Visit www.DefyMedical.com for more information. Dr John Crisler speaks to David Bruce about the difference between TRT and bodybuilding doses.
Transcript: When the average person that doesn’t have an understanding of how hormones work, they hear testosterone, the first thing they think of is anabolic steroids. I know that when you first became a physician, one of the things you did is you helped guys that were abusing steroids or had been coming off steroids to restore their levels and to mitigate some of the side effects occurring. First and foremost, what is the difference between testosterone replacement therapy and using testosterone in the setting of anabolic steroids to enhance performance?
Excellent question. I’ve treated a lot of guys with testosterone, I’ve never prescribed an anabolic steroid. We need to really stay away from any kind of comparison between appropriate testosterone replacement therapy and performance enhancement. That’s what we tell our guys. We’re here to make them healthy and happy, not to make them more than their genetic potential was going to be. We’re treating a deficiency and bringing them back to health.
What is the difference between, say, an anabolic steroid and actual testosterone?
Well, actually very little, in that the molecule is based on cholesterol, that’s where the ester in steroid comes from, and they’re based on… many of them are based on that same molecule. A lot of it is just a matter of a dose dependent response, that some testosterone is like a glass of wine but doing a steroid is like drinking a fifth of liquor, respective of effects on our health.
It sounds like a lot of the anabolic steroids out there are synthetic, whereas testosterone is more of a bioidentical, or natural to what our body produces.
All testosterone is bioidentical, whether it is a transdermal gel or cream, or it’s injectable. In my mind, testosterone cypionate is still bioidentical, you’re just adding the cypionate ester to improve its performance and the body does not make it non-bioidentical, because it’s still exactly the same testosterone molecule. So we’re placing something in the body that it was supposed to have in the first place and no longer does, although there are a fair number of people out there who never really did develop. You’ve got a guy who’s 22 years old and is still not shaving, the guy needs some help with his hormones, and that’s where somebody who really knows what they’re doing needs to take care of him.
So for a young man that might’ve abused steroids and their testosterone is now suppressed because of that steroid abuse, what kind of protocol or what kind of treatment would you prescribe to help restore their hormone levels?
Well, it’s all entirely patient specific, given the patient’s individual situation. Some guys you use HCG in order to stimulate the testicles to begin to produce, so they’re ready, willing, and able to accept the luteinizing hormone stimulation from the pituitary once it comes. I do like to use selective estrogen receptor modulators, either clomiphene or Nolvadex depending upon the patient. One thing of note is that we’re finding that we’re getting by with much less dose than previously before we see guys using 50 mg of clomiphene and adding nolvadex to it and so forth and we’re finding now in many cases we can go by with only 12.5 mg of clomiphene, which not only is good because it saves the patients money but also less drugs is more.
A little bit goes a long way.
You bet. [inaudible 00:03:06]. The problem with those drugs is also the benefit of those drugs in that they contain not only an estrogen blocker but half of that pill is actually acting like estrogen in the body, so a small dose that we use, we can block the estrogen sufficiently in order to increase testosterone production. The estrogen is blocked at the hypothalamus, the pituitary, and that fools the brain into thinking that testosterone is low because estrogen comes from testosterone.
The problem is when you start using higher doses of these types of medications, that you’re also as I previously mentioned, adding a lot of estrogen and that estrogen can cause problems. It can on its own. You can have an estrogen build up because you’re producing more testosterone now, and in a small number of patients it also can increase the sex hormone binding globulin. If the sex hormone binding globulin goes up, then you have to produce more and more testosterone to overcome it so the guy has enough free testosterone, bioavailable testosterone, and that may limit the results. In some cases, I will lower sex hormone binding globulin with some danazol 50 mg in pure oral form, because you want that first pass effect to go through the liver to lower the sex hormone binding globulin and that can be effective in some cases. Truncated due to word limits.