The T Club

Cover and art by Scott Hollaway of Switch Technologies.

Book layout and design by Danielle Larsen of Larsen Writing and Design, LLC.

Special thanks to my copy editor, Nancy Wall.

The amount of research and article reviews to complete this book would not have been possible without the wonderful assistance and meticulous work of Ashley Moeller. Her future in health care is bound to change the world.

THE T CLUB – A STRATIGIC GUIDE TO MALE HORMONE REPLACEMENT

Copyright © 2013 by Warren Willey

Published by The Fitness Medicine Clinic, PC

Pocatello, Idaho 83201

ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means – electronic, mechanical, digital, photocopy, recording, or any other – except for brief quotations in printed reviews, without the prior permission of the author.

Printed in the United States of America

ISBN: 9781619273757

TABLE OF CONTENTS

CHAPTER 1:

INTRODUCTION & HISTORY

CHAPTER 2:

PHYSIOLOGY OF T

CHAPTER 3:

CONDITIONS THAT FIND BENEFIT IN FIXING T

CHAPTER 4:

TESTOSTERONE BOOSTING THERAPY

CHAPTER 5:

INITIAL TESTING AND MEDICAL MONITORING

CHAPTER 6:

METHODS OF TESTOSTERONE REPLACEMENT

CHAPTER 7:

RISKS, SIDE EFFECTS, AND CONTRAINDICATIONS OF TRT

CHAPTER 8:

SUMMARY

APPENDIX I:

TRT IN WOMEN

APPENDIX II:

LOW T QUESTIONNAIRES

APPENDIX III:

TRT GENERAL CONSENT FORM

APPENDIX IV:

CHEST TO WAIST RATIO AND THE DIAGNOSIS[..]

REFERENCES

CHAPTER 1:

INTRODUCTION & HISTORY

Introduction

Life cycles are fun to watch. Take, for instance, the birth of a helpless foal: it starts with its mother going into labor, then proceeds to baby struggling to get out of its mothers womb. Once out, exhausted and likely wishing to crawl back in, it lies in a pile of placental fluid and feces. Once it has had a chance to dry, the baby horse clumsily attempts to stand. Finding it was much easier to lie down; it quickly stops trying and falls over. Mother then gently prods baby with her nose, encouraging yet another try. Finally, after what likely seemed forever the foal, winds up standing. The first step is always the one most nerve racking, but with effort and once again mothers encouragement, it is not long before baby is running around the meadow, jumping and kicking, and finally realizing this is much better than being confined in a tight, dark, hidden place where people knew where you were, but thought nothing of it. More experienced horse breeders, trainers, and lovers, could tell the mare was pregnant and growing to eventually give birth, but most people who saw momma horse where none the wiser.

So it is with the life cycle of Testosterone, here on referred to as T, in the medical world. T has been around for a long time but unless you were an athlete or a progressive caring doctor, you only might have been aware of its presence. Hence the horse analogy: we are at the lifecycle of T that involves its running around the fields being both admired and feared at the same time.

T’s history is fascinating but its use for medical replacement has been hindered by a couple of unfortunate misnomers. First and foremost, most doctors, including recent graduates, have been taught that T causes prostate cancer. I will cover this in great detail in coming chapters. Secondly, T is a steroid. The word ‘steroid’ instantly stirs up discomfort in a majority of people that hear it, as we all think of athletes using performance enhancing drugs. Our minds roll into the ‘unfairness’ of steroid use, and adjectives such as scary, thoughtless, mysterious, and lazy cross our minds. Cheating, of which no one ever wants to be accused, also comes to the forefront. The word steroid has been linked to bad things. In reality, your body is full of steroids of many different types. The word steroid simply defines its organic shape, but does not imply action or function as the many different steroids in your body do many different things.

I continually have to explain the difference to people when I prescribe different steroids for different reasons. One of my favorite examples of this very common nomenclature error involves a 56- year- old petite, well groomed female who came to me with knee pain. Once my evaluation and examination were done, I offered her a number of therapeutic options, including a steroid shot. As the word steroid rolled off my tongue, her eyes became wider as her eyebrows sprang to the top of her head and her jaw simultaneously dropped. After the gasp that accompanied the facial expression ended and she had reflected for a few seconds on my offer, her response was classic: Doctor…my husband will not sleep with me if I have big muscles and a beard like him! Of course, the steroid shot I offered was a corticosteroid shot – also referred to as cortisone, a strong anti-inflammatory.

Steroids in general and T in particular cause a visual fallacy to be conjured up when spoken: an assumption is made that if you optimize T you will look like this:

I can guarantee that will not happen especially at the medically approved dosing regimens provided. For that matter, not with super-physiologic doses either! This is probably relieving to some and depressing to others. For those of you who want to look like this, it’s not likely to happen. You cannot expect, after sitting on your backside for 20 + years, since you were a high school superstar athlete (right Al Bundy?), to look like someone who has been eating right and exercising most days of the week since age 14. Gymnasts are a great example. A childhood gymnast has, since an early age, developed highly sought after abs and shoulders, bulging biceps and sculpted calves. Of course, if they quit exercising altogether and join the ranks of the languid, that desired look will become a thing of the past. But even with the minimal amount of upkeep, they look amazing.

T therapy will make you feel better. You will be stronger, more energetic, more likely to go to the gym, better prepared to say no to the work place donuts, and in general improve your quality of life. It will not, and I repeat WILL NOT make you look like Arnold Schwarzenegger at his prime. That is an Internet filtered lie. Do not be disappointed.

Low T is a deficiency state, and can be described with the simple analogy of oil used in your car after prolonged driving. Yes, it is a natural occurrence to have falling oil pressure in your car after use, but you replace it, do you not? Accepting age related change as natural cannot be considered, as T levels have declined for the whole population over the last 30 years for a number of different reasons which I allude to throughout the book. Total T levels in the 1980’s, for 50- year-old men was around 550 ng/dl; In the mid- 1990’s it dropped to the 475 ng/dl range, and in the early 2000’s the average 50- year- old man had total T levels of 440 ng/dl.

I am absolutely certain that if T did not have a surname of steroid and if doctors understood the prostate and T’s effects on its growth and cancer, T would be as common a prescription as estrogen is in female hormone replacement.

T is a controlled substance, as you will learn a little more about in the portion on the history of T. Therefore, it must be provided to you by your doctor on the appropriate prescription paper, and with a limited number of refills per your local state board of pharmacy. In the drug reference section of all the different TRT delivery systems, under Drug Abuse and Dependence the only thing listed is Testosterone is classified as a Schedule III controlled substance under the Anabolic Steroids Act of 1990. There is no mention of abuse or dependence. Can T be abused? Of course – so can pizza. T is not addictive under the standard definitions of addiction. For a drug to cause dependence it must be craved, binging must occur, withdrawal to its effects has to be present, and the drug must have cross-sensitization with other drugs. T may be sought after, but not craved. Some may binge on it, but that’s very unlikely. There is no physiologic withdrawal from T. You may not feel your best as you revert back to your low T levels, if you stop using it without your doctor’s help, but you will not have a seizure.

T is not the answer to all of life’s questions and complaints. It is far from a universal remedy for what ails people in general and men in particular. Low sex drive, poor erections, fatigue, loss of muscle mass and increased fat have multiple causes and multiple explanations. T is but one thing a good doctor must think of when evaluating a patient with these concerns. The T Club will help you self-examine and understand the panacea of possibilities when it comes to these all-too-common complaints. Elevating T levels is medicine at its best, because it is going after a potential causes of disease, not just bandaging the condition.

Given that, my hope with starting The T Club is to provide real, unbiased evaluation and information to both doctor and patients alike as they consider Testosterone Boosting Therapy (TBT) or Testosterone Replacement Therapy (TRT). The T Club will give you multiple options including diet, exercise choices, supplements, etc. - choices to optimize your T and better your life. The T Club will not review all of the T off shoots and Anabolic Androgenic Steroids (AAS) that many people take and claim as TRT. I will focus on pure and legitimate T replacement as understood in the practice of medicine.

The T Club should also be a resource for you to both read others’ experiences and share your own. www.theTclub.net is an informational website for you to ask questions and interact with people in a non-biased, non-sales atmosphere as you optimize your T. It is also a resource for your doctor if he or she has questions or concerns with prescribing or optimizing your T levels. TBT or TRT is not only a prescription to better your life, but as you will soon read, to manage and treat disease.

Not everyone in the medical field agrees with TBT or TRT, and I appreciate that. As a matter of fact, I relish it. It provides an opportunity for everyone involved in the discussion to hear the other side(s), and get the name of the article/author who described/researched part of the topic. It’s a chance for intelligent discussion among doctors and between patients and their doctors. Hence, once again, why I started The T Club: I cannot recall too many instances in times gone by when fights broke out during afternoon T…

Writing a book like this and running a web site like The T Club is difficult in the sense that I want to talk to doctors and patients at the same time. Occasionally the topic necessitates I use medical terminology intertwined with laymen’s terminology. I ask forgiveness from both groups if I get too simple in one section and too technical in the next. My goal was/is to interpret the topic for everyone reading it.

One final discussion in the introduction that I mention throughout The T Club: The bell-shaped curve. I think life can be explained on a bell-shaped curve (see below). Too little of something can be bad. Too much of something can be bad. Being in the middle of the bell-shaped curve in most subjects and situations is usually best. There are obvious examples, but with our topic at hand - too little T can be just as bad as too much T. The right point on the bell-shaped curve is different for everyone, as everyone has factors influencing the distribution and outcome of the bell. It is important to keep that in mind, as it will help you better understand the importance of finding a doctor familiar with TRT and TBT.

Enough esoteric horse stories: let’s dive right in and start with some fascinating history about TRT straight from the annals of medicine and the text-books of the streets.

The History of T

TRT is nothing new in the human domain. Reports abound of ancient warriors eating their enemy’s testicles to increase vitality and vigor. The original Olympiads were said to have eaten the testicles of animals prior to competition to improve performance, stamina, and strength. And you thought today’s modern Baseball players came up with it…

Eating a fellow mammal’s testicles may seem far out, especially as they had no idea why this culinary practice worked to increase vitality and vigor, but it gets even better as we walk down T’s memory lane. In 1849, a zoo curator in Germany named Arnold (snicker) Berthauld observed that castrated roosters quit flying, stopped fighting, and unlike their non-castrated counterparts, had no interest in the opposite sex. He also documented that their comb shrank up and basically disappeared. When he re-implanted testicles to these wimpy and weak roosters, their combs grew back, as did their flight, fight, and sex drive. Arnold had stumbled onto T therapy. For that matter, he lurched onto the whole field of hormones and endocrinology!

In 1889, a 72-year-old physician named Charles-Edouard Brown-Sequard claimed he had rejuvenated himself by injecting himself with testicular extracts from guinea pigs and dogs. The effect of this self-injecting, we now know, had zero physiologic effect, as his immune system would not have stood by idly with dog cells lying around, but none-the-less, he was instrumental in getting a few future researchers thinking. He was quoted in the famed medical journal The Lancet later that same year saying ...a radical change took place in me, I fully regained my old powers, my limbs showed a decided gain of strength. With regard to the facility of intellectual labor a return to my previous ordinary condition became quite manifest during and after the first two or three days of my experiments. Of likely esoteric note, but interesting all the same, there is a medical condition named after this experimenting bright doctor, called Brown-Sequard Syndrome, in which there is a loss of sensation and motor function caused by a hemisection (partial cutting) of the spinal cord. He most likely did not come up with this syndrome by experimenting on himself, however…

In the 1920s, Sergio Voronoff transplanted testes from animals to men, but this too was ineffective due to the immune system response. Finally, in the mid-1930’s T was chemically synthesized independently by Aldolf Butenandt and Leopold Ruzicka. So important was their discovery, that they won the Nobel Peace Prize for Chemistry in 1939.

In an article in the Journal of the American Medical Association (JAMA) in 1944, two internists, Carl Heller and Gordon Myers, wrote the first article to appear on the effects of male hypogonadism, called The Male Climacteric. They classically describe depression, loss of sex drive, and poor memory. Mind you: this is 1944 - a sad statement in my small brain as I think of the millions of men who could have had better quality of life with application of T therapy from then to today - really unfortunate.

The popular and well read great grandfather of The T Club was written in 1945 by Paul de Kriuf, and is titled The Male Hormone. It brought to light a number of studies reporting the benefits of TRT in men. Take a second gander at that date – a book on the benefits of TRT published in 1945…Seriously folks – that kind of pisses me off - Fifty plus years of men not getting the benefits of TRT! This is due in part and, unfortunately, (I will define this word in the next paragraph) to the fact that at the exact same time, T was developing an alter ego. Underground and behind locker room doors, T therapy was found to improve athletic performance. This fact, as I mentioned in the introduction, is one of the reasons so many men for so many years did not get proper care and treatment for their low T.

I have to define the word ‘unfortunately’ as used above for clarification before I expand on the use of T derivatives in sports. I feel it is extremely unfortunate that so many men, including a number of my relatives, did not get T treatment when they should have due to the misconceptions of T due to its use in sports. (Part of this non-use was