Drugs work! But so what? Drugs are also illegal and can harm your health. Besides that, if you're a competitive athlete and you get caught, you can suffer serious damage to both your reputation and finances.
Yeah but we've heard that using testosterone isn't necessarily bad for your health. So what's the big deal?
The big deal is that the testosterone is just a drop in the bucket. Bodybuilders and many other athletes use so many hormones and drugs that it's a wonder that some of them are still with us.
Bodybuilders, especially the competitive ones, have used and tried almost every hormone and drug that has even been remotely connected to some sort of ergogenic or anabolic process, and a large number of drugs to deal with the side effects of these hormones and drugs.
The most widely used are hormones and drugs that are anabolic, anti-catabolic or both and include anabolic steroids and prohormones, their OTC counterparts, growth hormone, IGF-1, insulin, thyroid, clenbuterol, diuretics, stimulants, narcotics, etc.
The blood of the average competitive bodybuilder is a chemical cocktail waiting for something bad to happen. Maybe not right away but somewhere down the road.
Why such doom and gloom? Because the use of drugs in bodybuilding is totally out of control.
NO ONE, I don't care how much experience and savvy he thinks he has, can safely orchestrate the stacking of all these hormones and drugs. I certainly can't do it, even though I've been researching the use of drugs in sports for four decades and considered by many to be a world authority on drug use in sports.
So what the H is the average bodybuilder doing using all these hormones and drugs? Does it even enter his or her mind that maybe they don't have all the answers, and that either now or down the road there's going to be a payback from all the junk they've been on for the last decade or two? Sure it does.
But getting big and ripped and looking freaky at shows is more important. But there's always that nagging thought - what am I doing to myself? Is this delusional quality of life on drugs really worth it?
Enough of the preaching. Besides you've heard it all before in more cataclysmic terms than I'm using. Let's not redo the "Death in the Locker Room" bit.
Getting Off The Roller Coaster
But let's say you want off the roller coaster. You want to stop the Jekyll and Hyde rehearsals and want to live a normal healthy life.
So you decide to stop using and within a few months (the wimp transformation starts after about three to four weeks depending on how much stuff you've been on) you lose so much size that even your own mother doesn't recognize you. "Junior, is that you or has your sister's beard gotten thicker?" You can't stand losing all that meat and sizzle.
So you go back on and get your muscle mass and energy back, but you're scared stiff that you're hurting yourself. So what's a guy to do? Why is it so hard to get off the drugs?
The problem of course is that coming off the drugs is not as easy as everyone thinks it is. JUST SAY NO! doesn't cut it. When you stop using drugs, and this is especially true of the use of testosterone and the anabolic steroids, but is also true to varying degrees of GH, thyroid hormone, and various drugs that affect the neurotransmitters in the brain, the body needs to readjust itself to reality. It needs to adapt as best it can to the new situation.
If you're more than thirteen years old you should know by now that taking anything or doing anything results in an adaptation reaction from the body.
When you lift weights, your muscles adapt by getting bigger and stronger (or so you hope, but we'll be covering the adaptive response to exercise, diet and supplements in another article). When you take hormones and drugs your body also adapts. It adapts by cutting back on the natural production of some hormones and other biological compounds.
The Anabolic Steroid Catch-22
When you use physiological (like baby bear's porridge, just the right amount for your body) to supraphysiological (i.e. more than would ever be in your system naturally) amounts of testosterone and/or anabolic steroids (regardless of the kind of anabolic steroid), and even prohormones (leaving aside the question of whether they work like steroids or not, they definitely have some of the same side effects) your body shuts down the machinery that normally produces your own testosterone and other androgens.
The body seems to be saying, "if you're providing me with the stuff, then I don't need to make it - wake me up when you need me to make some." The problem is that waking the body up is sometimes difficult and at times impossible. It's as if the machinery has seized up from not being used. Sometimes no matter what you do, you can't get it going again.
What this all means is that even if you want to stop using anabolic steroids, sometimes you can't because your body won't co-operate.
If you try going off the steroids, you don't produce enough of your own testosterone to keep yourself from losing more muscle than you gained from using the steroids. That's right. Not only do you lose any muscle you gained while you were on the juice, but you also lose some that you had before you used drugs. What a bummer.
No wonder it's so hard to get off steroids once you've used them. If you go off them you end up looking like you never went through puberty and feel like you wish you hadn't, and if you stay on them you're worried to death of what they might be doing to you.
Never mind the cardiovascular, cholesterol, liver, and other possible side effects of anabolic steroid use, including gynecomastia (bitch tits), acne, baldness and for women the added extra of facial and body hair, lowered voice, clitoral enlargement, and other masculinizing goodies.
Never mind the possible side effects down the line - possible cancers, heart disease and perhaps an early demise. Never mind anything.
And while it's usually long time abusers of steroids that run into this problem, anyone who has used steroids can suffer the heartache of functionally losing his testicles. Even though it's not the norm, I've even seen it in bodybuilders and other athletes who just went through one or two steroid cycles.
So what can you do if you want out but you want to keep your manhood and some of your hard earned muscle?
Getting Your System Back To Normal
Before we get into the details, it's important that you know a bit about how your body produces testosterone and who the major players are. At the end of this article I've included a very simplified drawing I did of the Hypothalamic-Pituitary-Testicular Axis (HPTA) showing the main players and their interaction. It'll help if you refer to that drawing as you read the info below.
The testicles produce testosterone. When testosterone levels fall, part of the brain senses this (actually it's sensed at three levels, the suprahypothalamic, hypothalamic and pituitary levels - see the diagram above) and prods the pituitary gland to produce leutenizing hormone (LH).
LH in turn prods the testicles to produce testosterone. When testosterone levels rise the brain lets up on the pituitary gland and less LH is released and thus less testosterone is produced. This give and take by the brain, pituitary gland and the testicles maintains the normal amount of testosterone in your body.
When you take testosterone or any of the anabolic steroids, or the prohormones, the brain relaxes as far as prodding the pituitary to produce LH. Because of low LH levels the testicles essentially shut down. It's like the testicles relax because they're not being nagged anymore. They get lazy and pretty soon shrink in size.
The brain, pituitary and testicles slack off as long as you're on the juice. Once you go off the steroids, the levels of the drugs you used start going down. Now if everything was kosher, within a few weeks after going off the steroids what SHOULD happen is that as the level of steroids drop, the brain, pituitary, and testicles should get into gear to get that level back up by producing enough of your own testosterone to keep you hormonius.
Unfortunately, what does happen in many cases is that one or more of players can't get it going, or the whole axis is out of synch. Even though the testicles are down in size, they're usually game.
Given the proper stimulus, such as using LH, or HCG (human chorionic gonadotropin) that acts like LH, or clomiphene (Clomid) or anastrazole (Arimidex) that stimulate LH production that in turn stimulates the testicles, they usually kick in and start producing more than enough testosterone.
The pituitary is usually game as well since using anti-estrogens (such as clomiphene, cyclofenil, and even tamoxifen) or aromatase inhibitors (such as anastrazole) will usually increase LH production which will in turn increase testosterone production. But even though both the pituitary and testicles seem to be able to function, the system still may not work on its own.
If you leave it alone, it'll usually get back to a semblance of normal, eventually, but in some cases leaving it alone just doesn't cut it as the whole shebang acts like it's never heard of testosterone, or acts like lower levels of testosterone are perfectly normal. It's as if the testosterone thermostat has been permanently reset at a lower level than it was before you went on the steroids.
So what's a guy to do?
Take It Step By Step
First of all it's important to stop taking the steroids, and the prohormones as they both suppress the HPTA to the extent that nothing will turn it around while you're on them.
While prohormones are part of the problem, other testosterone boosters may be useful to get your system going again. It's also useful to use along with whatever else you use to kick start your system.
If this doesn't work, the next step is to see where the problem is. It could be the testicles themselves and this is the problem in a small number of cases.
You can check this out by seeing a doctor and having him give you 4 to 8 shots of 2500 IU of HCG spaced out over a two to four week period. You should only do this after you've been off the steroids for a few weeks to a month otherwise it doesn't do much good.
Have him measure the serum Free or even better, Bioavailable testosterone a few days after your last shot. You should get a marked increase in the level of free testosterone compared to before the shots. If you do then the problem is not in the testicles.
Step number two is to get him to prescribe an anti-estrogen such as clomiphene (Clomid) or an aromatase inhibitor such as anastrazole (Arimidex) being the one I use most commonly (Leder BZ, Rohrer JL, Rubin SD, Gallo J, Longcope C. Effects of aromatase inhibition in elderly men with low or borderline-low serum testosterone levels. J Clin Endocrinol Metab. 2004 Mar;89(3):1174-80.), and see how your LH and testosterone are affected.
After using either Clomid or Arimidex for at least 30 days gets your free testosterone and LH levels checked. Both should be getting into the high normal or supranormal range or at the very least show a significant improvement above the previous readings. If so then you know that the pituitary and testicles are functioning. Maybe not in synch but at least they work.
If everything checks out OK then it's usually a good idea to take the anti-estrogen for a few more months and then slowly discontinue it.
Once off it for a month or so get the various levels checked again to make sure that your system is functioning and that you're levels are in the normal range.
If after the use of the HCG and either an anti-estrogen or aromatase inhibitor there's still a problem then the next steps may be one of several options. The next step I use is to use gonadotropin releasing hormone (or analog in bursts - not continuously) with or without the use of dopaminergic compounds such as bromocriptine and metoclopramide, and seeing how this affects LH and testosterone.
If both levels are increased but your testosterone levels take a dive again once you stop using the releasing hormone with or without ancillary dopaminergic compounds, then you're dealing with a problem with the mechanism that co-ordinates the HPTA (hypothalamic-pituitary-testicular axis) or with non-responsive testicles.
As such the treatment becomes more involved and is beyond the scope of this article, being best dealt with in conjunction with a doctor who has some experience dealing with refractory cases of HPTA dysfunction secondary to anabolic steroid use.
As an interesting side note, it may be that if you can kick start your system after a prolonged period during which the testicles have not been functional, there is a chance that the testosterone level will actually roll back in time and be comparable to the levels found in someone younger. Basically by using anabolic steroids you create a situation in which you have endocrinological metabolic arrest of Leydig cells.
Studies in rats have shown that the administration of contraceptive doses of testosterone suppresses endogenous LH and leads to a temporary arrest of steroid biosynthesis in the Leydig cells. One study found that when middle-aged Norway rats (13 months old) were treated with testosterone for 8 months, the previous level of testosterone production was restored by the end of the treatment (Chen H, Zirkin BR. Long-term suppression of Leydig cell steroidogenesis prevents Leydig cell aging. PNAS 1999; 96:14877- 14881.).
This means that the 23-month-old rats showed the same serum testosterone levels as animals half their age. Thus by placing your testicles in what amounts to hibernation, the reductions in testosterone production that usually accompany aging did not occur. If this mechanism functions the same way in men it opens up another valid argument for the medical use of testosterone and perhaps even some anabolic steroids as hormone therapy for contraceptive purposes.
A more recent paper by the same authors, looking at the mechanism behind age related decreases in testosterone production, also makes for interesting reading, as it points out mechanisms by which the aging testicular cells can be made to product youthful levels of testosterone. (Chen H, Liu J, Luo L, Zirkin BR. Dibutyryl cyclic adenosine monophosphate restores the ability of aged Leydig cells to produce testosterone at the high levels characteristic of young cells.).
This paper, and others, indirectly point out ways to combat the decline in testosterone with aging. For more on this and to see the info on TestoBoost click here.
While there are a lot of treatment options to solve the HPTA dysfunction, in some cases nothing works. In these cases you're almost back to where you started.
The only "cure" is using replacement levels of testosterone. But there is a difference. This time you'll be monitored by a doctor, use reasonable amounts of testosterone, and working toward improving your health. And you'll be using high-grade pharmaceutical stuff; a whole lot better, and safer, than the black-market junk (is it real or not? Is it dangerous or not? - No one really knows) you used before.
Unlike trying to get a doctor to prescribe steroids to a healthy athlete, it shouldn't be all that hard to get a doctor to work with you. After all you've repented, so to speak, and you need his medical help. No decent doctor should refuse you since you'll both be working towards normalizing your system from a hormonal deficiency.
As well, there's a lot of peer-reviewed literature that shows the safety and benefits of using testosterone for replacement therapy, even in light of hormone replacement and anti-aging therapy (Kaweski S; Plastic Surgery Educational Foundation DATA Committee. Anti-aging medicine: hormone replacement therapy in men. Plast Reconstr Surg. 2004 Apr 15;113(5):1506-10. ).
For example Bhasin et al., almost a decade ago (well seven years is pretty close to a decade), published a review of the literature dealing with the issues involved in androgen replacement therapy (Bhasin S, Bremner WJ. Clinical review 85: Emerging issues in androgen replacement therapy. Journal of Clinical Endocrinology & Metabolism 1997; 82(1):3-8.)
In this review the authors present the rationale for anabolic applications of replacement and supraphysiological (above the normal testosterone range) doses of testosterone. They also discuss in detail the pros and cons of certain testosterone preparations including the different testosterone products available then including oral, injectable and topical (patches) forms.
Since then a number of other studies and articles have appeared in both the scientific and lay press covering hormonal replacement therapy and some of the new preparations that have come on the market (for example Handelsman DJ, Zajac JD. 11: Androgen deficiency and replacement therapy in men. Med J Aust. 2004 May 17;180(10):529-35. and Oettel M. The endocrine pharmacology of testosterone therapy in men. Naturwissenschaften. 2004 Feb;91(2):66-76. Epub 2004 Jan 28.).
What To Use
There's obviously more than one way to replace testosterone in testosterone-depleted bodies.
By far the best way is to have your own body produce testosterone, and all the related and all the inter-related steroids and metabolites naturally. That means kick starting your HPTA so that it produces physiological levels of testosterone in synch with your own natural rhythm.
These levels vary according to internal and external influences, as they should. Also the levels of precursors and metabolites, all of which can be active and contribute to your well-being, vary according to physiological and psychological needs.
The bottom line is resounded in that old cliché¬ Nature knows best. And knowing best means being able to adjust levels of testosterone in accordance to whatever else is going on inside and around you.
Although, admittedly, there are times when natural testosterone levels, affected by stress in one form or another, may not be optimal and some sort of manipulation, working through endogenous systems, may be beneficial.
We've mentioned ways to kick start your system using HCG and a variety of other drugs including anti-estrogens and aromatase inhibitors.
We've also mentioned natural ways of boosting endogenous testosterone production using TestoBoost (for more information on TestoBoost and why it can help see the information on version 3.0 of TestoBoost, my latest reformulation, at:
Actually the use of TestoBoost along with HCG, Clomid, Arimidex and others will enhance the process of getting your HPTA axis back to normal, and in some cases getting testosterone levels in the high normal range.
It's also great for getting your sex drive back on track, regardless of what you're using. That's because I formulated TestoBoost to address several of the pathways that determine both testosterone production and disposition, as well maximizing the anabolic and fat burning effects of the formulation.
Also because TestoBoost is manufactured in a pharmaceutical grade facility, what's on the label is in the bottle, AND NOTHING ELSE.
- Increase testosterone
- Block excessive estrogen production
- Block excessive production of dihydrotestosterone
- Enhances prostate health in men
- Increase libido and sex drive in both men and women
- Provide a potent anabolic effect
- Decrease body fat
As I mentioned, the ingredients in TestoBoost impact on several pathways involved in testosterone production. For a few of these have a look at my diagram on Androgen Metabolism below. The diagram will make more sense when you read the on line information on TestoBoost.
Prohormones, like testosterone and anabolic steroids, shut down your HPTA axis and obviously shouldn't be used to get your endogenous testosterone levels back to normal. In fact, most of the prohormones carry a triple whammy.
First of all they don't work or have borderline effects (yeah, I know what the ads promise, but they're mostly full of it), secondly they shut down your natural testosterone production and thirdly some of them, especially the norsteroid (such as norandrostenedione and norandrostenediol) and boldenone (for example Boldione, which is 1,4 androstadienedione) prohormones, can make you positive for anabolic steroids if you're drug tested.
The ones implicated in almost all of the nutritional supplement positive drug tests are the norsteroid prohormones. That's because even though these products don't have the anabolic properties of nandrolone (also known as 19-nortestosterone and most commonly known as Deca or Deca-Durabolin), they break down into the same metabolites and it's these metabolites that are checked for in the urine as an indication of the use of nandrolone.
And it's not just the prohormone products that have been implicated. In several cases the positive drug test was secondary to prohormone contamination of other nutritional supplement products (Maughan RJ, King DS, Lea T. Dietary supplements. J Sports Sci. 2004; 22(1):95-113. and Geyer H, Parr MK, Mareck U, Reinhart U, Schrader Y, Schanzer W. Analysis of non-hormonal nutritional supplements for anabolic-androgenic steroids - results of an international study. Int J Sports Med. 2004 Feb;25(2):124-9.).
The problem is that a facility making prohormones, unless they're really careful about cleaning up after making a prohormone product, can leave behind traces of the prohormones that in turn can contaminate other products that use the same equipment. In this kind of scenario even a multivitamin sloppily produced may result in a positive drug test for steroids.
Testosterone And Anabolic Steroids For Replacement Therapy
Although a number of anabolic steroids could be used for replacement therapy, the most natural, and the one that's least objectionable to practitioners and patients alike, is testosterone. After all, we're trying to replace what's lost and what's been lost is mainly considered to be testosterone, which, as we'll see may not be completely accurate.
As far as to which hormone to use for replacement therapy, it's possible that some anabolic steroids may be preferable to testosterone as some of these compounds have a better profile in some respects.
For example 7-alpha-methyl-19-nortestosterone, while having most of the properties of testosterone, is resistant to 5-alpha-reductase and thus spares the prostate from excessive androgenic stimulation (Anderson RA, Wallace AM, Sattar N, Kumar N, Sundaram K. Evidence for tissue selectivity of the synthetic androgen 7 alpha-methyl-19-nortestosterone in hypogonadal men. J Clin Endocrinol Metab. 2003 Jun;88(6):2784-93.). As such it may have advantages over testosterone in hypogonadal men.
However, to most using some form of testosterone to supplement low endogenous levels of testosterone seems logical enough, and as a result there are many preparations that compete for consumer bucks in a market that, mainly because of age related declines in testosterone, is huge. See Table 1 below for a rundown of the commonly available testosterone preparations, the dosages used, and pros and cons.
Injectable Forms Of Testosterone
Testosterone for injection purposes is available as a suspension in water (not used much therapeutically) or as an ester in oil. Of the known and commercially available fatty acid esters of testosterone (propionate, enanthate, cypionate/cyclopentylpropionate), testosterone enanthate is used more than the rest because of its relatively good pharmacokinetic pattern, wide availability, and reasonable cost. It's injected once every 7 to 21 days depending on dosages used and convenience.
The disadvantage of all these intramuscular esters is that they initially produce supraphysiological (higher than normal levels) serum testosterone levels which then decline slowly to low normal levels or even to subnormal levels before the next injection. Some people consider this profile to be an advantage rather than a disadvantage because they feel that it's a better scenario for building and/or maintaining muscle. However, it can also be a disadvantage since it creates unnecessary highs and lows that affect how you feel and your sex drive.
To avoid these disadvantages, an injection form with testosterone undecanoate (trade name is Nebido by Schering) was developed and has just been introduced in Europe after being approved in July of 2004. This long acting form of testosterone has been a long time coming.
I first wrote about athletes using home brewed testosterone undecanoate injections almost two decades ago. It wasn't long after published studies first appeared on the effects of the oral form of testosterone undecanoate in humans date back to 1975 (Nieschlag E, Mauss J, Coert A, Kicovic P. Plasma androgen levels in men after oral administration of testosterone or testosterone undecanoate. Acta Endocrinol (Copenh). 1975 Jun;79(2):366-74.), that athletes started experimenting with the injectable form.
This new (meaning recently available commercially) pharmaceutical formulation, because of the long undecanoate side chain, requires much fewer injections than other preparations.
Injections roughly every two to three months result in stable testosterone levels within the normal range and avoids both supraphysiological and subphysiological serum testosterone levels. (Hubler D, Christoph A, Schubert M, Oettel M, Ernst M, Mellinger U, Krone W, Jockenhuvel F. Effect of a new long-acting testosterone undecanoate formulation vs. testosterone enanthate for intramuscular androgen replacement therapy on sexual function and mood in hypogonadal men. Int J Impotence Res 2001; 13 (Suppl 1):S31.). However, in contrast to implants, the injection interval is short enough for relatively fast interruption of the therapy when needed.
In my view the use of testosterone decanoate injections will soon be the most popular form of testosterone replacement therapy, as long as the cost is kept reasonable. In my opinion the cost of the testosterone gel, up to twenty times more than the equivalent biological amount of testosterone enanthate, are totally out of line and will keep it out of the running as a viable option for most people.
Other Methods Of Testosterone Delivery
Other testosterone delivery methods include pellet implants, oral, transdermal and buccal systems. Even though the use of subdermal pellet implantation has been around for more than 50 years, it's still looked at as a viable alternative to testosterone injections and to transdermal testosterone.
In fact there have been some recent studies on the dynamics of testosterone pellet implants (Kelleher S, Howe C, Conway AJ, Handelsman DJ. Testosterone release rate and duration of action of testosterone pellet implants. Clin Endocrinol (Oxf). 2004 Apr;60(4):420-8.).
The transdermal delivery of testosterone offers several benefits compared with oral or intramuscular routes or implants. The new gels (such as Androgel) are more acceptable and more consistent as far as absorption compared to the older scrotal and dermal patch systems, with less likelihood of contamination.
When applied to the skin, the gel dries rapidly, due to the evaporation of the alcohol vehicle, and the steroid is absorbed very fast into the stratum corneum of the skin, which serves as a reservoir.
Some recent studies have looked at the new testosterone buccal system (Wang C, Swerdloff R, Kipnes M, Matsumoto AM, Dobs AS, Cunningham G, Katznelson L, Weber TJ, Friedman TC, Snyder P, Levine HL. New testosterone buccal system (Striant) delivers physiological testosterone levels: pharmacokinetics study in hypogonadal men. J Clin Endocrinol Metab. 2004 Aug;89(8):3821-9.) and compare this with the testosterone gels on the market (Dobs AS, Matsumoto AM, Wang C, Kipnes MS. Short-term pharmacokinetic comparison of a novel testosterone buccal system and a testosterone gel in testosterone deficient men. Curr Med Res Opin. 2004 May;20(5):729-38.).
Is Testosterone Replacement Enough?
The problem with testosterone replacement is that it not only shuts down the body's normal endogenous testosterone production but it also shuts down the production of a lot of androgens in the body that would normally be used to make endogenous testosterone.
If you look at the diagram I drew on Androgen Metabolism you'll see that there are a lot of androgens and other precursors that are affected by replacement therapy, including androstenedione, androstenediol, and DHEA.
As well, some of the brain, hypothalamic and pituitary pathways are also affected. It's likely that some of these hormones and other factors that are affected by testosterone replacement have important physiological and psychological functions that may be affected and this in turn may impact on physical and emotional health. In other words by you're suppressing various precursors and metabolites that may normally contribute to your well-being.
It's possible, and perhaps beneficial to some who are not satisfied with the effects of replacement therapy with just testosterone, to use some other modalities either with or instead of testosterone replacement. For example some people with use small amounts of HCG once or twice a week along with some form of testosterone replacement. They state that they feel better and that their quality of life improves when they're using both together as against either one by itself. For the same reasons, others alternate the use of testosterone replacement with periods of HCG and/or Clomid and/or Arimidex.
Also if have to stay on testosterone replacement therapy to feel normal, you might want to take "testosterone-free breaks" just to give your body a chance to normalize some from the replacement therapy. For various reasons, including the possibility of initiating (unlikely) or sustaining certain conditions, including cancer, especially of the prostate, taking some time off every once in a while may be a wise move.
For example you could use testosterone for eight or so weeks and then take a month off before starting again. Actually any regimen you feel comfortable with and suits your purposes would do. As long as you take some breaks and don't keep the body on a steady sustained dose for long periods of time.
If you need help getting off steroids, see your doctor and bring this article as well as some of the papers I mention above. If you have some problems getting any of the articles, drop me a line and I'll see if I can help.
Then once you've rejoined mankind, read up on some of my articles and books for ways of getting big and ripped without using drugs.