2016年1月5日星期二

HGH Cycles for Beginners

Human growth hormone, or HGH, is a naturally secreted hormone that causes most of our body's growth through puberty and beyond. HGH production drops off after puberty, reducing the impact that physical activity has on the body. HGH is popular in both the weight training and therapeutic rehabilitation worlds for its ability to increase muscle size. HGH injections contain actual HGH, whereas pills and powders contain nutrient precursors to help your body produce HGH. HGH cycles are required to minimize negative side effects while you acquire the full benefits of treatment.

Talk to Your Doctor


Schedule an appointment with your doctor to discuss how HGH treatment can benefit you. Discuss your goals for a cycle of HGH treatment. Obtain a prescription from your doctor for injectable HGH. Your doctor will prescribe a proper dosage amount to follow. HGH for rehabilitative purposes is often prescribed at 0.5 IU to 4 IU per day; those seeking the performance-enhancing effects of HGH are prescribed daily dosages of 4 IU to 6 IU. Common HGH cycles are 50 days of treatment followed by 20 to 40 days off of treatment.

Talk with your doctor about the side effects of HGH use. Too much HGH supplementation, or improper use, can result in breast enlargement, liver damage, fluid retention and joint pain.

Dosage Schedule

Follow the dosage schedule laid out by your doctor. Daily dosages of HGH will often be broken up into multiple injections. Normal dosage times are in the morning and a half hour after a workout. HGH has a half-life of 20 minutes, and peak blood levels are reached between two and six hours after injection. Administering HGH after a workout or physical therapy increases the physical gains from both types of exercise.
Resisting Dependency

Allow your pituitary gland to function without HGH injections for a period of time. The length of this wait period will be determined as part of your cycle. Although long-term HGH supplementation of safe dosage levels isn't extremely harmful, it may negatively impact the pituitary gland. The pituitary gland is responsible for most of the body's natural HGH production. HGH injections require the pituitary gland to do no work, weakening that organ's functioning. Abstain from HGH injections for the entire wait period to promote proper pituitary functioning. Prolonged consistent HGH treatment also increases the risk of side effects.


How to inject HGH? Women inject hgh for anti-aging.


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1.Hygetropin,Growth hormone (GH) is a peptide hormone. buy hygetropin,It stimulates growth and cell reproduction in humans and other animals. It is a 191-amino acid, single-chain polypeptide hormone that is synthesized, stored, and secreted by the somatotroph cells within the lateral wings of the anterior pituitary gland.
Somatotrophin refers to the growth hormone produced natively in animals,whereas the term somatropin refers to growth hormone produced by recombinant DNA technology, and is abbreviated "rhGH" in humans.Growth hormone is used clinically to treat children's growth disorders and adult growth hormone deficiency.Where to buy hygetropin?www.hygetropinreviews.com.In recent years, replacement therapies with human growth hormones (HGH) have become popular in the battle against aging. Reported effects include decreased body fat, increased muscle mass, increased bone density, increased energy levels, improved skin tone and texture, and improved immune system function.buy hygetropin.At this time HGH is still considered a very complex hormone and many of its functions are still unknown.In its role as an anabolic agent, HGH has been used by competitors in sports since the 1970s,and it has been banned by the IOC and NCAA. Traditional urine analysis could not detect doping with HGH, so the ban was unenforceable until the early 2000s,when blood tests that could distinguish between natural and artificial HGH were developed Blood tests conducted by WADA at the 2004 Olympic Games in Athens,Greece primarily targeted HGH.buy hygetropin HGH online.


2.OF HYGETROPIN Secretion patternsHGH is synthesized and secreted from the anterior pituitary gland in a pulsatile manner throughout the day; surges of secretion occur at 3- to 5-hour intervals. The plasma concentration of GH during these peaks may range from 5 to even 45 ng/mL.The largest and most predictable of these GH peaks occurs about an hour after onset of sleep. Otherwise there is wide variation between days and individuals. Nearly fifty percent of HGH secretion occurs during the third and fourth REM sleep stages.buy hygetropin.Between the peaks, basal GH levels are low, usually less than 5 ng/mL for most of the day and night. Additional analysis of the pulsatile profile of GH described in all cases less than 1 ng/ml for basal levels while maximum peaks were situated around 10-20 ng/mL.A number of factors are known to affect HGH secretion, such as age, gender, diet, exercise, stress, and other hormones. Young adolescents secrete HGH at the rate of about 700 μg/day, while healthy adults secrete HGH at the rate of about 400 μg/day.

3.Functions of GH HYGETROPIN
Effects of growth hormone on the tissues of the body can generally be described as anabolic (building up).buy hygetropin,Like most other protein hormones, GH actsby interacting with a specific receptor on the surface of cells.Increased height during childhood is the most widely known effect of GH. buy hygetropin HGH online.Height appears to be stimulated by at least two mechanisms:
1.Because polypeptide hormones are not fat-soluble,they cannot penetrate sarcolemma.buy hygetropin HGH online.Thus,GH exerts some of its effects by binding to receptors on target cells,where it activates a second messenger.buy hygetropin.Through this mechanism GH directly stimulates division and multiplication of chondrocytes of cartilage.
2.GH also stimulates production of insulin-like growth factor 1 (IGF-1,formerly known as somatomedin C),a hormone homologous to proinsulin.The liver is a major target organ of GH for this process and is the principal site of IGF-1 production. IGF-1 has growth-stimulating effects on a wide variety of tissues.Additional IGF-1 is generated within target tissues,making it what appears to be both an endocrine and anautocrine/paracrine hormone.buy hygetropin.IGF-1 also has stimulatory effects on osteoblast and chondrocyte activity to promote bone growth.Where to buy hygetropin?www.hygetropinreviews.com.In addition to increasing height in children and adolescents, growth hormone has many other effects on the body:
a.Increases calcium retention, and strengthens and increases the mineralization of bone
b.Increases muscle mass through sarcomere hyperplasia
c.Promotes lipolysis
d.Increases protein synthesis
e.Stimulates the growth of all internal organs excluding the brain
f.Plays a role in fuel homeostasis
g.Reduces liver uptake of glucose
h.Promotes gluconeogenesis in the liver
i.Contributes to the maintenance and function of pancreatic islets
J.Stimulates the immune system


4.INSTRUCTIONS FOR USE & HANDLING OF HYGETROPIN
Releasing the vacuum inside vial
Hygetropin® vials are air-vacuumed to preserve the powder. Before using an Hygetropin® hGH vial you should let all air out of the vial, this should be done only once for every new vial to be used. buy hygetropin HGH online.It can be done by inserting a bare needle or one attached to a syringe into the vial to let all air get out of the vial.
Reconstitution OF HYGETROPIN
Hygetropin® should be used with sterile bacteriostatic water for injection. The water acts as a solvent to dissolve the powder inside the vial and turn it into an injectable solution.buy hygetropin,Use a new sterile syringe (pin width should be 19G-27G) to pull solvent into syringe (1ml of water or less) Inject the water very slowly in a controlled manner to the side of the vial and let the water slide down the bottom of the vial. Do not push the water directly onto the GH powder! Where to buy hygetropin.Doing so will damage it.buy hygetropin,Gently dissolve the drug with a slow, swirling motion. Do not shake vigorously, or the active ingredient might denature. buy hygetropin HGH online.Inspect to see if there is still powder at the bottom of the vial, you may need to let the vial in room temperature for a few minutes in order for powder to dissolve completely.
Injection HYGETROPIN
Using an sterile syringe gently withdraw from the vial the desired dose to be injected and release any unwanted air from the syringe. Hygetropin® should be injected subcutaneously by preferred areas are stomach or upper thighs.buy hygetropin,Wash hands and rub skin with alcohol pad, with one hand pinch 2" inch fold of skin between your thumb and index finger.buy hygetropin HGH online.Where to buy hygetropin?www.hygetropinreviews.com.Hold the syringe with the other hand. Insert the needle at 45- 90 degrees angle to the pinched skin. Gently pull back the plunger to check for blood. If blood enters the solution do not inject, withdraw the needle and start again at a new injection spot. Push the plunger gently to inject, when plunger is all the way down, remove the syringe gently and lightly hold an alcohol pad on the injection spot. Do not rub the area. Dispose of syringe, needles and alchohol pads are always use new ones for each injection. The injection spot should be varied to prevent lipoathrophy.


5.How much Hygetropin GH should I use?
These are the typical Hygetropin hGH doses that people use:
Anti-Aging: 2iu-4iu daily
Fat loss: 4iu-8iu daily
Muscle building: 8iu-24iu daily
* Most people follow one of the following protocols:
- Every day injections
- Every day injections, with 2 days off every 6th day (a.k.a. 5 days on, 2 days off)
- Alternate day injections - In this manner the dose taken every other day is double that of the "Every day injection" protocol.





6.Your doctor will deterimine the best protocol for you.
VERY IMPORTANT - WE ARE NOT DOCTORS AND WE DO NOT PROVIDE ANY KIND OF MEDICAL CONSULTATION OR LICENSED TO ADVICE ANYONE ABOUT THE USE OF HGH.buy hygetropin,YOU SHOULD ONLY USE HYGETROPIN OR ANY HGH PRODUCT UNDER THE CARE OF A LICENSED PHYSICIAN.Where to buy hygetropin?www.hygetropinreviews.com.ONLY ADMINISTER THE HGH DOSE THAT YOUR DOCTOR PRESCRIBED YOU.


7.How do I turn Hygetropin into an injectable solution?
Hygetropin is shipped in vials each containing 8iu of GH in powder form.buy hygetropin HGH online. Before you can use Hygetropin you need to mix it with a solvent such as sterile water or bacteriostatic water, a process known as reconstitution.buy hygetropin.It is only after you mix it with the solvent that it becomes a clear solution you can inject.Where to buy hygetropin?www.hygetropinreviews.com.This process shouldn't take more than a few minutes. 


8.Where can I get sterile or bacteriostatic water?
You can try you local pharmacy as it may not require a prescription in your country. Most people get strile water and bacteriostatic over the internet. buy hygetropin HGH online.Just run a google search forBacteriostatic Water.buy hygetropin.You should get plenty of sites offering it. Prices are very low. Make sure the water you get reads "for injection" on the vial. Where to buy hygetropin?IronMan Muscle is the best choice


9.What is the difference between sterile and bacteriostatic water?
You can use either, the difference is for how long the hgh solution will remain potent.Reconstituted with Bacteriostatic Water for Injection (also known as Sterile Water water with 0.9% benzyl alcohol) - An Hygetropin vial should be used within 10 days. Where to buy hygetropin?www.hygetropinreviews.com.Reconstituted with Sterile Water for Injection - An Hygetropin vial should be used within 3 days. 


10.How can Hygetropin stay unrefrigerated during shipping ?
Hygetropin was formulated specifically to withstand being out of refrigeration for 28 days without getting ruined.buy hygetropin.It's just important to place it in the refrigerator once you receive it and avoid exposure to light, heat or extreme temperatures. Where to buy hygetropin?Simply store in the fridge as soon as you get it. buy hygetropin HGH online.


11.STORAGE OF HYGETROPIN
Keep at 2~8ºC in the refrigerator,away from light.Where to buy hygetropin? www.hygetropinreviews.com.
Before reconstitution OF HYGETROPIN: 
--If refrigerated between 2-8ºC, it's good until expiration date.
--At room temperature (under 37ºC) it's good for over 30 days.
After reconstitution OF HYGETROPIN:
--Use Bacteriostatic Water to reconstitute and keep in 2~8ºC, it will be
good for 10 days.
--Use Sterile Water to reconstitute and keep in 2~8ºC. it will be good
for 72 hours.


2016年1月4日星期一

Is Steroid-Induced Heart Enlargement Dangerous?

Dear Dr. Scally, Can you help me understand the relationship between anabolic steroids and the enlargement of the heart and the relative risks arising from the steroid-induced increase in heart size? I am concern because several studies have shown that left ventricular hypertrophy (LVH) occurs in individuals that use anabolic-androgenic steroids (AAS).

LVH in athletes is generally considered to be benign physiological LVH as opposed to the dangerous pathological LVH. Physiological LVH would include both anaerobic as well as aerobic training; the adaptation appears to be harmless and regresses over time when training is discontinued.

However, it seems as if the eccentric LVH from aerobic training is more beneficial since it causes an increase in hole diameter, relaxation, and elasticity as opposed to the concentric LVH from anaerobic training (e.g. resistance training) which may actually decrease hole diameter while simultaneously increase size, stiffness, and contraction. Is this true?

Pathological LVH is usually due to long-term uncontrolled hypertension (HTN) although it is very rarely caused by a pre-existing genetic condition known as hypercaridopmyopathy (HCM). Pathological LVH is a risk factor for myocardial infarction (MI), stroke, sudden cardiac death, and congestive heart failure (CHF). So, anything that causes pathologoical LVH should clearly be avoided.

Do you know why AAS causes LVH and what type of LVH it causes? Is it due to androgen receptor (AR) activation in the heart? Is it more likely to be concentric since most bodybuilders and powerlifters, drug-free or natural, already have concentric LVH due to the nature of their training routines?

The statements raise a number of questions all which would take volumes to fully answer. In brief, they are the different forms of left ventricular hypertrophy (LVH), physiological vs. pathological, and the forms that arise from physiological LVH. The cardiac morphologic changes regarding LVH include increased left ventricular cavity dimension, wall thickness, and calculated mass. Finally, what effects do AAS administration have upon LVH and can one safely extrapolate form this safety of long-term (life long) AAS use.

Pathological LVH, as you note, occurs after conditions such as myocardial infarction (pressure overload), inflammatory myocardial disease, with idiopathic dilated cardiomyopathy, or with volume overload. Of importance is the relative benefit/risk screening of athletes for Hypertrophic Cardiomyopathy (HCM) since HCM is regarded to be the most common cause of sudden death in young athletes.

The generally accepted clinical definition of hypertrophic cardiomyopathy, independent of age, is a disease state characterized by unexplained LVH associated with a nondilated ventricular chamber, in the absence of another cardiac or systemic disease, which itself would be capable of producing the magnitude of hypertrophy evident in a given patient. The prevalence of HCM in highly trained athletes is extremely rare. Further, structural and functional changes associated with HCM naturally select out most individuals from competitive sports. A small minority of male athletes may exhibit substantial increases in cardiac size that overlap with the phenotypic manifestation of the cardiomyopathies.

Physiological LVH observed in athletes is often associated with morphological changes in the heart, including increases in left ventricular chamber size, wall thickness, and mass. The increase in left ventricular mass as a result of training is called “athlete’s heart.”

The proposed LVH difference, concentric vs. eccentric, is known as the “Morganroth hypothesis.” In 1975, Morganroth and colleagues hypothesized that the cardiac morphological adaptation observed in athletes corresponded with the nature of the hemodynamic stimulus imposed on the ventricles during repeated exercise bouts.

Endurance training purportedly leads to an eccentric form of cardiac hypertrophy, principally characterized by increased left ventricular (LV) cavity dimension with a proportional increase in wall thickness, and thus LV mass (LVM), as a consequence of prolonged repetitive volume overload. There is an unchanged relationship between left ventricular wall thickness and left ventricular radius (i.e., ratio of wall thickness to radius).

In contrast, strength training is supposedly associated with a concentric form of hypertrophy where increased ventricular wall thickness, with no change in cavity size, underpins the elevated LVM as a consequence of the high systemic arterial pressure overload produced during strenuous resistive exercise. Strength-trained athletes are presumed to demonstrate concentric left ventricular hypertrophy, which is characterized by a changed, increased, ratio of wall thickness to radius.

The “Morganroth hypothesis” has been broadly adopted in the scientific and medical literature, partly as a consequence of a large body of cross-sectional evidence suggesting that endurance athletes have greater cavity dimensions than control subjects or resistance athletes. However, in conflict with the “Morganroth hypothesis,” several studies suggest that LV wall thickness is increased more in endurance, than strength-trained athletes and others have reported no morphological changes in resistance-trained athletes.

The controversial data may reflect variability in the training stimuli, with little obvious attempt to quantify these issues in previous research; more sensitive technologies, such as magnetic resonance imaging, are now being employed for the assessment of cardiac morphology; and the process of scaling (or normalizing) cardiac size for between-subject differences in body size and composition. These considerations emphasize the limitations of the predominance of cross-sectional comparisons in the available literature, which assume that differences between groups are due to a training effect per se rather than other between-subject differences. There are currently limited longitudinal data available to comment on the effects of different modalities of exercise training on LV cavity dimension and wall thickness.

In summary, significant caveats related to cross-sectional literature, the relative insensitivity of echocardiographic measurements and the paucity of evidence from longitudinal exercise training studies, warrant ongoing research to verify the “Morganroth hypothesis.” Currently, there is insufficient high-quality extant evidence to endorse the “Morganroth hypothesis” of differential adaptation to aerobic and resistance training.

Athlete’s heart is generally regarded as a benign increase in cardiac mass, with specific circulatory and cardiac morphological alterations, that represents a physiological adaptation to systematic training. Extreme LV remodeling evident in some highly trained athletes has intuitively raised a concern of whether such exercise-related morphological adaptations are always innocent. There is increasing recognition of the impact that prolonged conditioning has on cardiac remodeling, which may eventually mimic certain pathological conditions with the potential for sudden death or disease progression. Studies show ~15% of highly trained athletes show striking LV cavity enlargement, with end-diastolic dimensions similar in magnitude to that evident in pathological forms of dilated cardiomyopathy.

Overall, athlete’s heart demonstrates normal systolic and diastolic cardiac functions. There is no evidence at present showing that athlete’s heart remodeling leads to long-term disease progression, cardiovascular disability, or sudden cardiac death. The possibility that persistence of extreme remodeling after prolonged and intensive conditioning will ultimately convey deleterious cardiovascular consequences to some athletes is perhaps unlikely but at this time cannot be excluded with certainty.

One might expect AAS exposure to be associated with an exaggerated LV hypertrophic response to any other hypertrophic stimulus. In one very small study, several years after discontinuation of anabolic steroid abuse, strength athletes still showed a slight concentric left ventricular hypertrophy in comparison with AAS-free strength athletes. LVH is an independent risk factor for cardiovascular mortality and (through whatever mechanism) one might anticipate an excess cardiovascular mortality among AAS users in whom LVH occurs. Such data must nonetheless be treated with caution.

So, in your opinion, do you feel that there may be any reason to worry about LVH triggered by long-term AAS use?

At this time the evidence does not show a heightened concern for LVH, particularly at the doses cited in your post. There are no studies demonstrating an association between AAS use and cardiovascular morbidity and mortality. There are a number of anecdotal reports that must be read and interpreted with caution. In my opinion, since these questions are unresolved and other considerations that must be included regarding long-term AAS use, I would recommend against their use in this manner.

My next question is, if AAS induced LVH is not harmful, then would it be okay to stay on a low dose testosterone enanthate (TE) cycle, say 200mg/wk year round, OR 100mg/wk of TPP/NPP combo year round, to keep all my muscular gains? Then do a high dose 12wk @ 800mg/wk Primobolan cycle 1 time a year when I am ready to put on an extra 5-10lbs of dry tissue gains?

If LVH from AAS use is nothing to worry about, is there a downside to my low dose TE OR TPP/NPP year round? I know that there are some individuals that have to be on some type of high-dose AAS 24/7 for many years and even decades, examples being Jose Canseco, Hulk Hogan, and Superstar Billy Graham, with each of these individuals not having any type of heart related ailment that I am currently aware of. On the other hand though, the autopsy report of Eddie Guerrero noted that one of his reasons for death was acute heart failure, so I don’t know if this may have been attributed to AAS induced LVH or not.

Your question makes an assumption, which actually exposes the reason for your post! Since this assumption requires a leap in faith and disregards all other considerations to take into account with long-term AAS use, I do not think that any amount of evidence regarding the adverse effects of AAS use will deter you. In my opinion, even if one was to assume that “AAS induced LVH is not harmful,” there is little to support your idea of AAS use.          Anabolic steroids and left ventricular hypertrophy of the heart

Why are Steroids Stacked?

Q: What is the premise of stacking and what anabolic-androgenic steroids (AAS) can be stacked?

A: The concept of stacking dates back decades, essentially to the beginning of non-medical anabolic steroid use. These drugs were used medically long before athletes began to utilize them for performance enhancement. By the time they became popular in sports, there was already a full class of steroid drugs available in the pharmacies.

Some came as pills, while many others were made into injections. They all offered the potential of muscle growth, although each drug did seem to have its own qualitative properties different from the others.

This led to a great deal of experimenting among bodybuilders and athletes, each searching for the most effective or comfortable option(s) for their goals. User experiences led to an early understanding of which drugs worked best, which were less effective, and of course, which caused the most and least side effects.

Athletes quickly began separating steroids into two general categories.

The first includes those drugs usually identified as more androgenic, such as testosterone, oxymetholone, and methandrostenolone. These “androgens” were very strong for building muscle, but were also highly prone to side effects, especially when taken in higher dosages. Each seemed to have a relatively low dosage threshold for how much was tolerable. Higher doses would quickly cause side effects like gynecomastia, water retention, and/or aggravated hair loss.

The second category included the less androgenic steroids such as stanozolol, oxandrolone, and nandrolone. These “anabolic” steroids were known to produce fewer side effects. They, however, never worked quite as well for building muscle as drugs of the “androgen” class. So very basically, the “anabolics” were actually weaker for building muscle, but more tolerable overall. Note that I use quotes because these are informal classifications, not scientific.

The idea of taking more than one steroid at a time was a natural curiosity. This curiosity was quickly placed into widespread practice, however, given drugs with dose-dependant anabolic effects and no overdose threshold. The experimentation eventually evolved into a more organized concept of “stacking”, or the utilization of more than one steroid at a time in order to maximize gains and manage side effects.

We can look at stacking as combining drugs with a purpose. Most often, it involved the use of a stronger base “androgen”, and a milder (primarily “anabolic”) steroid. The androgen was typically used to the maximum tolerable dosage point. From there, the anabolic was added, and both drugs adjusted so that a peak muscle-building effect could be reached without excessive side effects. The weaker steroid was essentially used to compliment/add to the effects of the stronger, which could no longer be comfortably dose escalated.

Today, we understand much more about ancillary medications such as anti-estrogens and reductase inhibitors, which can be used to minimize the side effects of steroid therapy. As such, an argument could be made that stacking is less important now than it was decades ago, when the most common form of side effect mitigation was a dosage adjustment.

For example, a recreational weightlifter running a couple of steroid cycles per year could probably take something like testosterone enanthate by itself (along with some tamoxifen or anastrozole when needed) and still yield the improvements they are looking for. Since testosterone offers the lowest cardiovascular toxicity of all popular steroids, it is something I certainly would endorse if I could.

Not everyone can get by with only testosterone drugs, especially when body sculpting becomes a primary focus. There is really no set right or wrong way to combine AAS into stacks. Arguments can be made for essentially unlimited approaches. Since anabolic steroids are strong muscle building drugs, I doubt you will find many stack concepts that don’t “work”. Still, I would say you have a few more logical types of combinations.

This first involves an injectable stacked with an oral. Since most orals are liver toxic, you really do not want to take more than one at a time. There are many highly effective oral-injectable combinations. In fact, the most effective bulking stack of all time is arguably the simple combination of testosterone and oxymetholone (Anadrol).

Another stack might be the already discussed androgen base with anabolic add-on. Remember that nandrolone and methandrostenolone (Deca + D-Bol) was one of the most popular stacks of the ‘80s. Of course, it works just as good today as it did back then. How about using a moderately estrogenic steroid with a low/non-estrogen producer? Testosterone (any ester) and methenolone enanthate (Primobolan Depot) comes to mind. It works very well and avoids the use of a liver toxic oral.


Can I Avoid Polycythemia while on TRT?

Q: Is there any way to avoid Polycythemia when doing TRT? I know that injections are more prone to causing this. I recently switched from shots and am currently doing 25mg T cream and 100iu HCG every day, but I am still getting elevated hematocrit and RBC. It looks like I might need to do a therapeutic phlebotomy twice in the next month for my numbers to come back within the normal range. Is there anything to be concerned about with doing frequent phlebotomies?

A: This is something that is sure to come up with testosterone replacement therapy (TRT). This is an additional reason why I suggest individuals who are on TRT for low normal testosterone come off once every 12-18 months. This not only ensures the functionality of the HPTA but if polycythemia is a problem this will ameliorate or fix it. I was referred a patient who had polycythemia and the referring doctor was unable to stop TRT due to symptoms.

Comparison of transdermal nonscrotal testosterone patch with intramuscular injections of testosterone enanthate observed that 15.4 percent and 43.8 percent of patients, respectively, had at least one documented elevated hematocrit value (defined as over 52 percent) during the course of ~1 year. Erythrocytosis was associated with supraphysiologic levels of bioavailable testosterone and estradiol, and it occurred more frequently in the group that received intramuscular injections of testosterone.

There has been demonstrated a direct relation between testosterone dosage and the incidence of erythrocytosis. Erythrocytosis occurred in 2.8 percent of men receiving 5 mg per day by nonscrotal patches and in 11.3 percent and 17.9 percent of men treated with gel preparations of 50 mg per day (delivering 5 mg per day) and 100 mg per day (delivering 10 mg per day), respectively.

Phlebotomy is on the whole a safe procedure, the frequency of side effects being low and their severity weak. Although untoward events are unlikely with mild erythrocytosis of relatively short duration, the hematocrit or hemoglobin level should be monitored in men receiving testosterone-replacement therapy so that appropriate measures, such as dosage reduction, the withholding of testosterone, therapeutic phlebotomy, or blood donation, may be instituted if erythrocytosis develops. It is reassuring that as far as we can determine, no testosterone-associated thromboembolic events have been reported to date.