Written by DR. GEORGE TOULIATOS, MD
14 September 2021

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Has Your TRT Hit a Plateau?

By George Touliatos, MD

 

HitPlateau in TRT

 

Q: I’ve been using testosterone for the past two years. Initially, everything seemed to be fantastic; energy, libido, mood, stamina. But lately I feel that I kind of hit a plateau. What could be wrong?

 

A: In some men who receive TRT, the bioavailable FT is blocked by elevated SHBG. Reasons such as NAFLD, alcoholism, IF/KD and aging may contribute to that. Moreover, prolactinemia and excessive aromatization can affect erections and orgasms. Optimization of TRT and hormonal balance is they key for physical and mental health. So in brief, the use of certain medications such as mesterolone, danazol, DHEA and boron can help to liberate more FT and suppress SHBG. Kicking insulin by small and frequent meals will ensure that SHBG goes down. Furthermore, the use of a dopamine agonist such as cabergoline, or bromocriptine, will manage elevated prolactin. Regarding aromatization, the moderate use of an aromatase inhibitor will ensure estradiol is not spiking out of range. Another medication that can improve sex drive is HCG. This LH analogue will increase intra-testicular testosterone and overall steroidogenesis synthesis (pregnenolone, progesterone, DHEA).

 

Steroids for Women?

 

Q: I’m a female Figure competitor and I’m considering using steroids to bring my game to the next level. Are there steroids that are safer, or better for women? What could be any medical issues?

 

A: The DHT derivatives (oxandrolone, stanozolol, methenolone) are of low androgenicity. The androgenic index is responsible for the androgenic side effects (virilization in women), such as hirsutism, voice deepening, androgenic alopecia, and clitoric enlargment. Moreover, nandrolone is of low androgenicity, but more important is a 19nor testosterone derivative that doesn’t metabolize to DHT, but to DHN (less androgenic than DHT). Therefore, a safer option for a woman during the off-season would be nandrolone decanoate (50mg/w), along with methenolone enanthate (100mg/w). During the cutting phasae, stanozolol and oxandrolone are the options (1x3/d). Other compounds that are also stacked are thyroxine, clenbuterol, ephedrine and growth hormone. I wouldn’t recommend the use of anti-estrogenic agents (SERMs, AIs), or other potent androgenic AAS. Spironolactone is a diuretic (potassium sparing) that is able to act as anti-androgen in women, especialy to reverse hirsutism. It should be taken is small doses (12.5mg/d).

 

George Touliatos, MD is an author, lecturer, champion competitive bodybuilder and expert in medical prevention regarding PED use in sports. Dr. Touliatos specializes in medical biopathology and is the medical associate of Orthobiotiki.gr and Medihall.gr, Age Management and Preventive Clinics in Athens, Greece. Heis the author of four Greek books on bodybuilding, has extensively developed articles for www.anabolic.org and is the medical associate for the book Anabolics, 11th Edition (2017). Dr. Touliatos has been a columnist for the Greek editions of MuscleMag and Muscular Development magazines, and has participated in several seminars across Greece and Cyprus, making numerous TV and radio appearances, doing interviews in print and online. His personal website is https://gtoul.com/

 

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