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Quick Guide to Understand The Basics of Testosterone Replacement Therapy for Clients

Quick Guide to Understand The Basics of Testosterone Replacement Therapy for Clients By Rene Abreu M.S., ACSM,NASM,NSCA www.reneabreu.com. Testosterone Replacement Therapy - a.k.a. “TRT”: *Method to the Madness - Science not Speculation *Different TRT Options *Goal of Proper TRT Therapy. 1.

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Quick Guide to Understand The Basics of Testosterone Replacement Therapy for Clients

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  1. Quick Guide to Understand The Basics of Testosterone Replacement Therapy for Clients By Rene Abreu M.S., ACSM,NASM,NSCA www.reneabreu.com Testosterone Replacement Therapy - a.k.a. “TRT”: *Method to the Madness - Science not Speculation*Different TRT Options*Goal of Proper TRT Therapy 1

  2. Testosterone Replacement Therapy - aka “TRT”: Understanding the Method to the Madness and the Different TRT Options • As we age, we all lose hormones that are responsible for healing and repair • these hormones are collectively known as “sex-steroids”-testosterone,estrogen • the only steroid hormone that goes up with age is the one most responsible for tissue break-down, lack of healing, and “getting old”; CORTISOL

  3. Overall Goal of TRT: Although it is often known as “Replacement” therapy the actual goal is “Optimization”. Typical TRT aims to raise testosterone to the “youthful” levels of a 30 year old healthy man. • Overall Purpose of HRT: To balance and restore the natural hormonal ratio in the body so that the accelerated “break-down” that occurs with aging is partially reversed towards “healing and repair”. • The end RESULT: Better mental and physical function, restoring, improving and sustaining a higher quality of life, and most importantly - decreased risk of age-related disease and illness.

  4. Testosterone to Estrogen Ratios In Aging Men Total Testosterone Lab Reference Ranges (most labs) = 300-1100ng/dl

  5. Bottom Line: With Aging Comes a Progressive Decrease in Testosterone and an Increase in Cortisol Which Accelerates the Aging Process By Impairing the Body’s Ability to Heal and Recover from Stress other hormones are also affected such as Growth Hormone, thyroxine, insulin, IGF-I and others Each of these can be a separate topic but all function best when the body has a “high-healthy” testosterone level Correction of Testosterone levels to the “optimal” range tends to improve but not necessarily “fix” these hormones

  6. Option 1: Testosterone Creams/Gels etc.Everything You Need to Know - Defined in 3 Simple Steps • Step 1: “Percent Strength” = the general potency of a T product expressed as a fraction. Remember the % symbol means “divided by 100”. ex. 5% T gel = 5/100. • Step 2: “Testosterone Delivered” - the amount or quantity of T contained in a single dose of a specific formula or product • Step 3: “Percent Absorption" - amount of pure T that is absorbed by the skin into the body

  7. Step 1 of Understanding T Gels and Creams: “TOTAL STRENGTH”: • def.* = *the total amount of testosterone contained per “dose” of product (as listed on the product label) • Most products on the market contain anywhere from 1g up to 10g of Testosterone per dose of of product • Most common are 5g, 7.5g, and 10g “total strength” per dose of product

  8. Step 2 of Understanding T Gels and Creams: “PERCENT STRENGTH”(or CONCENTRATION) • The “CONCENTRATION” of the product - similar to how alcohol concentration in beer is 3-6% alcohol, gives us the quantity of testosterone in each gram of product • percent strength varies from 1-10% for most commercial versions, brands, makes, etc. • 1% = closer to female products, 10% = closer to male products

  9. Step 3 of Understanding T Gels and Creams: Testosterone “Delivered”: • The simplest way to understand this is to multiply the number in Step 1 by the number in Step 2. Total Strength x percent strength = Testosterone Delivered • def.*= “the quantity of testosterone actually rubbed onto the skin.” ex. 10% T cream at 10 GRAM “TOTAL STRENGTH” = 100mg “Delivered” to the skin surface • Ex. 1: Testim: one of the main US commercial T-gel products contains 5g of total testosterone per dose of product and has a 1% CONCENTRATION. 1% of 5 GRAMS = 50mg. Therefore a single dose of Testim “Delivers” 50mg of testosterone to the skin surface.

  10. Step 3 Continued: another T product example: AndroForte (Australian brand) • They make it simple and give you the T “DELIVERED” right on the label... • product comes in 2 different potencies: each 1 milliliter (ml) giving 20mg Testosterone for the 2% product, and 50mg Testosterone for the 5% product.

  11. The Fun Part - Making the Math Count: Absorption Through The Skin - Quick and Easy Calculation Method • Take the TOTAL STRENGTH and multiply by %STRENGTH to get Testosterone Delivered. • ex. 1% = 5 x .01 = .05 GRAMS or 50mg Testosterone Delivered. • 10% is the Standard absorption for T products through the skin • 50mg (DELIVERED) x .10 absorption = 5mg absorbed into the body

  12. Second Main Option for TRT: Intramuscular (I.M>)Testosterone Preparations • Carbon Chain ‘Esters’ yield the half-lives of various oil based solutions (hydrophobic) • Half-lives range from as little as three days (propionate) to as much as 3 weeks or so in the literature (testosterone undecanoate) • Quantity is measured in cubic centimeters (cc’s) or milliliters (ml’s) (1cc = 1mL) and strength range from as low as 50mg/ml to 250mg/ml and higher in some ‘underground’ preparations • Many Docs still dose TEST far too low to have an effect and can actually LOWER the Baseline level by inducing negative feedback

  13. Massive amounts of misinformation based strongly on opinion has propagated a field of pseudo-science that has evolved into ‘subjective fact’ • All testosterones ultimately become the EXACT same form once the enzymes in the blood remove the ‘shell’ • the ‘shell’ is often known as an “Ester” - a chain of carbon atoms attached to the TEST molecule at a specific functional position to make it last longer in a hydrophilic (water loving or water-based environment etc. - blood) • These carbon chains or tails attached at the “roof-top” or 17th beta position of the TEST molecule are more commonly recognized by terms such as propionate, enanthate, cypionate, decanoate, etc. • These are chemistry terms describing the # of carbons in the chain

  14. Testosterone Injection Rules #1 and #2: • The Length of the “Ester” is #1 factor influencing the half-life of the drug. • The “Ester” length is determined its number of carbons • English Please? Sorry, that is the correct way to say it - in layman terms the longer the ester chain attached to your TEST formulation the longer it will last in your bloodstream • Why? Purpose of ester is to slow absorption of TEST into the bloodstream from minutes to hours, days and weeks. • You don’t have to be a chemistry wiz to know that a longer chain of carbons is p-r-o-b-a-b-l-y going to weigh more than a shorter chain... • Although this is a simple concept, the truth and accuracy of this topic has been slaughtered on the internet blogs, forums, and article postings.

  15. RELATIVE POTENCY? The weight of a single TEST molecule (molecular weight) divided by the total weight of the TEST + ESTER • Remember we said earlier that the longer the ester the longer it lasts in the body - this is by design, and is the sole purpose of the ester • Recall that we also mentioned that longer carbon chains weigh more than shorter carbon chains - ex. Cypionate (8 carbon ester chain is heavier than propionate (3 carbon ester chain) • Does this mean that the longer lasting TESTOSTERONE products are...Less Potent than the shorter acting ones? Answer: ON a mg per mg basis – ONLY…YES. This is by simple math - addition and subtraction

  16. Example: Testosterone Enanthate • Long, heavy ester 8 carbons in length • 69% Testosterone • Comes in 100mg/ml, 200mg/ml strength on the general market • Simple Math says 69 or if we round up, 70 of every 100mg of TE is actual ‘pure’ Testosterone

  17. Testosterone Cypionate • If we round up after the decimal, TE and TC are the same % testosterone • TC is a bit heavier than TE 420 vs 418 Daltons • This will equate to an insignificant 2mg difference between products which makes them interchangeable

  18. Testosterone Cypionate(TC): The Most Commonly Prescribed Testosterone Formula in the US • Testosterone ester formulations are abundant internationally and some of these preparations offer convenience, efficiency and better overall quality of life benefit than TC • The laboratory process of attaching the ester(s) is a simple one for any trained lab chemist and is very inexpensive - probably less than $50/month to maintain for the average TRT dose range of 200-300mg every 7-12 days • Society here in the US along with media propaganda and the American fascination with “Steroids” has created red tape preventing all but a handful of less effective products from being ‘scripted’ by US Docs

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