How do I safely cycle testosterone with peptide therapy, such as growth hormone-releasing peptides (GHRP), under medical supervision?

Safe Cycling of Testosterone with Peptide Therapy

Testosterone therapy should not be cycled with peptides like growth hormone-releasing peptides (GHRPs) without medical supervision, as exogenous testosterone can suppress natural hormone production and affect fertility. 1

Understanding Testosterone Therapy

Testosterone Formulations

• Testosterone is available in several formulations, each with specific advantages and disadvantages 1:
  • Long-acting injections (testosterone enanthate/cypionate): 100-200 mg every 2 weeks or 50 mg weekly
  • Transdermal gels/patches: Applied daily to skin
  • Subcutaneous implants (pellets): 150-450 mg every 3-6 months
  • Buccal tablets: 30 mg twice daily

Target Testosterone Levels

• Clinicians should adjust testosterone therapy to achieve levels in the middle tertile of the normal reference range (450-600 ng/dL) 1
• Monitoring should occur 2-3 months after treatment initiation and after any dose change 1

Important Considerations and Contraindications

Fertility Concerns

• Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive or planning future fertility 1
• Testosterone therapy interrupts normal spermatogenesis and can cause severe oligospermia or azoospermia 1
• Recovery of sperm to the ejaculate after cessation of testosterone may take months or even years 1

Cardiovascular Considerations

• Testosterone therapy should not be commenced for a period of three to six months in patients with a history of cardiovascular events 1
• Recent evidence suggests testosterone replacement therapy is noninferior to placebo regarding major adverse cardiac events in men with preexisting or high risk of cardiovascular disease 2

Monitoring Requirements

• Before starting therapy, measure 1:
  • Baseline hemoglobin/hematocrit (withhold if Hct >50%)
  • PSA in men over 40 years (to exclude prostate cancer)
  • Assessment of cardiovascular risk factors
• During therapy, monitor 1:
  • Testosterone levels (targeting 450-600 ng/dL)
  • Hematocrit (intervention needed if >54%)
  • PSA in men over 40 years

Alternatives for Maintaining Fertility

Fertility-Preserving Options

• For men desiring to maintain fertility while addressing testosterone deficiency, consider 1:
  • Human chorionic gonadotropin (hCG): 500-2500 IU, 2-3 times weekly 1
  • Selective estrogen receptor modulators (SERMs) 1
  • Aromatase inhibitors 1
  • Note: Only hCG has FDA approval for use in males 1

Peptide Therapy Considerations

• Growth hormone-releasing peptides (GHRPs) act via specific receptors at the pituitary or hypothalamic level 3
• GHRPs have potent stimulatory effects on somatotrope secretion but their long-term safety profile when combined with testosterone is not well established 3

Recommended Approach

1. Medical Supervision: Any hormone therapy should be conducted under medical supervision with appropriate monitoring 1

2. For those prioritizing fertility:

   • Avoid exogenous testosterone therapy 1
   • Consider hCG (500-2500 IU, 2-3 times weekly) as first-line treatment 1
   • Add SERMs or aromatase inhibitors if needed 1

3. For those not concerned with fertility:

   • Use commercially manufactured testosterone products rather than compounded testosterone 1
   • Target testosterone levels in the middle range (450-600 ng/dL) 1
   • Monitor regularly for adverse effects 1

4. Common pitfalls to avoid:

   • Using alkylated oral testosterone (associated with liver toxicity) 1
   • Failing to monitor hematocrit (risk of polycythemia) 1
   • Neglecting PSA monitoring in men over 40 1
   • Transferring topical testosterone to women or children 1