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Low testosterone & bullfrog neck?

Aug 24, 2013

Hi Nelson I am a former triathalete and sportsman aged 41. Have had HIV since 2010 and have been on atripla for 18 months, VL <40 CD4 around 500. I have been through some stress so take remeron sometimes in small amounts to help sleep. I go to the gym 4-5 times weekly, work out pretty hard when I do with plenty of cardio, some weights. Basically, I am getting fit even though its a bit of a struggle to do so! Recently, checked my blood levels, everything is roughly ok except for a low white cell count (same since 2010 around 3.6) and my first testosterone reading which is 0.4ng/dL. All I've read indicates that anything under 300 would be low, this is way below that. I am not and could not be sexually active since my HIV diagnosis, and slowly slowly my neck is developing a slight double chin, even though the rest of me is actually in quite ok shape.

I've not trained this hard in a long time, and the gains are slight. I am not a big fan of needles. Do you recommend testosterone therapy of some sort, or is there something I should be doing, because I have no motivation problem, if I have a medical issue your advice would be appreciated.

Response from Mr. Vergel

You need to talk to your doctor about getting you on a testosterone gel or cream. We have lots of options: Androgel, Testim, Fortesta and Axiron. Androgel is the oldest and has 1.62 percent testosterone, Testim has one percent (I do not like its smell), and newer options like Fortesta has 2 percent and Axiron has 1 percent (applied on armpits to avoid transferring testosterone to females or kids we may come in contact with). Normalizing testosterone can help you decrease body fat and improve vitality. You can read more about each option by typing its respective name plus .com

You can also find a lot of information about testosterone in my book "Testosterone: A Man's Guide" , blog:Nelson's Testosterone Blog or videos:Nelson's videos

Remeron (mirtazapine) is an antidepressant used a lot for two other purposes besides depression: sleep and as an appetite stimulant. I would talk to your doctor about having you try other medications like zolpidem that do not cause increased appetite since you are trying to lose your "bullfrog neck" ( Banishing Chipmunk Cheeks and Bullfrog Neck )

Remeron can also change glucose transporter Glut4 activity that has been associated with protease inhibitor (i.e. Norvir) metabolic dysfunction, so it may not be advisable for HIV+ people with metabolic issues and fat gain. Effects of different antipsychotics and the antidepressant mirtazapine on glucose transporter mRNA levels in human blood cells

HIV Protease Inhibitors Act as Competitive Inhibitors of the Cytoplasmic Glucose Binding Site of GLUTs with Differing Affinities for GLUT1 and GLUT4

If you cannot stop Remeron, talk to your doctor about metformin since it may reverse the effect on Glut4 caused by the drug.

You may want to give this information to your physician.

Let me know how it goes.


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