Testosterone and Diurnal Rhythms

Dear Dr. Dean,

My husband is interested in PropeL. He has been injecting 4 ml of testosterone weekly, and HCG twice weekly to keep his testicles from shrinking. Our question is whether or not he should continue to take these two prescriptions after starting PropeL.

Based on Dr. Wright’s advice, he has already started using DHEA cream, rather than the capsules, and seems to be doing better.

Please advise.

Nell, Richmond, TX

Dear Nell,

There is no problem taking PropeL along with testosterone, since the two act by different mechanisms (see Will Block’s article in the June, 2006 issue of Life Enhancement magazine, available on the LE website).

Figure 1. Diurnal variation of serum testosterone levels each day. The levels are highest in the early morning, dropping progressively during the day.
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The problem with weekly doses of testosterone, however, is that this tends to produce a “flat-line” steady state of testosterone in the body. Testosterone levels normally have a diurnal rhythm — higher in the night and early morning, dropping progressively during the day (see Fig 1).

When hormone receptors are constantly bombarded by their activating hormones, the receptors become progressively less sensitive to the hormone’s effects. Unfortunately, there’s no way that I know of to administer testosterone in any fashion that will mimic the normal daily rhythm.

Like your husband’s physician, I use testosterone injections — but at somewhat higher doses, with longer intervals between injections (usually 200 mg testosterone cypionate every three weeks). Although the levels may be slightly supraphysiologic during the first week, they will drop into the “normal” range during the second week, and may go subnormal during the third week — but that’s OK, as it gives the receptors a “break,” and they’re “hungry” for the next shot. So instead of a daily rhythm, I use a several-weeks rhythm (just as the hormone cycles of a premenopausal woman are about 4 weeks). In this way, I believe the loss of receptor sensitivity can be delayed for many years.

You didn’t mention anything for the excess estrogen that is undoubtedly being produced. Testosterone is aromatized by the enzyme aromatase into estrogen. Excess estrogen can be even more problematic than a testosterone deficiency.

I recommend that your husband take 1 mg of anastrazole (Arimidex) each week to maintain normal estrogen levels — or the dietary supplement DIM (diindolylmethane) 100 mg daily (DIM acts as an estrogen “vacuum cleaner,” metabolizing it via a safer pathway).

Figure 2. The patterns of DHEA measured at 3-hour intervals over 12 hours after awakening.
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Finally, with regard to DHEA: DHEA, like testosterone, has a daily diurnal rhythm, with levels highest from 4 – 8 AM (see Fig. 2). Therefore, I always recommend DHEA be taken first thing in the morning, to mimic the normal cycle. Topical creams tend to be absorbed in the subcutaneous fat, resulting in “flat-line” rhythms, throwing the body out of sync.

Ward Dean, MD

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