T Nation

Nerd Talk - A Study on Testosterone Administration (Methodology)


#1

Not sure where to post this, but given my profession I enjoy reading studies and I most enjoy peer reviewed studies. I have found a few that may apply to this bored but I figured I would post this one. This peer reviewed article covers TRT for male hypogonadism and specifically the pharmacology and efficacy of topical/transdermal, patch/transdermal, transbuccal (inner-check), oral, intramuscular and subcutaneous implants. In addition what may be next. I will not post any further studies or peer reviewed articles if it is not desired here. Just thought this would be a fun read.

note sucks I can not upload the pdf and not sure if linking outside is ok (as I could host the pdf on one of my websites). Which sucks because the figures are important as it shows study results that are being referenced.

References

Seftel, A. (2007). Testosterone replacement therapy for male hypogonadism: Part III. Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents. International Journal Of Impotence Research, 19(1), 2-24. doi:10.1038/sj.ijir.3901366

Summary


#2

Great study. Thanks for posting. Some interesting findings for sure. For one thing, even AndroGel 1% @ 5mg daily was sufficient for increasing testosterone levels significantly after 3 months, raising libido, and reducing depression Seems that Testim is better at raising T levels - which I’ve heard before.

What I found very surprising was that for intramuscular injections – the study stated that 25% of the patients had gynecomastia symptoms within the first two weeks. All the more reason to make sure that there is a proper AI in place when beginning therapy – and to get testosterone and estrogen checked every 2 to 3 weeks to see how things turn out.


#3

Every 2-3 weeks! That’s sounds excessive to me. Maybe every few months.


#4

I found this paper interesting because it aggregates so many studies together that focused on a single method of delivery and compared the pharmacologic profiles. Being able to see the side by sides and methodology of application allows an apples to apples comparison so to speak.

Every 2-3 weeks is excessive to check effectiveness of an AI. Using the information in this paper to compare to how levels of testosterone rise and fall again can assist with determining when to get blood work. It seems from reading peoples accounts on this forum that the people whom do best on therapy are those who are able to smooth the levels with less extreme peaks and valleys (this would most likely correlate to easier establishment of proper AI dosage and schedule though I lack peer reviewed data to support that). This study seems to imply the best way to do so is to use slower delivery methods, however they also tend to have lagging beneficial results in other medications (think SSRI, SNRI etc.). While I did not locate a study yet that directly compared intramuscular injections at twice per week, weekly, bi weekly and monthly with control groups, and associated serum levels coupled with response through an generally accepted scale (such as SIS [Sexual Interest and Satisfaction Scale] or perhaps GRISS), we do have anecdotal evidence based on the information contained in this forum (and others I viewed) that twice weekly injections provide less peaks and valleys of serum testosterone and may allow for better control of estradiol (E2) if a “generally accepted” (though non officially exists for men with regard to the Endocrine Society’s Clinical Practice Guidelines) E2 protocol is followed and monitored.


#5

Noble idea. I, myself, have been reading peer reviewed journals to try and make sense of all of this. As a previous heavy benzodiazepine and SSRI user for severe anxiety, I was trying to find the root cause of my hypogonadism, and if it could be reversible.

I haven’t gotten around to reading the last one that my library recently pulled for me, but, here they are for your enjoyment as well.

Aydogan, U., Aydogan, A., Akbulut, H., Sonmez, A., Yuksel, S., Basaran, Y., Uzun, O., Bolu, E. & Saglam, K. (2012). Increased frequency of anxiety, depression, quality of life and sexual life in young hypogonadotropic hypogonadal males and impacts of testosterone replacement therapy on these conditions. Endocrine Journal 2012, 59 (12), 1099-1105

Basically, TRT improves quality of life as we all know. But, doctors love writing that Prozac script as opposed to messing with hormones…

And this one, more specifically for my case,

The Journal of clinical endocrinology and metabolism: In vitro and in vivo effects of the triazolobenzodiazepine alprazolam on hypothalamic-pituitary-adrenal function: pharmacological and clinical implications.


#6

But were any of the TRT methods/protocols actually good or well managed? Most of any problems reported are results of doctors not really knowing what they are doing or should be doing.

Many outcomes are determined by achieving normal ranges. Many normal ranges would be considered failures in this forum.

When you see outcomes listed as positive if two weeks after an injection that T levels were normal, you know that that is a disaster.


#7

Yes. I meant initially as one begins treatment - get a pulse on E within a few weeks


#8

Got it. I still think if you start with a solid protocol, you need to give your body at least four weeks to adjust before drawing labs and making changes. Of course this can be debated if a guy really feels bad. What I’ve seen on this forum is too much adjusting too quickly. This usually leads to hormones being all over the map and results in wasting months. Start with a good protocol and stick with it awhile then fine tune based on labs. JMHO


#10

Protocols are listed in the methodology section in each study as a to ensure it is not a variable. I could look up each study. Reading the methodology, it can not be wrong no mater how administered (assuming constitancy), it just provides additional data to aggregate for best treatment for the largest population of the particular target of research (disease state). Although in this case I would not be surprised someone feels better after two weeks of testosterone injections alone. Ask them in two months after their bodies have shut down natural LH and FSH I feel the “success” might not be as well graded (if a standardized scale is used).