T Nation

TRT After Full Knee Replacement

Has anyone resumed or started TRT after a joint replacement? I’m 56 y/o male and was on a TRT of (testosterone/HCG) for a year before my surgery. It seemed to work and I felt better than ever. Is it still safe to do and what changes have you made to the injection site if any(different leg than the prostetic)? I’ve gotten conflicting answers from my doctors and any infections could be a major issue with my knee.

You came off of TRT for the replacement? How do you feel cuz that sounds awful? Having an optimized hormone profile would only benefit your healing. There should be no issues with TRT and a joint replacement. TRT is for life.

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I definitely don’t feel as good as I did prior to stopping. I have 10 weeks worth of t and hcg still to use. My major concern is any infections I could possibly get.

Infection from what a dirty needle?
IMO I’m 65 been on trt for >4 years. You need to get back on the juice asap.
It will boost your IGF-1 and GH which will speed your healing.
You own the doc that told you to go of your TRT no thanks. What a dumb asss.

On your next blood test get your IGF-1 tested if it is under 200 look into the peptides Sermorelin and Ipamorelin. They will boost your natural production of GH.

You are going to love that new knee once you’ve healed. Don’t cheat the physical therapy.
Getting your T lvl back to normal will also help with the pain by increasing your tolerance.

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I haven’t done a ton of research on IGF-1 levels and where you should be. Where did you get the 200 number? Last April was 162 and then in September I was 206. In April I was on 55mg a week and in September 90mg a week. Does increased T increase IGF-1 and is this the reason for increased muscle growth on T?

Many have. A knee replacement is not an issue.

I don’t understand why you would stop TRT because you’re going to have surgery, you’re going to need your hormones if you’re going to recover. Testosterone and estrogen strengthen muscle and joint tissue.

If a doctor forces you to stop TRT due to a surgery, it’s due to ignorance.

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KYour body would naturally make testasterone … your worse off without. t is the building block to life for man. People take hormones for injuries all the time. Especially athletes. Take care of the joint health because t helps growth and healing. More blood flow and etc.

Defy consult. Remember I am 65 and they say my IGF-1 should be 200 I have also heard other Defy patients not on this forum in their early 30 post they want to see 300 for them.
How old are you NH_Watts from your avatar you look about mid 40’s if so I would think your IFG-1 should be ~250-270 range.
Now that I have said that. I have done a shitload of research on IGF-1/GH and it has a very bad down side. If you have cancer diagnosed or undiagnosed GH will increase or speed up its growth.

The same happens if you start TRT. Speeds up growth. It’s very rare. That’s also why they run blood panel. Anything wildly wrong and they have you see a specialist before starting omen on trt. Oh and family history and genetic studies need to be reviewed and the doc can use that to make sure.

I don’t think this is based in any fact. Some doctors (some that have been on TOT podcast) have talked about treating prostate cancer with high amounts of testosterone and curing it.

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Yeah @hrdlvn Im 47. So how do I go about raising it? Peptides? If so, aren’t the affects only temporary? Or is it just Test that will bring it up? Is it more gradual? Thanks.

Yup they sure did.

@NH_Watts yes peptides. Believe it or not you cycle them 3 months on 1 month off 3 months on. Its pretty cheap 30bucks a bottle from bluesky defy wants 165.
The form hates it when I post links so I will try to copy and past my notes from my research lets see how badly the mod or forum software handles this:

Severe GHD that is relatively unresponsive to monotherapy of either peptide can be best treated by taking advantage of synergy between both families of peptides.
In this case, combinations of 2:1 Sermorelin and Ipamorelin in a ratio generally representing
(more or less) will be effective and most appropriate, especially for the older patient.
Thus, because of the different properties of Ipamorelin and Sermorelin they are often used
as monotherapies after identifying the condition to be best treated.
However, under certain conditions of relatively severe growth hormone insufficiency,
combination therapies are indicated.

Order Sermorelin 15mg and Ipamorelin 6mg strengths
Patients must reconstitute both bottles and store them separately (do not combine them into the same bottle otherwise it becomes unstable)

Using a single 1mL insulin syringe, draw ipamorelin then Sermorelin followed by
administering by SubQ injection
Rec. dosages:
High dose: 1000mcg Sermorelin + 500mcg Ipamorelin qhs
Low/Maintenance dose: 500mcg Sermorelin + 250mcg Ipamorelin qhs

Sermorelin monotherapy is commonly prescribed for relatively younger patients who have significant pituitary reserve and only need treatment for a few months, to increase exposure to endogenous hGH
Since Sermorelin eventually down regulates its pituitary receptors and actually “turns off” production of endogenous GHRH due to ultra short feedback and activation of somatostatinneurons in the hypothalamus, its efficacy of slowly lost and recovery is often required for restoration of function.

Recovery may be facilitated by subsequent monotherapy with Ipamorelin which will restore GHRH function and suppress somatostatin activity that is enhanced by Sermorelin therapy.

Ipamorelin monotherapy is also beneficial when provocative testing reveals that pituitary reserve is low, possibly due to hypothalamic deficiency of GHRH and enhancement of somatostatin influence. This condition often occurs at early somatopause and can be treated well with ipamorelin alone.
Administer Sermorelin at 500mcg - 1000mcg qhs for weeks 1-12 followed by ipamorelin at 500mcg qhs for 12 weeks

How do I take Sermorelin?
Sermorelin is injected into the body fat, subcutaneously, using a very small needle similar to what a diabetic uses to inject insulin. Injections are initially prescribed for every day and are decreased in frequency over time.
When do I take Sermorelin?
The best time to take Sermorelin is prior to bedtime. Growth Hormone is primarily released during sleep and most beneficial to the body’s recovery and repair during this time. Sermorelin has a promoting effect on sleep and can therefore make you tired if taken during the day.
How do you measure the effectiveness of Sermorelin?
Due to the pulsatile nature of both endogenous HGH and IGF-1, a single blood draw is not sufficient for accurate measurement. Most physicians who prescribe Sermorelin and similar peptides measure effectiveness in patients through symptomology (the study of your symptoms-see benefits); physical appearance and measurements; and blood analysis.
How will I know its working?
After 4 years of observing patients taking Sermorelin, I have noticed that patients usually report improved sleep within the first few weeks of therapy. Of course, this is only noticed in patients who have trouble sleeping in the first place, however most patients at least notice an increase in sleep quality. This is usually concurrent with increased energy levels and improved mood.
After 3-6 months of therapy patients start reporting noticeable or significant body changes, such as increase in muscle tone and a leaner physique.
Over time patients will also notice a significant improvement in skin tone and health.
How long does it take to work?
Just like most HGH medications, Sermorelin usually has a “loading” period of 3-6 months before full effects are noticed. Once injected, both Sermorelin and rHGH are eliminated from then body very quickly and therefore need to be injected frequently. Its actions are dependent on a chain reaction of biological processes which result in elevated and sustained HGH and growth factors. It takes some time for levels to become optimal and initiate the benefits we are seeking to achieve.
Do I need to take Sermorelin forever to keep seeing results?
Actually, no. Sermorelin has an ongoing effect in which optimal HGH levels can be sustained long after the last injection. Just like synthetic HGH, Sermorelin initially must be injected every day. Unlike synthetic HGH, once optimal levels are sustained with Sermorelin injection frequencies can be decreased or stopped altogether. Once results are achieved, patients are then switched to a maintenance protocol eliminating the need for ongoing daily injections and reducing the total cost of therapy!
Sermorelin Starting Dose: 500mcg-1000mcg (1mg) injected sc before bedtime.
Studies have shown that 1mg of Sermorelin will create maximum stimulation to the pituitary to create a good level of growth hormone within the pituitary. This dose should be used for approx. 6 months as the anterior pituitary is recrudesced. Therefore, a dose of aprox. 500mcg delivered sc each evening has been shown to provide maximum stimulation to the pituitary releasing optimum endogenous growth hormone. After aprox. 12 months of sermorelin injections, the patient can try reducing injection frequency to 1mg 2-3 times per week to maintain levels.
Sermorelin Dosing protocol for optimizing GH stimulation
Studies have shown that 1mg of Sermorelin will create maximum stimulation to the pituitary to create a good level of growth hormone within the pituitary. This dose should be used for approx. 6 months as the anterior pituitary is recrudesced. Therefore, a dose of aprox. 500mcg delivered sc each evening has been shown to provide maximum stimulation to the pituitary releasing optimum endogenous growth hormone. After aprox. 12 months of sermorelin injections, the patient can try reducing injection frequency to 1mg 2-3 times per week to maintain levels.
Again, because the manufacture of endogenous growth hormone by the pituitary is governed by a negative feedback loop, meaning that if the body recognizes that there is an optimum level of endogenous growth hormone being already being produced, then no matter how strongl stimulated by sermorelin, no more endogenous gh will be produced. Note that in truth, the relationship between sermorelin dosing and endogenous growth hormone production is not exactly linear. However, for purposes of discussion and materiality, the aforementioned relationships and limits between sermorelin and endogenous growth hormone are true. So it makes sense to utilize sermorelin to optimize growth hormone levels as determined by the patient’s response itself rather than use exogenous growth hormone through either guesswork or extensive repeated testing.
Using Sermorelin Acetate will promote longevity and lifespan by increasing both production of Human Growth Hormone and increasing pituitary reserves of HGH. Sermorelin does not bypass the pituitary-GH axis therefore allowing control of IGF-1- fluctuating levels as needed to preserve health.
“Growth Hormone Releasing Hormone, called Sermorelin - may provide a superior product for endogenous production of hGH. Unlike exogenous recombinant human growth hormone (rhGH)that causes production of the bioactive hormone IGF-1 from the liver, sermorelin stimulates the patient’s own pituitary gland by binding to specific receptors to increase production and secretion of endogenous hGH.”- Dr . Rand McClain, Sports Medicine Physician LA.
Summary of studies using Sermorelin (GHRH) in adults (dose 1mg per day) (from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2544358/) :

“Once daily GHRH injections can stimulate increases in GH and IGF-I at least to the lower part of the young adult normal range (Merriam et al 2000). The University of Washington study of 6 months treatment with daily bedtime subcutaneous injections of GHRH(1–29)NH2, alone or in combination with supervised exercise conditioning, was begun in response to the NIH initiative (Merriam et al 2002, 2003). IGF-I levels rose approximately 35%. As with GH, subjects showed an increase in lean body mass and decrease in body fat (particularly abdominal visceral fat). However, there was no improvement in strength or aerobic fitness associated with GHRH injections. Testing again confirmed the benefits of exercise but showed no effect upon IGF-I levels; thus it appears that GH/GHRH and exercise work through different mechanisms (Vitiello et al 1997). Subjects receiving GHRH also showed no change in scores on an integrated physical functional performance test mimicking activities of daily living, but there was a significant decline in physical function in the placebo group (Merriam et al 1997, 2003; Cummings and Merriam 2003). This tantalizing finding, suggesting that GHRH can stabilize if not improve physical function, needs confirmation. There is only one other published study of chronic GHRH in normal aging, which reported positive effects on exercise testing after 3 months of treatment (Veldhuis et al 2005).
Sleep and cognition were also studied in the GHRH trial, with surprising results. GHRH failed to improve and may even have impaired deep sleep, despite the rise in IGF-I and pulsatile GH. However, GHRH treatment was associated with improved scores in several domains of fluid (but not crystallized) intelligence – those measures previously found correlated with circulating IGF-I levels (Vitiello et al 2006). This intriguing preliminary finding is now being studied more systematically at the University of Washington in a new NIH-funded study (the Somatotrophics, Memory, and Aging Research Trial, or “SMART”).
Thus as with GH, there is a consensus on hormonal and body composition effects but inconsistent functional effects on function; and in addition there is a very encouraging but still unconfirmed positive effect on some domains of fluid intelligence.”
Note: The above studies checked for IGF-1 at baseline and week 2. If IGF did not increase by at least 15 percent, they would double the dose. 83 out of 89 people did not require a dose adjustment. Average IGF-1 increase was 30 percent at the 1 mg per day dose.
Using Sermorelin to Decrease Body-Fat
Lipodystrophy is a medical condition that defines the rapid accumulation of adipose tissue (body fat) usually unevenly distributed in certain areas of the body (legs, hips, stomach, lower back). In basic concept, lipodystrophy is very similar to the increase in body fat experienced as we age, accumulating unevenly in different areas of our body. The Journal of the American Medical Association (JAMA) published a study in 2008 of the effects Sermorelin had on HIV positive men suffering from lipodystrophy.
The study concluded that patients provided the Sermorelin lost adipose (fat) and increased lean muscle, significantly improving total body composition.
Study Conclusion: GHRH was well tolerated and effectively increased levels of IGF-1 in HIV-infected men with lipodystrophy.
Total and regional body composition improved in response to GHRH, with increased lean mass and reduced truncal and visceral fat. Use of GHRH may potentially be a beneficial treatment strategy for this population. JAMA. 2004;292:210-218 www.jama.com
Sermorelin & Diabetes
Typically the blood sugar issues associated with “growth hormone” are caused by taking high dosages of synthetic HGH which result in a large, unnatural, bell-curve in IGF-1 (Insulin-Like Growth Factor-1). IGF-1 competes for insulin within the same cell receptors and therefore can lead to hyper or sometimes hypoglycemia. Diabetic patients would have a difficult time tracking their sugar and risk taking too much, or not enough insulin.
When it comes to Sermorelin, or even conservative dosages of HGH, there should be no detriment to blood sugar and insulin.
It is still important to instruct patients the importance of eating low glycemic for both the benefit of managing his diabetes, but also to maximize the effectiveness of the Sermorelin’s coversion to IGF-1.
Sermorelin and all GH peptides work better in people who maintain lower blood sugar/insulin through a low glycemic diet.

Sermorelin Acetate 15mg now available for $165 ! (Normally $225)
Defy Medical is pleased to announce that our compounding pharmacy is now offering Defy Medical patients a discounted price for Sermorelin Acetate 15mg (15,000mcg) vials. The new price is $165 (normally $225).

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Looks like I’m going to start back up with my HRT. Previously I was taking:
1ml Testosterone Cypionate/Anastrozole 1x week
50 units HCG/Theanine 5000iu/100mg 2x week
Without taking another blood test right now, should I be ok with that post knee replacement?

1ml does not tell us your weekly dose. Was your T cyp 100mg/mL or 200mg/mL its on the label.
Not having blood work I would guess 100mg/wkT cyp and NO AI would be a good starting point and get bloods in 5-6weeks TT/FT/SHGB/E2/HCT if you are donating blood often add ferritin to the blood test.
50 units of HCG also sounds like a very strange dose.
The recommended dose is 800iu to 1500iu per week. I do 400iu on M/T

Yah 50iu hcg caught my eye to.

How did you feel when you were on it and what were u on. Same as listed?