Bioidentical Hormone Replacement Therapy, Mexico How to Dose Testosterone Pellets, Creams and Injections in Men

Bioidentical Hormone Replacement Therapy, Mexico

How to Dose Testosterone Pellets, Creams and Injections in Men

Jake Ames, MD, HMD

I have used subdermal testosterone pellets, testosterone creams and testosterone injections in males since 1994.  All three of these approaches to replacing a man’s testosterone has its advantages and disadvantages.

Since I graduated from medical school in 1986, I have seen the upper testosterone laboratory range keep decreasing.  The ranges at some labs today are 280-790 ng/dL Years ago the upper reference range for testosterone was 1,200 ng/dL.  I ask the lab directors occasionally, when are you going to lower the upper range to 600 ng/dL?

Men are getting feminized.  Just do Google searches: estrogen mimickers and endocrine disruptors.  We are being exposed to phthalates, bisphenol A (BPA), plastics and hundreds of endocrine disruptors daily.  Most of my male patients at age 50 have higher estrogen than their wives at the same age!

To make matters worse, many insurance companies want to see a few lab tests showing testosterone below 280 ng/dL for men to get reimbursed for their testosterone supplements.  Also, many endocrinologists won’t prescribe testosterone to men unless they are below the reference range.  Some state medical boards look unfavorably at physicians when they prescribe testosterone to their patients when the lab tests show “normal.”

I will explain to you men how to get your testosterone levels to an optimal range.  Women, in general, are better at preventative medicine than men.  Most men will not see a doctor unless they’re impotent or their back hurts too much watching football on the sofa.  Usually, the wives bring men in to see me.  Men, make sure you bring your wives in with you at your doctor’s appointment.  They will keep you honest, and most wives have a better memory than you.

Testosterone Pellets

I’ve used subdermal testosterone pellets in many men and myself.  They work fine if your doctor finds the correct dose.  Five weeks after testosterone pellet insertion your testosterone lab range should be 1,200 ng/dL to 1,500 ng/dL.  They are advertised to last 6 months, but rarely they last 6 months unless you’re over 80 years.  They only last 2 months for me.  They are very expensive and require you to have a doctor’s appointment for insertion.  The usual dose for men is 1,200 mg to 1,500 mg.  Some big, athletic men need 1,800 mg.  Living in Mexico, we have access to more forms of injectable testosterone than in the U.S.  I would not get testosterone pellets.  For women, that’s another story.  Women do very well on subdermal testosterone and estradiol pellets.

Testosterone Creams

I’ve prescribed testosterone cream to thousands of men and they work if you can find a cream with a base that absorbs well.  Most compounding pharmacies use VersaBase ® cream or gel.  It works, but I have found the cream at Women’s International Pharmacy to work better.

Women’s International Pharmacy

12012 N 111th Ave, Youngtown, AZ 85363

Telephone:  1-800-279-5708

I usually start men on 75 mg/gram cream, applied alternating on the arms and legs daily.  If men are under 700 ng/dL four weeks after using the creams, I raise the dose, sometimes to 100 mg daily.  Men should not take their testosterone cream on the morning of their lab tests.  Your doctor needs a trough level.

Most compounding pharmacies can’t compound a higher dose than 100 mg/gram.  If you need a higher dosage, you’ll have to apply the cream twice a day.  You might need for example another bottle of 25 mg/gram cream.

Men should usually have their testosterone at 700 ng/dL to 1,200 ng/dL.  Too high of a level of testosterone will aromatize to estradiol and estrone and cause more side effects like erectile dysfunction and prostate enlargement.

The best test to see if a man has the correct dose of testosterone is how many morning erections he has, and how many erections he has in the middle of the night after a dream.  Some men will do fine at a testosterone level of 500 ng/dL.  Treat your patient, not the lab.

Don’t rub testosterone cream on the scrotum or perineum, because it raises dihydrotestosterone (DHT) to very elevated levels.  That said, I have colleagues using it on the scrotum and they get very good erections, and the DHT has not enlarged their prostate glands.

Testosterone Injections

Mexico offers more types of injectable testosterone than in the U.S.  An injectable testosterone, which I have prescribed for thousands of men, is Depo-Testosterone (testosterone cypionate) 200 mg/ml.  I usually prescribe 0.2 ml subcutaneous injection three times a week.  Men use either an allergy or insulin needle.  Injecting a small dose three times a week decreases estrogen slightly and gives men better erections.  Some men take 0.3 ml three times a week.  They are usually taking anastrozole 1 mg ¼ tablet on Mondays and Thursday.  In one month do a trough blood test for CBC, free and total testosterone, PSA, DHT, progesterone, and Estradiol.  I also check DHEA-sulfate and pregnenolone if I just started them on these hormones.

Sustanon 250 (generic Sostenon 250) is a trade name produced by Organon Pharmaceuticals.  Sustanon 250 is a blend of four esterized testosterone compounds:

30 mg testosterone propionate

60 mg testosterone phenylpropionate

60 mg testosterone isocaproate

100 mg testosterone decanoate

Each of these testosterone salts has a different half-life, so I have found Sustanon or the generic Sostenon works quite well.  The 250 mg dose is too high for most men.  Some men can take this dose every three weeks, but it is better to use sterile technique and put it into a small syringe, and try 50-60 mg a week.

Nebido ® (Testosterone undecanoate)

This is a very long half-life testosterone.  At this time I do not have enough experience with Nebido to comment on it.

Side Effects

Allergies to benzyl alcohol, rare allergy to benzyl benzoate and rarer yet allergy to cottonseed oil.  Cottonseed oil should not be put into the human body.  Some compounding pharmacies can compound it with olive oil and use only benzyl benzoate.  The FDA has put more restrictions on compounding pharmacies, so the cost of compounding injectables has risen.

Other side effects can be an elevated hemoglobin and red blood cell count. Most men taking testosterone should donate blood twice to three times a year.

Too much testosterone can cause erectile dysfunction, because of the aromatase enzyme converting testosterone to estrogen.

Too much testosterone can cause pedal edema.

Aromatase Inhibitors

Getting old sucks!  Most men need an aromatase inhibitor after age 50.  With obesity being an epidemic, I have some men in there 40’s taking an aromatase inhibitor.

What is aromatase?  Aromatase is an enzyme produced in the testicles, ovaries, adrenal glands, adipose tissue (fat), placenta, and the brain.  Visceral fat (fat around the intestines, not subcutaneous fat) produces a lot of aromatase.  Fat guys have more aromatase than skinny guys.  However, I see skinny guys with high estrogen.  I’ve talked with “experts” all around the world, and no one can give me a good reason why skinny guys over age 50 make more aromatase.

There is a natural aromatase inhibitor called Chrysin, which is supposed to lower estrogen in men.  I have found that it just gives men yellow underwear.  Men are supposed to apply it once or twice a day to the scrotum and perineum.  Don’t use it, it doesn’t work.

Two aromatase inhibitors which work are Arimidex ® (anastrozole) and Femara ® (letrozole).

I usually have men use anastrozole 1 mg ¼ tablet a week.  Some men, usually fat men need ¼ tablet twice a week or more.

Femara ® (letrozole) 2.5 mg at 1/8 of a tablet twice a month was causing erectile dysfunction in my patients.  Men need a little estrogen for brain and bone health and to achieve and maintain erections.  I don’t use Femara because it’s too strong.

Keep estradiol levels between 20-30 pg/ml.

Prostate cancer

Around 60% of men over age 65 have prostate cancer.  85% of these men will have a slow, growing prostate cancer, and they may die of natural causes, not from their prostate cancer.

It was thought in the past, and many physicians still believe that testosterone will fuel prostate cancer.  Usually, prostate cancer occurs in men with low testosterone and high estrogen.  Cadmium can also cause prostate cancer, and possibly chronic prostate gland infections.

Some books to read to quiet your concerns on whether testosterone will cause you to get prostate cancer are:

Testosterone for Life: Recharge Your Vitality, Sex Drive, Muscle Mass, and Overall Health by Abraham Morgentaler, M.D.

The Testosterone Syndrome: The Critical Factor for Energy, Health, and Sexuality—Reversing the Male Menopause by William Fryer and Shippen, Eugene, M.D.

Maximize Your Vitality & Potency for Men Over 40 by Jonathan V. Wright and Lenard, Lane, Ph.D.

Progesterone

I usually have men put progesterone cream on their scrotum after their shower.  The usual dose is 4 mg/gm, one gram daily.  Progesterone at the right dose can help with erections and it tends to lower the PSA.

© 2018 Copyright Jake Ames All Rights Reserved.  No part of this document may be reproduced in any form with permission.

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