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Do You Need Testosterone Replacement Therapy?
How to know if the rewards outweigh the risks of these powerful drugs
9/14/2011 3:27:51 PM
Fact: There is a lot of money to be made in the field of testosterone replacement therapy (TRT).

Nearly three decades after contracting HIV, Nelson Vergel is still going strong.How much money? Despite being a relatively new drug treatment and one that is often not covered by insurance, about $400 million a year is being spent on prescriptions in the United States on these drugs. A lot of money is being invested in research as well. In fact, the National Institutes of Health is currently sponsoring a $47 million study of 800 men with low testosterone levels. This begs the question “If so much money is being spent on using and researching this type of drug therapy, isn’t that proof that it works – at least, for some people?” If there is one individual who can answer this question, that person is Nelson Vergel.

For Vergel, a chemical engineer from Venezuela, the topic of hormone replacement therapy is a personal one because in 1983 he contracted HIV. At the time there were few treatments for HIV, and Vergel was concerned about the possibility of his muscles wasting away. Thus, he chose what he considered one of the only options he had to survive this disease: He devoted his life to studying hormones. This research led Vergel and coauthor Michael Mooney to write Built to Survive: HIV Wellness Guide, now in its fourth edition. But Vergel’s passion didn’t stop there.

Vergel has conducted more than 500 seminars in English and Spanish, in numerous countries. In 1994 Vergel created a national nonprofit organization – the “Program for Wellness Restoration (PoWeR)” – the purpose of which is to disseminate information about how those with HIV can achieve health and productivity. Then in June of 1998 Vergel founded the Body Positive Wellness Center in Houston, which to date has helped more than 3,800 HIV patients live healthier lives. For all the humanitarian and health-related efforts Vergel has made on behalf of the HIV community, the mayor of the city of Houston designated Sept. 13, 2001, “Nelson Vergel Day.”

Vergel’s most recent publication is Testosterone: A Man’s Guide: Practical Tips for Boosting Physical, Mental and Sexual Vitality (, 2010). For the more than 13 million men who are affected by testosterone deficiency, this book provides the latest research on the following topics:

•    How to find a doctor who prescribes testosterone
•    What questions to ask your doctor about starting testosterone replacement therapy (TRT)
•    How to determine the best TRT options for you
•    How to avoid common mistakes made with TRT
•    How diet and medications can affect testosterone levels
•    The truth about nonprescription testosterone boosters
•    Ways to apply for financial assistance from testosterone manufacturers

Asked what the biggest challenge is in educating the public and medical profession about TRT, Vergel replies, “I’ve worked with many doctors over the past 20 years, and many of them have no training in hormone replacement therapy and simply believe that all hormone replacement therapies are bad – with the possible exception of thyroid. But now with more long-term studies being conducted, we’re seeing less of this type of skepticism.”

Testosterone therapy is becoming more commonplace, to the extent that Vergel believes it will soon be a billion-dollar-a-year industry. But if we look back to a time before the recent progress in hormone therapy, the roots of TRT can be found in nearly a century of research – some of which is rather horrific.

Rough Beginnings
Vergel says people have always been fascinated with the role the penis and the testicles play in enabling a man to be a man, such as the belief that “the eating of penis or testicles from animals was a way to improve virility,” and that there is still a big demand for rhino and seal penis.

In 1889 Charles Édouard Brown-Séquard developed a liquid extract from dog testicles and claimed it increased his strength. Extreme experimentation? Not compared to the body of work of Dr. Leo Stanley, the chief surgeon at San Quentin Prison from 1913 to 1951. Vergel says that during this time Stanley performed a variety of experiments on hundreds of inmates. “Many of the experiments involved testicular implants, where Stanley would take the testicles out of executed prisoners and surgically implant them into living prisoners. In other experiments he attempted to implant the testicles of rams, goats and boars into living prisoners. Stanley also performed various eugenics experiments and forced sterilizations on San Quentin prisoners.” Vergel says that Stanley thought his experiments would control crime, prevent the “unfit” from reproducing and even rejuvenate old men.

Fortunately, more practical methods of increasing testosterone would soon be developed. In fact, when research groups led by Adolf Butenandt and Leopold Ruzicka developed methods to prepare synthetic testosterone, they were jointly awarded the 1939 Nobel Prize in chemistry. This led to more effective forms of testosterone drugs, which in the ’50s attracted the interest of weightlifters and bodybuilders. Considered a form of cheating, testosterone was classified in 1990 as a controlled substance, making it illegal to use in the United States without a prescription.

The amount of information about testosterone replacement therapy that Nelson Vergel has acquired in his two decades of study is overwhelming, as anyone who has perused his books will attest. As a sample, here are Vergel’s insights about some common misconceptions concerning testosterone replacement therapy:

The safety of using street testosterone. Vergel says these products are dangerous because often you don’t know what they contain. They are also illegal.

Avoiding treatment because of the cost. Although Vergel says there are some TRT options that cost in excess of $700 a month, there are other methods that are less expensive and some treatment options that are free. Says Vergel, “Some men without insurance or financial means decide not to seek help since they do not know that there are patient assistance programs set up by manufacturers, or that there are compounding pharmacies [which make customized medicines] that can make cheap gels and creams with a doctor’s prescription.”

Not taking into consideration all the factors associated with the treatment. Some factors to consider besides cost are fear of needles and one’s preference for daily versus weekly use.

Believing that there is a single best TRT. Vergel believes that every testosterone option has advantages and disadvantages; this means that a particular option may be more suitable for one person than another. And you don’t have to take injections! Here are some treatment options that Vergel explains in detail in his new book: oral capsules, transdermal (absorbed through the skin) creams or gels, transdermal patches, buccal (sublingual and gum adherent), and pellets that are implanted under the skin.

Not realizing that TRT is a lifelong commitment. You can’t cycle on and off testosterone “to give your body a rest.” Vergel says that when you take testosterone, your testicles stop producing it; therefore, when you cycle off, there is no testosterone in your system. He says this can lead to depression, weight loss, lack of motivation and loss of sex drive, all of which can appear rapidly and with a vengeance. He says that some men “never have their hormonal axis return to normal after stopping testosterone.”

Not knowing how to deal with potential side effects. Vergel says he knows of men who have stopped their TRT because of side effects such as swollen nipples, acne, hair loss and moodiness. He says this is a mistake. “You may just need to readjust the dose, change the delivery method or take a medication to counteract the problem.” And this goes back to finding a physician who is knowledgeable about testosterone replacement therapy.

Not understanding the effects other medications can have on your treatment. Vergel says some doctors may blame testosterone for adverse side effects when it is taken concurrently with other medications. As a result, these doctors may want to take these patients off TRT because they think it is the cause of these problems.

Believing that testosterone can counter the effects of poor health habits. Vergel refers to a “testosterone-friendly lifestyle” that does not include drinking, smoking, lack of exercise or eating poorly.

Being afraid to switch doctors. Vergel advises against regarding your doctor as an “unquestioned authority.” If your program is not working, don’t be afraid to switch doctors.

Being noncompliant. Proper testosterone therapy requires good time management; failing to follow protocols will result in poor results.

Believing that TRT is a life extension treatment. Vergel says that determining if TRT helps to extend life would be difficult to determine. “That is almost an impossible study to do, but that being said, there is some evidence in small studies that with TRT there is an improvement in lean body mass. Lean body mass is correlated to survival in any pathology – that is, the more lean body mass you have, the greater your chances of survival. In that context, TRT may help extend life.”

Not keeping current with the latest research. Vergel recommends networking with other patients and participating in online groups that discuss testosterone replacement therapy.

Is testosterone therapy for you? That is a complex question you need to discuss with your doctor. But before making that potentially life-changing appointment, educate yourself on the latest research in the field by picking up a copy of Nelson Vergel’s remarkable book Testosterone: A Man’s Guide.
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