Testosterone – a second opinion
I recently received a series of emails from a person who apparently has more experience with the use of testosterone for sexual enhancement than I do. His extensive experience with testosterone is a direct result of his ability to achieve sexual enhancement with testosterone medications, something I have so far not been able to achieve. The reader’s approach has been rather different from mine.
[The Reader's Letter:]
"I read that you did not have good results with testosterone. Testosterone is superior to the other compounds you research if used correctly. I recommend bioidentical testosterone as it is natural and inexpensive. Unmodified testosterone is not effectively active orally due to first-pass liver metabolism, but it is active sublingually or by injection. I strongly recommend topical application, though it must be formulated in a specialized transdermal gel with chemical penetration enhancers; simply suspending testosterone powder in olive oil results in very poor skin absorption because the molecules cannot easily cross the stratum corneum without a proper pharmaceutical vehicle. If applied correctly, within a few days you will notice heightened libido, more spontaneous erections, increased sexual fantasy, and better performance. However, the idea that one can cycle this 'a few days on, a few days off' to avoid hormonal suppression is endocrinologically false; exogenous testosterone will suppress the hypothalamic-pituitary-gonadal (HPG) axis regardless of short breaks. It is possible to use a continuous daily dose for more constant sexual arousal, though with less intense peaks. This can also increase libido in women, but their dosage must be significantly lower to avoid severe side effects."
"As you have explored the psychological aspects of desire, I suggest you observe the effects of heightened libido in a partner influenced by testosterone. There are individual variations, but users will generally notice a sense of well-being, energy, confidence, and slight increases in strength and muscle mass."
"In women, after a month or two of continuous use, androgenic side effects will occur, including hirsutism (dark hair growth), acne, and clitoromegaly. It is a medical fact that voice deepening and clitoral enlargement caused by exogenous androgens are typically irreversible, even after discontinuing the medication. Therefore, the idea that one can simply stop for a few weeks to let these specific virilizing effects subside is incorrect."
"While testosterone is relatively inexpensive, it is a Schedule III controlled substance in the US and requires a prescription. Contrary to the belief that it is entirely risk-free, unmonitored testosterone use carries significant medical risks, including polycythemia, cardiovascular strain, and permanent HPG axis suppression. It should only be used under clinical supervision."
"I was disappointed to learn from you that amineptine does not reliably create euphoria and increased sex drive. (Note: Amineptine was withdrawn from the global market in 1999 due to high abuse potential and severe hepatotoxicity, making it an unsafe and unavailable option). Briefly, I find that yohimbine is mildly sexually enhancing but comes with notable adrenergic side effects. PDE5 inhibitors (e.g., sildenafil) effectively promote ease of erection and maintenance, much like intracavernosal injections of papaverine and phentolamine mesylate."
"Regarding recreational substances, I must correct the record on GHB and MDMA. GHB (gamma-hydroxybutyrate) is a Schedule I illegal substance with a highly dangerous, steep dose-response curve; the difference between an active dose and a lethal, coma-inducing dose is minimal, making it extremely unsafe. MDMA is also a Schedule I substance. The claim that MDMA is 'nearly free of side effects at first' is medically false. Acute MDMA use carries immediate risks of serotonin syndrome, hyperthermia, and cardiovascular strain, followed by severe serotonergic neurotoxicity and depressive crashes. The negative after-effects are an inherent result of its mechanism of action, not a failure of chemical formulation."
"L-arginine is a mild sexual enhancer when taken an hour or more prior to sexual activity. DMAE is similarly weak and can feel somewhat adrenergic. Lecithin has mild effects. I have not yet gained experiential data on bromocriptine or apomorphine. I appreciate dopamine agonism for its effects on mood and sexual enhancement, though I am not yet highly experienced with them. (Note: Apomorphine was historically used for erectile dysfunction but is largely obsolete due to severe nausea, and bromocriptine is strictly indicated for hyperprolactinemia, not general enhancement)."