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Monday, April 25, 2011

Testosterone Side Effect Management Table

Problem
Solution and Comments
Acne/oily skin 
Caused by Dihydrotestosterone (DHT) effect on
increased oil production
·     Accutane – a powerful prescription item - 40 mg/day for one week sometimes stops acne if started at the first sign or as directed by your doctor. Accutane is potentially highly liver toxic.
·     Sporanox – Effective for some acne-like eruptions that are caused by fungi. Some doctors also prescribe antibiotics, like tetracycline, for acne with good results. 
·     Anti-bacterial soaps - Use a scrubbing brush and wash twice a day, especially after sweating during a workout.
·     UV light or sunlight with moderation.
Hair loss 
Caused by DHT effect on hair follicles
·     Nizoral shampoo– Available by prescription and over-the counter as a lower dose product.
·     Rogaine – Available by prescription. 
·     Propecia (finesteride) - Available by prescription. A few males experience decreased erections with finesteride
Increased sex drive 
·     A problem?  Sex drive is part of quality-of-life. This is not necessarily a bad side effect. Enjoy it.
Unresolved erectile function
·     Viagra, Cialis, Levitra – Available by prescription; enables robust erections. Take an allergy medication and ibuoprofen with it to minimize sinus congestion and headaches.  
·     Yohimbine (Yocon) - Available by prescription; increases sex organ sensitivity. Can increase heart rate and blood pressure
·     Muse - Available by prescription; pellet inserted into the urethra to produce erection.
·     Trimix – Available by prescription. The best and cheapest formula for injection into the penis for lasting erections. Visitwww.apsmeds.com
·     Caverject - Available by prescription. An injection into the penis that produces an erection that can last 1 to 2 hours. Be careful with injecting too much since it can produce dangerously ling erections that need to be treated in emergency rooms! Follow instructions from your urologist. 
·     Papaverine – An older injectable medication, less expensive than Caverject. 
·     Wellbutrin – Prescription at 300 to 450 mg/day; increases dopamine.
·     Human chorionic gonadatropin (HCG) – First dose is 5,000 IU, then 250-500 IU a week. No protocol has been proven in controlled studies yet. Note: If impotence happens while on testosterone, try varying the doses of testosterone. E.g. higher and lower.
Insomnia  
Usually this is caused by dosages that are too high. Find the least amount that gives you a good result.

·     Sleeping medications – e.g. Ambien, Sonata, Restoril
·     Melatonin - 1 to 3 mg before bedtime.
·     Avoid working out too close to bedtime.
·     Limit caffeine, especially after 3 pm.
·     Visit houstonbuyersclub.com for a comprehensive sleep formula with tryptophan, melatonin and inositol. Nutrients do not work as well as drugs, but they can help some people.
Sleep Apnea
·     Have a sleep specialist prescribe a sleep study. Some people may have to wear a C-PAP machine to breathe at night. Visit http://www.sleepapnea.org/ for more information
Testicular atrophy 
·     Human Chorionic Gonadotropin (hCG)– One 5,000 unit injection per week for 2 weeks, followed by maintenance of 250 IU twice a week.  Decrease testosterone dosage accordingly after starting hCG
Enhanced assertiveness 


·     Count until 10 and be aware of your interaction with others.
·     Decrease caffeine.
·     Meditation, yoga, breathe from your belly for a few minutes when over reacting.
·     The testosterone dosage may be too high.
·     Make sure your estradiol level is not much over 25 pg/dl
High blood pressure/water retention 
·     Blood pressure medications - Elevated blood pressure is usually transient and stops within a few weeks of the end of a steroid cycle. However, ongoing or chronic steroid use is associated with high blood pressure. Try ACE or ACE II inhibitors since they seem to have fewer sexual dysfunction related effects  
·     Supplements – Magnesium (600 mg/day); vitamin B(100 to 200 mg/day); may help reduce water retention. 
·     Water - Drink extra water every day to help flush the kidneys.
Gynecomastia (male breast development) 
Caused by overproduction of estrogen, which can happen when is there is too much testosterone. (Testosterone converts into estrogen.)
·     Arimidex - Inhibits estrogen production. Available by prescription. 1 mg/day until sensitivity stops, then ½ mg per day. Some people take .5 mg three times a week for maintenance. Ensure that your estradiol is under 20 pg/dl but do not go too low since it is needed for bon, skin and hair health. Some people get it online if doctor does not prescribe.  
·     Nolvadex – Competes with estrogen for receptors. Available by prescription, 10 to 20 mg/day. Not as effective as Arimidex. Use of Nolvadex during a steroid cycle may reduce the net anabolic effect, as it decreases the production of GH[i] and IGF-1. Severe cases may require removal of the breast tissue by surgery.
·     DHT cream- Some people have obtained great results by robbing a 10% DHT cream on their nipples. Ask your compounding pharmacy.  By prescription only.
·     Some cases require surgery if not treated early
Virilization (body hair growth, deepened voice, clitoral growth in women) 

·     Women with this problem should ensure that they are using the lowest possible dosage
·     Testosterone replacement in men seems to exacerbate body hair growth in males.
·     Proscar – Available by prescription at 1 to 5 mg/day, for men.
Benign Prostate enlargement 
·     Proscar - Available by prescription. For men, 1 to 5 mg/day. (Note: Can cause decreased sex drive and erections in some men.)  
·     Hytrin, Flomax - Available by prescription.
·     Saw palmetto extract – Very effective for reducing prostate problems, but one study suggests that this herb may reduce the effects of testosterone, too.[ii]
·     Estrogen inhibitors like Arimidex. Estrogen dominance appears to increase prostate growth.[iii] [iv]
·     Check your prostate specific antigen and have a digital rectal exam before starting any steroid program, to detect potential for prostate cancer, especially if you are over 35 or have a family history of prostate problems, and have it checked on a regular basis.
Polycythemia (Elevated hematocrit, which means there are too many red blood cells that can increase blood viscosity and cardiovascular risks) 
·     Therapeutic phlebotomy means to have a pint or more of blood removed, usually 1 pint per week over several weeks. (1 pint usually will lower hematocrit by about 3 points.) Polycythemia is a compelling reason to avoid using higher steroid doses than are necessary. Taking the lowest effective dose reduces the risk of over-production of hemoglobin (red blood cells).



[i] Metzger, DL, et al. Estrogen receptor blockade with tamoxifen diminishes growth hormone secretion in boys: evidence for a stimulatory role of endogenous estrogens during male adolescence. J Clin Endocrinol Metab (1994) 79(2):513-518.
[ii] el-Sheikh, MM, et al. The effect of Permixon (saw palmetto) on androgen receptors. J Acta Obstet Gynecol Scand (1988) 67(5):397-399.
[iii] Suzuki, K, et al. Endocrine environment of benign prostatic hyperplasia: prostate size and volume are correlated with serum estrogen concentration. Scand J Urol Nephrol (1995) 29:65-68.
[iv] Gann, PH, et al. A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia. The Prostate (1995) 26:40-49.

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