Highly effective treatment of Fibromyalgia and Chronic Fatigue Syndrome—results of a placebo controlled study and how to apply the protocol

Townsend Letter for Doctors and Patients, Oct, 2002 by Jacob Teitelbaum

For men, the standard dose is about 100 to 125 mg by intramuscular injection (IM) every seven to ten days. It can also be given as 200 mg each two weeks, but this can result in peak levels (right after the shot) that are too high, and levels that go too low for a few days before the next shot. Adding the testosterone patches on day nine through fourteen (when getting the shot every fourteen days) can avoid the levels going too low. I feel that giving the shot weekly is much better, however. I use Delatestryl 200 mg/cc and give 1/2 or 6/10 cc every seven to ten days. Unfortunately, the skin patches alone are not adequate for the job. Although I've avoided using testosterone tablets in men, testosterone cream (100 mg/gm in PLO Gel) 25 to 50 mg 1-2 x day (available from most compounding pharmacists) can be very effective. I will sometimes wait until after a patient has been on the shots for eight weeks so he can tell what the optimum effect is. The problem (for men) with taking tablets instead of transdermal cr eams is that oral testosterone goes to the liver first. The higher dose in men (versus women) can sometimes raise cholesterol levels (cholesterol is produced by the liver). Avoiding other possible side effects by taking the transdermal hormone daily, instead of getting high and low levels by taking it IM every week or two, may be another benefit of the transdermal creams. The benefits of treatment (it takes six to eight weeks to see the effect) are often dramatic. Androderm gel (25 and 50mg/5cc) is also now available in most pharmacies, but is much more expensive than compounded testosterone.

For women, the treatment is easier. Natural micronized testosterone (and natural estrogen and progesterone) are available through most compounding pharmacies. Belmar pharmacy and Cape Drugs are two of many that do mail-order prescriptions. The usual dose is 2 mg one to two times a day by mouth (po) or transdermally (4mg/gm cream). If the patient needs estrogen or progesterone, these hormones can be combined in the same capsule for a lower cost.

I check free testosterone blood levels (in men and women) six to eight weeks after starting therapy (in men, before their eight-week shot) and adjust the dosing accordingly. Blood levels are not reliable, however, if the patient is taking synthetic methyl testosterone instead of natural testosterone. In addition, blood levels for oral or transdermal dosing peak at about two to three hours and are back to baseline by five hours, so the blood level should be checked two to three hours after oral or transdermal dosing.

In women, if acne, intense dreams, or darkening of facial hair occurs (as can occur with DHEA as well), the dose is too high and should be decreased (these are usually reversible). These side effects can also be caused by estrogen being too low, relative to the testosterone level and may be avoided in women by supplementing both together. In men, acne suggests the dose is too high. It is important to monitor levels because (as in body builders who abuse testosterone by taking many times the recommended physiologic dose) elevated levels can cause elevated blood counts, liver inflammation, decreased sperm counts with infertility (also usually reversible) and elevated cholesterol with increased risk of heart disease. Because of this, in men, I would monitor a CBC, cholesterol, and liver enzymes intermittently. Testosterone supplementation can also cause elevated thyroid hormone levels in those taking thyroid supplements. If the patient is on thyroid supplements, I would recheck thyroid hormone levels after six to twelve weeks or sooner if they get palpitations or anxious or hyper feelings. Raising a low testosterone level has been shown repeatedly to lower cholesterol, decrease angina and depression, and improve diabetes. Unfortunately, our training mostly focused on the effects of abusing testosterone with pharmacologic and illicit dosing.