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Testosterone cypionate, when utilized correctly, can safely and effectively boost testosterone levels in men and women experiencing hypogonadism (low T). Reading the instructions below prior to beginning testosterone replacement therapy (TRT) – including critical health and safety warnings – is necessary to avoid any negative health impacts resulting from improper dosing or from the administration of the medication.
Ongoing blood testing before, during, and after therapy can detect and alert your doctor to any potential side effects before they become major health issues. Often, adjustments to therapy protocol can mitigate these unwanted effects and maximize the effectiveness of TRT.
To guide patients along their TRT journey, we’ve compiled the essential information on testosterone cypionate from the Food and Drug Administration (FDA)
Testosterone Cypionate Indications
Endocrinologists (hormone doctors) have used testosterone cypionate in their clinical practices since it was first approved for testosterone replacement therapy (TRT) in 1951. Testosterone cypionate acts as an androgen receptor (AR) agonist, meaning that it binds to and activates these sites. In turn, this results in increased secretion and uptake of testosterone in various tissues, glands, and organs located throughout the body – including the brain, heart, and liver, among others.
As a result of its direct activity in vivo on these AR receptors, testosterone cypionate can eliminate or reduce the many symptoms of testosterone deficiency that can include:
- Mental health issues such as anxiety and depression
- Loss of sex drive (low libido)
- Erectile dysfunction (inability to achieve or maintain an erection)
- Loss of muscle mass
- Reduced strength
- Weight gain due to higher body fat percentages
- Poor body composition (fat distribution)
- Chronic fatigue (low energy)
- Loss of interest in everyday activities
Testosterone Cypionate Contraindications
Here are a few key contraindications for testosterone cypionate. They are listed below:
- Hypersensitivity to testosterone cypionate
- Men with breast carcinoma (cancer)
- Men with prostate gland carcinoma
- Pregnant women – “Testosterone is teratogenic and may cause fetal harm. Testosterone is known to cause virilization of the female fetus when administrated to pregnant women.”
- Patients with current heart, liver, or kidney disease
If you believe that you meet any of these criteria, discuss the potential dangers of beginning therapy with this medication with your endocrinologist. With TRT as with any hormone replacement regimen, never begin therapy before screening for contraindications in consultation with an experienced healthcare provider.
Testosterone Cypionate Doses
Although each individual patient is unique, the typical testosterone cypionate dosage is 50-400 mg every 2-4 weeks. Occasionally, weekly (or even more frequent) injections may be necessary. The factors that inform the proper testosterone cypionate dosage on a case-by-case basis are:
- The patient’s age
- The injection interval (weekly, semi-weekly, monthly, etc.)
- Underlying health conditions
- The extent of the testosterone deficiency
- The goals of treatment
Many endocrinologists utilize a therapeutic method that calls for a gradual escalation of dosages from a modest starting point. Using this approach, the provider can monitor for any adverse events while checking the patient’s response in terms of elevated testosterone levels. This allows space to safely adjust the dosage as necessary to achieve optimal results.
Testosterone cypionate’s half-life (the time it takes to reduce the active components of the drug by 50%) is about 8 days. As the metabolic process runs its course, the liver filters out the testosterone cypionate metabolites from the blood for elimination. Approximately 90% of testosterone cypionate is passed through the urine and 6% is passed through feces. Warning: Athletes and individuals looking for performance-enhancing benefits of testosterone are at risk of abusing testosterone supplements – even legally obtained ones – which seriously threatens their health.
Repeated administration of high doses of testosterone cypionate may cause various disorders of the liver such as:
- hepatic adenomas
- hepatocellular carcinoma
- peliosis hepatis
Given the dangers of incorrect dosing, ever increase your dosage without first consulting with your endocrinologist.
Testosterone Cypionate Storage
To preserve the efficacy of the medication and prevent spoilage, patients must take a few basic precautions in terms of how and where they store their testosterone cypionate supplies. Here are a few notes on how to properly store testosterone cypionate:
- Store at room temperature — 20° to 25°C (68° to 77°F). When hormone supplements – particularly testosterone cypionate – are left for extended periods of time outside of this temperature safety range, they become susceptible to a process called crystallization:
“Testosterone Cypionate is more prone to supersaturation when compared with Testosterone Enanthate. This makes it more susceptible to crystallization… Manufacturers of cypionate globally provide the universal advice to inspect your testosterone medication for crystal particulate matter before administering. If crystals are present, they recommend warming the solution and shaking to dissolve. “
If, for whatever reason, your medication crystalizes, consult with your healthcare provider to ensure that the drug is still safe for use.
In addition to the risk of crystallization in cold temperatures, high temperatures can likewise damage testosterone cypionate by degrading the testosterone itself or the carrier oils. Heat also increases the chances of pathogenic bacteria breeding in the vial.
Never leave your medication in your car, your mailbox, your garage, or other spaces that are not climate-controlled.
- Store in a dark place away from direct sunlight. UV light (i.e., direct sunlight) causes a process called “pharmaceutical degradation,” a chemical breakdown of the drug in which the molecules contained inside collide. Examples of pharmaceutical degradation are hydrologic, and oxidation. Although the amber glass that holds testosterone cypionate provides a degree of protection from UV light, you should avoid long-term exposure to sunlight. Your testosterone cypionate should be delivered in packaging that prevents light exposure – if not, its integrity may be compromised.
Testosterone Cypionate Warnings
Let’s get into a few key warnings against potential dangers that patients receiving testosterone cypionate injections should be aware of.
Hypercalcemia is the medical term for an unhealthy accumulation of calcium in the blood. Some of the negative health impacts of hypercalcemia include:
- Weakening bones
- Kidney stone formation
- Digestive issues like nausea, upset stomach, and diarrhea
- Heart palpitations, cardiac arrhythmia, and other cardiovascular events
Cases of hypercalcemia – most notably in instances of anabolic steroid abuse – due to testosterone cypionate’s effects on calcium levels have been documented:
“The most likely cause of the patient’s systemic and metabolic disturbances is hypercalcemia. As previously reported, constipation, anorexia, nausea and vomiting are often the prominent symptoms of hypercalcemia.”
Hypercalcemia risk can be eliminated or reduced by regular blood testing. Trained endocrinologists will carefully monitor calcium levels in patients receiving TRT to look for any adverse effects.
Cardiovascular Risks Associated With Testosterone Cypionate
Although the risks of adverse cardiovascular events due to testostserone cypionate supplementation are not fully known, some evidence shows that patients receiving therapy may be more susceptible to:
- vein thrombosis (DVT)
- pulmonary embolism (PE)
- other major adverse cardiovascular events (MACE)
Accordingly, your healthcare provider will perform a full evaluation of your cardiovascular health before beginning therapy to screen for risk factors and adjust the therapeutic protocol as necessary.
One of the ingredients in testosterone cypionate – a preservative called benzyl alcohol – is implicated in a condition called “gasping syndrome” characterized by severe shortness of breath and multi-organ failure. Although it is most common in infants (neonates), patients with an allergy to benzyl alcohol may be at risk of the gasping syndrome.
Acute Urethral Obstruction
TRT patients with a pre-existing benign prostatic hypertrophy might be at risk of developing acute urethral obstruction, a blockage of the vessel that carries urine out of the body. Left untreated, acute urethral obstruction can cause fever, pain, infection, kidney dysfunction, sepsis, and, ultimately, death. Quick medical intervention, in most cases, can cure acute urethral obstruction and reverse these effects.
Potential Testosterone Cypionate Drug Interactions
One of the reasons your endocrinologist will ask about any medications you are currently taking before beginning TRT with testosterone cypionate is to avoid any negative interactions between drugs. Some of the common medications that may cause such issues with concurrent testosterone cypionate administration include:
- Oral anticoagulants. Drugs belonging to this class (for example, Warfarin), which are used to prevent thrombosis in multiple cardiovascular contexts – may interact with testosterone cypionate. Patients taking both medications might become hypersensitive to these anticoagulants. Accordingly, many doctors recommend reducing anticoagulant dosage to achieve the same therapeutic hypoprothrombinemia goals.
- Oxyphenbutazone. Commonly prescribed as a nonsteroidal anti-inflammatory therapeutic, many patients receiving TRT may also take oxyphenbutazone. When combined with testosterone cypionate, oxyphenbutazone concentrations in the blood may increase, potentially resulting in complications. As with anticoagulants, adjustments to dosing may be necessary.
- Insulin. As testosterone cypionate may affect insulin levels, healthcare providers should monitor the blood sugar levels of diabetic patients taking testosterone cypionate for any fluctuations due to the medication.
Testosterone Cypionate Dependence
Dependence – defined clinically as “withdrawal symptoms after abrupt drug discontinuation or a significant dose reduction of a drug – is a potential concern for patients receiving long-term TRT with testosterone cypionate.
Even at therapeutic levels, testosterone cypionate may trigger some uncomfortable and potentially hazardous withdrawal symptoms upon discontinuation that might include:
- depressed mood
- major depression
- decreased libido
- hypogonadotropic hypogonadism
The risk of withdrawal symptoms like the ones listed above increases significantly with supratherapeutic doses (meaning doses that exceed that prescribed amount).