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And we are optimizing.

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We're not trying to replicate what our body has done because clearly our body is not doing

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a good job.

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So we are optimizing and the best effects with the least amount of side effects is going

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to come from steady levels.

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Welcome to the Hormones Happen podcast, a podcast designed for individuals like you

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who are curious about the amazing benefits of hormonal placement therapy.

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I'm your host, Jeremiah, and I'm a nurse practitioner who specializes in HRT.

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I've seen firsthand the debilitating effects of hormone deficiency and have personally experienced

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the benefits of optimization.

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My goal is to arm you with information regarding the good, the bad, and even taboo aspects

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of HRT while answering your burning questions.

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Please join me for today's episode of the Hormones Happen podcast.

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Ladies and gentlemen, boys and girls, men and women.

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Well, you get the point.

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Welcome back to the Hormones Happen podcast.

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Today I want to talk to you about some of the intricacies of testosterone, but not the

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symptoms of when it's low and the amazing benefits of when it's replaced, but more so

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specifics as to different forms that it comes in, how to take it, and just some tips and

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tricks.

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Testosterone replacement therapy is incredibly versatile and comes in a variety of different

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forms such as orals, creams, pellets, injections, even nasal sprays, and probably patches too,

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which goes into kind of transdermals.

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But I just want to touch on each of them, some of the pros and cons, and then my experiences

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in prescribing them.

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Starting off with the oral formulation, historically, because with an oral anabolic, it has to have

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what's called a 17 alpha alkylation attached to it.

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It has been harsh on the liver because that 17 alpha alkylation prolongs the amount of

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time that it's in the liver, which can often show increases on some of the blood work that

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we get.

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There is a newer form of testosterone called testosterone undercannuate, which actually

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has a very, very long ester attached to it.

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And for this reason, it actually bypasses the liver and gets absorbed through lymphatic

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circulation.

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It's still a very expensive medication at the time, and I'm not sure if any of the compounding

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pharmacies are able to actually make it.

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But as it becomes more available, I think this is going to be a great option for a lot

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of people who have hesitation to use injections or they have difficulty with the high maintenance

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application schedule of a cream.

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Topical creams are a great option for both men and women.

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With men, there are some things we need to take into account, such as transferring to

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other people, because this is a high dose cream in comparison to women.

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So placing the cream on, let's say your forearms or the crook of your arms right behind your

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elbow is not a great idea because if you go to hug your wife or your children, you're

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going to pass it on.

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Although with wives, I mean, women can also use a little testosterone, not horrible, but

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you know, children, pets, we want to avoid it.

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There is some things to take into consideration with the cream, such as how often you apply

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it and where you apply it.

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So what do I mean by this?

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So the creams are applied twice a day.

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Some people say once a day is sufficient, but for absolute steady levels, twice a day

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application is apex.

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Twice a day application to the scrotum.

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Now that might be bad enough for some people, but now we also need to shave the scrotum.

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And I'm not talking electric razor, but straight razor.

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And this makes a huge difference.

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It can vary the levels by up to 400 points they've seen in studies.

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So application to the scrotum twice a day, once weekly shaving would be a great option.

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But you also have to consider some of the skin textures.

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If you have some really thick skin there, which on the scrotum, it's usually a thin,

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very vascular membrane, thick skin, dry skin, not showering before.

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These are all things that can also affect the levels.

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The time of the year, what kind of clothing are you wearing?

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Depending on the base that it's mixed in that can vary how long it takes to actually fully

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absorb into the skin.

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There's a lot to take into account.

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And this is creams.

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Now gels are different.

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That's an alcohol based base essentially.

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And that is something that I don't recommend placing on the scrotum.

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Guys will usually apply this on the shoulders, but you cannot get a gel as strong as you

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can a cream.

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Creams you can compound to a much higher level and there's better absorption.

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Not a huge fan of the gels at all, but definitely don't place that to the scrotum.

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Just the creams.

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These are specially compounded creams with safe bases that you can apply to the scrotum.

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One more thing with the creams, if you're going to apply it to your testicles, your

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scrotum, one thing you need to consider is sexual intercourse.

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And recommendations are waiting six hours after application before engaging in sexual

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intercourse.

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Like I said, it's not going to be devastating if you don't, but that's just one more thing

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that you need to consider with the creams.

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If you've listened to the podcast before, you know I'm not a fan of pellets for a variety

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of reasons.

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The idea is great that you have a pellet inserted for three to four months and life is fantastic.

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But the reality is that there's a guessing game in trying to determine the dosage for

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this pellet and trying to realize is this dosage going to last you for three to four

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months.

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Oftentimes, what I'll see is someone will get benefit for three to four weeks and then

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for two months, maybe three months, they're just dwindling down on that hormone to a point

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to where maybe they feel even worse than they did before towards the end of the pellet's

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life.

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Because what they may say is that your body is only going to pull from this pellet what

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it wants, what it needs.

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But the reality is, is in the world of optimization, we're augmenting it probably past where you

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were at 20.

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It's not a great science.

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It sounds great.

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And I will say it's safe.

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If the person knows what they're doing, the application is safe.

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I have seen some botched insertions where the pellets have come out.

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There have been infections.

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That is something you need to consider.

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But I don't even hone in on that because I would just assume anyone placing a pellet

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is an expert in that field and they're doing that great.

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So I'm not going to harp on the application, but I am going to harp on the fact that we

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do not know how long that pellet is going to last, how long that pellet is going to

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provide you relief.

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And if that pellet is going to give you your money's worth.

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In my personal opinion, I do feel that the pellets are more of a cash grab presented

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by the pharmaceutical companies to just try to basically just get money from you guys.

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But I also know some people that do fantastic on them.

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So it's not the same all the way across.

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I do know people who had the pallets for years and they've done great.

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The first year or so they kind of struggled with getting the dosage.

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Once the dosage was situated, they were good to go.

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Injections.

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In my opinion, this is the gold standard form of application of TRT because it's very predictable.

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It's very reliable.

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And we know so much about its effects compared to other formulations.

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So the things you have to consider when you have an injection of testosterone is you have

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a small vial.

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And inside that vial, you've got a couple things.

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You've got the medication, which is testosterone.

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But if you were just to inject the testosterone without an ester, you would get it all in

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a couple minutes.

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So we have to attach what's called an ester, which is essentially a chemical compound to

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it that gives it its time released properties.

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And so for instance, I specifically use cypionate.

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It's a very commonly used ester.

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There's other ones out there like proponate, enanthate, and decanoate.

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There's several out there.

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But cypionate is one of the more tried and true in TRT.

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Now testosterone cypionate has an action of onset of about three to four days and a half

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life of seven days.

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So what this means is that if you're injecting every seven days for the first three to four

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days, you're going to feel great.

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But then right before your next injection, you're going to feel like crap.

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Probably not as bad as before you started, but close.

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And then let's say, let's play devil's advocate and say you did every two weeks.

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At that second week, you're going to feel worse than you did when you started because

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now your natural production of testosterone has turned off and we're giving you such a

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low dose that your baseline testosterone, if you were to actually check this on labs,

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would probably be less than when you first started.

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So cypionate just gives us our time release properties.

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It's very important.

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And then lastly, there has to be some type of oil, a carrier oil attached to this testosterone

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and ester because testosterone is what we call hydrophobic.

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It doesn't like water.

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So we have to attach it or we have to compound it in some type of oil.

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And there's different types of oils out there.

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Some of the most commercially available oils are things like cottonseed oil and sesame

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seed oil.

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I specifically compound all of the medications in grape seed oil because it's not as viscous,

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meaning thick, but it's also not nearly as inflammatory.

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So it gives us options as to how we can administer it, such as subcutaneous into the fat tissue

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or intramuscular into the muscle.

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One consideration with subcutaneous versus intramuscular is that when you're injecting

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it into the subcutaneous tissue, it's going to absorb at a slower rate.

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Intramuscular is going to be much quicker because you have greater vascular supply to

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that area.

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And when you're injecting testosterone, depending on the volume into the subcutaneous, you may

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develop a small nodule that will dissipate over time.

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You can also rub it to help it go away quicker, but that's just something to take into consideration

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between the two of them.

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The two most common that I often see used and I personally use for my patients is creams

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and injections.

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Now one big thing to consider between the two of these is with a cream, you can only

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compound it so strong.

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Most formulations are 200 milligrams per milliliter.

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There are some that are 220 to 250 milligrams per milliliter, but it's really hard to say

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at what point are you over saturating the base to where any excess is not going to be

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able to be disassociated into the capillaries.

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That's a possibility.

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With the injections, the sky's the limit.

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You want more, you inject more.

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It's very simple.

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With both the creams and the injections, there's a multitude of ways you can apply it.

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As I said before, creams highly recommend the scrotum, shaving scrotum twice daily for

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the most consistent, accurate results.

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Now with injections, you have more variability here.

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You can, assuming you're using grape seed oil, inject this like insulin into the fat

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tissue subcutaneously, or you can inject it into the muscle.

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Whether that be the side of the shoulder, the outer aspect of the thigh, some guys really

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gravitate towards the glutes.

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Just depending on how thin you are, depending on the size of your needle, you may not get

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into the muscle.

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I'm not a huge advocate for the large 23 to 25 gauge one and a half inch needles.

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Those are the needles used for deep intramuscular injection.

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Usually if a guy's doing once a week, twice a week, they're doing larger volumes.

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Also, if they're using something like sesame seed or cottonseed oil, you probably wouldn't

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want to try subcutaneous.

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So with those, you're really having to bypass a lot of fat, get into the deep glute muscle

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to inject.

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But with grape seed oil, you're completely fine doing this subcutaneously, just like

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you would insulin, pinch up a little belly fat, poke it right into the belly.

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Now as far as frequency, as we talked about with the esters and the action of onset and

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the half-lifes, I highly recommend twice weekly injections.

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Because like I said before, once a week and God forbid, twice a week, you're going to

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feel like crap towards the end of the life cycle of the medication.

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But if we're doing twice a week, you're going to feel much more stable.

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You're going to be at a much more stable level.

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And some people say, I've had people tell me this, they're like, well, why are we trying

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to maintain steady levels when our body doesn't naturally produce steady levels of testosterone

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throughout the day?

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And they're not wrong.

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That is true.

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But the difference is that now we are manipulating this and we are optimizing.

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We're not trying to replicate what our body has done because clearly our body is not doing

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a good job.

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So we are optimizing.

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And the best effects with the least amount of side effects is going to come from steady

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levels.

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That's the goal.

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With any form of supplementation, we want steady levels.

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That is what gives us the best results.

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Now with the injections, there is one more tip I'd like to give.

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When you have your vial, realize it's going to be mixed in oil.

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When you're drawing it up, especially with, let's say a 27 gauge half inch needle, which

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is the ones that I recommend, it's going to take some time to draw it up.

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Now some people will actually switch the needle to a larger size needle, like an 18 gauge

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or some people will do a 16 gauge.

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Those are very large, almost harpoons.

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I don't recommend it because when you access the top, the little rubber top of the vial,

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you're going to cord out a little bit and there's going to be a piece of rubber sitting

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in the bottom of your vial.

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And I honestly do not know if this is going to cause some negative issues in the future.

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I don't think there's been any studies on it or a whole lot of documentation, but I

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know it exists and I have seen in some cases where people will have preloaded syringes

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from another clinic and over time it'll become discolored depending on how long they have

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it.

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Usually over a month I see the oil almost looks discolored, which tells me the rubber

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stopper inside the syringe is leaking into the medication.

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Why would the rubber stopper on the vial not leak into the medication?

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So I recommend drawing it up with the small needle, which is completely fine to do.

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That's what we do for insulin in fact.

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It's the same size needle, same size process.

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One thing I can say that will make it quicker is if you just put your little vial in a warm

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water bath for three to five minutes, it's going to drop probably about twice as quick,

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which is going to make this a lot more manageable.

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It does make a big difference.

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Typically if you can get into a routine, for instance myself, I inject in the morning before

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the gym.

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So when I'm showering for the gym just to kind of warm everything up, I'll have my vial

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sitting in the sink in some warm water.

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When I get out, I'll draw it up.

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It's much quicker and then I'll inject right then and there.

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I used to draw my testosterone out the night before and just leave it overnight.

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I don't see the point of it.

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Granted, it's probably not in contact with that rubber stopper long enough to cause harm.

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It doesn't take long at all if you warm up the testosterone vial.

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We interrupt this program to bring you an important announcement.

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Look guys, the harsh reality is that aging naturally is no longer possible.

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We're bombarded with endocrine disruptors every day without even knowing it.

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00:16:55,200 --> 00:17:01,000
Seeking treatment usually leads to the prescription of unnecessary medications and unwanted reassurance

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that what we're experiencing is normal, but it's not.

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At Steel City HRT and Weight Loss, we not only ask questions, but listen to answers

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and believe that treatment cannot be a cookie cutter protocol.

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If you're curious about the amazing benefits of hormone replacement therapy or have been

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turned away by our traditional Western medical society, don't hesitate to call 719-669-4223

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now to schedule labs and discuss treatment options.

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All right.

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Welcome back to the Q&A section of the podcast.

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Are SARMs testosterone?

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Absolutely.

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Unequivocally, no.

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A lot of people have the misconception and have actually been told that SARMs are testosterone.

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Now SARMs, which stand for selective androgen receptor modulators, it's a great idea.

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It can activate specific androgen receptors while sparing others.

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In theory, it sounds amazing.

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It's like baking a cake and eating it too.

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But some of these SARMs, and just for reference, such as RAD140, TT701, LGD3033, these are

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very commonly sold over the counter with a lot of claims behind them that they're going

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to boost your testosterone level, lose body fat, and there may be some truth to this to

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some degree.

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What I've seen time and time again is multiple men come to me on these SARMs under the idea

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that they're already on TRT.

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We get some blood work.

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We see that their endogenous pathway, their natural production of testosterone is still

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functioning, but now their testosterone is suppressed.

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I don't know why.

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I'm not by any means a SARM expert.

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I'm just telling you what I see in my practice.

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I don't know why this happens, but I don't necessarily know if there's long-term issues

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with it.

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I don't know.

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The idea of a SARM if it was truly pharmaceutical is amazing, but the biggest issue with SARMs

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is that being sold over the counter, there's no regulating body, there's no governing body

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who determines if it's actually in there.

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I've seen studies where they've evaluated several different SARMs that claim to have

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a specific compound in it.

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In actuality, it either has incredibly lower concentrations than what was stated.

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It doesn't have any of the medication that was stated, or it has a completely different

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medication than was stated.

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It's really so variable in the manufacturing process that that's why I am not really a

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huge fan of SARMs.

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I think they're relatively safe, but I don't think they're very efficacious.

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It is by no means anything like testosterone.

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If someone's on testosterone, which like I said, I've had guys come to me on SARMs that

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get on TRT, they will tell you it is a night and day difference.

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It is completely two different games here.

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I'm 27 years old, just started on TRT through an online clinic.

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Should I be concerned about ROID rage?

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That's a great question and one that I get very, very commonly.

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ROID rage, what is it?

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It's the idea that someone gets testosterone, exogenous forms of testosterone, and now their

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anger level increases, their aggression increases.

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Well, I can tell you firsthand, your aggression, your directable aggression will increase.

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It's going to give you this assertiveness.

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It's going to give you this aura about you that makes you more assertive.

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It will happen, but will it make you essentially a juiced up asshole?

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No, absolutely not.

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Now this is the thing.

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If you were an asshole to begin with, you're probably going to be a bigger one.

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It's going to augment you from your base state.

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In reality, oftentimes what I see is men will actually relax.

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The anxiety that we don't even know is building up inside of us oftentimes causes a lot of

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this tension.

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And when we can actually decrease it through testosterone's ability to increase serotonin

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and re-uptake transporters, which is essentially a natural antidepressant, you would be amazed.

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These men chill.

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They calm down.

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I noticed it the first couple of times I took it.

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I felt almost tired.

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I could just go to sleep.

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I felt very relaxed.

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And this is the majority of men that I treat.

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They feel just absolutely calmer.

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And so this whole ROID rage premise, I mean, you have to realize that when they've done

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these stereotypical things about it, these are usually top performing athletes that are

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on multiple substances other than testosterone.

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And yeah, sure, it can augment that aggression to the point of being out of control.

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But depending on their baseline state of health, their baseline mental health is really what

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depends on.

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So testosterone is not inherently going to give you ROID rage or make you this aggressive

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animal.

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It's going to increase your aggressiveness, but it's going to be a controllable, directable,

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very productive aggressiveness.

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It's not just going to make you throw things and hurt the people that are closest to you.

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I'm 35 years old.

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I've been on TRT for five years and I recently increased my dosage.

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I feel amazing.

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No one has ever treated me to this level before.

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However, I'm experiencing back knee.

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And for those of you that don't know what back knee is, it's essentially just a term

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that says back acne.

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Okay.

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Now, TRT testosterone is going to cause increased acne.

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It does this because of five alpha reductase type one, increasing the conversion of testosterone

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to DHT, which then causes epithelial cells to release sebum, which clog pores.

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And a real indicator is if you had really bad acne when you were a child and adolescent,

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you're probably going to have some acne with TRT, maybe not to the same effect.

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And there are ways that you can mitigate this such as dosing protocols and what so on and

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so forth.

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But when you do start experiencing this back knee or the acne on your chest or on the face,

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it can be very distracting and it could be debilitating.

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And some men get it to a severe point to where they develop cystic acne.

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That's almost unmanageable.

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I haven't seen that in my practice.

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I personally have experienced some acne on my back and my chest.

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One thing I do recommend, there's a couple of things you can do.

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First and foremost, skin hygiene is huge.

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Make sure you're showering, you know, twice, three times a day.

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Make sure you're using an antibacterial soap.

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Make sure that you're scrubbing your skin.

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If you need to, you can always dilute a little bit of apple cider vinegar and some water

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and use that to rub over the little lesions.

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But one thing that I have found to work really well is just getting a basic back scrubber

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from Walmart.

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They're cheap, maybe like three bucks, three, four dollars.

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Get some antibacterial soap, just squirt it on there and just really vigorously go to

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town on your back, your chest, wherever you're having the acne and, you know, even other

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areas.

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You know, we're prone to break out on our arms, our shoulders, our chest, sometimes

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our abdomen.

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It can really come anywhere.

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And then just a washcloth for the face.

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But if you're maintaining this skin schedule, just keeping your skin clean, we're going

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to prevent the blocking of those pores and the development of this acne.

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Sometimes can be really hard when it gets pretty significant and now you're trying

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to catch up.

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So prevention is the best cure for this one.

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But once again, like I said, there are ways to mitigate it through dosing.

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But acne is just something that we kind of have to to some degree expect.

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And there are some men who are just genetically blessed.

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They don't have any problem with this.

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I want to thank everyone for listening to today's episode of the Hormones Happen podcast

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and hope that you were able to find some value in the information that was provided today.

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If you have any questions that you would like to have discussed on the podcast, please send

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them to the email listed below or message us on the StillCity HRT and Weight Loss Facebook

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page.

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Remember, you are not alone in the war on hormones.

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Stay optimized.