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Hi Dr. Xhardo. I Have A Follow Up Question On

Posted on Wed, 31 Oct 2018

Question: Hi Dr. Xhardo. I have a follow up question on my testosterone replacement therapy.
I am currently on 120 mg per week of testosterone cypionate. I have read that the injection sharply raises testosterone and for the first few days following, some of the testosterone can be converted to estrogen . Would splitting the dose into two weekly injections of 60 mgs avoid this effect? Thank you. Anthony Campeau

Answered by Dr. Elona (30 hours later)

Brief Answer:
No,the lower dosis will not avoid the convertion.

Detailed Answer:
Hello Anthomy Campeau
I appologise for the late reply.

The suggested dosage for Testosterone Injections varies depending on the age, sex, and diagnosis of the individual patient.
Dosage is adjusted according to the patient's response and the appearance of adverse reactions.

For replacement in the hypogonadal male,the recommended dosis should be 50–400 mg every two to four weeks.

Yes,it is true.This therapy increase the T Level in the days or weeks following the inections and some of the testosteron is converted to estrogen from the aromataze enzyme.

Aromatase converts testosterone to estrogen, further depleting free testosterone levels and increasing estrogen levels.
This enzyme is one of the most important factors that affect testosterone levels and the ratio between testosterone and estrogen .

The split dose of Testosteron will not stop the effect of aromataze enzyme.

Intense exercise and good sleep are the two best ways to increase your testosterone levels and indirectly inhibit the effects of aromataze enzyme.

At the other side ,i want to underline that it is very impotant to contact your treating doctor if you want to change or modify your Testosteron therapy because hormone replacement therapy is a complex process and requires careful attention to signs and symptoms, as well as laboratory testing( free testosterone, total testosterone, and estrogen and PSA screening).

Have you done these tests recenly?

Let me know if i can assist you further.
Ragards.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Elona (1 hour later)

thank you for the response. The lab values are within the last week so they are quite current with Free Testosterone around 300 pmols/l. I felt more energy when I was on 150mg/week, but my MD feels that although my RBC are well within normal limits, it is best to target a free test value in the middle of the normal range, and that is what 300 is. When I felt very energenic my free test was 500. I know this is at the high range of normal but maybe its ok for me re my symptoms?

Thanks. XXXXXXX

Answered by Dr. Elona (7 hours later)

Brief Answer:
Your actual test result is OK!

Detailed Answer:
Hi again XXXXXXX

It is normal that with a higher weekly dosis you had higher free test values and you felf more energetic.This is the main effect of testosteron in the body.

But considering the side effects and the riscs of long term use of Testosteron replacement therapy,it is better if you take the minimal dosis that control your symptoms(the symptoms of low T) and make you feel normal for your daily activities.

A free testosteron test at the higher limit of the range for a long time,can produce dangerous side effects.
So,The free testosteron test in the middle of the normal range is OK.
The goal is to have a free testosteron level that is 2% or more of total T.

Anyway,if i was your treating doctor ,i will ask to do the estradiol ,testosteron total and free measurements , PSA test, CBC and Comprehensive Metabolic Panel w/EGFR six months after starting the therapy and than yearly.
These test are decisive to understand the positive effects/side effects and the optimal dosis of TRT in your specific case.

Hope this is helpful.
Wish you good health.

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Above answer was peer-reviewed by : Dr. Vaishalee Punj