Photo of Steroidogenesis of Testosterone in the human body

The Testosterone Connection – Part II

Background

It’s been a month since I originally posted “Prostate Surgery and Sex – the Testosterone Connection” on March 27, 2013.  Many of you have asked that I keep you updated on this subject so that you can be informed of the “continuing saga” on testosterone supplementation. Thus, this post.

In the earlier post, we left off with my having to wait until July before my urologist would permit testosterone supplementation. My first blood test, taken to determine how low my testosterone level was, returned a result of 195 when the normal range for men is 300-600. Obviously, I was in tough shape. I had decided to explore “natural”, non-prescription testosterone “boosters” on my own. These included specific food items as well as non-prescription food supplements that were known boosters and could be purchased at stores or websites like GNC.

What Has Changed In the Last Month?

The master plan that I outlined in the last post has been changed. My urologist allowed me to begin the testosterone replacement program on March 4, 2013. I was miserable and ready to cut a large hole in the lake ice and jump in it. Since male testosterone regulates just about everything in your body, including your metabolism, mood, demeanor, and cognitive abilities, Low-T for any length of time can really make you feel miserable 24/7. That’s where I was at. I needed help and I needed it fast.

One interesting fact that I learned while I was interviewing with the urologist’s PA (physician assistant) is that not all men who are experiencing severely low testosterone levels (below 200) are necessarily sensitive to the symptoms of Low-T. In fact, she explained that the majority of Low-T patients that she treats do not feel any different after testosterone supplementation than they did before they started supplementation.

I couldn’t believe it! I was ready to jump off a cliff. I went through a period of approximately four months when I did absolutely nothing. I couldn’t even sit at the computer to compose a blog. I simply had no interest. I had no interest in doing anything. Even watching TV was painful. My mind was functioning about as effectively as a turnip’s. I had chronic fatigue. The nurse could not tell me why I am affected so negatively by Low-T. And now that I’m on the road to recovery, I don’t care. My advice to readers is – you don’t ever want to go there. If you think you have Low-T, get it tested and do something about it. Discuss how you feel with your doctor. Only men over 50 or men who have had other issues or surgery affecting male sex organs need be concerned.

A word of caution – most Low-T conditions are diagnosed by physicians as depression. When I originally described how I felt to my personal physician, he said I was depressed and prescribed an anti-depressant medication. I took that for a couple of months as he gradually increased the dosage. By the end of the second month, I went from chronic fatigue to zero energy and I was sleeping 22 hours a day. That’s when I threw the medication out and demanded a blood test to check my testosterone level.

The symptoms of Low-T and depression are practically identical. If you suspect Low-T, get the test. It’s cheap, easy, and your insurance will pay for it. So do it.

Testosterone Supplementation Options

The “natural” testosterone boosters that I mentioned above which includes food items and non-prescription supplements proved to be ineffective. I still include the food items in my diet. But I’ve pretty much given up on the non-prescription supplements.

The prescription skin patches and gels, like Androderm or Androgel, are expensive since they require a prescription and currently enjoy “brand” status. All new prescriptions receive “brand” status for seven years after their introduction to the market. That means that a particular prescription has no competition for seven years. The drug manufacturer can charge whatever they like. After the seven years of brand status expires, other drug companies can manufacturer cheaper generic clones of another drug companies product if they so choose. Androgel, Androderm, and Axiron are all “brand”. My medical insurance would pick up the majority of the cost of the drug. But that leaves a $60/month co-pay for me, which didn’t excite me much.

On top of the expense, the products that you apply to the skin as patches or gels deliver 20% of the product as absorbed testosterone and 80% of the product is wasted or never absorbed.

There are only three ways to get testosterone into the body. Trans-dermal – absorbed through the skin. Trans-lingual – absorbed through the gums in your mouth with the use of a lozenge. Or testosterone can be injected into muscle tissue using a needle and syringe. I opted for the latter because it’s cheap and effective.

 Here’s How the Injections Work

I had originally chosen to self-administer the injections. That means that I would give myself a shot every month and the urologist would teach me what to do. Doctors actually permit self-injecting all kinds of medicines as long as you have a prescription and receive instruction on what to do. The syringes and testosterone serum can be purchased at my local Walgreens Pharmacy with a prescription.

Once the details of self-injecting were explained to me, I chose to opt-out of self-injecting. The testosterone must be injected into a muscle. It was not something that you injected under the skin. Specifically, testosterone must be injected into either your thigh, or your buttocks. Obviously, if I was going to self-inject, the buttocks was not an option.

The needle was huge. The nurse said that was because synthetic testosterone is oily and thicker than most injectables. So it needs a bigger needle. To make matters worse, this huge needle had to be inserted full-length into the thigh muscle. Then you had to pull the plunger back a bit and check for blood in the syringe in order to insure that you had not hit a blood vessel. If you did hit a blood vessel, you have to withdraw the needle and start all over again. I had performed injections before. But this was ugly. No thanks.

I bent over her examining table, dropped my pants, and she pumped 200 mg. of pure testosterone into my buttocks in a flash. That was that.

In April, I have an appointment at my local clinic for another injection. I get an injection every month for the rest of my life. I don’t mind shots. And driving to town once a month doesn’t bother me either. I’ve already seen what life looks like without these injections and it’s not pretty. So I’ll gladly take the injections.

My Theory of What Happens In the Body After a Testosterone Injection

No one has ever explained this to me. But I’m not your average patient. I like to know what is going on with my health, and medications that are given to me. I like to be part of the “team”.

Here’s what I think happens when a person receives an injection of 200 mg. of synthetic testosterone as a supplement. These injections are pre-planned approximately 30 days apart. So figuring this out should be pretty obvious.

The 200 mg. injection is obviously an overdose. After you receive the injection, your body begins to utilize and deplete the testosterone. So if one were to perform a blood test daily or weekly to determine the level of free testosterone as a specific point in time, this gradual depletion of available testosterone could be charted.

So the objective is to NOT have the level of free testosterone in the blood drop out of the bottom of the acceptable range for men, which is 300-600, before it’s time for the next injection of testosterone. If one does drop out of the acceptable range, then the injection quantity needs to be bumped up to 250 mg. or 300 mg. or whatever until the patient can make it to the next injection without dropping below 300.

I my case, a blood test taken three weeks after my first injection showed that I had moved from 195 into the normal range of 300-600, but barely. My result was 311. I had gained 116 points. But considering that the target level is a consistent 450, I have a ways to go yet.

Fortunately, the change in my symptoms is gradual. I don’t want you to think that I’m ready to tear someones head off when I get that 200 mg. blast of testosterone. The changes in metabolism and other idiosyncrasies that I have mentioned are gradual. I noticed the subtle change over the days after the injection and I noticed subtle changes over time as I was on my way back down to 311.

For those who are interested, testosterone is measured in nonograms per decileter or ng/dL. A nanogram is one-billionth of a gram. A gram is about 1/30 of an ounce. A deciliter measures fluid volume that is 1/10 of a liter. A liter is a little bigger than a quart. So there you go. The normal free testosterone range starts at 300 ng/dL.

And the Results?

How to I feel? Pretty darn good. I’m doing things. I’m back to the point of being engaged with my life. Feels good. I have a long way to go yet. I need to get back on my Bowflex and tone up the muscles that have been dormant for so many months. And I need to walk or jog to build my endurance back to what it was. Low-T had caused me to waste away for about six months before I realized that something was wrong.

The bad news? After receiving that 200 mg. dose of testosterone a month ago, my testosterone level is low again. It tested at 311 this week. A bit higher than the original 195 but no where near the 450 mid-range where it should be. It likely dropped off gradually from the day that I received the injection. I’m due for anther blast of testosterone on April 12. Eventually, my urologist will figure out the dosage so that I don’t experience these highs and lows. I already feel my energy level declining. Consequently, I’m pretty excited about that shot on April 12th. I feel like a junky.

Stay tuned.

 

References

Is Sex Possible After Prostate Gland Surgery? – Part 0 to this post published 1/13/2013

Prostate Surgery and Sex – The Testosterone Connection – Part 1 to this post published 2/27/2013

Prostate/Surgery/Sex Photo Gallery – photo gallery published 1/13/2013

WebMD is a great source for information on Low-T.

 

 

 

 

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