Testosterone Therapy and NIP-TUCK!

So, first time posting here.

I am a 28 year old professional mountain climber and am a certified exercise physiologist, so I know my physiology pretty well. This last year I started noticing a major decrease in my performance, and decided to go see my doctor, who is board certified in exercise endocrinology. She found that I am hypothyroid, and training with this condition has wiped out my natural testosterone. I am now on a T and thyroid replacement program, and am feeling light years better! Strength and speed have drastically improved, even since a week ago! The game plan is to closely monitor my levels and slowly ween off the exogenous hormones over the next year.

I started taking thyroid hormone 4 months ago, and started Testosterone 3 weeks ago. Over the past 5 days I have developed the classic steroid user complaint: Nipples are sensitive as hell! And I have identified the classic small lump of fat tissue under my left tit.

Little background: I began with using a low dose of androgel on a daily basis for one week, then had an injection of T-cypionate of 1.25mL (250mg). Continued using a little bit of androgel for a few days, and then weened off. I Just had my second injection (250mg), and emailed my doctor about the nip-tuck situation. She is going to run a blood testosterone and estrogen panel on Tuesday (Today is Friday), and then I get to see the results one week later.

My major concern/question, is how fast can irreversible gynecomastia form / set in? I do not have immediate access to Nolvadex, and my doctor wants to see what my test and estrogen levels are doing before prescribing any. I’m wondering if the nipp sensitivity is more to do with the Androgel than the cypionate injection? I do know that there is a substantially higher amount of aromatase in the epidermal layers and visceral fat than exists in the blood stream. Since androgel has to travel through these layers first, it makes sense that it could be converted at a much higher rate?

Since I’m betting that there are a great number of steroid users on this site, what empirical wisdom can you guys give me? Should I say screw it and try to get a hold of some Nolvadex as soon as possible? Even if I ordered some today, it wouldn’t be here for two weeks, so perhaps I’m fucked either way? Naturally, no healthy man wants tits.

Have a great day!

[quote]bmxer109 wrote:

Since I’m betting that there are a great number of steroid users on this site, what empirical wisdom can you guys give me? [/quote]

Read the stickies…they answer either directly or indirectly almost all of your questions. The only one not addressed is how quickly irreversible gyno happens.

I went through the same as you. Was feeling really weak, ect. and found I had Thyroid issues. Started meds and was a little better, then found the low T. I was on 1ml injections every 2 weeks and had the same nipple/breast problems. I since switched to SQ injections 2 times a week and have no issues with it at all now. I do have some other problems that I am working on. Good luck.

Few issues going on here:

If she suspects your thyroid is causing your low T, why would she give you medication that shuts down your natural T production? The longer you are on synthetic T, the more likely this shut down is permanent. This is why we recommend that you make absolutely sure you need it before you start taking it, because once you do it’s for life. Spending a year on TRT will only ensure that you will shut down. It won’t “jump start” it back to work because it’s telling your body that it doesn’t need to produce any testosterone, even though it was producing so little in the first place!

If we had some labs it would be easier to help you out. Do you have any numbers? Include the ranges if you can.

You shouldn’t be using the gel and the shots, so it’s a good thing you weaned off. Smaller doses of testosterone injected more frequently are preferred. This is covered in the Sticky “Protocol…”. You likely started with too high of a dose: The standard starting dose of Test-C is 100mg a week spread out over 2 doses, though there are many guys who take more than that. It’s just a good starting point since most guys are fine at 100mg/wk. If you’ve been taking the gel and the two 250mg shots in the last three weeks, then you’re likely doing 2-3 times the Test recommended for TRT, though I can’t know for sure since I don’t know how much gel you had. Doses over 200mg/wk of Test-C are rare since most guys will have Total T levels of around 1000-1200ng/dL from 200mg, and any more than that and you are going above normal human ranges of testosterone and are in the “low-grade steroid cycle” territory.

I don’t think your doctor knows what she is doing. If you’re taking things as they are prescribed then I can’t blame you for not knowing, but it’s a good habit to research important things like hormone therapy before going on them, just in case things like this happen.

So, now we get to the nipple issue. You are likely in the starting stages of gyno. You have taken two decent sized shots of an esterfied testosterone and, no surprise, your estrogen levels are likely soaring. Obviously we don’t know for sure since we have no labs, but it stands to reason that this is the case. For reference, I take 200mg a week of Test-C and take .25mg of anastrozole four times a week. Some guys need up to twice that dose when on 200mg of Test-C to keep their E2 levels in check. The higher the T dose the greater chance of aromatization of testosterone into estrogen.

Gyno is reversible provided you get it treated before it’s so bad that you need surgery to remove the breast tissue. The longer you wait to fix it the worse it will get, so treating it as soon as possible is preferable. Nolva won’t lower your E2 levels, but it will fight off developing breast tissue. You’ll need to get on aromatase inhibitor (AI) like anastrozole and figure out the right dose to get your E2 in check, if it is in fact out of whack.

“Since I’m betting that there are a great number of steroid users on this site”

You’d be betting right because you’re on the Testosterone Replacement Therapy forum, where guys are being treated with supplemental Testosterone. If you’re using “Steroids” in the vernacular then you’re incorrect since “steroid” users (guys who juice) aren’t treating low testosterone, but using the same medications to bring their testosterone levels to those beyond the normal human range.Most guys on TRT don’t like the label of “Steroid User”. Wasn’t sure which way you meant with that, so I thought I’d cover both bases.

Best of luck to you. Get back to us with some labs, and keep us posted on what you find out. In the meantime, read through the “Stickies” on the main-page, and re-evaluate your current regiment.

Hey thanks for the replies!

By “steroid users”, I meant other men who have / are taking T replacement. Please don’t take offense!

Catastrophe: My doctor put me on thyroid hormone back in March. My TSH was at 5.4, and my active T3 was less than half of where it should have been. My cortisol levels were good, but at that point my Free Testosterone was at 12.5 ng/dL (range 8-24 ng/dL). When I went in to get stuff checked again, my testosterone actually went DOWN since going on thyroid! All the way down to 9 ng/dL! She ran a bunch of other tests on adiponectin, leptin, and did a comprehensive insulin:glucose panel. She found a significant problem with most of my parameters, and found that my system isn’t utilizing carbohydrates very efficiently. She is a very well-regarded physician, and has worked with many elite level athletes, and publishes metabolic research every month. So, I really do trust her judgement.

She explained to me that my testosterone production will come back on line as I’m able to improve adiponectin and leptin. She says that this is a common problem she runs into with her practice, and has had a lot of success putting men on T replacement while they work on these underlying parameters. Basically, she explained that the low thyroid function probably threw my metabolic system out of whack, which is why my T was so affected. She says that establishing T levels to the optimal range, whilst working on these underlying parameters works very well. In her practice, she has found that every month checking testosterone, levels will start to come in too high for the optimal range, and can slowly lower the amount of exogenous injection. I actually have a close friend who went through this successfully, so, its wasn’t too scary of an idea to start this.

I really do trust her… About 6 years ago I went through a major overtraining with mild eating disorder experience, and she has helped me tremendously in my training periodization and nutrition. Every year since then I have had my testosterone (and other hormones) checked out in order to make sure I’m on the right track. Long story short I’ve made a tremendous recovery, and have been able to put on more than 35 pounds of muscle! 1.5 years ago my free testosterone was at 20ng/dL, which is basically exactly where it should be, but even then my thyroid showed signs of shutting down. Then, over the past two years its just tanked.

With the nipple situation, it seems to have improved a lot today… The tenderness has calmed down, and the puffiness has gone away. I think you may be exactly right that I was just “double dosed”. I’m going to try and stay calm about it!

Thanks so much!

Good stuff.

Make sure to keep tabs on your E2 or you will absolutely be in a world of shit, especially if you’re going to be continuing those hefty doses.

Any time you take exogenous T you shut off LH and FSH production. It doesn’t matter how large or small the dose. When these shut off, your body’s production of testosterone shuts off. It is impossible for you to take supplemental testosterone and in the middle of your therapy spontaneously “kick on” and start producing natural levels of testosterone above what levels you’re getting from medication.

If you want to prevent shutdown you need to take hCG. This mimics LH/FSH and keeps the boys running despite the introduction of exogenous T. It’s recommended around here that you take 250iu every other day, subcutaneously, as this dose is high enough to keep the boys running, but low enough to be safe to be on long-term. This too can/will raise E2 levels, so make sure you’re adding an AI to the mix.

And about the “levels will start to come in too high for the optimal range”, at 250mg a week you will be above the range of total testosterone right off the bat. If you add hCG to the mix you will likely be well over 1500ng/dL (gorilla math on my part, but estimated on experience) where the top end of the range is 1100ng/dL (if you care about the range).

Hope this helps.

This is good stuff!

Quick questions: What are these guys THINKING injecting 500mg of T per week??? It may help them get huge, but don’t they understand the long term consequences?

[quote]bmxer109 wrote:
This is good stuff!

Quick questions: What are these guys THINKING injecting 500mg of T per week??? It may help them get huge, but don’t they understand the long term consequences? [/quote]

Please don’t pontificate on things you know nothing about.

But if you want to humor me, I will certainly listen to what you think the “long term consequences” are.

[quote]bmxer109 wrote:
This is good stuff!

Quick questions: What are these guys THINKING injecting 500mg of T per week??? It may help them get huge, but don’t they understand the long term consequences? [/quote]

That is about the un-quickest question you could have asked! Short answer just to get the ball rolling: If you do steroids correctly there’s a good chance there will be no long term consequences. These guys nowadays have almost perfected the art/science of hormone manipulation, to the point where, if you do your homework and plan out your cycle and post-cycle therapy, you can be nearly 100% side-effect free with no side-effect being permanent. Over-do anything, or do anything wrong, and of course there’s going to be severe and lasting consequences.

It’s the morons who have no idea what they are doing who give the guys who do it right a bad wrap. I don’t Cycle personally, but have nothing against guys who want to. It’s actually pretty amazing what these guys can put together and the things they can achieve through using different hormone combos. There’s always going to be people who do something wrong, and people who are just unlucky and have a bad reaction to something, and they are the ones that get all the attention.

You never see the headline “Man increases bench-press 100 pounds, thanks steroids”, but “Some stupid 16 year old did steroids and fucked themselves up because they had no idea what they were getting into, parents call for steroid ban”.

There’s an interesting documentary called “Bigger, Stronger, Faster”, that I totally wouldn’t recommend obtaining through any illegal means, like bit-torrent or usenet. It does a pretty good job of being balanced and is one of the things I have people watch when learning about Steroids.

[quote]VTBalla34 wrote:

[quote]bmxer109 wrote:
This is good stuff!

Quick questions: What are these guys THINKING injecting 500mg of T per week??? It may help them get huge, but don’t they understand the long term consequences? [/quote]

Please don’t pontificate on things you know nothing about.

But if you want to humor me, I will certainly listen to what you think the “long term consequences” are.
[/quote]

Question: Do you think there aren’t any long-term consequences?

There are multiples of studies out there…

Here’s two possible consequences:

Personally, if I were cycling supra physiologic anabolic agents, a condition called Hypertrophic Cardiomyopathy would be on my mind. There is a great deal of research out there showing a direct correlation to long-term anabolic steroid use and altered hemodynamic responses to exercise. Its quite simple actually: Supraphysiologic testosterone not only affects skeletal muscle and bone density, but it has dramatic effects on heart muscle cells. You can actually see clinical left ventricle remodeling to the point where heart efficiency is dramatically changed. In some instances the left chamber will not undergo complete emptying with contractions because it has hypertrophied so much. With normal strength and cardio training you will see significant changes in heart muscle architecture, however, the degree to which anabolic steroids can affect heart structure and function over the course of years is a major reason for concern. Guys can be just fine for years, but then at age 50, you see a statistically significant increase in cardiovascular events in self-reported AAS users.

Also, because testosterone, in its basic sense, is the primary anabolic stress hormone, it dances a critical routine with its counterpart hormone, cortisol. With chronic supraphysiologic testosterone you can see long-term cortisol axis disruption. When you truly do damage the hypothalamus, it can take YEARS for it to start functioning properly again… if ever.

I’m not placing any judgement calls against guys to decide to use roids, rather, I just feel that being aware is critical. I want to get off testosterone replacement as soon as I can, but dude, if I knew my T was perfectly healthy, the LAST thing I would do is mess with it.

On a different note, drug use in sport is indeed a fantastically interesting subject. Research on “Selective Androgen Receptor Modulators” is VERY interesting. It appears that in sarcopenia patients undergoing anaobolic therapy do not show signs of HPTA disruption, and in rodent models on supraphysiologic doses, LH seems to be unaffected. Because SARM’s are not testosterone, they don’t seem to message with the hypothalamus. Anyway, physiology fucking kicks ass!

Please cite your source for the cardiovascular events for self-reported AAS users…things that you dreamed last night are not a source

I know dozens of guys that take AAS for sports, and not a single one has used SARM’s as part of their protocol…I wonder why that is?

The documentary I mentioned earlier: - YouTube

Worth a look.

Reports of hypertrophic cardiomyopathy do exist…I’ve seen mostly case reports which aren’t the best level of evidence.

Interesting that you equate cortisol and testosterone as having counter-regulatory actions. I’d argue cortisol and insulin have opposite actions based on the fact that severe fetal diabetes that ensues in pancreatecomized animals can be ameliorated by adrenalectomy. Cortisol’s unopposed action by the lack of insulin in the pancreatecomized animal causes diabetes and death but if you remove the source of unopposed cortisol by adenalectomizing the animals you can maintain them simply by feeding them saline. No such relationship exists between adrenalectomized animals and castrated animals.

Furthermore the actions of cortisol are to raise blood sugar and are nearly all catabolic (you can get massive glycogen deposition in the liver via cortisol’s action to activate glycogen synthase and inhibit glycogen phosphorlase and while strictly speaking this is anabolic in nature it’s REALLY done to support catabolism elsewhere)…the breakdown of glycogen, fat, and protein are all accelerated in the presence of cortisol while insulin has all opposite anabolic effects. Also, testosterone production is primarily regulated by E2 inhibition…when you say “dances with” that suggest some level of fine regulation between the two which testosterone and cortisol just doesn’t have…cortisol and insulin do.

About the only relationship between cortisol and testosterone is one is anabolic and one is catabolic but the interplay between them in the regulation of overall energy metabolism is weak at best…certainly not as direct as that of insulin and cortisol.

Guys, you hijacked this guys thread/case!

[quote]dbsmith wrote:
Reports of hypertrophic cardiomyopathy do exist…I’ve seen mostly case reports which aren’t the best level of evidence.

Interesting that you equate cortisol and testosterone as having counter-regulatory actions. I’d argue cortisol and insulin have opposite actions based on the fact that severe fetal diabetes that ensues in pancreatecomized animals can be ameliorated by adrenalectomy. Cortisol’s unopposed action by the lack of insulin in the pancreatecomized animal causes diabetes and death but if you remove the source of unopposed cortisol by adenalectomizing the animals you can maintain them simply by feeding them saline. No such relationship exists between adrenalectomized animals and castrated animals.

Furthermore the actions of cortisol are to raise blood sugar and are nearly all catabolic (you can get massive glycogen deposition in the liver via cortisol’s action to activate glycogen synthase and inhibit glycogen phosphorlase and while strictly speaking this is anabolic in nature it’s REALLY done to support catabolism elsewhere)…the breakdown of glycogen, fat, and protein are all accelerated in the presence of cortisol while insulin has all opposite anabolic effects. Also, testosterone production is primarily regulated by E2 inhibition…when you say “dances with” that suggest some level of fine regulation between the two which testosterone and cortisol just doesn’t have…cortisol and insulin do.

About the only relationship between cortisol and testosterone is one is anabolic and one is catabolic but the interplay between them in the regulation of overall energy metabolism is weak at best…certainly not as direct as that of insulin and cortisol.
[/quote]

You’re off base man. Nitty gritty of physiology is definitely important, but ya gotta look at the bigger picture.

The anabolic to catabolic ratio is entirely determined by hypothalamic control of the whole shebang. The hypothalamus supports high intensity exercise through many, many metabolic pathways, but to stay on the topic of cortisol and testosterone, I’ll stick to those two hormones. You are correct that in healthy people who are non-diebetic, insulin is the KEY ingredient in deciding which side of the mountain one’s metabolism will slide; anabolic or catabolic. Cortisol and testosterone do play a dance with each via hypothalamic control of the endocrine response to stress (believe me, an exogenous steroid IS stress on your body). As you exercise harder and harder (given that glucose is maintained and insulin is adequate), pituitary LH will rise as much as it possibly can to support anabolic metabolism. At some point, however, LH cannot keep up, and you begin to see a switch: Cortisol rapidly comes online. Natural testosterone drops off, and cortisol takes its place. This is a natural event, and this is usually when most people end their workout. Acute Overreaching occurs when this balance is tipped a tad too far. If nutrition is not adequate, this balance will be tipped far sooner than later. Hypothalamic control of pituitary LH can be suppressed for days following intensive exercise, and natural testosterone will stay suppressed until physiologic repair of the central nervous system has taken place. This is the primary flaw with the theory behind body-part training. Although individual muscles are getting time off from loading, the central nervous system isn’t necessarily repairing adequately.

So, to pull things back. With the administration of an exogenous anabolic steroid, you are, in essence completely bi-passing the natural cycle of lowered anabolic sex hormones following high intensity exercise. With supra physiologic testosterone, you will still see the delayed cortisol response to exhaustive training, HOWEVER, because the administered agent is being released by a different mechanism (oil base release, vs. testicular release from pituitary LH), there simply is no drop in testosterone following exercise. This is a double-edged sword, because this is exactly the benefit of anaboic steroids: You don’t get the post-exercise muscle catabolism. Generally, this is WONDERFUL! Muscle just keeps building. Because of neurosteroidal messaging, the athlete using anabolics can just keep training and training. Where the long-term problem arrises, is that all of this extra testosterone (which in turn triggers higher and higher training intensity/volumes) is messaging with the hypothalamus that the body is extremely anabolic. Remember that the primary goal of the brain is to keep the body in homeostasis, and in the instance of supraphysiologic androgens, the way it responds is to continually up-regulare the sympathetic nervous system. This is not neurolgically sustainable however. When the cortisol axis never gets a chance to down-regulate, a situation of hypothalamic fatigue can turn into a situation of hypothalamic INJURY. That’s right, you can get a BRAIN INJURY. In fact, that’s exactly what chronic Overtraining Syndrome is… An injury to the Hypothalamus. And in that instance, in a bad situation, it can take as long as 5 years for the central nervous system to fully re-build phospholipid membranes and neurotransmitter circuitries.

A healthy, highly trained athlete might show a morning Testosterone : Cortisol lab like this:

23ng/dL : 17ng/dL

An athlete juicing to supra-physiologic levels might look like this:

64ng/dL : 30ng/dL

Over the long term, exogenous supra-physiologic androgens will jack your endocrine response to stress. If you read steroid user websites, so many times will you read a thread titled “Steroid recovery… Last Winstrol cycle last year. Foggy head, no energy. Problems with anxiety”.

The shits real man!

[quote]bmxer109 wrote:

A healthy, highly trained athlete might show a morning Testosterone : Cortisol lab like this:

23ng/dL : 17ng/dL

An athlete juicing to supra-physiologic levels might look like this:

64ng/dL : 30ng/dL

[/quote]

Still waiting for sources…

How much of that do you think is attributable to your classroom hypothesis, and how much of it do you think is attributable to them not completing a proper PCT?

I guarantee if you quiz those guys, the majority of them did not run a SERM PCT with the proper dosages, for the proper amount of time, with the proper waiting period between AAS administration and PCT. I also guarantee if you take lab tests, they will show an adequate cortisol response and a low LH/FSH.

But what do I know, I’ve only read several thousand posts on steroid forums over the years.

At least I can link to them as a source lol