The Ultimate TRT Guide for Aussies – Part 3

The Ultimate TRT Guide for Aussies – Part 3

Hello all. Continuing on from (Part 2 here), in Part 3 we will discuss the scenario whereby a patient has managed to jump through the necessary hurdles (discussed in Part 1 and 2) for testosterone deficiency diagnosis and he has found himself a willing physician to prescribe and monitor his testosterone replacement therapy. For exemplar’s sake, lets uniquely name this patient, Joe. As we know now, if a patient is receiving testosterone therapy in Australia it was likely he has very low levels of testosterone and was tested on a number of occasions. That was Joe.

Joe tested 7 nmol/L on two separate occasions and he is suffering from all of the classical low testosterone symptoms. Joe turns 45 in 3 months and would love to find some resolve upon his next consultation in the hopes of feeling a bit better before his birthday. This reminds me of a factor involved in testosterone deficiency diagnosis; one I could not find in the prescribers’ guidelines, but one that I know to play a major role. That factor is age! If you’re 45 years old, you stand a significantly greater chance of acquiring a prescription for TRT than you would if you were 25 years old. It is often presumed by Doctors that because you’re young, your hormones should be fine and even if they’re not, they should bounce back soon anyway. Once again, another example of where there is no urgency to resolve what is a serious medical condition for many with life threatening symptoms such as depression—even suicide. If you are young and reading this, then unfortunately you stand a slim chance of successfully acquiring a testosterone prescription if you need one, with or without qualifying for testosterone deficiency via the harsh Australian prescribers’ guidelines.

Does aging play a major role in the decline of testosterone levels? If so, does that mean declining testosterone could be seen as a natural part of life and that perhaps declining testosterone levels as we age serves a healthy purpose?

Testosterone ages at approximately 1% per year after the age of 30 years old which is significant depending on how old you are, but this statistic (which is not thoroughly verified) can hardly be the main cause for reductions in serum testosterone of 100-200% in many males who present with low testosterone diagnosis. To argue the point made by some that testosterone deficiency is a natural part of the aging purpose—well, I would respond with both “maybe” and “no.” There is often a purpose for every deep-rooted trend in nature and there is often a consequence for disrupting the balance; but we’re not so sure this is the case with the inevitable decline in testosterone as we age. One of the best arguments against this claim is such that there are several accounts of men with healthy natural testosterone levels well into old age and the majority of these men are those who take care of themselves who have a good bill of health. Unless every modern man lived as nature had intended, we will never know for sure the conclusion to this naturalist’s theory because at the moment all I see are health benefits for those who require TRT. I wouldn’t bet on the contrary to my stance, put it that way.

There are hundreds of papers now that support the high safety profile of testosterone therapy when administered properly—of which study papers are putting a lot of myths about TRT, to bed. When you weigh up the known cost to benefit ratio for TRT, it’s a no brainer that testosterone therapy is a much safer, healthier and happier solution than living the rest of your days miserable and wondering whether or not it was “natural” or not. I often wonder whether the “I’m a lifelong natural” title is more of a pride statement, rather than a health journey. If you require testosterone therapy, use it! Before I go further then, a quick note on natural vs man-made in the realm medicine. There are examples of natural products being unsafe and examples of man-made products showing great safety all throughout the medical literature. However, there is a saying I heard once that is rather clever:

“If it’s natural, it’s innocent until proven guilty and if it’s not natural, it’s guilty until proven innocent.”

Now that quote is to be taken tongue in cheek, but at least we know testosterone therapy has now proven itself to be “innocent.” There are risks with all medicines of course and there will always be adverse events. You cannot list a single drug ever manufactured that hasn’t caused an unwanted side effect to at least one person who tried it. When it comes to drugs, it’s never about whether or not it’s perfect. No perfect drug exists. The decision to take to not to take a medicine should be about whether or not the cost to benefit ratio is in great favour of benefit for the patient. I digress a little, or a lot. Back to poor Joe, nearly 45 years old and desperately looking for help to manage his symptoms. Joe has been confirmed to have low testosterone and his next visit with his Doctor is D-Day for the beginning of his TRT journey. After 2 months, 2 consults and 2 blood tests later, Joe has received his prescription. Joe’s Doctor prescribes him 250 mg of testosterone enanthate every 14 days. testosterone enanthate or testosterone cypionate are for most the overall choice of prescription. In Australia it is enanthate because that is what our main pharmaceutical supplier provides, but the difference between cypionate and enanthate is simply insignificant. There are several other methods of TRT that can work, but we will discuss alternative prescriptions in another part.

Back to ol’ Joey. Joe chooses to self-inject his prescription. With YouTube, learning anything is possible if you have an internet connection. Within only days after his first testosterone injection of 250 mg, Joe begins to feel himself again. His mental clarity, energy, wellness and all-round quality of life has vastly improved. Is some of that placebo? Maybe. More likely though, the 250 mg of testosterone that peaked within 2-3 days has begun to exhibit its positive effects on Joe. Joe isn’t 100% better yet though. After all, it may take a few weeks or months for the full effects of testosterone therapy to take effect and Joe has some lifestyle changes he wants to make as well. Since the partial return of his mojoe [see what I did there], Joe is more motivated to make healthier lifestyle choices. It’s a rather toxic cycle to be in when you have testosterone deficiency because although the patient often knows a lot of how he is currently living is worsening his situation, because the patient is testosterone deficient, they lack the motivation to make healthier lifestyle changes. It’s a double-edged sword of sorts.

After a great first week, Joe doesn’t feel so good the second week. Especially towards the end. Joe is also noticing some nipple sensitivity. What happened? Joe begins to lose motivation again until about the same timeframe after his second shot. Surely enough, 2-3 days later he begins to feel improvements, although the nipple sensitivity is still apparent. Well, the 30 day mark is approaching and Joe has a follow up consult with his Doctor. Joe explains to the doctor his experience over the last 30 days, only to be told to stick it out another 14 days until his next consult and to receive another sheet of paper for some more blood work to see how everything is working. The Doctor explained to Joe that he may have to prescribe Joe some Arimidex to reduce his Estrogen levels if his Estrogen comes up high in his next blood test. It’s a little depressing for Joe as he thought there would be some swifter resolve. Thankfully, Joe is not exactly a flintstones character and he’s done a little research of his own.

Testosterone enanthate has a half-life of approximately 4.5 days and a Mean Residence Time of approximately 8.5 days. The most comprehensive data strongly supports weekly (even twice weekly) injections for testosterone enanthate, not every 10 days or fortnightly injections—which you’d think would be obvious based on the pharmacokinetic profile of testosterone enanthate. When a single 250 mg injection of testosterone enanthate is administered, it will produce supra-physiological levels of testosterone. This is a scientific way of saying “higher levels than are commonly natural.” The male body also requires estrogen and most of this estrogen is made from the conversion of testosterone to estrogen via aromatisation. “So higher testosterone levels mean?” Yep, you guessed it—higher estrogen levels too! Joe’s nipple sensitivity was due to the fact his peaks of testosterone are too high. Also, the last few days before Joe’s next shot, he could also feel the valley in his testosterone levels which were likely below baseline due to the elimination time of testosterone enanthate. No biggy though. Joe could always take the initiative to split his dosing into weekly or twice weekly injections and not tell his Doctor (or tell him and see what comes from it). Not a major problem here, but the testosterone enanthate we are prescribed in Australia (unless it is compounded) is Bayer Primoteston Depot – Testosterone Enanthate 250 mg/ml, Pre Filled Syringe. Because the 250 mg comes in a pre-filled syringe, you’ll need to go through the additional task of injecting your pre-filled syringes into a sterile vial to make dosing easier. This is the easiest method and pre-filling your own injections with disposable syringes and needles is not technically safe and not recommended by the medical literature. Although I know for many to pre-fill their own injections and have not experienced an issue, I still do not recommend it. Joe decides to split his 250 mg pre-filled syringe into 4 x 62.5 mg injections which is also 125 mg per week, split into 2 shots weekly. When Joe transitions to this protocol, the way he feels quickly reflect the stability in his serum testosterone levels. No more drastic highs and lows. The fact Joe had to turn to the internet for this kind of information that massively changed his mind about testosterone therapy is a little concerning.

So why do Doctors in Australia often prescribe testosterone enanthate at 250 mg every 10-14 days when the patient will likely experience these highs and lows?

Part 3 has dragged a little longer than my usual word limit. I know it’s all so captivating so far, but I’ll have to keep you all in suspense until Part 4 where I’ll explain the reasons why many Doctors in Australia still prescribe TRT in ways that do not maximise the patient’s comfort and experience with TRT. Until then lads and lasses!