The knowledge is here. There is guidance for TRT and suggested HPTA restart details. Next is what you want to do and then the issue is getting a doctor to play the game.
The answers i am getting are very vague. Don’t getting me wrong, i really do appreciate you helping out. I’ve learned why more here from your stickies than any doctor. However, like i said, replies i am getting are just vague. I am asking direct / clear questions but i am getting vague answers, which honestly leaves me right were i started. Now i don’t know if you are being cautious because you do not want to be held liable for anything bad that might happen from your advice, or because my questions are not clear…although i can’t see how it can be that because i am making sure that my questions are clear. I am keeping them short and concise; i am using quotes, highlights, numbers…etc. Or maybe it’s just me who is not understanding.
My style is education and letting you see what can be done and allowing someone to resolve what they want to do.
At your age, we encourage guys to try to understand what is wrong and to attempt to fix it. The HPTA restart sticky provide guidance and there are a number of ways that are equally valid to approach that. Getting very specific assumes then that your doctor would go along with that. So its not good enough to guide you, you may need to be trying to guide your doctor.
[quote=“KSman, post:23, topic:221305, full:true”]
My style is education and letting you see what can be done…[/quote]
OK. You know my case. I’ve provided you the information you wanted…such as lab work, temps…etc. Now tell me, in your opinion; What can be done? What can be done to fix it?
Again, that is why i am here…to understand what is wrong and to attmpt to fix it. Now i ask you, simply, in your opinion, what is wrong? What do you think is the cause of the low T and how can i fix it?
I asked you before and i will ask again:
Looking at my lab results below, which method do you think I should start…hCG+SERM (of course taking SERM depending if the hCG works) or just SERM?
TT 216ng/dL (286 - 802)
fT 34.17pg/mL (34.51 - 107.78)
E2 32.6pg/mL (7.6 - 43.0)
SHBG 16.0nmol/L (14.5 - 48.4)
LH 4.0mIU/mL (1.7 - 8.6)
FSH 3.5mIU/mL (1.5 - 12.4)
Prolactin 16.7ng/mL (3.46 - 19.4)
To the above, you replied back with:
[quote=“KSman, post:23, topic:221305, full:true”]Never do hCG+SERM. Do one or the other with anastrozole.
A restart will not work if reason for E2 is not resolved or post restart will be anastrozole forever.[/quote]
To which i replied back with:
What i meant by hCG+SERM was to do hCG for 4-6 weeks and if that works, do SERM for 4-6 weeks to get the “hypothalamus and pituitary in the game”. Just like what is suggested in the sticky…or just do SERM (Nolvadex for 4-6 weeks) and if things go back to normal (it’s a succesful restart), i continue with my life and pray my body will keep up by itself - meaning: no hCG.
To which you haven’t given an answer.
So the question remains. Which protocol do i go with? hCG first and then SERM or SERM only?
I understand you said “there are a number of ways that are equally valid”. But the reason i ask is because i am thinking that i already have enough LH/FSH but despite that, my T is still very low. So i was wondering if more LH/FSH is going to make a difference. Would really appreciate if you could comment on this part.
Lets just assume, for the sake of simplicity, that the doctor is open to anything i suggest. So please do feel free to be as specific as you can.
Both will have similar results. Using hCG allows the testes to be recovering longer and preference depends on whether you can even get hCG.
If hCG falls in your lap, great. Otherwise a SERM only should work just as well if anything is going to work and at this point I suggest Nolvadex because some guys flounder on Clomid. But that is another doctor issue because doctors like clomid and Nolvadex can be a hard sell and the doctors cannot think their way out of that wet paper bag.
Not quite sure i understand. It sounds like that’s not a good thing. Could you elaborate please?
I can get hCG no problems.
[quote=“KSman, post:25, topic:221305”]If hCG falls in your lap, great. Otherwise a SERM only should work just as well if anything is going to work and at this point I suggest Nolvadex because some guys flounder on Clomid. But that is another doctor issue because doctors like clomid and Nolvadex can be a hard sell and the doctors cannot think their way out of that wet paper bag.
[/quote]
So lets see if i got this right…
Day 1-42 (6 weeks): hCG 250iu eod
Day 1-42 (6 weeks): Anastrozole 0.5mg/week in divided doses.
Day 43: Test fT and E2.
Day 44 (or whenever results arrive): Receive lab results. If T is still low, stop here and do TRT. If T is good, do the following:
Day 44-85 (6 weeks): Nolvadex 20mg eod.
Day 44-85 (6 weeks): Anastrozole 0.5mg/week in divided doses.
Day 84: Test LH/FSH, fT and E2.
Day 85 (or whenever results arrive): Receive lab results. If either LH/FSH or T is bad, start TRT. If both are good, then pop a bottle of champagne and keep your fingers crossed hoping your body can maintain on its own.
Day 86-92 (1 week): Nolvadex 10mg eod.
Day 86-92 (1 week): Anastrozole 0.25mg/week
Day 92-98 (1 week): Nolvadex 5mg eod.
Day 92-98 (1 week): Anastrozole 0.125mg/week
Day 99: Clean / Done
Day 118 (3 weeks after last dose of anything): Test LH/FSH, fT and E2.
Is the above correct?
You missed two points:
-
your E2 was very high and liver issues AST/ALT need to be considered, you are above E2 target with low T and increased T post restart is impossible because of E2 negative feedback on HPTA
-
you will need to cruise on anastrozole post restart and 0.5 may work, might need more if you are a normal responder, I suggest cruising on anastrozole in all cases to prevent estrogen rebound
Otherwise, I like your write-up. You do allow a lot of time for testicular recovery.
Your border line prolactin sticks in my mind as a piece on the chess board.
[quote=“KSman, post:27, topic:221305, full:true”]
You missed two points:
-
your E2 was very high and liver issues AST/ALT need to be considered, you are above E2 target with low T and increased T post restart is impossible because of E2 negative feedback on HPTA
-
you will need to cruise on anastrozole post restart and 0.5 may work, might need more if you are a normal responder, I suggest cruising on anastrozole in all cases to prevent estrogen rebound
Otherwise, I like your write-up. You do allow a lot of time for testicular recovery.
Your border line prolactin sticks in my mind as a piece on the chess board.[/quote]
I posted my AST/ALT results like you asked but you didnt comment on it.
AST 24.9u/l (≤40)
ALT 40.2u/l (≤41)
So the restart protocol above is correct?? Just want to make sure it is correct and that i understood the sticky so i don’t mess my self up. Is it correct that i will be using anastrozole for 12 weeks?
Also your comment above when you said “Using hCG allows the testes to be recovering longer”. I didn’t understand it. Could you please help me understand what you meant by that? Thanks!
Use anastrozole all through PCT then stay on it after, cruising, until you seem stable and have labs.
We do not know why your E2 was high, there cannot be much FT–>E2 expected, so ability to clear E2 is in doubt. ALT was a bit high and really does not explain this. If you did TRT with high normal FT, there would be more E2 floating around.
If it is not coming from T, do you think fat could be a reason for such E2 levels? Or is it not a very strong reason?
Fat can always be a factor, but with low FT one still needs to consider that clearance may be impaired. But in any case, E2 will need to be manages post restart or restart will be limited or shutdown.
Well, just got my supplies and now trying to figure out how to dissolve the Arimidex tabs for small dosages.
Read the sticky about the vodka. Is there anything else i could dissolve the tabs in besides alcohol?