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Testosterone, Judith Rabkin's studies, eugonadal, seriously underweight, depression
Jul 23, 2010

OK, there's a lot to to unpack in my question title!

1. Here are my lab results. Poz for just about five tears now, In a couple of studies (viremic controller). http://www.thebody.com/Forums/AIDS/Labs/Archive/Relationship/Q207169.html

2. Depression (endogenous, as it used to be called, also stress-triggered more recently) since the age of ten. On antidepressants since 21`, with a few breaks. On Effexor XR for 8 years, up to 300 mg/day now.

3. Free testosterone (without supplementation) 542 ng/dl.

4. 5'8", slim build, but currently 112 lbs. Needless to say, *seriously* underweight. With a *helluva* lot of gym work and protein shakes, can bring it up to 135 lbs. But then, depression, stress, a very demanding job, loss of gym routine... you get the idea I think (or hope).

5. Am interested in testosterone as an anti-depressant augmentor. Hence the Rabkin reference. Have been taking 200 mg (intra-muscular) every two weeks (cypionate), self-medicating. Lately, switched to Sustanon 250 every three weeks. The dopamine "action" is what I'm interested in.

6. Puzzled by recent answers on this forum, which would seem to indicate that you're moving away from a position you once, I think, advocated: that even eugonadal men can benefit from testosterone supplementation -- especially if depressed and/or underweight. And that gels (avoiding peak/trough effects) are the way to go, if at all. Could you clarify?

7. I'll write back, but would be grateful for your thoughts on my situation or condition or "case," whatever.

Thanks!

Response from Mr. Vergel

You have been doing your research. Good for you!

Yes, Dr Rabkin studied the use of testosterone in men who had normal testosterone blood levels who had symptoms of hypogonadism (low sex drive, fatigue, etc). Eeven though these men had total testosterone blood levels of over 500 nanograms per deciliter, they had all symptoms of hypogonadism (low testosterone). Most doctors do not think that a man with over 500 ng/dl total testosterone should be feeling that way! So, it is interesting that she actually found men that would be consider "normal" or eugonadal who would still benefit from testosterone injections.

Treatment consisted of 12 weeks of bi-weekly intramuscular injections of testosterone cypionate. Twenty-three men enrolled in the study; mean age was 37. All had an AIDS diagnosis and the mean CD4 cell count was 150 cells/mm 3. All baseline serum testosterone levels were within the laboratory reference range and above 500 ng/dl. Diminished libido was an inclusion criterion, plus each patient had at least one additional symptom (low mood, low energy, loss of appetite and/or weight). Nineteen men completed the trial and a majority of patients responded with regard to libido (89%), mood (67%), energy (71%), and appetite (67%) as rated by the Clinical Global Impressions Scale. With the exception of appetite, self and clinician rated measures showed significant improvement in all symptom domains. Among the 14 study completers with significant weight loss, the average weight gain was 2.3 kg, with a 1.8 kg increase in body cell mass and no change in body fat. These results suggest that testosterone is as effective in treating these symptoms in eugonadal men with AIDS as we have found in our research with hypogonadal HIV+ men.

So, testosterone could be useful in those who may look good on paper but have symptoms of low testosterone. However, any patient who is thinking about using testosterone should keep in mind that there may be side effects like increased red blood cells ( which make the blood very thick and increase cardiovascular risks), prostate inflammation (which can reduce urine flow), increased blood pressure, and some moodiness in some. Some men do not get any of these side effects, however, and report dramatic improvements with testosterone. But most men I have talked to do not know that if you stop testosterone supplementation you run the risk of becoming extremely hypogonadal for weeks or months since your hypothalamic-pituitary-gonadal axis has been shut down with the use of testosterone. So, starting this therapy should be done with commitment in mind.

From what I gather in your email, it seems that you are using street sources of testosterone. I assume that your doctor does not want to prescribe. Your total (not free like you say) was above 500 ng/dl before you started testosterone. Most doctors do not feel comfortable prescribing testosterone to men with normal levels even if they have hypogonadal symptoms. And most have not read Dr Rabkin's study.

I am wondering how your appetite is and if you are a very active person. Yes, you are thin for your height but some men have very small frames, so most doctors look for what was a "normal" weight for that person. If we go by body mass index, you would definitely have a low one. Some may think that being thin may be a problem if you get an opportunistic infection or severe diarrhea that would make you lose weight into a danger zone for survival.

Your CD4 cells and viral load are great. It seems that you have been poz for 52 months and are not taking HIV medications.

Is the Effexor decreasing your appetite?

When you say you are looking for "dopamine action", are you inferring that you may have low dopamine? Have you used street drugs in the past or currently?

My book called "Testosterone: A Man's Guide" is being printed right now and will be available by the end of August. I address some of these issues there.

As you mentioned, I have been following testosterone and androgens since 1993. I have seen miracles but I have also seen side effects in men who have no idea of what they are doing when using this hormone. Many doctors are now experienced in the use of this hormone.

Since most of us are not wasting anymore due to HAART, the use of testosterone to improve weight in those who may have normal testosterone levels is as widely spread as it used to be. Although I believe in personal choice and responsibility specially if you are an educated patient, I do not blame physicians who are reluctant to prescribe testosterone to men who have normal levels (above 500 ng/dl) of this hormone in their blood without exploring all other factors that may be involved in their low weight or sexual dysfunction.

Let me know if you can answer some of the questions I listed here so that I can have a better idea on your situation.

Nelson



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