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Urology/Testosterone and Muscle


QUESTION: Hello Mr. Suppe

Although prior to TRT my testosterone levels were in the low 300s, I always maintained a noteworthy amount of muscle mass, although I certainly was not as strong as I once was and I struggled to add more despite the fact that I have been lifting for some years now.  Is this common?  Could I have had enough testosterone to keep muscle but not enough for a satisfying libido?

ANSWER: Chris,
1st I would like to know your age ? Secondly what form of TRT did you have prescribed (pellets, shots or gel ? And finally what was the dose ? Many physicians under-dose patients due to fear of the unknown like possible cancer acceleration, elevated RBCs ect. If you are hypogonadal (Low T) and want to bulk up some then testosterone cypionate inj 1cc a week is very safe. The depot testosterone is clinically rated for 14 days but through our extensive evaluation here at Baylor we see men crashing to hypogonadal numbers by day 14 we do not prescribe less than 1cc Q10 days and 90% of all men are Q7 days because they feel better with less roller coaster effect. I can also give you tips off the forum that will help, look my email up at and e-mail me . Best wishes.

---------- FOLLOW-UP ----------

QUESTION: Hello Mr. Suppe

I am 24 years old

I was prescribed 200mg (1cc) of Testosterone cypionate in the form of injections every two weeks

It has been six weeks since my first shot and I recently had my levels checked about three days after the shot because for some reason my urologist wanted to see me the same week of an injection.  My testosterone was up to 1540.

Bulking up was not my primary motive for going on TRT.  It was a diminished libido which I had been suffering from for about a year and a half.

Reason I asked this question was that I always thought it was unusual that I still had some muscle despite borderline low levels, but having a nonexistent libido at my age was unacceptable at my age.  I also heard it can take some months for erectile function to fully recover.

1540 is a normal number for post 3 days injection, testosterone cypionate will spike within 48-72 hrs post injection and and diminish down to where you were prior within 21 days. Just because a T is in the 300s it will not create wasting of musculature, the muscles are maintained by nitrogen content, hematocrit and hemoglobin. The red blood cells are the repair center for muscles and if your RBCs are fine then no wasting takes place. The T at 300 can be common for low libido. No it does not take months for libido to recover but it does take consistent administration of T to keep it once it is back. The fact you are 6 weeks out from injection is counterintuitive to improving libido. I would hope the doctor made you aware that exogenous T will cause infertility this is why with patients your age we recommend clomid-HCG (human chorionic gonadotropin) to boost endogenous T from the testes so it does not halt sperm production (spermatogenesis) from shots.  


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Thomas A Suppe RDMS CLT


Invervential urologic radiology , urologic laser surgery, cryotherapy of the prostate and kidney, extracorporal shockwave lithotripsy, holmium laser lithotripsy, urodynamics (video-non video),male infertility, erectile dysfunction, Peyronies disease, hypogonadism ,kidney stones, prostate cancer detection, BPH, voiding dysfunction, bladder cancer and continent diversions.


For the past 20 years performing intervential and diagnostic uro-radiology for a multitude of urologic surgeons from New York, New Jersey, Lousianna and Texas. Founder of DMS medical LLC introducing the Texas Medical Center to the first high power Green Light laser for the treatment of BPH just after its release by the FDA from Laserscope and its sucessful trials at the Mayo Clinc.

American Registery of Diagnostic Medical Sonographers (ARDMS), American Urologic Assocoation (AUA), American Medical Systems (AMS) Laserscope,Oncura, Allergan and Auxilliam pharmaceuticals.

Comprehention of Urologic Ultrasonography for the Resident Physician (Journal of Urology 2012), Author of the syllabus for the uro-radiology residency course at The Scott Dept of Urology at Baylor College of Medicine Houston Texas (2010 to present). Past Clinical Studies: Principal radiology investigator Allergan Inc for "The treatment of BPH with intra-prostatic injections of Botox" with Larry I Lipshultz MD 2011-2012, principal radiology investigator for Allergan Inc for "The treatment of Peyronies disease by intra-lesional penile injections of Botox" with Mohit Khera MD MBA MPH (2011-2012). Current studies: Principal investigator of "Blood pressure risk factors of intra cavernosal injections of Trimix and PGE1 during Penile Duplex's.

BS from Ramapo College of NJ, Registered diagnostic medical sonographer with the ARDMS, 2 year fellowship of Uro-Radiology and intervential sonography at Baylor College of Medicine Houston TX, laser safty officer in state of Texas and certified in KTP, Holmium and Lithium Tri-boride laser systems from Laserscope San Jose, California and American Medical Systems Minnatonka Minnasota, trained and certified by Oncura Inc Isreal in ultrasound guided argon cryotherapy of the prostate and kidney.

Awards and Honors
Honorary instructor of GU ultrasound course 2012 international meeting of the American Urologic Association. Author of the the AUA course for "Ultrasonography of the Testes and Scrotum" 2012.

Past/Present Clients
Baylor College of Medicine (BCM) Lousianna State University (LSU), LSU Medical Center Shreeveport LA, The Methodist Hospital Houston Texas, St Lukes Episcopal Hospital Houston Texas, Memorial Herman Health Systems Houston Texas, Palestine RMC Texas, Doctors Regional Hospital Corpus Christi Texas, Valverde Regional Medical Center DelRio Texas, Current instructor/technologist for two internationally recognized urologists : Larry I Lipshultz MD and Mohit Khera MD, MBA, MPH at Baylor College of Medicine. I served as intervential sonography consultant for Oncura Inc cryotherapy systems. Former lead trainer for Urosource mobile medical services , training new surgeons in PVP or photo-selective vaporization of the prostate for BPH, BNCs and urethral stricture vaporization.

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