In this Article I’ll discuss what I did to get my Prescription for Hormone Replacement at a Renowned & Internally Recognized Hospital in Thailand. This Prescription allows me to Legally Travel with a Small Supply of Rotex Medica Testosterone Enanthate & Pfizer Aromasin (Exemestane).
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Blood Work Markers while using Exogenous Hormones
At the Time of deciding to get a Prescription for Testosterone, I had been Blasting & Cruising for Several Years and was on a Moderate Steroid Cycle, consisting of:
• 500mg Bayer Testosterone Enanthate per Week; 250mg on Monday & Friday
• 25mg UGL Aromasin Twice per Week; 25mg on Injection Days (Monday & Friday)
In this Scenario; Total, Free & Bio-Available Testosterone Levels are High & Elevated Above of the Reference Range, Estrogen & Sex Hormone-Binding Globulin (SHBG) was somewhere in the Middle of the Range and both Luteinizing Hormone (LH) & Follicle-Stimulating Hormone (FSH) were below the Reference Range. I did not confirm this with Blood Work before attempting to get a Prescription, as I’ve done so much Blood Work over the Years that it’s very easy for me to KNOW, what my Blood Work should look like in certain Situations.
However, in my own Specific & Personal Case, as long as I only use Testosterone as the Sole AAS in the PED Protocol, my FSH Levels tend to stay within the Reference Range, albeit at the Bottom of the Range. I’ve seen this on Blood Work of Coaching or Consultation Clients only a very small Amount of Times, I’d say less than 5 Times in Total, including my own Blood Work. FSH Levels within the Reference Range while using Exogenous Testosterone, is about as Rare as a Drug-Free Individual, with a Total Testosterone Level of 1,000ng/dL or Higher. Which I’ve also seen a Handful of Times in my 7+ Years of Coaching Drug-Free Body Builders & Blood Work Analysis.
Prescription-Favorable Sex-Hormone Panel
Needles to say, Excessively High Testosterone Levels with Bottomed Out LH & FSH Levels will raise a Red Flag with the Endocrinologist and doesn’t make anybody a Candidate for Testosterone or Hormone Replacement, unless you’re Working with a Very VERY Progressive Endocrinologist.
In order to get a Legitimate Prescription, I’d have a show I’m Suffering from a Hypo-Gonadal State and Prove this to the Endocrinologist with Blood Work . The Following Hormone Markers play a Factor in States of Hypo-Gonadism:
• Total Testosterone; either Below or Bottom of the Reference Range
• Free Testosterone; either Below or Bottom of the Reference Range
• Bio-Available Testosterone; either Below or Bottom of the Reference Range
• Estrogen; within Bottom to Middle of the Reference Range
• Sex Hormone-Binding Globulin (SHBG); within Bottom to Top of the Reference Range
• Luteinizing Hormone (LH); either around the Bottom or Top Part of the Reference Range
• Follicle-Stimulating Hormone (FSH); either around the Bottom or Top Part of the Reference Range
NOTE: Albumin or DHT Levels usually aren’t Considered when Diagnosing a State of Hypo-Gonadism, although Testosterone & DHT do Weakly bind to Albumin Levels in the Blood, most Endocrinologist will look at SHBG Levels over Albumin and Total Testosterone Levels over DHT (unless also Suffering from Hair Loss and/or Benign Prostate Enlargement)
Keep in mind that TRT & HRT is a Relatively new Medical Field and doesn’t follow Exact Set Guidelines. Standard for a Testosterone Prescriptions vary from Country to County, State to State and Endocrinologist to Endocrinologist. Or there’s no Standard at all and you’re not able to get a Prescription in the First Place, because the Medical Field in your Residing Country is still stuck in the Stone Age!
How to Simulate Male Hypo-Gonadism
In my Case, it was very Straight Forward. I stopped Injecting Testosterone when I decided to use attempt to get a Prescription, I also stopped the use of Aromasin in order for my Estrogen & SHBG Levels to increase slightly to the Ranges mentioned Above. Although Aromasin has a Half-Life of around 24 Hours, it has an Active Life of about 5 Days. While Testosterone Enanthate has a Half-Life of around 10.5-12 Days, with an Active Life of 1 Month or Longer (depending on Carrier Oil used).
Serum Testosterone & Estrogen Levels
Meaning that Serum Testosterone Levels are still Sufficiently Elevated, as the Aromasin is Metabolized from your System. This allows for a Significant Amount of Aromatase Activity, resulting in Higher Serum Estrogen & SHBG Levels. While the Serum Estrogen Levels slowly taper down, as the Testosterone Enanthate taper down, SHBG Levels stays Elevated in the Decline or Absence of Sex-Hormones, due to it’s Relatively Long Half-Life of around 7 Days.
This Method of Stopping Testosterone Enanthate & Aromasin at the same Time, will result in Low Testosterone Levels & Medium Estrogen & SHBG Levels over the Course of about 4 Weeks. However, this Method doesn’t keep Factors in Consideration, which could change Aromatase Activity or SHBG Production / Metabolism.
Aromatase Activity is decreased by Increases in Serum Prolactin, Anti-Müllerian hormone (AMH) & Glyphosate (common Herbicide) and can be Inhibited by the Following Compounds; Apigenin, Catechin, Nicotine, Resveratrol, Vitamin E, Zinc, Proviron, Masteron as well as Aromatase Inhibitors. Certain Medications are also known to Inhibit or decrease Aromatase Activity, although they’re not Commonly used by Fitness Enthusiasts or Body Builders.
On the Opposite End, Aromatase Activity can increase due to High Body Fat Levels (over 12%), Systemic Presence of Nandrolone (Endogenous Intermediate in Conversion of Testosterone to Estradiol) or High-Stress Situations.
Serum Sex Hormone-Binding Globulin Levels
SHBG is Predominantly Produced by the Liver, from which it’s Released into the Blood Stream. The Brain, Testes (in Men) or Uterus & Placenta (in Women) also Produce SHBG and release it into the Blood Stream, albeit in far Lower Amounts compared to the Liver.
Injection Frequency, High Dosages of AAS, Usage of DHT-Derivatives, Growth Hormone Usage, Impaired Liver Function & Low Estrogen Levels (due to Overuse of AI or Exclusion of Testosterone) all Contribute to Low SHBG Levels. While High SHBG Levels are Rarely, if ever, seen when using Exogenous Hormones, even as Low at 50mg Testosterone per Week.
4 Weeks after my last Testosterone Injection & Aromasin Administration, my Testosterone Levels had Significantly Declined to the Bottom of the Reference Range, while Estrogen & SHBG Levels were somewhere in the Bottom to Middle of the Range, I made an Appointment to Visit the Hospital. In Hindsight, It would’ve been the Perfect Time to Start Post Cycle Therapy (PCT), as ALL Exogenous Hormones had Metabolized from my System and there wasn’t anything to send a Negative Feedback to the Hypothalamus-Pituitary-Testes-Axis (HTPA), which would otherwise Prevent Full Recovery of HPTA Function.
Since I Definitely Noticed all the Symptoms Associated with Low Testosterone; Loss of Libido, Lack of Motivation, Declined Cognition and reduced Ability to Focus on Work, Zero Pump while Working Out and even Unwillingness to go to the Gym at all… I felt it was Time to get the Prescription ASAP, instead of Suffering through a PCT. Without the Immediate need to get my Girlfriend (now Wife) Pregnant, I opted for the Prescription!
Serum Luteinizing Hormone & Follicle-Stimulating Hormone Levels
All I needed to do was to increase my Serum LH & FSH Levels to Indicate a State of Hypo-Gonadism. I used 50mg Clomid (Clomiphene Citrate) before Bed for 3 Days once I had made the Appointment at the Hospital.
Clomid is a Selective Estrogen Receptor Modulator (SERM), that is both an Antagonist as well as an Agonist of the Estrogen Receptor. Clomid binds to Estrogen Receptors in the Hypothalamus, which Depletes ERs Content of the Cell Membranes. This Blocks the Negative Feedback Effect of Circulation Estradiol, which in turn increases Circulating Concentrations of Luteinizing Hormone (LH) & Follicle-Stimulating Hormone (FSH). However, it takes a few Days before LH & FSH Levels reach Peak Concentrations for Full HPTA Recovery, due to their Relative Short Biological Half-Life; 20 Minutes for LH & 3-4 Hours for FSH.
I found that 3 Days of 50mg Clomid per Day, is enough to Acquire Serum LH & FSH Levels at the Bottom of the Reference Range, after Several Years of Blasting & Cruising. For this Purpose, Triptorelin could also be used to increase Serum LH & FSH Levels, but I found the Dosing & Timing of Triptorelin a bit Difficult to Manage. A Single Injection of 50-100mcg Triptorelin brought my Serum LH & FSH Levels close to the Top of the Reference Range, merely 4 Days after Administration.
Acquiring the Prescription
Long Story Short; I Discontinued Testosterone & Aromasin for 4 Weeks, then took 50mg Clomid per Day for 3 Days, went to meet the Endocrinologist to Explain / Complain about my Symptoms of Low Testosterone, did a Full Blood Work Panel to assess my Current State of Health & Hormone Balance, Qualified for HRT & Walked out with a Prescription for 150mg Bayer Testoviron (Testosterone Enanthate) & One 25mg Tablet Pfizer Aromasin (Exemestane) per Week. A Nurse Administered my “First” TRT Injection and Showed me Safe & Sterile Injection Techniques so I could do my own Injections at Home.
Unfortunately I don’t have the Blood Work Results which Qualified me for the Hormone Replacement Therapy Prescription. The following Values are based on Memory of the Consult a few Years ago, while Discussing my Hormone Levels with the Endocrinologist:
• Total Testosterone; Below the Range around 200ng/dL, Reference Range: 240.0-980.0 ng/dL
• Free Testosterone; Bottom of the Range around 4ng/dL, Reference Range: 2.29-21.2 ng/dL
• Free Testosterone (Percentage of Total Testosterone); In Range at 2% based on guestimations above, Reference Range: 1.6-2.9 %
• Bio-Available Testosterone; I honestly can’t Remember…
• Serum Estrogen / Estradiol E2: Bottom-Middle of the Range around 20pg/mL, Reference Range: 10-44 pg/mL
• Sex Hormone–Binding Globulin (SHBG): Middle of the Range around 30nmol/L, Reference Range: 10-60 nmol/L
• Luteinizing Hormone (LH); Bottom of the Range around 2.0mIU/mL, Reference Range: 1.0-9.0 mIU/mL
• Follicle-Stimulating Hormone (FSH); Bottom of the Range around 3.5mIU/mL, Reference Range: 1.0-13.0 mIU/mL
NOTE: I’ll Request a Copy of my Blood Work Results from the Hospital where I’ve got my Prescription from, when I go to get my Script Extended!
Depending on the Endocrinologist, Clinic, Hospital and National Guidelines & Restrictions in regard to Hormone Replacement Therapy, the Prescription might be anywhere between 50-350mg Testosterone per Week. Some Countries tend to Prescribe Enanthate, while others Prescribe Cypionate, in some Cases the Undecanoate Ester is Prescribed in Countries where Self-Administration of Testosterone, falls outside of the Medical Guidelines for a Testosterone Prescription.
NOTE: Nebido (Testosterone Undecanoate) is often a Single Injection of 1,000mg/4ml into the Glute, or 500mg/2ml in both Glutes (upon Request), which Supposedly Lasts for 12 Weeks. However, most Users of Nebido notice a Severe Decline in Testosterone Levels after 8 Weeks and prefer Bi-Weekly Administrations of Testosterone Enanthate or Cypionate over Undecanoate!
It all Highly Depends on where you’re getting your Prescription from and the National Guidelines & Restrictions you’re subject too. Before you attempt to get a Prescription, make sure you Understand the Entire Process, (Potential) Costs, Insurance Limitations, Commonly Prescribed Weekly Milligram Dosage of Testosterone & Follow Up Medical Obligations, to assess if it’s even worth your Time & Money, or Grey-Area Self “Prescribed” Testosterone usage is a more Suitable Approach to TRT / HRT.
Medical Obligations to Maintain the Prescription
This also depends on where the TRT / HRT Script was Prescribed & Filled. In some Countries you’re only able to get One 10ml Vial of Testosterone Cypionate at 200mg/1ml, for a 10 Week Supply of 200mg Test Cyp per Week. While others allow you to Walk out of the Hospital with an Entire Years’ worth of Hormones, given it doesn’t reach the Expiration Date prior to Finishing the Prescription.
Here in Thailand I can Extend my Prescription every Year with a Blood Work Consultation, without having to Purchase the Testosterone or Aromasin from the Hospital Directly. Keep in mind that I’m Paying everything out of my own Pocket and don’t rely on the Health Care System to Finance my Prescribed use of Hormones. I buy my Rotex Medica Testosterone at the Pharmacy and can use as much as I like; Cruising at 250mg per Week and Blasting at 1,750-2,000mg per Week, until I need to Extend the Prescription and reduce my Testosterone Intake to 150mg per Week. To be 100% Transparent, due to the Extremely Price Markup on Pfizer Aromasin, I often use UGL Aromasin which keeps my Serum Estrogen Levels in Range just the same on Cycles over 500mg Testosterone Enanthate per Week!
In the Years that I’ve had my Prescription, Bayer Testoviron has been Pulled from the Market and my Prescription has been Changed from Bayer to Rotex Medica Testosterone Enanthate, while my Prescription for Pfizer Aromasin hasn’t changed.
In order to Extend my Prescription with another Year, I need to Visit the Hospital for a Yearly Follow Up with the Prescribing Endocrinologist, where we Confirm my Current State of Health with Blood Work, before my Prescription is Extended. Without going into too much Detail about Manipulating Hormone Levels to Acceptable TRT / HRT Levels, below are the Ranges where I Ensure my Markers are when I go for my Yearly Review:
• Total Testosterone; Top of the Range around 900-1,000ng/dL Reference Range: 240.0-980.0 ng/dL
• Free Testosterone; Top or slightly Above the Range around 20-25ng/dL, Reference Range: 2.29-21.2 ng/dL
• Free Testosterone (Percentage of Total Testosterone); In Range around 2-3%, Reference Range: 1.6-2.9 %
• Bio-Available Testosterone; Top or slightly Above the Range around 200-300ng/dL 40.0-257.0 ng/dL
• Serum Estrogen / Estradiol E2: Middle to Top of the Range around 40pg/mL, Reference Range: 10-44 pg/mL
• Sex Hormone–Binding Globulin (SHBG): Bottom-Middle of the Range around 20nmol/L, Reference Range: 10-60 nmol/L
• Luteinizing Hormone (LH); Below the Range around 0.2mIU/mL, Reference Range: 1.0-9.0 mIU/mL
• Follicle-Stimulating Hormone (FSH); Bottom of the Range around 2.0mIU/mL, Reference Range: 1.0-13.0 mIU/mL
NOTE: The very Large Majority of Men using TRT / HRT will have their Serum FSH Levels Below the Reference Range, around 0-0.5mIU/mL. I’m Relatively Unique with FSH Levels at the Bottom of the Reference Range!
Managing Relations with the Endocrinologist
I Highly Advice EVERYBODY to have an Outstanding Working Relation with your Prescribing Endocrinologist. It might take a Long Time before you find a Progressive Endocrinologist, who’s willing to help you through your Temporary or Chronically Low Testosterone Levels. When you do find an Endocrinologist that’s very Helpful and is able to Provide you with a Script, making your Testosterone Usage 100% Legitimate due to Medical Necessity, you need to Maintain Relations just like any other High-Value Customer Business Relation!
This means never Arriving Late to your Appointment, never Arguing or Questioning your Endocrinologists Decisions when there’s a few Legal Loop Holes to Jump through in order to get a Prescription, Extension or Refill / Top Up. Tokens of Appreciation Highly Depends on Culture, in some Cultures it’s Appreciated, some it’s almost Mandatory and other Cultures find it Highly Offensive and might think you’re attempting to Bride…
Keep in mind that Endocrinologists are Bound to the Medical Field by the Hippocratic Oath and their Hard-Earned Board-Certified Medical License, which took a Decade to Acquire. If you’re unable to get a Prescription, or for whatever Reason, aren’t able to Extend it, there’s several Million People who Frequently use Testosterone without a Prescription or any sort of Medical Supervision. In the Fitness Industry having a Testosterone Prescription for Hormone Replacement Therapy is the Exception, certainly not the Norm!
International Travel with the Prescription
To be Completely Honest, I’ve never been asked to Show my Prescription when I was Traveling in Asia, Dubai, Kuwait or the Netherlands. In most Cases where I had my Luggage Searched by Customs in these Countries, the 1-4 Ampules & Injection Material were Completely Ignored. When I was asked about what my Bayer or Rotex Medica Testosterone Enanthate Ampules & Pfizer Aromasin were used for, I always said they’re the Medications for my Hormone Replacement, but was never asked to Prove this by showing a Script…
On the Opposite End, even though I Live in Thailand Permanently and am Married to a Thai Women, I still have Dutch / Netherlands Nationality. While my Prescription was Written in Thailand, I haven’t Obtained Permanent Resident (PR) Status. I’m currently unsure is my Prescription would be Recognized in Anabolic-Androgenic Steroid (AAS) Phobic Countries like the United States, Sweden or Australia. Even though it’s very easy to get a Prescription in many States of the US, the difference between State & Federal Laws are Confusing to myself and many American Clients who have a Legal Prescription for Testosterone Replacement.
Personally, I wouldn’t Travel to the US, Sweden or Australia with several Ampules of Pharmaceutical Grade Testosterone & Exemestane and my Prescription for Proof of Medical Necessity. Simply because I don’t want to Deal with Customs Officers, Frantically trying to Contact the Hospital and/or Prescribing Physician, who are in Complete Opposite Time-Zones. The last thing I want is to get stuck at the Airport until they’re able to Confirm the need for my Prescription, or Send me Home after Fining or Jailing me for Importing Steroids for Personal use.
When Traveling to these Countries I’d prefer to use a Long-Acting Testosterone like Bayer Nebido (Testosterone Undecanoate), which has a Half-Life of 14-16.5 Days. Although Bayer Nebido is Suspended in Castor Oil, which Extends the Half-Life of Enanthate, Undecanoate & Keto-Laurate Esters to 33.9 Days. This makes Nebido a Suitable Product to use for a Month of Traveling, as a Single Injection of 1,000mg/4ml should Sustain Hormone Levels for up to 1 Month, if not longer.
Keep in mind that using Nebido in as a Single Injection of 1,000mg/4ml, perhaps 2ml per Glute, you’ll get a Significant Amount of Estrogen Conversion within the First Week Post-Administration. This means you’d need to increase AI Dosing for a Week Following the Injection; I prefer 12.5mg Aromasin (Exemestane) per Day or 0.25mg Arimidex (Anastrozole) per Day before Tapering Down to a 12.5mg Aromasin or 0.25mg Arimidex Twice per Week! I throw the (Unbroken) AI Tablets with the Rest of my OTC Health Supplements in their Original Packaging, as I’ve never been asked to show the Content of a Zinc or Melatonin Bottle! However you decide to Travel with your Medication, is Completely your Decision and yours alone to make!!