update 4 March 2013: the bad news for cheats – especially after cyclist Lance Armstrong’s confessions in January 2013, and the St Valentines Day massacre – the Blade Runner Oscar Pistorius media frenzy including unfounded accusations of steroid abuse ‘roid rage – is that testosterone is not recommended and prescribed for bodybuilding or performance enhancement, but solely where medically appropriate.
the good new news is that, while worldwide supplies of testosterone periodically run out, it and estradiol are now available once more in South Africa as appropriate 70-year old pellet implants for men and women needng HRT . But the cost including implanting every 4-6 months remains likely much higher than fortnightly selfinjection or daily cream application.
at the beginning of 2013 authorities were bemoaning the end of attempts to market depot hormone contraception for men. But given increasing longevity, and falling male and female fertility, and potentially double the duration of fecundity of men compared to women, and the real hazards of male and female sterilization and continuous female contraception with all current commercial ie patented synthetics, for the determined couple implants offer physiological reversible contaception without the risks of commercial patents. For males implants of testosterone and progesterone, and for the female triple implants of testosterone progesterone and estradio, remain an option to be explored.
Jan 2010: the important report from South African authorities on testosterone replacement for men is wrong on one account: such replacement with injection need not cost almost R6000pa for the ideal 3monthly German Schering AG ultralongacting brand.
as this column has repeatedly pointed out, physiological depot injection has been available in South Africa for almost 70 years. Currently it retails at perhaps R350 per gram as depotestosterone, the equivalent dose to the 3monthly 1gm injection (ie 160mg/fortnight) being 160mg 1.6ml every 2 weeks ie a cost of about R1400 per year.
This is easily and safely self-injected subcutaneously with a tiny (insulin) 25g needle, and gives physiological blood levels to most men – as with all chronic drugs, the dose and interval simply needs to be titrated to individual metabolism and response, always under periodic medical screening. Eldrely men usually need and tolerate perhaps 20% less than younger men, who may well tolerate 200mg/fortnight.
It is blatantly wrong to give the shortacting Sustanon monthly- this brand has been banned by authorities- and unphysiological to give monthly the gold standard depotestosterone cypionate / enanthate- with a life of about 3 weeks, since it is well known that the irrationally marketed higher dose for less frequent injection eg 400mg imi monthly will give the adverse peaks and troughs that Dr Hafferjee notes. It’s like condemning eg spirits or wine when 4% beer provides far less alcohol- but common sense tells us they are equally good (or bad!), just the dose and interval needs to be proportionate.
Authoritative data on rational dose and interval of old depotestosterone has been freely available since at least 1991, so there is no justification whatsoever for proclaiming Nebido or other costly forms of testosterone replacement as the necessary gold standard- this is classic marketing hype.
We have long insisted that in this age of gender equity, men are as entitled as women to appropriate HRT- but the obtuse authorities and their stupid medical advisors refuse to recognize that both genders equally need all appropriate hormone replacement including physiological sex hormones for their vast life-extending multisystem benefits, least of which is sex.
Yet Discovery Health has recently refused an elderly man testosterone replacement (recommended by his psychiatrist) on the grounds that it is an aphrodisiac. Such refusal of long-validated endocrine replacement (by their medical officers) amounts to medical negligence let alone defamation, fraud and woeful ignorance.
Nebido and depotestosterone cypionate/enanthate are equally, superbly physiological if used rationally eg subcutaneously, to avoid the unnecessary multiple risks of intramuscular injection. It can be questioned whether any patient who refuses to be taught his own injection warrants such costly replacement- the same natural selection applies to millions of insulin-dependent diabetics. And replacement of testosterone often relieves type 2 diabetics of the need to use costly and risky insulin, when appropriate testosterone and metformin reduce all-cause mortality by perhaps half, whereas insulin in type 2 diabetics does not.
Just yesterday this column decried confusing causation with association in the comm0n but far from majority universal problem of hyperandrogenism in women. There are only two major anabolic hormones that decline seriously with both aging and disease in both men and women, in whom appropriate physiological testosterone and vitamin D3 replacement (with appropriate physiological estrogen for women) is thus often required lifelong from what is potentially middle age to maintain health into vigorous- rather than frail- old age.