

DHT is 3 to 10 times as androgenic (male characteristics) as testosterone.  The enzyme 5-alpha-reductase is responsible for this conversion of testosterone to DHT.  In the prostate, 95% of testosterone is converted to DHT by 5-alpha-reductase.  Specific medications can block this enzyme in the prostate.  DHT, along with estrogen, is the contributing factor to an enlarged prostate.  Testosterone has a protective benefit to the prostate.

A small percentage, just 0.2%, of testosterone is converted to estradiol by the enzyme aromatase.  This may seem insignificant but estradiol is 100 times more potent at the cell receptor site than testosterone.  This means that a male needs 100 times more testosterone than estradiol just to have an equal affinity for the receptor.  Approximately 80% of estradiol in males is produced via this conversion from testosterone.

The major determining factor in the removal of testosterone from the body are SHBG levels, the individual's circadian rhythm, amount of blood flow to the liver, genetics, and environmental factors.  The clearance of testosterone from the body is reduced with lower SHBG levels and reduced blood flow to the liver.

Beginning around age 35, there is a gradual decrease in testosterone and increases in estrogen and SHBG.  The decrease is accelerated and begins earlier with poor health or chronic illness.

Testosterone is transported by binding to SHBG.  SHBG is made and secreted by the liver.  SHBG binds 70% to 99% of the testosterone in a man's body.  The remaining 1% to 30% is either bound to other proteins or free to move into tissues resulting in an effect on the cell.  The higher the SHBG concentration, the lower the amount of free testosterone available to the body.  SHBG concentration is affected by testosterone levels, estrogen levels, liver disease, obesity, and genetics.  Once bound to these proteins, the testosterone is rendered "inactive" and is taken to the liver for removal from the body.

Testosterone peaks for men in the early morning and slowly declines throughout the day with a low in mid-afternoon only to rise slightly again in the evening.

Many physicians use blood to measure testosterone levels.  This is accurate for testing the total testosterone level but inaccurate for testing the free and active form.  Additional blood tests are rarely performed to determine SHBG and the "free testosterone" measurement is given as an estimate.  This estimate can vary by several fold and is generally considered useless in a clinical setting.  Without additional blood testing, the only true and accurate way to measure free and active hormone levels is through saliva.

Certain diseases and medications will increase the SHBG levels.  A hyperthyroid (fast thyroid) condition will increase the body's SHBG by stimulating release from the liver.  This will cause low testosterone symptoms while total testosterone levels remain unchanged.

Clinically, testosterone is used to treat anemia, osteoporosis, chronic obstructive pulmonary disease, angioedemia, immune system disorders, lung deficiencies, and muscular diseases.  Chronic heart failure is associated with low testosterone levels.  These conditions are usually treated with newer, more expensive therapies that show only a slight benefit over the much less expensive testosterone.  There are also no side effects to testosterone therapy with correct dosing.  At conventional doses for replacement therapy, there is no need to monitor the liver, kidneys, or electrolytes.

When taken orally, testosterone is quickly broken down by the liver into inactive metabolites.  Because of this, testosterone is best given by intramuscular injection, transdermal cream, or sublingually.

Testosterone production can be completely shut down in men using synthetic progestins.

Abuse of testosterone and it's anabolic/androgenic derivatives by athletes has produced a stigma surrounding the therapy.  These hormones allow the body to produce larger and stronger muscles in a shorter period of time.  They also significantly decrease recovery time between strenuous activity.  Taking high levels of testosterone also temporarily shuts down sperm production and is associated with male infertility while on supra-physiologic doses.

Limited studies show that short-term, high dosing of testosterone has little medical danger, is not physically addictive, and most abusers eventually stop.  After long-tern use, recovery of normal bodily testosterone production may take up to two years.

Testosterone replacement therapy, when done properly, is an inexpensive treatment to significantly improve the quality of life for males.  The therapy has been used successfully for decades but has recently been associated with abuse among athletes and recreational users.  Because of this, many doctors are reluctant to educate themselves of the risks, benefits, and protocols of testosterone therapy.

Also, since the hormones cannot be patented, pharmaceutical manufacturers cannot make a profit and therefore will not advertise this from of therapy.  The prescription form of testosterone that my patients use costs them about $5.00 a week.

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{ 53 comments… read them below or add one }

Henrique October 5, 2016 at 12:13 AM

Hello I have 32 years, my testosteron level is 600. ( Bloodwork done before starting the injections)
I took 3 injections of 250mg Test E, 1 per week.
Now since I am travelling, I will be 4 weeks without it…
Will I have problems in these 4 weeks ?
After I come back I can continue with the injections…

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Bill Hoke July 2, 2016 at 7:03 AM

How do your clients pay only $5 a week? I’m poisoning like $400 a month for the gel?

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Jeff January 8, 2016 at 10:40 PM

Is 200 mg a week too much been on it for years and my testosterone levels are ok,just wondering if I should worry about taking 200 mg for years?

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Gc November 17, 2015 at 2:58 PM

Question: my testosterone levels were at 81 most recent blood work. The norm according labxorp is approximately 300 to 1150…my dht levels were low too…I attribute this low levels to 1mg propecia. Over years Hair loss totally stopped. .hair is amazing full thick..stopped thinning …process..however drove test low????…. I use testosterone packet 50 mg daily. .starting feel better…should continue propecia? Will testosterone cause increase in dht hormone and cause hair follicles shrink again????

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sonu September 4, 2015 at 9:03 PM

Hi
What are the optimum free testosterone levels for male.

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DSR July 12, 2015 at 11:34 AM

Hello Dr. I am 41 and have been on trt for approximately 2 months. Testosterone peaked and my Dr. Told me to stop cold turkey. Is this safe and will my natural production of testosterone be shut down within 2 months. I was injecting 150mg every two weeks.

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Bob June 26, 2015 at 5:50 PM

Hi Dr. West,

I am a 38 male, 5’11”, 196 lbs. I have experienced low energy, low sex drive, low confidence for many years. Otherwise healthy, and I also had vasectomy in 2005.

Testosterone test has shown to be between 309 and 341 at it’s highest.
Recently went to my doctor and have had my first shot so far of testosterone cypionate 200mg. So far my first 4 days have felt amazing, with all previous symptoms reversed. I read that the half life is 8 days, does this mean its completely out of your system in 16 days? My doc want’s to put me on 200mg once per month. Is this a good recommendation from my doc, or should I be on 200mg every two weeks? Would appreciate your feedback.

Bob

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West Conner July 9, 2015 at 9:23 AM

testosterone cypionate should be a weekly injection

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DA May 19, 2015 at 9:13 AM

I am 44, 6′-0, 240 and have been gaining weight and visible water weight(swelling ankles) for the last 4 months (about 20pounds) and I exercise quit a lot. I have been on testosterone cypionate 200mg in 1ml vial for a few years. I have been on various cycles: 14 day 200mg/1ml, 10 day 200mg/1ml and 7 day 200mg/1ml vial but only took .75ml.

My testosterone numbers seemed best on the described 7 day cycle but dont have the estrogen numbers. I am currently on the 10 day cycle and my numbers at the end of cycle are:

testosterone: 255 ng/dl range >18 348-1197
Estrogen: 93 pg/ml range (40-115)

My Estrogen has been going from 50-145 pg/ml and I have seen many sites say anything over 30 is not good. The range for my lab says (40-115 is normal.

What is an estrogen level I should be trying to get to?

Do you think the estrogen is causing the weight gain?

I have Factor V Leiden (clotting issue) so I am wondering what is safe to take to block estrogen.

My doc wants me to go back to the 14 day cycle to reduce the estrogen but my Testosterone numbers at end of cycle are in the low 100’s when I do that…and I feel like crap for about 7 days of the cycle…

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Fred May 10, 2015 at 4:32 PM

Hello,

Background: for about two years I was put on androgel for anemia and low testosterone. Red blood cell count of 15 and t level of 200.

About a week ago I went in for a routine blood work and my red blood cell count jumped to 19. My doctor was concerned and took me off HRT. Since the stop I have been feeling the effects immediately. I am scheduled to take another blood test in a month. I am suspecting he will not put me back on HRT after that. I am really not doing well with the empty and weird feelings since the stop. If you don’t mind, I have a few questions. What are my options? is there any supplements that can help?

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Harry March 20, 2015 at 6:34 AM

Hi Dr,

I’m 43 and about to start 250mg per week of testosterone ethanate. Im concerned about this speeding up hair loss. (my hair is slightly thinning on top). Will taking this amount speed up the process? Will taking finasteride /dutasteride, prevent/limit the conversion of this amount to DHT? Should i be worried?

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Boywithaquestion March 19, 2015 at 4:25 PM

I have taken 500mg of testosterone enanthate for 3 months- I’ve been off for 2 months- will I pass an athletic urine test?

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jeremy February 7, 2015 at 8:43 AM

HI everyone. I am a 38 year old male with a testosterone level of 494. I would really like to get my levels in the up wards of 1000 to 1200. would 200 mg of testosterone injections get the results im looking for would it help me loose excessive body fat and gain more lean muscle. like I stated I am 38 year old male 6′ 2 and weight in at around 240 lbs. I am healthy in all aspect but have no energy, extra weight around mid section, very stressed out at times and my libido has gone down the toilet. Any and all help would be greatly appreciated.

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West Conner February 7, 2015 at 5:17 PM

200mg a week of testosterone cypionate should put you right there.

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Alexander February 2, 2015 at 3:48 AM

Hi,
my blood work results are:
Testosterone 3.89 ng/mL (2.49-8.36)
LH 5.28 IU/L (1.7-8.6)
FSH 3.33 IU/L (1.5-12.4)
Progesterone 1.16 ng/mL (0.2-1.4)
Prolactine 391 mU/L (86-324)
Cortisole 561.2 nmol/L (171-536)
DHEA-S 11.37 umol/L (2.41-11.6)
Estradiol 31.02 pg/mL (7.63-42.6)

T level is in normal range but low for my age (41). Doctors I’ve visited did not comment on those results but gave mi Cialis which actually treats consequence of low T. Can anything be deduced from my blood work results that could point to possible reasons of low T?

Thanks

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West Conner February 3, 2015 at 10:01 PM

Your prolactin is high. Have that checked for a possible problem. Also, high cortisol can block your hormones.

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Richard January 15, 2015 at 12:24 PM

I am worried if my DHT is excessively high.
Testosterone = 1007 (range: 348-1197)
DHT = 127 (high) (range: 30-85)
E2 = 30 (standard 4515)
SHBG = 28.6

thanks

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West Conner January 15, 2015 at 10:17 PM

It does look a little high. Some guys are just genetically predisposed to produce more DHT. I’m more concerned with it’s effect on your prostate. Get another test to verify the number and discuss it with your doctor. You may need to monitor your prostate more frequently than other guys.

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Chanel January 3, 2015 at 1:27 PM

Hi, im a trans woman (mtf) and i want to permanently remove testostrone from my body. And just have estrogen pumped through my body. Is this possible?

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West Conner January 5, 2015 at 9:46 PM

This isn’t my area of expertise, but I’d say it is not possible or desirable to remove all the testosterone from your body. You need testosterone regardless.

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xhulu January 1, 2015 at 3:35 PM

Hello Dr
I am 26 years old. I have been training for 6 years. Am well constructed. I want to inject 8 weeks long, testosterone every week 250ml. Would like to ready for Model picutre for big fashion labels.
Many consider it a low dose (Bodybuilding forum and so on). I think that Is a good dose and i will have successes because it is low I will have no major side effects.
My question: it will stop my own testosterone production, I needed a post cyle therapy?

Thanks and regards Form swiss

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West Conner January 5, 2015 at 9:48 PM

At that dose for just 8 weeks, I don’t think it will change your normal testosterone production very much. It may take a short time for your body to recover to normal levels but there shouldn’t be any long term adverse effects at 250mg a week for 8 weeks.

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Swim and Swiy December 11, 2014 at 8:49 AM

SWIY is 44 and has low testosterone with every text book symptom. The pathetic doctor wouldn’t reveal numbers but said if 11 – 34 was considered average he is at 12 (so on the lower end of the spectrum). Obviously it could be better or worse on different days. Either way they refused to treat him and he is done with their bullshit.. SWIY wants to take things into his own hands and begin dosing via injection once a week at 80mgs of testosterone enanthate. Is this too high a dose (swiy is willing to start on what ever dose would be most advised)? will swiy experience testicular shrinkage? is there a risk of aromatization taking place? what dose would you experts advise swiy begins on? can swiy take it permanently without issues or does he need to cycle using pct? also Swim (swiys good friend) is 27 and a good healthy natural bodybuilder. He wants to begin on a cycle of 500mg of testosterone enanthate also depo. Is swim likely to experience aromatization? Swim intended on either doing one single cycle and that’s it, or potentially doing repeated cycles for how ever long it can be sustained for (Swim will decide at the end of his first cycle). Would you experts advise swim to take Aromatase inhibitors in conjunction to prevent gyno? Swim would also do pct (regardless of whether its a one off cycle or a constant cycling). All advice and opinions is greatly appreciated.
Regards Swim and Swiy

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Matt September 13, 2014 at 7:05 AM

Whichever form of T Your Doc gives You the goal is to reach a good level of DHT and E2. With gel and cream You can easily reach this. Which inj You often need to take an AI to get enough DHT without excessive E2.

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Mikw August 28, 2014 at 12:20 PM

Dr. West,

Need quick advice if you can provide it. 29 yo male wrongly given androgel for symptoms of fatigue and low sex drive. T level was 474 at the time. Did it for month doc did not tell me of side effects like shrinkage. I stopped it about 4 months ago. Month after stopping got sick with a chest cold that lasted almost 6 weeks. During this time I was getting terrible sleep. Anyway I am still feeling a little run down, i feel much better than i did than wjen i first stopped the testosterone. But i think my levels could still be low cause im still not 100% and my ejaculate volume is kinda low. Testicles still feel a little smaller than normal too
I may go in and get blood work again, but will I recover soon without meds? Or would you suggest I ask my doc a course of hcg or clomiphene. I switched doctors.

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West Conner January 5, 2015 at 9:53 PM

I don’t recommend testosterone creams for men for several reasons. Taking it only a month shouldn’t have given you those effects. The lengthy cold was most likely a coincidence. If you find a doctor, get testosterone injection.

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Frank June 28, 2014 at 11:19 AM

Also a general comment to help those posting here, dont be fooled into taking painful injections with needles the size of a pencil, that are as long as your pinky finger. as long as you know your entering the muscle, you’re fine with the length, and as far as thickness goes, that’s largely (entirely?) a matter of how much patience you have with waiting for it to draw up the meds and inject in your body.

I often see people using 18g, 20g needles of 1.5″ and such. i have a bodyfat of about 18% or so, but as there is no fat at all on my thighs or deltoids i use an insulin syringe (30g/31g with a less than .5″ tip) or a “better” more “standard” syringe that is 28g with a 5/8″ tip.

As far as injection site, i find the deltoids and outer thigh (vastus lateralis) are the easiest for myself as i have great vision (clear view) and control (opposite of awkward positioning or angle) with those. in fact i have never and likely never will do the typical injection sight of “the butt” like many seem to do. I don’t like the idea of hitting a nerve, bone, or major vessel, and don’t run those risks where I inject as far as I know.

ive actually read recent documentation from multiple major medical bodies actually recommend NOT aspirating the syringe when injecting at such sites as it is not necessary as there is no risk of hitting an artery, etc and therefore can only cause other issues.

last tip, you can change the… tip of your syringes when using small ones to inject so you don’t need to wait forever to draw up your medication. you cannot do this with “all in one” designs like insulin varieties, but with regular syringes used popularly for intramuscular use, you can easily draw with a large gauge needle, then replace it with a higher, smaller gauge needle to inject with, so you get the best of both worlds.

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TANA June 20, 2014 at 4:24 PM

IN SOME OF MY PATIENTS THAT I GIVE TESTOSTERONE TO TRANSDERMALLY FOR INSTANCE RX OF TESTOSTERONE 50MG+CHRYSIN10MG THEY GET HIGH DHT LEVELS. BESIDES SAW PALMETTO, LYSINE AND GREEN TEA ANY OTHER SUGGESTIONS TO LOWER DHT WITHOUT USING AVODART. DO YOU SUGGEST HCG INJECTIONS?

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Frank June 28, 2014 at 10:43 AM

whoa woa whoa, your patients? you are a doctor? you shouldnt need random people telling you not to go lowering peoples dht levels if they are “high” without telling them they will get a limp dick first so they are aware and can make an educated decision as to whether or not they want to do that. if they aren’t suffering from bph or something else and dht isnt too high it shouldnt be a problem. i took the time to respond to you because , im guessing from your writing style and ability you are no doctor and just wanted some answers for yourself, so i figured id help. no real doctor would post for medical assistance HERE. best of luck.

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Tony April 28, 2014 at 2:11 PM

Sorry in addition to what I’ve just posted I meant to ask is it safe for me to take 5mg dhea per day?

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Frank June 28, 2014 at 10:44 AM

thats a tremendously conservative dose. i didnt say underdosed, but safe. start with that and get bloodwork done, then analyze and adjust accordingly. rinse and repeat.

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Tony April 28, 2014 at 2:03 PM

Some great information on here. I suffer with chronic back pain, depression, IBS, constipation, fibromyalgia, chronic fatigue, erectile dysfunction, no sensitivity in penis, unable to climax. I find it impossible to lose weight and I have man boobs. However since taking just 5mg per day of douglas laboratories micronized dhea my back pain has almost vanished. My libido has improved a bit and my mood has slightly lifted. I do have morning wood and feel more sensitivity in my penis but afternoon and evening my libido is weak. I’m worried about taking more than 5mg per day as don’t want to increase my estrogen. Is there anything else I can take with the dhea to improve my libido and to help with my other issues. Yes already had several doctors look at my bloods, hormones, thyroid but they can’t find nothing wrong. They even performed an MRI scan on my brain but couldn’t find anything wrong. Yes when they first checked my testosterone and vitamin D levels were low but since supplementation I’ve been told they have now normalized. Really desperate for help, almost suicidal. I don’t care about how much it costs, I just want the best supplement. Any help greatly appreciated.

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Frank June 28, 2014 at 10:41 AM

“I’m worried about taking more than 5mg per day as don’t want to increase my estrogen.”
Bloodwork is the only way to tell. that said there are many studies showing the use of 200mg daily without adverse results, just as there are studies showing increased estrogen from 50mg a day. it is all about the gender, age, condition of health, level of other hormones, etc of the user and bloodwork is your friend here. 25 should be safe for a starting dose for a man over 35, it is what dr. crisler believes and he is a nationally known hormone doctor who’s many views i respect.

“Is there anything else I can take with the dhea to improve my libido and to help with my other issues.” certainly. things that increase dopamine, testosterone, even things that affect histamine levels all effect the intricate network that operates your sexual desire and function. be careful, study long and hard, and consult a doctor for a proper plan. see a specialist who focuses on such things.

“Yes already had several doctors look at my bloods, hormones, thyroid but they can’t find nothing wrong.”
you say that, and my first though it is, you have low testosterone, you have low thyroid, and so on. just because they said you are ok does not mean you are ok. you could have been at the very end of the range of being ok. is that really ok? maybe if you came in the next day, you would have been a few points lower or higher on some scale for some hormone and they would have maybe said something differently. i would definitely get my hands on those numbers and take charge of my life.

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Olivier March 1, 2015 at 8:56 AM

Hi Tony,
Did you take finasteride?
I read a lot of symptoms that matches with the use of finasteride.
Even if you stop with finasteride, the symptoms get worse after months and years.
Many regards,
Olivier

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Jaron du Preez September 22, 2013 at 1:34 PM

HI, I had testicular cancer three years ago and have been in remission for two years. The BEP chemotherapy has affected my hormones negatively. My blood tests revealed levels as follows:
total testosterone is very high
LH is also high
Estradiol is high
SHBG is also high (3 times what it should be)
Free Testosterone is low.

I have virtually no energy and have stopped going to the gym. What approach would be best to decrease SHBG and estradiol? Which in turn will increase free t?

Regards
Jaron

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marc May 12, 2013 at 10:53 PM

i have been taking dhea for about 6 months now i am 54 years old, i initially started with one brand and i was taking 50 mg. a day, i initially and currently have seen a leaner me, however the first brand or manufacturer did not really have a mood change or libido change on me.
i have since switched over to dhea from general nutrition center and the change has been remarkable my libido has increased and i am able to achieve a stronger longer lasting erection.
i am thinking that perhaps 50mg. might be a little much so i will be cutting it down to approximately 37mg. as i tried 25mg. and that was insufficient.
i have also been doing some research on dhea and evidently taking dhea in a micronized powdered capsule form seems to be the way to go and perhaps 25mg taken in that form might be sufficient as absorption increases tremendously.
i think that taking the correct dose is optimal in order to truly experience the full benefits of dhea with minimal side effects if any at all.
i have tried testosterone before in the form of 250 mg injected once weekly intramuscularly the results were completely different there was much more muscle gain and greater strength however as far as libido and and erection issues the dhea is much better.
i only took the testosterone injections for 10 weeks and i would only take it again for muscle gains, however in all fairness to dhea users the dhea seems to be close to taking anabolic steroids but the results aren’t as obvious as quickly, but stamina, muscle gain and weight loss are all present with dhea therapy, i would also assume that dhea is not as bad on our bodies as anabolic steroids, not to mention much cheaper and available over the counter at walmart or any health food store.
just to be clear i was taking enathate as the anabolic steroid which is the mildest of all injectable steroids (as i have been told)
i hope this helps.
marc

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Frank June 28, 2014 at 10:35 AM

“i am thinking that perhaps 50mg. might be a little much so i will be cutting it down to approximately 37mg. as i tried 25mg. and that was insufficient.
i think that taking the correct dose is optimal in order to truly experience the full benefits of dhea with minimal side effects if any at all.”
Correct. Simply don’t guess, and test your levels. Adjust dosage accordingly.

“i have tried testosterone before in the form of 250 mg injected once weekly intramuscularly the results were completely different there was much more muscle gain and greater strength however as far as libido and and erection issues the dhea is much better.”
were you using the dhea after, before, during the testosterone? Do you know if your testosterone levels on the testosterone injections were providing too low of a level to see proper results? Were you getting more than you needed and it was converting into other hormones, worsening your libido? Without proper bloodwork you cannot say one is better or worse than the other, and the truth is, the human body will perform best libido-wise when both DHEA and testosterone are optimal , whether that comes to you naturally or via supplementation is an individual matter.

“i only took the testosterone injections for 10 weeks and i would only take it again for muscle gains, however in all fairness to dhea users the dhea seems to be close to taking anabolic steroids but the results aren’t as obvious as quickly, but stamina, muscle gain and weight loss are all present with dhea therapy,”
this simply is not true, regardless of your perceived experience. testosterone at safe dosages blow dhea out of the water in terms of muscle building, and when you take testosterone in large amounts and dhea in large amounts, the testosteron’s effects increase linearly giving massive gains while dhea will give you nearly zero if not worse results. This is based on hundreds of scientific studies, generally acknowledged medical fact, and anecdotal evidence.

“i would also assume that dhea is not as bad on our bodies as anabolic steroids, not to mention much cheaper and available over the counter at walmart or any health food store.”
whether something is legal over the counter has nothing at all to do with it’s safety or efficacy. for example dhea requires a prescription in canada. neither will cause issues when used appropriately, and at the appropriate level plus more, oftentimes testosterone can increase its benefits in various catergories while dhea will not continue to increase results linearly as well.

“just to be clear i was taking enathate as the anabolic steroid which is the mildest of all injectable steroids (as i have been told)
i hope this helps.”
enanthate is no more ‘acceptable’ or ‘less frowned upon’, than any other form of testosterone. on the same note, it is not any less potent than any other form of testosterone. so it is in fact not milder in any sense whatsoever from other testosterone products such as cypionate or propionate.

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John November 27, 2012 at 10:07 PM

I am a 68 y/o male, 6′ 5″ 220 lbs. Five years ago I was muscular, with good endurance but a minor accident resulted in a total-hip-replacement. The doctor totally botched the job, I am in constant pain, require narcotics to do anything. I have always been a little anemic, but now I am more anemic and have lost a tremendous amount of muscle mass. I am constantly fatigued and never want to do anything. I would like to try T-therapy, but don’t know where to start. Will a GP recommend testosterone for a situation such as this, does health insurance cover any of the costs. If my GP won’t recommend it, what’s the best way to get the treatment? I live in Ogden Utah and am not aware of any clinics in the area. I could use a total “quality of life transplant.” Thanks John

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randy March 19, 2013 at 9:06 AM

hi John, just wondering what you found out? I have been on Testosterone injections (I prescribe for myself and order off internet) for about a year. Usually high doses, but going to cut down soon. It has helped me immensely. I am 61 and have good muscle growth and have lost 120 lbs, although I did most of that before I ever started test…

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Todd April 2, 2013 at 9:33 AM

Opiates can cause low testosterone. I would recommend trying another avenue for relief of your back pain, if possible.

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Frank June 28, 2014 at 10:52 AM

“I have always been a little anemic, but now I am more anemic ”
” I am constantly fatigued and never want to do anything. ”
“I would like to try T-therapy, but don’t know where to start. ”

buddy, START with the anemia! get on some prescription iron if you are indeed iron deficient. if you aren’t, get on something safe and prove to increase your blood count… i dont know, say, TESTOSTERONE?! if you dont want to get on testosterone though and dont have a medical need for it, then of course don’t use testosterone, i was just saying it like that to get across the idea that it could be killing two birds with one stone. seriously get the anemia fixed. testosterone is not the first line of treatment to increase blood count, just making sure that im clear on that. it was just recommended for your particular situation, if medically applicable.

“I would like to try T-therapy, but don’t know where to start. Will a GP recommend testosterone for a situation such as this, does health insurance cover any of the costs. If my GP won’t recommend it, what’s the best way to get the treatment?”
Where to start?… go to the doctors office, get tested for testosterone and some other goodies, get results, walk out with prescription. its truly that simple. i speak from experience, and anecdotally for others. or go to antiaging clinic and pay possibly more, at least upfront and have someone more likely to prescribe you testosterone if you are having trouble getting your primary to prescribe it, or if you just want to start there because you know of a good place locally. always remember, if the doctor doesnt think you need it, but your results seem low, then go to another doctor, try again. do so until someone agrees. you just need to be tenacious. how much do you truly want to change your life? that is up to you friend. and yes, like most any other prescription it is covered by most any barebones insurance plan. maybe not the gels sometimes but at least the cheapo injections. cheapo does not mean not as good! just mean that without a script you can spend $100 on something that will last the “average guy on the average dosage” FIVE MONTHS!

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Terry H October 5, 2012 at 4:11 PM

Dr West Conner: I’m a 43 yr old male i’m considering using supplements 7keto- 7-ketodehydroepiandrosterone in safe levels what dosages can you recommend. Also can
you recommend a good aromatase inhibitor?

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Frank June 28, 2014 at 10:58 AM

well good that your going to use them at safe dosages. which i assume means your getting bloodwork done.

i would stay away from 7keto. why bother? what are you trying to get from taking this? real dhea is where the benefits are.

a good aromatase inhibitor? theres plenty, and they’ve been working incredibly well, demolishing massive levels of estrogen in women, saving their lives from cancer for years and years.
just use any of them, preferably a weaker one so its easier to titrate the dosage as you will need far less than a woman would. anastrozole, letrozole, and aromasin are some. there are also drugs like tamoxifen citrate and others that block estrogen at the receptors, like at the boobies for example, which are different from things like the ones i mentioned earlier, as those stunt the production of estrogen rather than blocking it from binding with estrogen receptors. thats the kind you want as a maintenence drug during trt therapy. that said, i dont know WHY YOU want to use an AI, so you may indeed actually not what an AI but something like nolvadex (tamoxifen citrate) after all. speak with your doctor.

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Brian P June 27, 2012 at 8:59 AM

Androgel pushed my E2 over 200 pmol/L, which is 2x the upper desirable limit. I was confirmed low-T before starting the gel. Serum free-T (not a reliable test, I understand) responded as expected, rising into the upper third of the reference range.

I am roughly 6 feet, 200lbs, with some evenly distributed trunk fat but no pot belly. I have started on Adex to reduce E2 levels but I find it flattens mood, even at .25mg EOD.

Would using a little transdermal progesterone to modulate E2 [and 5a-reductase] be worth trying instead?

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Frank June 28, 2014 at 11:01 AM

do not throw progesterone into the mix yourself. your playing with fire and further complicating things. you need to hold dosages for weeks and let things stabilize, check blood levels, and then asses your situation. you probably feel blunted moodwise becasue you drove your estrogen too low. .25mg EOD is a ton for not even having testosterone at 1000. your probably going to suffer from your wee wee not working pretty soon, if not already. keep e2 at 20-30 pg/ml. that is also recommended by LEF which is a seriously awesome foundation and i trust there word, even more so when it just backs up what i have prescribed to myself for years :)

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Michael G April 15, 2012 at 5:34 PM

I am a 43 year old male. Started therapy Feb 13 2012. Test level 243. One month of androderm level increased only to 246. One month of 200mg/ml testosterone cypionate bi weekly injections test level only increased to 257. Dr. recommended that I increase frequency of injection to every week. How long until test levels are normal?

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Frank June 28, 2014 at 11:07 AM

you say 246 for androderm, and i believe it. who knows how well you absorb it, where you spread it on your body, if you showered, etc.

you say you had levels of 257 on 200mg biweekly injections… the injections pretty much work across the board and dont have the person to person variability the gels can have with blood results, so here i do believe your results as well, but with the caveat that i dont believe this is your effective result. you need to realize if you tested your levels at the day before an injection or so, your levels are going to be a small percentage of where they were earlier. lets say your levels on day 14 should be half of what they were at the end of day 7, and the levels on day 7 are half of what they were when you peaked a day or two after your injection.. so you could have been at 1000, then end of the week 500 then the end of the next week 250. see what i mean?

anyway….try every week, and then restest, you will probably be much happier both with the result as well as the effects.

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adrian g. September 6, 2011 at 5:40 PM

What do i take now?

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adrian g. September 6, 2011 at 5:36 PM

Last three weeks i took. .5 testosterone 100 follwed by 1 ml then1ml again if want to finsh cycle what do i do or take?

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JP December 25, 2010 at 1:16 AM

How long does it take for testosterone to convert to estradiol? I took three shots of testosterone cypionate (250/150/100mgs E3D) and then my doc checked my estra level which is 191 pmol/L.It wasn’t checked prior to starting.
43 yrs old, 15.1 nmol/L testosterone start nothing else checked – not measured since. Just wondering if 3 shots could have put my estradiol that high that quickly or if there is a possibility that I was estrogen dominant prior to starting treatment?

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West Conner January 5, 2011 at 12:38 AM

JP,

Everyone converts at a different rate. You should be taking an aromatase inhibitor along with your testosterone therapy. Did you get 250mg, 150mg, then 100mg three days apart? If so, get a new doc.

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Pat White December 3, 2010 at 7:29 PM

So is there a side effect of taking DHEA since it produces more estrogen than Testosterone?

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West Conner December 8, 2010 at 12:43 AM

Pat,

For men, too much DHEA will convert over to estrogens. We need the right amount, about 25mg. At that dose, there usually isn’t any conversion and no side effects. Unless you count feeling better and having more energy side effects.

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