A Peat Approach To Unavoidable Testosterone Replacement Therapy

[samson]

Hi. Long time reader, first time poster here. I’ll keep this as short as I can.

I’m a man, mid-thirties, and on testosterone replacement therapy. And I need to be for my entire life. I have bilateral congenital anorchia, a rare condition that causes a normal XY boy to be born without testicles. I’ve been taking testosterone cypionate injections since I was 12.

If you read that and thought “wow, that’s rough”, it’s no picnic. But overall my life is pretty awesome. And since I started Peating 5 months ago, my life has gotten even more awesome. However, I have a few lingering problems and could use some advice.

Current issues:

1. Acne. You take steroids, you get acne. I’ve had acne since I was 12 and can only keep it under control using the acne.org regimen. But I’m looking for a permanent solution. Peating has improved my acne but not solved it.

2. Eczema. I get it on my fingers. It comes and goes. It has also improved since I started Peating but won’t go away.

3. Dandruff. It’s not much, but it’s there.

4. Hair loss. Very common with steroid users. I’m a Norwood 2A or a 3.

My stats:

Height: 6’5”

Weight: 220 lbs

Body temperature: Since Peating, between 98.4 F – 99.2 F, depending on the time of day. It used to be around 97.5.

Resting pulse: between 75 -90. Used to be about 60.

Blood pressure: 140/80. Used to be way, way lower.

My build:

I have a lean and muscular build. Thanks to steroids, I can build muscle just by looking at a set of weights. Before I started Peating I was a runner, and a pretty good one for how big I am. Now I just lift weights and row.

My diet:

My diet is about as Peat-y as it gets. I eat between 3,000 to 4,500 calories a day. Skim milk, eggs, cheese, gelatin, orange juice, lemonade, oranges, steak, ice cream, coffee, Mexican coke, sugar, daily carrot salad, celery, and salt. Lots of salt. I also eat 4 ounces of beef liver a week, sautéed mushrooms 3-4 times a week, and a can of oysters twice a week. I avoid gluten and PUFA as much as I can.

Before Peating I was paleo, like so many people here.

I stopped drinking all alcohol about 8 months ago.

My supplements (daily):

5,000 IU Vitamin D

200 IU Vitamin E mixed tocopherols

100,000 IU Vitamin A palmitate (topical)

10 mg Vitamin K2 (topical)

150 mg B1

A pinch of B2 powder

1500 mg Niacinamide

325 mg aspirin

1 mg cyproheptadine

2 tablespoons coconut oil

1 teaspoon baking soda dissolved in water

1/32 teaspoon cascara sagrada

5 mg pregnenolone and 5 mg DHEA 5 days a week. I skip them on the days I do my steroid shots.

I used to take t4 + t3 supplements, but since I started experimenting with red light therapy three weeks ago, I don’t seem to need them anymore. Red light therapy has shot my body temperature and pulse up more than thyroid supplements ever did.

Improvements noticed so far from Peating:

- A dramatic improvement in my hair quality. Thicker, fuller, shinier. The same lady who’s been cutting my hair for years comments on it when I get my hair cut, as have a few friends that I hadn’t seen in a while. I can’t say I’ve seen any real regrowth yet, but it’s only been 4 months.

- Big reduction in stress.

- Feeling a lot more awesome in general.

- Better concentration, better focus, better creativity.

- Younger, tighter, smoother skin (except for the acne). I believe it’s due to the pregnenolone and gelatin. If I had all of my hair, I could probably pass for 25.

- And most importantly of all… I was able to reduce my steroid dosage from 150 mg of testosterone cypionate a week to 100 with no loss of libido, energy, or focus. This is a really big deal, and something I tried and failed several times before.

My thoughts on next steps:

My already demonic metabolism is only getting faster since I started Peating. Am I getting enough nutrients? My latest Vitamin A bloodwork shows my A levels are almost too high. How much vitamin A is too much?

I know long term steroid use can stress the liver. Is there more I should be doing for my liver?

Summary:

I used to have a lot of health problems that made my life less than awesome until I decided to take my health into my own hands. Peating has given me impressive results so far, and the more I get into it, the better things seem to get. This forum has a lot of fantastic information and I thank you all for the help I’ve found here so far. I only have these few issues left.

I look forward to your recommendations. Also, if anyone has any questions about my results from Peating, my methods, or the laundry list of drugs and supplements I’ve tried in my life (it’s been a lot), just ask.

 

[Smee]

I am also on testosterone replacement after being diagnosed with primary hypogonadism (I have testicles but they are apparently only for show). I too have found rpf to be a treasure trove of information and have also wondered on how I could make the best of this situation. Obviously exogenous testosterone is not ideal for health, but it is most definitely better than none at all. Do you take HCG? Or an AI? When I started TRT last summer I was put on 210 mg/wk t-cyp, in addition to 1000 iu HCG and 2 mg of anastrozole. My doctor was an idiot. My E2 crashed hard and I think t dose was way to high for me. I am now using 125 mg split in 3 doses weekly, dropped the AI about 3 mo ago (not sure what my e2 or tt are but will be getting labs soon), and am taking 650 iu HCG. I feel pretty good still, libido is great. Since adopting peat style diet 5 no. ago my temps are similar to yours. I am interested in your supplementation regimen, I need to do more research. Much of what is recommended here I am not sure would be good for me as my cortisol is low. Much of what is recommended on this forum is aimed at pushing cortisol lower, so I guess I'll need to keep trying to understand all this stuff within context. My progesterone is low too. This ***t is complicated I wish I had a coach lol. Rpf is next best thing I guess.

 

[samson]

Yes, this stuff is complicated. I’ve been taking steroids since I was 12 and am still learning.

No, I don’t take HCG or an AI. I’ve thought about HCG and should probably get my levels checked. I don’t take an AI because I manage to keep my estrogen levels low without one. When I was on my old dose of testosterone cypionate, my T levels were about 1025 (above normal) and my estrodial was only 30.5 (high-ish normal).

Now my T is about 768. I need to get my estrogen checked again.

It took me a long time to learn how to get my estrogen this low.

Here’s a few things that have helped me:

- Hit the weights. When it comes to bulking up, we have an unfair advantage. Use it. Don’t lift too heavy, though.

- Avoid all phytoestrogens. Absolutely no soy, flaxseed, or anything estrogenic.

- Watch your blood sugar. Hypoglycemia and steroids go hand in hand. Eat often and make sure you eat enough.

- Don’t drink alcohol. This was one of the biggest game changers for me. I used to be a heavy drinker. Then I stopped, and now I feel so awesome I don’t miss it at all. If you drink, try holding off for 30 days and see how you feel.

You said you are hypogonad… how did the doctors determine this? Bloodwork?

I really like Ray Peat’s idea of focusing on healing your endocrine system before trying testosterone. Unfortunately for me, I can’t avoid testosterone cypionate, but if there’s any way you can, I’d look into it.

Have you had your pregnenolone and DHEA levels checked? I got mine checked after reading some insightful haidut posts and found that my levels were really low. That’s what 20+ years of steroids will do to your endocrine system. I supplement with pregnenolone and DHEA now and it helps a lot.

Do you have acne problems?

 

[EIRE24]

Hi. Long time reader, first time poster here. I’ll keep this as short as I can.

I’m a man, mid-thirties, and on testosterone replacement therapy. And I need to be for my entire life. I have bilateral congenital anorchia, a rare condition that causes a normal XY boy to be born without testicles. I’ve been taking testosterone cypionate injections since I was 12.

If you read that and thought “wow, that’s rough”, it’s no picnic. But overall my life is pretty awesome. And since I started Peating 5 months ago, my life has gotten even more awesome. However, I have a few lingering problems and could use some advice.

Current issues:

1. Acne. You take steroids, you get acne. I’ve had acne since I was 12 and can only keep it under control using the acne.org regimen. But I’m looking for a permanent solution. Peating has improved my acne but not solved it.

2. Eczema. I get it on my fingers. It comes and goes. It has also improved since I started Peating but won’t go away.

3. Dandruff. It’s not much, but it’s there.

4. Hair loss. Very common with steroid users. I’m a Norwood 2A or a 3.

My stats:

Height: 6’5”

Weight: 220 lbs

Body temperature: Since Peating, between 98.4 F – 99.2 F, depending on the time of day. It used to be around 97.5.

Resting pulse: between 75 -90. Used to be about 60.

Blood pressure: 140/80. Used to be way, way lower.

My build:

I have a lean and muscular build. Thanks to steroids, I can build muscle just by looking at a set of weights. Before I started Peating I was a runner, and a pretty good one for how big I am. Now I just lift weights and row.

My diet:

My diet is about as Peat-y as it gets. I eat between 3,000 to 4,500 calories a day. Skim milk, eggs, cheese, gelatin, orange juice, lemonade, oranges, steak, ice cream, coffee, Mexican coke, sugar, daily carrot salad, celery, and salt. Lots of salt. I also eat 4 ounces of beef liver a week, sautéed mushrooms 3-4 times a week, and a can of oysters twice a week. I avoid gluten and PUFA as much as I can.

Before Peating I was paleo, like so many people here.

I stopped drinking all alcohol about 8 months ago.

My supplements (daily):

5,000 IU Vitamin D

200 IU Vitamin E mixed tocopherols

100,000 IU Vitamin A palmitate (topical)

10 mg Vitamin K2 (topical)

150 mg B1

A pinch of B2 powder

1500 mg Niacinamide

325 mg aspirin

1 mg cyproheptadine

2 tablespoons coconut oil

1 teaspoon baking soda dissolved in water

1/32 teaspoon cascara sagrada

5 mg pregnenolone and 5 mg DHEA 5 days a week. I skip them on the days I do my steroid shots.

I used to take t4 + t3 supplements, but since I started experimenting with red light therapy three weeks ago, I don’t seem to need them anymore. Red light therapy has shot my body temperature and pulse up more than thyroid supplements ever did.

Improvements noticed so far from Peating:

- A dramatic improvement in my hair quality. Thicker, fuller, shinier. The same lady who’s been cutting my hair for years comments on it when I get my hair cut, as have a few friends that I hadn’t seen in a while. I can’t say I’ve seen any real regrowth yet, but it’s only been 4 months.

- Big reduction in stress.

- Feeling a lot more awesome in general.

- Better concentration, better focus, better creativity.

- Younger, tighter, smoother skin (except for the acne). I believe it’s due to the pregnenolone and gelatin. If I had all of my hair, I could probably pass for 25.

- And most importantly of all… I was able to reduce my steroid dosage from 150 mg of testosterone cypionate a week to 100 with no loss of libido, energy, or focus. This is a really big deal, and something I tried and failed several times before.

My thoughts on next steps:

My already demonic metabolism is only getting faster since I started Peating. Am I getting enough nutrients? My latest Vitamin A bloodwork shows my A levels are almost too high. How much vitamin A is too much?

I know long term steroid use can stress the liver. Is there more I should be doing for my liver?

Summary:

I used to have a lot of health problems that made my life less than awesome until I decided to take my health into my own hands. Peating has given me impressive results so far, and the more I get into it, the better things seem to get. This forum has a lot of fantastic information and I thank you all for the help I’ve found here so far. I only have these few issues left.

I look forward to your recommendations. Also, if anyone has any questions about my results from Peating, my methods, or the laundry list of drugs and supplements I’ve tried in my life (it’s been a lot), just ask.

Strange that you are taking such a high dose of A and levels showing high and you still have acne.

 

[samson]

Strange that you are taking such a high dose of A and levels showing high and you still have acne.

I agree. My last Vitamin A serum level was 81 on a scale of 24-85. I wonder if the Vitamin A is staying in my bloodstream and not getting into my cells properly. I take ribloflavin (B2) to help with this, and it seems to calm my acne a little.

I've been trying something new over the last few days. I upped my coconut oil from 1 tablespoon a day to 3. Morning, noon, and night. It has increased my waking temperatures a bit, upped my libido, and made me feel more energetic. It also caused my worst acne breakout in years. I've seen people online mention similar problems when they take more coconut oil. Supposedly it can be due to candida die off. If that's a real thing, then Ray Peat said in an interview that flowers of Sulphur are supposed to help. I ordered some sulfur powder, aka brimstone, 99.5% pure, from Amazon. I believe that is the same thing.

 

[Smee]

Yes, this stuff is complicated. I’ve been taking steroids since I was 12 and am still learning.

No, I don’t take HCG or an AI. I’ve thought about HCG and should probably get my levels checked. I don’t take an AI because I manage to keep my estrogen levels low without one. When I was on my old dose of testosterone cypionate, my T levels were about 1025 (above normal) and my estrodial was only 30.5 (high-ish normal).

Now my T is about 768. I need to get my estrogen checked again.

It took me a long time to learn how to get my estrogen this low.

Here’s a few things that have helped me:

- Hit the weights. When it comes to bulking up, we have an unfair advantage. Use it. Don’t lift too heavy, though.

- Avoid all phytoestrogens. Absolutely no soy, flaxseed, or anything estrogenic.

- Watch your blood sugar. Hypoglycemia and steroids go hand in hand. Eat often and make sure you eat enough.

- Don’t drink alcohol. This was one of the biggest game changers for me. I used to be a heavy drinker. Then I stopped, and now I feel so awesome I don’t miss it at all. If you drink, try holding off for 30 days and see how you feel.

You said you are hypogonad… how did the doctors determine this? Bloodwork?

I really like Ray Peat’s idea of focusing on healing your endocrine system before trying testosterone. Unfortunately for me, I can’t avoid testosterone cypionate, but if there’s any way you can, I’d look into it.

Have you had your pregnenolone and DHEA levels checked? I got mine checked after reading some insightful haidut posts and found that my levels were really low. That’s what 20+ years of steroids will do to your endocrine system. I supplement with pregnenolone and DHEA now and it helps a lot.

Do you have acne problems?

I was put on HCG from the start so I have no idea if it is helpful or not. The doctor's reasoning on it was that exog T would downregulate LH, which has many downstream functions other than stimulating T production, and that HCG is an analog to LH. Also, I am 34 so retaining fertility would be nice too.

I haven't had my T measured since dropping my dose but I hope mine is as high as yours at this dose. Mid 700's seems ideal. Also no idea on my e2 levels now that I have dropped T dose and AI. I will find out today or tomorrow, I think.

I have been getting my T prescription from a TRT clinic, which has been quite expensive (200 dollars/mo.). Yesterday I was able to get in to see an endo for the first time hoping that he would allow me to continue my treatment so I could bill it through insurance instead of paying out of pocket. He was OK with the T dose (125 mg/wk) but didn't believe in using HCG or AI (though he did not seem to know much about either). He also agreed on the primary hypogonadism diagnosis, which was made back in July of last year based on LH and FSH labs, which showed relatively high normal levels (which from what I understand would be low if I were secondary). This doctor also ordered an MRI of the pituitary (with contrast), which I am not sure I want to do - is this as bad as an xray? worse?

I am doing most all of what you recommend now, so that's good. I exercise with weights/calisthenics 3x/wk, don't drink, and never eat soy.

"I really like Ray Peat’s idea of focusing on healing your endocrine system before trying testosterone. Unfortunately for me, I can’t avoid testosterone cypionate, but if there’s any way you can, I’d look into it."

I was under the impression that with primary hypogonadism I would be at permanently low T levels if I did not take any exogenously.

I have not had my DHEA levels checked (though I take 5 mg with coconut oil daily), but I have had my pregnenolone levels checked back in December. The test result was <10 ng/dL (reference range <150 ng/dL). My doctor (TRT clinic) didn't seem to think this was a problem, but I know from reading this board that it probably is. The endo that I saw yesterday said there is no such thing as a pregnenolone (or progesterone) deficiency "in the USA" (whatever the **** that means lol). I assume he meant that it is not common. He said that the TRT doctor should have never even have checked those labs. I take 30 mg capsule daily along with the DHEA. (my progesterone was also low, <.1, range .0 - .5, as was my serum cortisol take in a.m. - 7.6 ug/dL, range 6 - 19; I'm not sure this is a problem from what I can gather and the test was performed at like 9 a.m. after I'd been awake for nearly 4 hours; the endo I saw yesterday says he wants to recheck it). How much pregnenolone and DHEA are you taking? Did you have your progesterone levels checked? I'm curious if this is a problem that I had before taking testosterone or if this is something that is caused by it, but there is no way of knowing now I guess.

Thanks for your help. Awesome to be able to talk to someone with long TRT experience that is also familiar with Peat's ideas.

 

[samson]

Smee, if I were in your shoes, the main question I would be asking is “Why am I hypogonad?”

You’re 34. You are way too young for it to be because of aging. Unless you have some medical condition like I do, your doctor might tell you that it just happens or it’s unknown. But I wouldn’t accept that. I would take inventory of everything you’re doing, everything you’re taking, and everything you’re eating. Any and all prescriptions, over the counter meds, and even bathroom products. Everything.

Write them all down. Write down everything you eat in a few weeks, from the cheese sticks at lunch to the Coke after your workout. Then start looking online for anything that might be estrogenic. Plug your food into cronometer.com if you haven’t already and see where you might have any deficiencies.

Are you under extreme stress? Everyone is under stress these days, but how extreme is your stress? That will drop your T levels fast.

So will chemicals like parabens. I use as natural of bathroom products as I can. I wash my face with sulfur soap, use paraben free deodorant, and use apple cider vinegar for shampoo. I used to need powerful anti-perspirants to avoid smelling like a dairy farm, but ever since I started using magnesium sprays and soaks, I don’t smell anymore.

All of this is very important because if you need 125 mg of testosterone cypionate a week to feel good, I think you may have some kind of testosterone uptake/utilization issue. I’m the size of a freight train and have 0 natural testosterone production and seem to be doing fine with 100mg a week.

You may also find that as your health improves, as you start feeling better, you need less testosterone.

I hope this helps.

 

[churchmouth]

After messing with vit A to 25k IU daily for a while, my acne never improved.

Interestingly, a different view on vit A here : Acne

 

[samson]

@churchmouth Wow, that is an interesting article. Excess iron is a known side effect of prolonged steroid use. I donate blood as often as I can to help mitigate this (@Smee I recommend you look into that too) and every time I donate, they tell me my iron levels are almost too high.

My diet is low iron right now, but it didn't used to be. I also used to be a heavy drinker, so I bet I have a ton of iron built up in my system. I have looked into this before but I bet I am not doing enough to address this.

Thank you very much for the link.

 

[churchmouth]

@churchmouth Wow, that is an interesting article. Excess iron is a known side effect of prolonged steroid use. I donate blood as often as I can to help mitigate this (@Smee I recommend you look into that too) and every time I donate, they tell me my iron levels are almost too high.

My diet is low iron right now, but it didn't used to be. I also used to be a heavy drinker, so I bet I have a ton of iron built up in my system. I have looked into this before but I bet I am not doing enough to address this.

Thank you very much for the link.

I didn't correlate any improvement in my acne with donating blood unfortunately (tanked my ferratin levels to almost bottom range though).

However it all still hit home with me, as over the last decade I seem very reliant on red meat (pretty much every meal, everyday), and a reduction is one of the few things I haven't tried.

So I am being more diligent with lowering my portions of red meat, avoiding fruit with red meat (vit c might increase iron absorption) and consuming coffee with the red meat meals.

 

[samson]

I hardly had any acne problems when I was a teenager. My acne didn't start getting bad until I was older. Years of fluctuating hormones started taking their toll on me. Back in my twenties, I was taking one testosterone shot every two weeks. Talk about a roller coaster...

My acne over the last 9 months has been fluctuating between horrible and almost clear. It's weird. It will get steadily better over five or six days and then suddenly get horrible. I've tried to see if it's linked to my steroid shots, anything I'm eating (right now my diet is the same every single day except the days I eat liver or oysters), or anything I'm doing. So far I've come up with nothing.

So I am being more diligent with lowering my portions of red meat, avoiding fruit with red meat (vit c might increase iron absorption) and consuming coffee with the red meat meals.

Yeah, I ate a ton of fruits with meat while I was on the paleo diet. Now I drink milk with my evening steak, but I've been having an orange for desert. Not good. I'm stopping that for now.

After looking at Nathan Hatch's blog, I stopped my Vitamin A supplements for now and ordered some lactoferrin (never tried it). I'm also experimenting with small doses of tetracycline. I took my first dose today.

Church, what is your diet and supplement routine? Are you taking any testosterone?

 

[Baltazar]

@samson

I'm on trt and somehow
Did it for the same reason

Are you doing blood tests ?

How's your fat intake
?
Do you eat ground Chuck beef ?
Olive oil ?

 

[Baltazar]

How do you take preg and dhea ?
What brand and TD or what ?

 

[benaoao]

Keep in mind TRT and Peating (high fructose) will lower SHBG so that you have more free e2. Estradiol tests show total estradiol. Typically free T% is higher when T is injected exogenous compared to natural men with the same total T. I’d expect the same with free vs total estradiol. Hence acne seen when total estradiol seems normal... I’d lower T a bit for a lower e2.

You may also have food sensitivities. How are your cholesterol + triglycerides usually?

That being said, this is a lot of supplements and maybe slowing down on the vitamins megadoses, alongside a better hydration; that shall help.

 

[stsfut]

Great thread. I am also a young male on TRT and trying to look at it through a Peat prism.

 

[Baltazar]

Dhea usually gimme acne terrible ones

 

[Sobieski]

It comes down to primary hypogonadism (Testes malfunction) vs secondary (pituitary). Primary means you're more likely to need TRT. Secondary, like I was, means that more carbs, less pufa means less restriction on LH conversion to steroids, so it can be resolved naturally (I did it).

 

[Smee]

Keep in mind TRT and Peating (high fructose) will lower SHBG so that you have more free e2. Estradiol tests show total estradiol. Typically free T% is higher when T is injected exogenous compared to natural men with the same total T. I’d expect the same with free vs total estradiol. Hence acne seen when total estradiol seems normal... I’d lower T a bit for a lower e2.

You may also have food sensitivities. How are your cholesterol + triglycerides usually?

That being said, this is a lot of supplements and maybe slowing down on the vitamins megadoses, alongside a better hydration; that shall help.

I was unaware that peat style diet lowered shbg. What modifications to peat can be made to harmonize diet with TRT protocol? As mentioned I have primary and am likely stuck doing injections for the long term (down to 100 mg testosterone cypionate weekly, injected in three divided doses), and I am trying to do all that I can to have hormones and health balanced in spite of replacement. I am following peat style diet but macros closer to 33/33/33%, with carbs split between mostly fructose and starch (potatoes and fresh masa). Only supplements im taking are 30 mg pregnenolone and 5 mg dhea. Also on hcg @ 600 iu weekly (÷3).

 

[Baltazar]

@Smee how are youou taking preg and dhea

 

[Smee]

@Smee how are youou taking preg and dhea

30 mg capsules of preg and 5 mg capsules dhea from Pure Encapsulations.