#274 - Performance-enhancing drugs and hormones: risks, rewards, and broader implications for the public | Derek: More Plates, More Dates

1. Educate Yourself on Health

Educate yourself at a base level to critically evaluate medical advice and ensure your providers are acting in your best interest, as this is a necessity to navigate health information.

2. Evaluate Medical Advice Critically

Be aware that proponents of certain health interventions (e.g., GH as a “fountain of youth”) may have financial incentives, so critically evaluate their claims.

3. Optimize TRT Dosing Frequency

If on Testosterone Replacement Therapy (TRT), inject testosterone more frequently (e.g., twice a week instead of once) to achieve more stable hormone levels, reduce aromatization spikes, and lower the overall side effect burden.

4. Prioritize Estrogen on TRT

Avoid arbitrarily crushing estradiol levels with aromatase inhibitors on TRT, as adequate estrogen is crucial for cardiovascular, neurological, and bone health.

5. Accurate Estradiol Testing

When testing estradiol, specifically request LCMS (liquid chromatography-mass spectrometry) for accuracy, as enzyme-based immunoassays can be unreliable and lead to incorrect treatment decisions.

6. Consider TRT for Primary Hypogonadism

If experiencing symptoms of low testosterone and blood work shows high LH/FSH with low total testosterone (primary hypogonadism), consider TRT after ruling out structural abnormalities.

7. Address Lifestyle for Low T

If low testosterone is accompanied by low LH/FSH (secondary hypogonadism), first address lifestyle factors such as sleep, stress, and diet before considering TRT.

8. Manage Body Fat for Hormones

Manage body fat to prevent excessive aromatization of testosterone to estrogen, as high body fat can suppress natural testosterone production.

9. Maintain Fertility on TRT

If on TRT and wishing to maintain fertility or prevent testicular atrophy, use HCG to mimic LH and stimulate testicular function.

10. HCG Dosing for Stability

Administer HCG more frequently (e.g., every other day) to maintain stable serum concentrations and avoid aggressive spikes in Leydig cell activation.

11. Exogenous T vs. Clomid

If considering testosterone optimization, exogenous testosterone may offer better mood, libido, and sleep outcomes compared to Clomid, as it avoids central estrogen inhibition.

12. Consider Progesterone for Sleep

If on TRT and experiencing sleep issues or anxiety, consider a low dose of progesterone, as it may improve sleep quality and provide anxiolytic neurosteroid metabolites.

13. GH for IGF-1 Deficiency & Sleep

If IGF-1 deficient and experiencing poor sleep, consider correcting IGF-1 levels with a minimum effective dose of GH to improve sleep quality.

14. GH Timing for Sleep

Consider taking part of your GH dose before bed, especially if aiming to enhance sleep, as exogenous GH suppresses natural output and natural GH pulses occur during deep sleep.

15. Ipamorelin for Sleep & IGF-1

Ipamorelin can enhance sleep and increase IGF-1 without significantly increasing hunger, making it a targeted option for GH-releasing peptides.

16. MK677 for Appetite Stimulation

MK677 (ibutamoran) might be useful for individuals with low appetite or suppressed appetite during recovery, but be prepared for significant and perpetual hunger.

17. GHRP-6 for Acute Appetite

GHRP-6 can be used to acutely stimulate appetite for specific situations like increasing food intake for bodybuilding.

18. Cancer Screening Before Peptides

If considering non-FDA approved growth hormone-releasing peptides, conduct thorough cancer screening to rule out existing malignancies due to potential growth-promoting effects.

19. Address Hair Loss Early

Address hair loss early to maximize chances of regrowth and prevent permanent miniaturization of follicles, as making back ground is much harder than preventing loss.

20. Topical Minoxidil First for Hair Loss

Use topical minoxidil as a first-line treatment for hair loss due to better tolerability and predictability; reserve oral minoxidil for those with weak topical response.

21. Hair Loss Treatment Beyond Growth

To effectively treat hair loss, focus on preventing further loss (e.g., via DHT inhibition) in addition to stimulating growth or transplants, as these alone don’t stop progression.

22. Explore 5-ARI Alternatives for Hair Loss

If considering hair loss treatment, explore alternatives to systemic 5-alpha reductase inhibitors (finasteride/dutasteride) due to potential irreversible sexual side effects.

23. Avoid 5-ARIs for BPH

Do not use 5-alpha reductase inhibitors (finasteride/dutasteride) for Benign Prostatic Hyperplasia (BPH), as better tools exist and there is no upside.

24. Consider Multi-pronged Hair Loss Protocol

For hair loss, consider a multi-pronged approach including reducing androgen burden, topical anti-androgens, 5-alpha reductase inhibitors (e.g., dutasteride), and potentially ketoconazole shampoo.

25. Be Aware of 5-ARI Fertility Impact

Be aware that 5-alpha reductase inhibitors (finasteride/dutasteride) reliably decrease sperm quality and count, impacting fertility.

26. BPC-157 for Minor Injuries

Consider BPC-157 for minor injuries, especially those in areas with low blood flow (e.g., tendons), due to its pro-angiogenic properties.

27. Avoid Proactive BPC-157 Use

Avoid using BPC-157 preventatively due to concerns about its pro-angiogenic properties potentially promoting cancer cell proliferation.

28. Study Bodybuilding for Fat Loss

Study bodybuilding principles for effective fat loss with maximum muscle preservation, even if not adopting their extreme lifestyles, as they have refined these techniques.

29. Share Personal Experiences

Share personal experiences and lessons learned to help others avoid similar mistakes, especially in complex areas like hormone management.

30. Mitigate Flight Clotting Risk

To mitigate clotting risk on long flights, consider using compression hose, staying well-hydrated, and maintaining leg movement/elevation.

31. Develop Jet Lag Strategy

Develop a personalized strategy to manage jet lag for immediate functionality upon arrival, as it is possible to be 100% functional even after long flights.

32. Caution with Rapid Weight Gain

Be mindful that rapid weight gain and drug use can exacerbate health issues like sleep apnea.

33. Monitor Blood Pressure with Drugs

Monitor blood pressure and recognize signs like bloody noses during intense exercise as potential issues with drug use.

34. Caution with Underground Labs

Be aware of the significant risks associated with obtaining injectable compounds from underground labs (UGLs) due to lack of sterility and quality control, which can lead to severe health issues.

35. Caution with GH for Height

Avoid using GH to unnaturally increase height in children due to unknown long-term bone health risks, such as potential for osteopenia.

36. Caution with GH for Longevity

Be wary of longevity clinics whose primary intervention is GH, as chronic supra-physiologic doses could propagate existing tumors.

37. Caution with Trenbolone Side Effects

Be aware that Trenbolone, while anabolic, has unique and severe side effects including night sweats and “Tren cough” due to its progestogenic activity.

38. Maintain Testosterone Base with Anabolics

When using other anabolic agents, maintain a testosterone base to ensure adequate estrogen production for neuroprotection and overall health, as most other anabolics do not aromatize.

39. Recognize GH Water Retention

Be aware that perceived benefits of Growth Hormone (GH) might be due to water retention (edema), not actual muscle gain.

40. GH Can Induce Insulin Resistance

Understand that GH use can induce acute insulin resistance, which can lead to diabetes at high dosages.

41. Peptides Provide Full GH Spectrum

Using peptides (GHRH/GHRPs) to stimulate endogenous GH production ensures a full spectrum of GH variants, unlike exogenous recombinant GH which provides only one variant.

42. Caution: Experimental Drug Cancer Risk

Be aware that some experimental drugs (like Carterin) may show promising metrics but have severe safety concerns (e.g., cancer in rodent studies).

43. Caution: Acromegaly & Heart Failure

Chronically elevated IGF-1 levels (as seen in acromegaly) are linked to increased cardiovascular death, specifically congestive heart failure, more than cancer.

44. Caution: Bodybuilder Organ Enlargement

Extreme bodybuilding drug use can lead to systemic organ enlargement, particularly the heart, contributing to early death.

45. Consider Nandrolone for Hair

If seeking muscle building with less hair loss risk, consider nandrolone due to its unique 5-alpha reduction to a non-androgenic metabolite in the scalp.