Growth Hormone vs. Testosterone for Lean Muscle Mass and Fat Loss.

Which is Better for Body Composition?
New research has shed some light on the anabolic effects of growth hormone. Several studies in the past have shown an increase in lean body mass in subjects taking growth hormone. However, lean body mass does not necessarily mean muscle, but anything that is not fat and this includes water, organ tissue growth, bone mass, and connective tissue growth. One recent study on HIV positive test subjects showed no significant change in skeletal muscle mass after taking six milligrams (about 18 units) per day of growth hormone for 12 weeks. Another study, also on HIV positive test subjects, also showed a lack of muscle growth when doses of nine milligrams (roughly 27 units) per day were given. Keep in mind that HIV positive individuals are often suffering from muscle wasting conditions, which should make them more responsive to any possible anabolic effects of growth hormone. Growth hormone is probably equally ineffective in healthy individuals.

One study on young (aged 22-33), highly trained athletes did show a significant increase in lean mass after six weeks of taking 2.67 milligrams (about 8 units) per day. However this increase was only 4%, and may have not included any muscle mass at all. It seems overwhelming clear that growth hormone is either non-anabolic or very weakly anabolic for skeletal muscle when taken by itself, and it definitely not worth the large price if you are taking it solely for gaining muscle. The only real use in gaining muscle may be as a synergistic agent with testosterone. A synergistic effect of taking growth hormone with testosterone has been reported for increases in lean mass, but further research needs to be done to see if this synergistic effects holds for skeletal muscle. Keep in mind that some increases in lean mass are not desirable. Growing some organs too big such as kidneys can produce some embarrassing effects seen in some professional bodybuilders. You do not want your "guts" sticking blatantly out of your body.

But enough on growth hormone for muscle gain. For information, see Bryan Haycock’s article in this issue or go to Michael Mooney’s web site. If you are going to spend the money on growth hormone to try to improve your body, your best bet is to use it as a fat loss or "sculpting" agent. The previously mentioned study with growth hormone on trained athletes did show an impressive 12% decrease in bodyfat. So well it is well established that testosterone is far, far better for building muscle than growth hormone, is growth hormone the better choice for fat loss? The research on this issue is mixed, and there is no easy answer to this question.

One recent study put growth hormone head to head with testosterone and measured its effects on fat loss. In this study, men on growth hormone lost an average of 13% of their bodyfat compared to 5.8% in the group taking testosterone. But before you jump to conclusions, there are a couple of reasons why this study doesn’t settle the question. For one thing, this study was on very old individuals (aged 65 to 88) who had low IGF-1 and testosterone levels. Another problem is that the doses of the hormones haven’t been reported yet (the study is only in abstract form right now) which also makes the comparison difficult to make. Most interesting about this study was that a synergistic effect was found in a group taking both testosterone and growth hormone, as they lost an average of 21% of their bodyfat. This is more than the averages of the testosterone alone and growth hormone alone groups combined.

Not all studies have shown this dramatic of an effect on body fat. One study using fairly large doses (adjusted by weight, but roughly 5 mg per day) on obese women failed to show any significant effects on body fat. The growth hormone group lost less than two pounds more than the placebo group over a one month period. The main significant result was that the growth hormone group lost much less lean mass (an average loss of 1.52 kg compared to 3.79 in the placebo). While this may seem impressive, the same results could be achieved with a caffeine/ephedrine formula at a fraction of the price. While there are a good number of studies showing growth hormone to be effective for fat loss, testosterone may be almost as good for this purpose.

Testosterone was recently found to be effective for fat loss in young men even in small doses. One recent study showed that men given only 100 milligrams per week of testosterone enanthate lost an average of six percent of their bodyfat after eight weeks. 100 mg per week is generally considered a very low dose by bodybuilding standards. Most impressive about this study was that the result was obtained in young, normal healthy men (aged 18 to 45), not obese or testosterone deficient. Most of the studies showing positive effects with hormone replacement therapy are on subjects who are obese or hormone deficient – i.e. the very subjects most likely to respond. While the amount of muscle gain reported in this study was not reported (it is still just in abstract form), another study showed 100 mg per week of testosterone enanthate was not anabolic. It appears that testosterone has a strong mechanism for fat loss other than increased ********* rate from increased muscle. Considering how much cheaper testosterone is than growth hormone, it may well be the cost-effective choice for burning fat even if it is slightly less effective overall.

Safety of Growth Hormone and Testosterone
Testosterone is widely believed to be far more dangerous than growth hormone. However, recent research is rapidly showing that much of these dangers have been exaggerated. For instance, the hypothesis that testosterone causes prostate cancer has never been established. In fact, one study even showed a slight negative correlation between testosterone levels and prostate cancer! A study on young men given supraphysiologic doses of testosterone showed no change is prostate specific antigen (PSA), which is one measure of prostate cancer risk.

Growth hormone may also be less dangerous to the prostate than previously believed. One study showed strong positive correlation with prostate cancer and IGF-1 levels. Since growth hormone stimulates IGF-1 synthesis in the liver, this study and others bring up the possibility of a link of growth hormone and prostate and breast cancer. Keep in mind that statistical correlations do not necessarily prove causality, i.e. IGF-1 has not yet been proven to be a cancer-causing villain. Actually IGF-11 may be one of the culprits in the cancer story, and not IGF-1. At the Serano sponsored Symposia on the Endocrinology of Aging in October, 1999 and at the Endocrine Society Meeting in June, 1999 there was an informal consensus that patients on growth hormone did not increase their risk of breast or prostate cancer. Several other recent studies have also cast doubt on the role of growth hormone as a cancer-causing villain.

Testosterone may have also gotten a bad rap for its effects on blood lipids. Since testosterone and other anabolic steroids have been shown in some studies to lower HDL cholesterol levels, it was believed that testosterone may increase the risk for heart disease. This was refuted in one recent study on testosterone that showed some positive results. A study on 21 hypogonadal men (aged 36 to 57) showed a replacement dose of testosterone using the Androderm transdermal patch to reduce blood clotting. While HDL levels did drop slightly, blood coagulability is believed to be the more important marker of heart disease risk. Another study showed a very strong negative correlation with testosterone levels and heart disease.

Growth hormone has shown mixed results on its effects on heart disease risk. One study on elderly men and women (aged 65-88) showed that growth hormone administration to lower LDL levels, but raised triglyceride levels. Since high LDL and triglyceride levels are considered measures of heart disease risk, growth hormone’s effects on heart disease risk are ambiguous. However, long-term use of growth hormone as been shown to decrease the thickness of the carotid artery lining – i.e. increased room for blood flow.

While much more research needs to be done, I am convinced right now that testosterone replacement therapy in hypogonadal men may be safer than excessively large doses of growth hormone. The long-term studies have not yet been done to test the true long-term effects of these hormones, but the research seems quite clear at the moment. Michael Mooney has reported similar results on safety and side effects of these hormones:

While none of the studies on testosterone or anabolic steroids used for HIV have documented any significant health problems associated with their proper therapeutic use, Dr. Gabe Torres' data on his patients who experienced a reduction in symptoms of HIV-related lipodystrophy with Serostim growth hormone showed that at the standard 5 and 6 mg doses, 80 percent of his HIV patients experienced significant side effects, that included elevated glucose, elevated pancreatic enzymes, or carpal tunnel syndrome.

Don’t get me wrong – I still use both growth hormone and testosterone as part of overall anti-aging programs in my patients. This article is not meant to say one hormone is "good" and another is "bad". It is just my opinion at the moment that the overall benefit/cost ratio for improving body composition is higher with testosterone than growth hormone. By cost, I mean both the monetary price – testosterone is far cheaper than growth hormone, and the side effect/safety profile – testosterone is safer than high-dose growth hormone use.

Since growth hormone is extremely expensive and perhaps riskier than testosterone, I screen patients very carefully and only recommend it to those who either have very low IGF-1 levels and fail growth hormone stimulation tests, or those who have failed to respond to testosterone or other therapies. The new research has also made me confident in encouraging more and more patients to go on testosterone. However, we must keep constant track of the new research to better refine both anti-aging and bodybuilding programs. The science of hormone supplementation is still in its infancy, and there is still a lot more questions that need to be answered. 

Soy protein found to deplete testosterone in men

The health detriments of soy consumption are reiterated in a new study out of the University of Connecticut that highlights the importance of avoiding soy at all costs. Researchers from the school found that men who consume soy protein rather than whey protein for muscle recovery and growth experience considerable reductions in their testosterone levels, as well as marked increases in levels of the stress hormone cortisol.

The randomized, placebo-controlled crossover study looked at how soy supplementation affects testosterone, cortisol and sex hormone-binding globulin (SHBG) levels in men who engage in resistance exercises and training. They compared these effects to those brought about in men who supplement with whey.

For the research, 10 resistance-trained men in their early 20s had their hormones evaluated in conjunction with an assigned supplemental diet. The men were divided into three groups: one receiving whey protein isolate, one receiving soy protein isolate and the last receiving a maltodextrin-based placebo control. The men were not allowed to take any other supplements, and vegetarians, vegans and individuals who were consuming high-protein diets were excluded. For two weeks, the men were told to ingest 20 grams of their assigned supplement every morning at the same time. The participants were then instructed to perform six sets of heavy resistance squats at 10 reps each, exerting 80 percent of their maximum lifting weight. At the end of the 14-day period, the researchers collected hormone profiles from each of the men and made comparisons.

They found that, compared to the men who supplemented with whey, those taking soy did not necessarily produce more estrogen. They did, however, experience decreased testosterone levels and elevated cortisol levels, a deadly combination that can leave men at risk of disease and weight gain. Lowered testosterone levels and elevated cortisol levels are also generally attributed to the feminization phenomenon occurring in men that sometimes leads to disorders like nipple discharge, breast enlargement and hot flashes. It can also lead to inhibited thyroid function, bone loss, sleeping disorders, decreased sex function and reproductive problems.

"Our main findings demonstrate that 14 days of supplementation with soy protein does appear to partially blunt serum testosterone," wrote the authors. "In addition, whey influences the response of cortisol following an acute bout of resistance exercise by blunting its increase during recovery."

In other words, soy protein is not what men who work out and train their bodies want to supplement with for muscle recovery and growth. Besides the fact that it lacks the right type of amino acid profile for muscle building, soy protein clearly exerts a demasculinization effect in multiple ways, robbing men of their manly essence and characteristics, including their strength and drive for life. "[O]ver the past few decades, many researchers have found that phytoestrogens have adverse effects on both the production and utilization of hormones in males," wrote Tim Boyd for The Weston A. Price Foundation, citing multiple studies looking specifically at soy protein, soy flour and other soy derivatives commonly found in the food supply.

"Testosterone might appear to be just a macho thing, but it's a vital hormone for growth, repair, red blood cell formation, healthy sleep cycles and immune function, in addition to sex function," he added, noting that "low levels of testosterone have also been linked to low thyroid function, another unwanted and common side effect of soy consumption. Low thyroid function leads to loss of libido in both men and women."

Aromatase inhibitors give women more muscle mass

Anastrozole ~ Men show little change in body composition if you block their estradiol production with the enzyme aromatase. In women things are different, oncologists at the University of Pittsburgh in the US discovered. Aromatase inhibitors boost muscle mass in the fair sex.

Let’s start with a recap: there are two sorts of anti-oestrogens. First of all there are SERMs, like Tamoxifen and Clomiphene. These block the estradiol receptors and thus prevent estradiol from doing its work. They often actually take over some of the functions of estradiol. In men SERMS raise testosterone levels; in women they don’t.

And then there are the aromatase inhibitors like Anastrozole. These interfere with the functioning of the enzyme aromatase as a result of which less androstenedione and testosterone are converted into estradiol.

Chemical athletes use anti-oestrogens to counteract the side effects of some anabolic steroids, but also to restore the body’s own testosterone production after taking a course of steroids. Doctors subscribe the same anti-oestrogens for breast cancer survivors, as they reduce the chance of the cancer returning.

Tamoxifen - Doctors have collected a lot of information on the side effects of SERMS, in particular those of Tamoxifen. Long-term use of Tamoxifen leads to negative changes in body composition. Women often lose muscle mass and build up fat. Not much is yet known about the side effects of aromatase inhibitors.

Letrozole - For example, what is the effect of aromatase inhibitors on women’s body composition? This is the question that the researchers set out to answer in the small study they did of 82 women, who they monitored over a period of two years. The women were all cancer survivors. Half of them were given a SERM – usually Tamoxifen. The other half were given an aromatase inhibitor, such as Letrozole, Anastrazole. During the 24 months that the study lasted the fat mass of the women who took SERMs increased by a kilogram, while there was no increase in fat mass in those who took an aromatase inhibitor.

SERMs had no effect on lean body mass, while the aromatase inhibitors led to more than a kilogram increase in lean body mass.

The aromatase inhibitors increased the amount of testosterone in the blood, and the researchers think that this was the reason for the increase in the women’s lean body mass.

Exemestane - We, the nit-picking compilers of this web magazine, have a teeny problem with this study: the researchers do not reveal how many of the women in the AI group were given exemestane. Moreover, we wonder whether the miraculous effects of the aromatase inhibitors would still be observed if the exemestane had been excluded from the study. Exemestane is not just an aromatase inhibitor: It’s also an androgen with an anabolic effect and it is an anabolic steroid.

Testosterone and the Heart

If you are a man, at some point in your life you are likely to be a candidate for hormone replacement therapy. As we age, our testosterone levels decline, and with them often a number of physical and psychological characteristics. It has long been understood that low testosterone levels can be linked to reduced libido, sexual dysfunction, diminished energy, and a reduced overall sense of well-being. For these reasons, replacement therapy with testosterone drugs is a strong and steadily growing area of medicine for aging men.

Beyond these basic facts, testosterone remains a controversial drug. Its abuse is linked to changes in the body that may increase the likelihood of cardiovascular disease, and partly because of this, the potential benefits and risks of testosterone replacement therapy have long been the subject of much debate. Is this therapy actually safe?

In recent years, evidence has been surfacing that testosterone replacement may actually reduce cardiovascular disease risk. Usually isolated in scope, these papers concern many favorable changes in cardiovascular health markers, such as the management of triglycerides and cholesterol.

One of the first potential benefits of testosterone replacement therapy (TRT) -  is the management of triglyceride and cholesterol levels. As detailed in a growing number of studies, testosterone replacement therapy consistently improves the lipid profile in men with hormone deficiency. The most consistent endpoints of improvement appear to be a reduction in total cholesterol, a reduction in LDL (‘bad’) cholesterol, and a lowering of serum triglycerides. The improvements in lipid profile appear to be more pronounced in older men, although both young and old populations tend to show improvements in serum lipids when testosterone is given to correct a deficient state.

The effect of TRT on HDL (‘good’) cholesterol levels is less consistent. Studies giving testosterone gels, patches, or the longest-acting ester (testosterone undecanoate) tend to show improvement or no consistent effect on HDL. Studies with the more common esters such as cypionate and enanthate tend to show minor decreases in HDL during therapy, likely owing to the brief supraphysiological peaks for several days after administration. Note that HDL is often improved when TRT is combined with exercise and other lifestyle modifications.

Androgen deficiency is associated with an increase in certain inflammatory markers that can support the progression of atherosclerosis. Testosterone replacement therapy has been shown to reduce some of the same inflammatory mediators, specifically TNF-alpha (tumor necrosis factor-alpha) and IL-1B (interleukin-1beta). Inflammation in the vascular system is an especially important concern with heart disease. For one, vascular inflammation is associated with the deposition of arterial plaque, a key component of this disease. Inflammation of the blood vessels may also damage the arteries, making them both thicker and weaker. Scarring may be noticed, and blood flow may be reduced. All of this can restrict blood flow and reduce the heart’s blood pumping capacity. By helping to reduce the production of TNF-alpha and IL-1B, hormone replacement therapy may reduce inflammation, vascular damage, and the chance for atherosclerosis. Again, instead of seeing a neutral or ‘negative’ effect, we find a specific improvement in the cardiovascular disease risk profile with the administration of this drug.

A growing number of studies have linked androgen deficiency to insulin resistance, as well as increased abdominal obesity. These two factors are also common with men suffering from cardiovascular disease, and may directly contribute to (among other things) endothelial cell dysfunction and vascular damage. Androgen substitution has been shown in several studies to reduce midsection fat deposits, increase glucose tolerance, and improve the overall metabolic state. It has additionally been postulated that due to the important role of testosterone in managing insulin sensitivity, androgen deficiency may be a contributing factor to adult-onset (type 2) diabetes. Likewise, the substitution of testosterone in aging men with hypogonadism might reduce the likelihood of developing diabetes.

The endothelium is a layer of cells that lines the blood vessels throughout the entire circulatory system. These cells are responsible for managing the passage of some materials in and out of the blood vessels, and supporting the flow of blood through the system. Endothelial cells play a role in vasoconstriction and vasodilation, they regulate certain inflammatory processes, and they’re involved in blood clotting and in supporting the formation of new blood vessels. Endothelial dysfunction is linked to androgen deficiency in men, and may result in elevated blood pressure (hypertension), vascular ‘stiffness,’ and significantly increased risk of cardiovascular disease. Likewise, replacement of testosterone in men with a deficiency has been shown to improve endothelial function, blood vessel dilation, arterial vasoreactivity, and blood flow.

One additional important ‘endpoint’ of improvement to this therapy appears to be an increase in endothelial progenitor cell activity, which helps repair damage to the vascular system.

 Traditionally, most physicians are extremely cautious with testosterone drugs. Many family doctors are very willing to prescribe estrogens to their female menopausal patients complaining of symptoms such as sexual dysfunction, but when it comes to their male patients with similar complaints, the response is often different. Many of these same physicians are much more willing to prescribe a drug like Viagra than the basic male androgen testosterone. Some mistakenly consider testosterone to be ‘too dangerous’ to give most of their patients, and reserve its use for extreme cases. And when testosterone is considered, it is given only for a very narrow and specific set of psychological or physical symptoms.

It seems clear that we can no longer paint testosterone as simply a ‘bad’ hormone for the cardiovascular system. While excessive high-level elevations of this hormone may indeed damage an individual’s cardiovascular health, we have strong evidence that within a certain physiological range, it may also protect the cardiovascular system from some of the same health issues. As such, its replacement may indeed turn out to be very important medical intervention for millions of men across the country, helping us to not only live better— but also live longer.

After all this time, it appears that this very controversial hormone, the same steroid demonized in the media, might actually help reduce the risk of cardiovascular disease in aging male patients. The study we reviewed this month is, likewise, something all men should take to heart— literally.

More Sleep Can Double Your Testosterone Levels

Older men can sometimes double their testosterone levels by getting more sleep, according to a human study that Plamen Penev of the University of Chicago.

Nearly all of us probably get too little sleep, mainly because we are seduced every day by the technology around us. It enables us to generate light at night, provides us with 24-hour entertainment and information through electronic media, and makes it possible for us to have contact with each other whenever we want. Every evening, when our body tells us that it’s time to sleep, we can also do a thousand other things instead.

Too little sleep messes up our hormone balance. It makes our body less sensitive to insulin for example. Dutch researchers recently showed that after just one night of four hours’ sleep, young men’s insulin sensitivity went down by 20 % and that of diabetics by a quarter.

In the latter case, lack of sleep is clinically relevant, so doctors could advise diabetics who react insufficiently to their medicines to get more sleep. “Sleep duration might become another therapeutic target to improve glucoregulation in type 1 diabetes”, the Dutch researchers say.

Testosterone is also affected by amount of sleep. That’s not so strange, as our bodies make much more testosterone when they’re asleep than when they’re awake. We’ve taken the figure below from the study mentioned here. It shows how much testosterone is present in the blood of 22-32 year-old men while asleep and during the rest of the day.

The better men sleep, the higher their testosterone level rises while they are asleep.

In the average male over forty, the testosterone level goes down by 1-2 % per year, but researchers occasionally come across men in their eighties with a testosterone level you’d expect in a young man. Add to that the fact that many older men – but not all men – sleep less and less deeply as they get older, then you automatically think of the idea that Plamen Penev wanted to test in his study: does the testosterone level decrease in older men because they sleep less?

More sleep can double your testosterone level

Penev based his theory on, among other things, research done by Eve Van Cauter, a sleep researcher at the University of Chicago who has celebrity status in the field of endocrinology. Van Cauter discovered early in the 21st century that men in their forties make less testosterone while sleeping than men in their twenties.

Penev measured the amount of testosterone 12 slim, healthy, non-smoking men aged between 64 and 74 had in their blood in the morning. He also got the men to wear a small gadget around their wrist, which enabled him to see how many hours per night the men slept. That varied from 4.5 to 7.5 per 24 hours. The longer the men slept, the figures below show, the more testosterone there was circulating in their blood.

The men that slept the least had a testosterone level of 200-300 ng/dl. That’s a normal amount for men of this age, but it’s on the low side. The men in the study who slept the most had a testosterone level that was twice as high: 500-700 ng/dl. That’s a level you’d expect in healthy young men.

“These findings suggest that complaints of poor or insufficient sleep in otherwise healthy older men can be associated with a more pronounced age-related androgen decline”, writes Penev. “Eliciting such sleep complaints in the physician’s office may facilitate the judicious interpretation of lower testosterone levels in the older male patient.”

Before men consider doing testosterone therapy, they might first measure the amount of sleep they get. And ‘measuring’ is different from ‘guessing’ or ‘estimating’. Most people overestimate the number of hours that they sleep. This was also the case in Penev’s study. The men thought that they slept seven and a quarter hours per day on average, but Penev’s recordings showed that they only slept six hours a day.

How Is Testosterone Deficiency “low T” Diagnosed?

Testosterone deficiency, popularly known as “low Testosterone”, has entered the center stage in both the lay and medical communities. However, how is Testosterone deficiency (a.k.a. hypogonadism) diagnosed? What is the testosterone level threshold below which you can say you have low Testosterone? What are the references ranges for healthy men?

The Endocrine Society clinical practice guideline recommends making a diagnosis of Testosterone deficiency only in men with consistent symptoms and signs, who also have unequivocally low blood Testosterone levels. They recommend Testosterone therapy for men with symptomatic androgen deficiency, with the goal to improve their sexual function, sense of well-being, muscle mass and strength, and bone mineral density.

The Endocrine Society clinical practice guideline is against starting testosterone therapy in patients with:

• Prostate cancer or prostate-specific antigen (PSA) greater than 4 ng/ml or greater than 3 ng/ml in men at high risk for prostate cancer (such as African-Americans or men with first-degree relatives with prostate cancer without further urological evaluation).
• Hematocrit greater than 50%.
• Severe lower urinary tract symptoms with International Prostate Symptom Score (IPSS) above 19.
• Uncontrolled heart failure.

When Testosterone therapy is instituted, we suggest aiming at achieving Testosterone levels during treatment in the mid-normal range with any of the approved formulations, chosen on the basis of the patient’s preference, consideration of pharmacokinetics, treatment burden, and cost. Men receiving Testosterone therapy should be monitored.

The normative reference ranges for total and free Testosterone levels in healthy young men vary among assays and laboratories. While variation between laboratories for the same Testosterone assay (analytical method) is negligible, it should be noted that reference intervals for Testosterone (as well as LH and FSH) differ widely and significantly between assays.

In some laboratories, the lower limit of the normal range for total Testosterone level in healthy young men is 280–300 ng/dl (9.8–10.4 nmol/liter), and the lower limit of the normal range for free Testosterone level (measured by the equilibrium dialysis method) is 5–9 pg/ml (0.17–0.31 nmol/liter).

According to the medical guidelines, clinicians should use the lower limit of the normal range for healthy young men established in the specific assay that is used.

However, it should be noticed that many assays have established Testosterone reference ranges that were compiled from small convenience samples of subjects, and frequently used unreliable laboratory analytics based on the immunoassay technique, whose accuracy, particularly in the low range, has been questioned. Importantly, the immunoassay technique, which is the most widely used method for measuring total Testosterone levels, overestimates true levels and has very limited accuracy at levels below 300 ng/dl. Another study found that over 60% of the samples tested (with Testosterone levels within the adult male range) measured by most commercial assays had a spread of up to +/- 20% of those reported by LC-MS (liquid chromatography mass spectrometry), which is the gold standard Testosterone analytical method.

Table 1 shows reference ranges for total and free Testosterone levels, established in a large population of healthy young men aged 19-40 years and older men aged 70-89 years, using the gold standard LC-MS analytical method.

The first thing to note when comparing the reference ranges between young and older men is the dramatic decline Testosterone levels. Total Testosterone levels in older men are about 40-50% lower than that of younger men. Free Testosterone levels drop even more with age. This data confirms findings from previous studies which have shown that as men get older, levels of free (or bio-available) Testosterone decline at a faster rate than total Testosterone levels.

According to the approach used for defining reference limits for biological parameters, total and free Testosterone values below the 2.5th percentile (approximately 2 SD [standard deviations] below the mean) are deemed low. For total and free Testosterone in young men, this corresponds to 348 ng/dL and 70 pg/mL, respectively. The same applies to defining the high end of the reference limit (approximately 2 SD above the mean). For total and free Testosterone, this corresponds to 1197 ng/dL and 230 pg/mL, respectively.

As table 1 shows, the normal range for both total and free Testosterone is large, going all the way up to 1322 ng/dL in young men. This means that there is a lot of room for expression of different health outcomes when contrasting the low end with the high end of the normal range. In other words, it is very likely that being in the low end will have very different health consequences vs. being in the high end.

Symptoms

As stated by the US Endocrine Society, and also by European medical organizations, the diagnosis of Testosterone deficiency requires the presence of symptoms and signs suggestive of Testosterone. Table 2 lists symptoms and signs suggestive of androgen deficiency in men, according to the Endocrine Society.

TABLE 2. Symptoms and signs suggestive of androgen deficiency in men.

More specific symptoms and signs of low-Testosterone

• Reduced sexual desire (libido) and activity
• Decreased spontaneous erections
• Loss of body (axillary and pubic) hair, reduced shaving
• Very small or shrinking testes
• Inability to father children, low or zero sperm count
• Low bone mineral density
• Hot flushes, sweats

Other less specific symptoms and signs of low-Testosterone

• Decreased energy, motivation, initiative, and self-confidence
• Feeling sad or blue, depressed mood, dysthymia
• Poor concentration and memory
• Sleep disturbance, increased sleepiness
• Mild anemia (normochromic, normocytic, in the female range)
• Reduced muscle bulk and strength
• Increased body fat, body mass index
• Diminished physical or work performance

Questionnaires

Several questionnaires are available to help doctors make a diagnosis of Testosterone deficiency according to the current medical clinical guidelines. The Androgen Deficiency in Aging Men (ADAM) and the Aging Male Survey (AMS) questionnaires are two examples. Table 3 shows what you will get asked in the ADAM questionnaire.

Table 3: The Androgen Deficiency in Aging Males (ADAM) questionnaire.

1. Do you have a decrease in libido (sex drive)?
2. Do you have a lack of energy?
3. Do you have a decrease in strength and ⁄ or endurance?
4. Have you lost height?
5. Have you noticed a decreased enjoyment of life?
6. Are you sad and ⁄ or grumpy?
7. Are your erections less strong?
8. Have you noticed a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?

If the answer is ‘yes’ to question 1 or 7, or at least 3 of the other questions, you might have a low Testosterone level.

While the ADAM and AMS questionnaires may be useful rough screening tools to screen for hypogonadism across the adult male lifespan, it should be noted that they (like all other questionnaires) are non-specific, i.e. lack diagnostic accuracy. In other words, a man who doesn’t fulfill the criteria can still have low Testosterone levels, and vice versa, a man who does fulfill the criteria can have Testosterone levels in the normal range. Therefore, the symptoms and signs related to lowTestosterone levels are only suggestive, not diagnostic of hypogonadism.

How to use Sustanon 250

• Cycle length – 6 weeks 
• Normally you have to inject once a week. But if you are dissatisfied with the results, try to split it on two shots, if possible.
• Start anti-estrogen from week 2, 10mg/ED and stop 4 weeks after it.
• Start using natural testosterone boosters - 3 weeks after the cycle.
• For maximum efficiency use proteins and special diet
• For better results try to stack it.

Sustanon is a mixture of different testosterone esters. First developed and introduced by Organon as a means of hormone replacement therapy when there is insufficient secretion of endogenous testosterone. Currently, almost all of the mixture of testosterone esters equated to Sustanon, a large number of drugs manufactured clandestinely .

Sustanon contains 4 forms of testosterone :

30mg Testosterone Propionate

60mg Testosterone Phenylpropionate

60mg Testosterone Isocaproate

100mg Testosterone Decanoate

Each form of testosterone, which is part of Sustanon has a different rate of absorption, which allows to maintain constant high level of anabolic hormones in the blood during the month. There is no need to perform frequent injections, for medical purposes Sustanon is injected only 1 time in three weeks. Some believe that Sustanon is a combined course in one bottle, but it is not true, because every component of the drug converted in the body only in testosterone.

Sustanon works just like any other form of testosterone. This means that the main effects of sustanon are:

• Increased muscle mass ( an average of 6 kg per month)
• Anti catabolic effect
• Increased appetite
• Increased blood – increasing the number of red blood cells provides a better oxygen transport , due to which increases endurance
• Increased libido (at the time of taking sustanon)
• Doping control: Time of detection of the drug is up to 3 months.

Sustanon – side effects

Like any other form of testosterone, Sustanon is converted into estrogens. For this reason, Sustanon cause side effects such as gynecomastia, edema, deposition of fat on the female type and the oppression of its own testosterone production. These side effects can be prevented, if applied antiestrogen – Tamoxifen (Nolvadex) or Clomiphene citrate (Clomid).

As a result of reduced production of endogenous testosterone may develop a serious adverse effect of Sustanon is testicular atrophy. This side effect can be prevented if you do not do a course of Sustanon longer than 8 weeks and take antiestrogen. For longer courses require the use HCG.

In the body, testosterone is converted into dihydrotestosterone, which causes the following side effects: hypertrophy of the prostate, baldness, acne and others. This so-called androgenic side effects of Sustanon .

Also, athletes often report fever and flu-like condition during the course of  Sustanon . Like most steroids, Soest increases the level of harmful cholesterol in the blood.