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Athletes or bodybuilders using anabolic doses Middle-aged men combining TRT with growth hormone Younger males using testosterone non-medically Men on blast and cruise regimens (cycling between high and low doses) By contrast, those on physiologic testosterone replacement monitored by a testosterone specialist or TRT specialist rarely encounter this issue

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Stage 4: Advanced gout (chronic tophaceous gout) This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi (see Figure 2: Illustration of Toe Joint With Gouty Tophus ), frequent attacks of acute gout, and often a degree of pain even between attacks (see Figure 3: Progression of Gout )

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