Anti-Aging

Testosterone cypionate: What is it?

TRT or testosterone replacement therapy is medically indicated for men with low testosterone. It sounds simple, right? You get a blood test, your testosterone level is low, whether from aging or other causes, you get a prescription for testosterone cypionate injections and your testosterone level goes up. Testosterone cypionate is the most common form of injectable testosterone prescribed in the U.S. to treat low testosterone levels or hypogonadism. It is available legally with a prescription, and with a prescription, you can get started on TRT online. Problem solved! Not so fast or easy, I’m afraid. The endocrine system is complicated, and a decrease in one hormone can affect many other hormone levels and, subsequently, many other body systems. This article will look at the use of testosterone cypionate and examine the risks and benefits associated with its use.

Step 1: A medical diagnosis

Hypogonadism or low testosterone levels combined with the associated symptoms of low testosterone are a long-accepted medical indication for testosterone replacement therapy. A medical indication means that other patients with the same lab values and clinical findings have had their symptoms improve after starting testosterone replacement therapy.

The natural decline in testosterone levels associated with aging and the symptoms associated with its decline is a subject of many clinical trials to seek a better definition of the risks versus benefits ratio and better identify who would benefit most from testosterone replacement. Using testosterone injections to increase muscle mass and athletic prowess in men with normal levels of testosterone is not medically indicated.

Testosterone in aging men

The normal aging process in men is associated with a progressive decline in both growth hormone and testosterone. Testosterone production is reduced by nearly one-third by age 70 and by one-half by age 80. Twenty percent of men aged 60 to 70 and more than half of men by age 80 meet the clinical definition of hypogonadism (Giannoulis et al., 2012). A reduction in testosterone production results in loss of bone and muscle mass, diminished libido and potency, impaired psychological well-being, and a variable reduction in the production of red blood cells (Harman et al., 2001).

Chronic illnesses such as high blood pressure, diabetes, chronic kidney disease, and kidney failure are associated with decreased testosterone levels in men of all ages (Reckelhoff et al., 2005).

The physiological decrease in both growth hormone and testosterone can adversely affect the quality of life by increasing the risk for falls and fractures, decreasing exercise capacity, and increasing the probability for a potential loss of independence due to medical frailty.

Clinical studies have indicated that growth hormone replacement and testosterone hormone replacement can lead to enhanced lean body mass, greater strength from increased muscle protein synthesis, increased bone density, and an improved sense of well-being. However, higher doses of testosterone can increase the risk of side effects (Brill et al., 2002). As with any medical condition, risks and benefits are weighed to determine whether to begin medical treatment for a disorder and, if so, how aggressively.

Diagnosis of low testosterone levels

Diagnosis of low testosterone levels starts with measuring total testosterone on two separate occasions between 8 AM and 10 AM using the same laboratory. The American Urological Society recommends using a total testosterone level below 300 ng/dl as a cut-off to support starting TRT (Mulhall et al., 2018). Testosterone levels vary by age and lab. Additional lab values are usually obtained to define the cause of low testosterone levels better. Learn more about these lab values.

When you call or set up a consultation with a health care provider at a reputable TRT clinic such as Invigor Medical, you can expect to learn more about the benefits of TRT treatment. You will be asked to share the symptoms you are experiencing. You will learn about the TRT testing process and the steps you need to complete to determine whether low testosterone levels are causing your symptoms. If you and your health care provider determine that testosterone replacement is the best treatment option for you, you will receive a prescription and instructions on using your medication properly.

Side effects of testosterone injections

When testosterone is injected, it suppresses the secretion of gonadotropins, LH and FSH, from the pituitary which results in decreased natural testosterone production and decreased sperm production. Testosterone in supraphysiological doses has been associated with various neuropsychiatric effects, including problems with impulse control, aggression, anxiety, and mania. Whether the relationship is causal is not clear. Increased testosterone levels have been associated with cardiovascular disease secondary to abnormal lipid levels, specifically low high-density lipoprotein cholesterol (HDLs). Testosterone increases the production of red blood cells, which may increase the risk of blood clots. Screening lab panels for hormone levels, cholesterol panel, and hemoglobin and hematocrit levels can help ensure that these potential side effects are being tracked. Testosterone is converted to estrogen by an enzyme called aromatase. Testosterone supplementation can result in excess estrogens and gynecomastia or excess breast tissue development in males.

Most men who use testosterone supplements for less than a year will regain normal hypothalamic-pituitary-testicular function within three to six months of discontinuing treatment. Medications are available to speed up this process in men who have used testosterone supplements for longer than a year (Anawalt, 2019). Many of the side-effects of testosterone supplementation are decreased when an injectable form is used as it bypasses the first-pass metabolism in the liver (Clement et al., 2012).

Step 2: A prescription for testosterone cypionate from an online physician is necessary

Testosterone cypionate is a synthetic derivative of testosterone in the form of an oil-soluble ester. Compared to other forms of testosterone, it has a slow rate of release after injection and a longer half-life. Testosterone cypionate was FDA approved in 1979. Testosterone levels can reach 400% above baseline within 24 hours of injection and remain elevated for 3 to 5 days with a half-life of 8 days. The peaks and valleys lead to some side effects noted by users.

Depo-Testosterone (Testosterone cypionate) is not indicated for women, especially during pregnancy. It is contraindicated in men with known or suspected cancer of the prostate or breast. It should not be used in people with a known hypersensitivity to its ingredients. Additional warnings are listed for seniors, children, and those with liver, heart, and kidney problems.

Pfizer Monograph for Depo-Testosterone

Pfizer also provides the following warnings:

Depo-testosterone use in those with diabetes may cause decreased blood glucose levels and result in a decreased need for insulin. Monitor your blood glucose levels carefully.
Injectable testosterone increases the rate of clearance of propranolol from the body and may cause a need to adjust dosages.
Using testosterone with corticosteroids can increase edema (swelling), which may lead to serious problems in those with heart, kidney, or liver disease.
Androgens may increase sensitivity to oral medications used to thin the blood and decrease the risk for blood clots.
No interactions with foods have been reported.
Some herbal products, such as St. John’s Wort, may decrease plasma testosterone levels.

The usual dosage for Depo-testosterone is 200 mg intramuscularly every two weeks. However, each clinical situation is unique, and your health care provider will determine the appropriate dosage for your condition.

Every medication comes with risks and benefits. The risks and benefits in this guide are not meant to be comprehensive or complete (Daily Med, n.d.)

Step 3: Buy testosterone cypionate online

Testosterone cypionate is classified as a schedule III drug by the U.S. Drug Enforcement Agency (DEA), so a prescription is required to buy testosterone cypionate online legally. Most websites selling testosterone are not located in the U.S. and do not require a prescription to buy testosterone cypionate. Since a prescription is required to buy testosterone cypionate online, your package may be confiscated at the border if it is identified. An even bigger risk is that you cannot be sure what is in the testosterone injections from a country that is not required to follow FDA guidelines.

To ensure that you are filling your testosterone cypionate prescription online safely, consider the following:

Does the pharmacy provide a phone number and contact information?
Are you able to have your questions answered by a pharmacist?
Can you verify that the pharmacy is located in the U.S.?
Can you verify that the pharmacy is licensed?
Do they require a prescription to fill testosterone cypionate online?

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Summary

Increased longevity and population aging will increase the number of men interested in testosterone replacement therapy. The diagnosis of low testosterone levels requires two separate measurements of low testosterone levels combined with symptoms and signs of hypogonadism. Many benefits have been cited for using TRT to correct low testosterone levels. The risks associated with TRT are less clear and need more clinical trials to define them better. Once a diagnosis is made, men are given a prescription for testosterone cypionate, a much safer alternative to oral testosterone. Testosterone cypionate is a schedule III drug and requires a prescription in the U.S. Men can buy testosterone cypionate online with a prescription. Follow-up should be scheduled to evaluate lab values changes and watch for any potential side effects from treatment (Bassil et al., 2009).

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

Anawalt B. D. (2019). Diagnosis and Management of Anabolic Androgenic Steroid Use. The Journal of clinical endocrinology and metabolism, 104(7), 2490–2500. https://doi.org/10.1210/jc.2018-01882
Clement, C. L., Marlowe, D. B., Patapis, N. S., Festinger, D. S., & Forman, R. F. (2012). Nonprescription steroids on the Internet. Substance use & misuse, 47(3), 329–341. https://doi.org/10.3109/10826084.2011.630225
Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR 2001 Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab 86:724–731 https://pubmed.ncbi.nlm.nih.gov/11158037/
Brill, K. T., Weltman, A. L., Gentili, A., Patrie, J. T., Fryburg, D. A., Hanks, J. B., Urban, R. J., & Veldhuis, J. D. (2002). Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. The Journal of clinical endocrinology and metabolism, 87(12), 5649–5657. https://doi.org/10.1210/jc.2002-020098
Giannoulis, M. G., Martin, F. C., Nair, K. S., Umpleby, A. M., & Sonksen, P. (2012). Hormone replacement therapy and physical function in healthy older men. Time to talk hormones?. Endocrine reviews, 33(3), 314–377. https://doi.org/10.1210/er.2012-1002
Mulhall, J. P., Trost, L. W., Brannigan, R. E., Kurtz, E. G., Redmon, J. B., Chiles, K. A., … & Platz, E. A. (2018). Evaluation and management of testosterone deficiency: AUA guideline. The Journal of urology, 200(2), 423-432. https://www.auanet.org/guidelines/guidelines/testosterone-deficiency-guideline
Reckelhoff, J., Yanes, L., Iliescu, R., Fortepiani, L & Grandger, J. (2005). Testosterone supplementation in aging men and women: possible impact on cardiovascular-renal disease. Am J Physiol Renal Physiol 289: F941–F948, 2005 https://journals.physiology.org/doi/full/10.1152/ajprenal.00034.2005
Bassil, N., Alkaade, S., & Morley, J. E. (2009). The benefits and risks of testosterone replacement therapy: a review. Therapeutics and clinical risk management, 5(3), 427–448. https://doi.org/10.2147/tcrm.s3025
Daily Med. (n.d.). Testosterone Cypionate. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6909596e-4bf7-4e11-8029-b89740a30aec