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What To Expect From Therapy

What To Expect From
Testosterone Injections

The only reason to undergo testosterone injections therapy is to restore your hormone levels back to the elevated numbers of your youth. The road to stably increased hormone levels varies according to the form of testosterone used, the route of administration, and the dosing level and frequency. This section will educate you on the differences between these factors to help you make informed decisions.

Testosterone Injections

Everyone wants and expects immediate results, but unfortunately, that is not realistic. It takes several months to see the full benefits of testosterone injection therapy. Testosterone replacement therapy can significantly accelerate muscle, bone, and cellular reproduction. However, it is important to understand that slow and steady is the way to go! When dieting, if you lose weight too quickly you usually end up gaining it all back; the same is true for physical transformation and development. Exaggerated dosages of testosterone, anabolics, and/or improperly protocolled therapies may yield visibly quicker results. However, the internal damage and the level of taxing your organs have to endure, which goes hand-in-hand with that type of accelerated development, is not worth the damage was done to your physiology and endocrine system. Not to mention, and more importantly, although the muscle may be bigger in size, it will not be as strong as a muscle of the same size that was properly built and strengthened over time.

With a well-structured testosterone injection program, you can expect to see the following results:

• Week One. If you have never received testosterone injections before and are suffering from hypogonadism (clinically low testosterone), you should begin to experience invaluable changes just 3 or 4 days after your first administration. You should sleep better and have more energy.

• Week Two. Morning erections make a significant comeback! In men with erectile dysfunction problems, morning erections help to determine if their problems stem from a psychological or a physiological problem.

• Week Three. You will begin to notice a sense of clarity as your cognitive function improves. Your ability to recall information and your articulation will improve. You will suddenly realize that you feel more mentally sharp and able, which will allow you to better cope with stress and pressure.

• The End of Month One. Your energy levels should be noticeably increased throughout the day.
• Month Two. The same health manifestations that you were experiencing throughout your first month should continue to develop and improve. Your energy levels should still be increasing, and you should have a stronger “go-getter” attitude.

• Month Three. There should now be a significant, noticeable difference in your energy level and output. Your workouts will require less effort and will yield quicker, more visible results. The time you need for muscle healing and recuperation after exercise should be reduced.

• Month Four. By now, your endurance, stamina, exercise potential, and overall performance ability should supersede all your expectations. If you have never been on testosterone therapy before your first program and you have been eating well and exercising from the beginning, you will be surprised at the level of transformation you have experienced. Furthermore, it will be evident that these results and this amount of energy output would not be possible without restoring your testosterone levels to the numbers had in your youth.

• Month Five. The changes and improvements in your physical performance, ability, and growth will be fantastic. If you were experiencing mental problems such as sadness, depression, anxiety, or even mental fatigue, by now you should notice substantial progress in your ability to deal with unpleasant or challenging scenarios and circumstances. Remember that all the other positive changes you have experienced will also contribute to a sense of self-improvement. This makes you naturally feel better about your personal progression and growth. More importantly, the physiological changes in brain chemical secretion add to your sense of fulfillment, happiness, and overall well-being.

• Month Six. All individuals receiving testosterone experience different effects by 6 months of therapy. What you experience will also depend on how many cycles of testosterone therapy you have participated in previously. Sometimes, a user’s sense of improvement begins to dwindle or remain stagnant. The body can become used to the type, or ester, of testosterone that is being used if the same therapy is continued for more than 1 or 2 years. Also, because other processes in the body cease to function when testosterone levels are manipulated using testosterone injections, the benefits of therapy begin to diminish and the “feel good” scenarios that were being experienced stop.

Is it Really Important to Do a Cleanse? What is a PCT (Post-Cycle Therapy)?

There are several therapeutic efficacy and safety reasons why you should not continue with testosterone injections indefinitely without giving your body time to normalize and “reset”. Because of the widespread decline in benefits after six months of a testosterone regimen, our physicians regularly incorporate a cleanse (PCT) in an attempt to reactivate the endocrine and related systems. As you increase your testosterone levels using any kind of testosterone enhancement program, the high levels of circulating testosterone mean that your body shuts down the production of endogenous testosterone; it also increases the production of estrogen, which can lead to a series of undesirable side effects. This means that the synthesis of luteinizing hormone (LH; the hormone produced by your brain to stimulate testosterone production in the testes) and follicle-stimulating hormone (FSH; the hormone produced by your brain to stimulate sperm production) stops. When FSH and LH levels are no longer detectable, you will not experience the exceptional benefits and energy-optimizing results expected from a testosterone injection program.

Another important concern for men receiving testosterone therapy is testicular atrophy. Patients that participate in testosterone therapy may experience some shrinkage of the testes. This occurs as a result of the lack of work performed by testes after testosterone and sperm production has been reduced or shut down in response to the testosterone therapy. In particular, men with smaller testes suffer more from shrinkage while on therapy than those with larger testes.

What does PCT consist of?

Your post cycle therapy consists of a testosterone secretagogue to stimulate the secretion of endogenous testosterone from the testes to reignite natural production. This medication mimics the signal from your brain to your testes (LH) to induce the production of testosterone, even though your levels are already elevated due to therapy. An example of a testosterone secretagogue is human chorionic gonadotropin (hCG), which is administered either using sublingual troches or subcutaneous injections once or twice a week during therapy and then on 10–15 consecutive days as part of a PCT. hCG mimics LH to stimulate testosterone production by the testes. It works by effectively tricking the testes into thinking that they are being instructed to produce testosterone, even though levels are comfortably elevated because of the injectable testosterone therapy. The testosterone production stimulated by hCG is not sufficient to sustain healthy testosterone levels on its own, but that is not the reason for this supplementation. The purpose is to ensure that the testes remain functioning during therapy to help avoid any shrinkage or atrophy.

You will also take an anti-estrogen or aromatase inhibitor. For example, Clomid/clomiphene blocks certain types of estrogen from getting to the pituitary and hypothalamus, where it elicits signals that stop testosterone production. Anti-estrogens or aromatase inhibitors also help to reactivate the normal functionality of LH and FSH signaling, while also helping to flush out any residual estrogen that has accumulated during therapy. The estrogen that accumulates during treatment is responsible for many of the negative side effects associated with testosterone therapy.

An example of a PCT protocol is as follows (note that the exact drug and dose prescribed will depend on the specific information contained within each patient file, as well as the individual patient goals):

• 250–800 units of a testosterone secretagogue every day for 10 consecutive days
• One estrogen blocker or antagonist by mouth every day for 10–15 consecutive days

At AAI Rejuvenation Clinic, we pride ourselves in providing real information to our patients without any obligations. We hope that helping to educate you will incite a strong, long-lasting relationship based on your trust in us and confidence in our programs and our ability to help you reach your goals.

One chats with our friendly staff, and you will see that we mean what we say.

Men who experience testicular atrophy can be placed on a special regimen to help normalize all their hormone levels and physiological functions. Contact us if you are experiencing any atrophy so that we can take care of it right away. Aesthetics are important, so you should act fast to ensure that your testes are returned to their normal size without too much effort.

Where Do I Buy Testosterone? How Do I Know If I Am Purchasing Real Testosterone?

Purchasing a medication is a big step, and it is important to make smart decisions. As you do your research, you will have a number of questions. In this section, we do our best to help you answer some of these key questions.

What is better to use: testosterone boosters, testosterone injections or pellets?

The truth is that there is no easy answer to this: one form of testosterone may be better than another depending on the individual patient characteristics and history.

How do I know that I am purchasing the right medication for me and that it is coming from a trusted source?

If you are interested in your overall health and wellbeing, then ensuring that your medication is prescribed by a physician specialized in age-management should be the primary objective. Please do not read this as a push for selling our products or services: there are many excellent, high-quality, FDA-compliant age-management organizations in the United States. Your focus should be to find a location that makes you feel comfortable and people that you trust.

Keep in mind that you will be injecting your testosterone directly into your body, and significant amounts enter your blood stream rapidly. Therefore, understanding where your testosterone is coming from and knowing the standards followed to create it is absolutely critical. However, it is so often overlooked by users who are interested in therapy but are unaware or nonchalant about the risks of being uneducated about how the medication is created.

If the organization orchestrating your protocol and providing you with access to your testosterone medication is reputable and legitimate they should be able to answer the following questions:

• Where are your bricks and mortar locations? A reputable organization would typically have an established, functioning, active practice where they provide relevant services.
• What is the name of the pharmacy you use to obtain the medications? Here, the patient can do additional research on that organization to make sure there have been no issues such as deactivations, contaminations, or grade declines, etc.
• What is the name of the prescribing physician?
• What are the DEA numbers of the prescribing physician and pharmacy?
• If there are any problems with my protocol or its incorporated medications, with whom in your organization would I be able to speak?
• Is the medication incorporated in my protocol “brand” or “compounded”?

If the institution you have decided to work with can answer all of these questions to your satisfaction, there is a much higher probability that the medication will be sent from a reputable source. Of course, if the chosen clinic can provide patients with “brand” rather than “compounded” medication, it is a safe way of being confident that the medication is 100% legitimate. Nevertheless, modern technology means that packaging, labeling, and all associated documentation can be easily doctored, so consumers must still use their judgment and be vigilant.

What are the differences between brand and compounded medications?

There is typically a significant cost difference between compounded and brand medications, with the latter being significantly more expensive. If you purchase a brand-name medication the US FDA tightly regulates and approves all details surrounding the quality control, manufacture, and packaging of the medication to ensure that it is safe and efficacious. Compounded medications are not necessarily subject to the same scrutiny as branded medications because they do not undergo the FDA-mandated quality control testing. It is possible that a compounded medication will have a slightly different effect on the equivalent brand medication because it is not produced in exactly the same way. Nevertheless, the FDA recently outlined specific regulations that outsourcing facilities producing compounded medications must follow to become compliant; these regulations are related to both the manufacture and labeling of the final drug. If you obtain a compounded medication you should ensure that the facility that produced it is FDA-registered and licensed.

It is important to clarify that brand medications are not necessarily better or “more potent” than compounded medications. In fact, sometimes the opposite can be true. It depends on a number of factors, including how the drug was manufactured and the quality of the conditions used to manufacture the medication. This is why obtaining information on the specific pharmacies that will create your medication is just as important as researching the organization that will be orchestrating your program and protocol.

Testosterone Analogs

Finding information on testosterone analogs that is easy to understand and unbiased can be challenging. However, at AAI Clinics, our intention is to make sure that all our patients are as well-informed as possible. So, in this section, we describe an overview of these agents, followed by a specific discussion of the testosterone analogs used in AAI Rejuvenation Clinic protocols.

Anabolic steroids, including derivatives of testosterone, are often used illicitly and are now controlled substances that cannot be purchased legally without a prescription from a physician. Men participating in testosterone-replacement programs appreciate the rapid results and the extraordinary muscle growth that they experience from these substances, even at the eventual cost of irreversible endocrine system malfunction.

Testosterone Injections, like many anabolic steroids, was classified as a controlled substance in 1991. Testosterone is administered parenterally in normal and delayed-release (depot) forms. In September 1995, the FDA approved testosterone transdermal patches (Androderm), and many transdermal forms and brands are now available including implants, gels, and topical solutions. A testosterone buccal system, Striant, was FDA-approved in July 2003; Striant is a mucoadhesive product that adheres to the buccal mucosa and provides a controlled and sustained release of testosterone. In May 2014, the FDA approved an intranasal gel formulation of testosterone (Natesto). A transdermal patch (Intrinsa) for hormone replacement in women is under investigation; the daily dosages used in women are much lower than for products used in males. The FDA refused approval for Intrinsa in 2004 stating that more data regarding safety, especially in relation to cardiovascular and breast health, where required.

Most forms of testosterone injections used in testosterone-replacement programs are “esterified” forms of testosterone. Esterification is a chemical reaction that leads to the formation of an ester group (a chemical compound formed from an acid). The addition of an ester to the testosterone molecule alters its solubility, allowing the drug to be administered as an injectable.

There are several different acid molecules that can be added to the parent testosterone molecule, including cypionic acid (which forms testosterone cypionate), decanoic acid (which forms testosterone decanoate), and propionic acid (which forms testosterone propionate). The characteristics of the acid that become attached to testosterone determines the different characteristics of the injected agent. Generally, fatty acids with longer length carbon chains are released more slowly into the circulation, and that they are active for longer. Conversely, fatty acids with shorter chains tend to achieve higher peak levels but have a shorter duration of action.

There are pros and cons to long and short chain esters. Although longer acting analogs have to be administered less frequently because they remain active for longer, the longer a medication stays functioning in the body, the higher the potential for side effects.

Some potential side effects of long-chain analogs are:

• Acne
• Bloating or water retention
• Irritability
• Weight gain

But do not worry! The protocol designed for you my AAI Rejuvenation Clinic’s physicians will not just include testosterone, regardless of the ester. Our patients are prescribed and an array of accompanying nutraceuticals to help minimize or prevent side effects. These medications are prescribed based on the data contained within each individual patient’s medical file. Moreover, our patients undergo regular blood tests to ensure that everything is running according to plan on your quest to reach your health and wellness goals.

Fill out our Medical History Form, and you will be contacted within 24 business hours by one of our expert Wellness Advisors.

Mechanism of Action

Most of the steroid hormone testosterone is produced in cells in the testes known as Leydig cells in males and in theca cells in the ovaries in females. Low levels of testosterone are also produced by the adrenal gland. Testosterone exerts both and androgenic (characteristic male sexual development) and anabolic (increasing muscle mass and enhancing protein synthesis) effects, depending on the target cells, tissues, or organs.

The increased production of androgens (testosterone, androsterone, and dihydrotestosterone [DHT]) that occurs during puberty is responsible for the characteristic physical changes that occur in teenage males, such as sexual organ development, sperm maturation, the growth of body hair, deepening of the voice, increased muscle and bone mass, and increased libido.

When considering the effects testosterone, it is important to think of it as both a prohormone and a hormone. This is because testosterone can modulate a variety of physiological processes itself, or it can be converted into other hormones to exert different effects. The mechanisms by which dozens of steroid hormones (including androgens) are interconverted are very complicated. Generally, testosterone is produced from the precursor androgens androstenediol and androstenedione. It then functions directly or is converted into dihydrotestosterone (DHT) or estradiol, which exert their own biological effects

Testosterone and related molecules exert direct effects by binding to the androgen receptor in target tissues to stimulate gene transcription and protein synthesis. However, they can also elicit indirect responses by increasing or decreasing the secretion or activity of growth factors, hormones, and other proteins.

The direct effects of testosterone and androgens are exerted via the androgen receptor. In the inactive state, the androgen receptor is retained in the cytoplasm of a cell and prevented from exerting its biological effects. However, any DHT or testosterone in the cell binds to the androgen receptor and causes a conformational change, which allows it to enter the cell nucleus. It can then bind to specific regions in target genes to regulate the expression of genes and proteins that are important for a variety of biological processes, including muscle development, contraction, and repair, as well as energy production.

Testosterone injections have two major indirect effects. First, it stimulates the release of calcium from specific stores in skeletal muscle, which is critical for muscle contraction, repair, and regeneration. Second, testosterone and its’ analogs prevent the breakdown of muscle by blocking the expression of proteins that cause muscle atrophy and protein breakdown. This goes hand-in-hand with the direct effect of testosterone on promoting protein synthesis to enhance the successful building of muscle mass.

Exogenous androgens promote protein anabolism and stimulate appetite, which reverses catabolic processes and a negative nitrogen balance. These agents can also increase the lean body mass in patients with cachexia (e.g., malnourished dialysis patients), and decrease bone resorption and increase bone density in patients with osteoporosis. Erythrocyte (red blood cell) production can also be increased by androgens by enhancing the production of an erythropoietic stimulating factor. For example, patients with anemia associated with renal disease exhibit an increased red blood cell volume and hemoglobin levels after receiving nandrolone decanoate.

The administration of exogenous testosterone and related agents can serious disturbances to growth and sexual development if given to young children, and causing unwanted masculinizing adverse effects in women. Exogenous androgens suppress gonadotropin-releasing hormone, thereby reducing the gonadotropic function of the pituitary via a negative-feedback mechanism. Reversible increases in low-density lipoproteins (LDL) and decreases in high-density lipoproteins (HDL) can also occur.

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