Benefits of Estrogen for TRT Patients

Thanks for taking the time to provide your thoughts. It’s great you’re trying to help. Based on watching and reading the over last year there’s three points that have been touted I just can’t get down with:

  1. Dear TRT user, no concerns with running your E2 level as high as possible. Hey look, young men have estradiol levels of 75-100. That’s great, right? Unfortunately they don’t have estradiol levels of 75-100. If your T/E2 ratio is really low (especially when taking exogenous T), your body is probably telling you something, like “hey, don’t be fat.”

  2. Running Hct above 50 is perfectly fine and harmless. This statement is dangerous to men who have compromised cardiovascular systems. Sure, you can get away with running high Hcts for a while if in great shape, but this suggestion is not helpful to obese, poor cardio dude who goes on TRT. Do no harm.

  3. hCG is bad ju-ju. So tell me, what does one do when they induce organ failure through the use of exogenous T? The patient’s testicles become soft and painful after a few months. For those patients that are secondary, their testicles work just fine and hCG stim test confirms. So what now?

EDIT: my link to other site was removed but if you go to ExcelMale you can find it by searching for

Hematocrit, TRT → systemic vascular resistance response

This is important enough topic that I wanted to make sure people understand the pros / cons of blood viscosity.

An E2 of 35 does not accomplish all those effects. How do we know? By doing decades of studies on people that dont have any and giving it back. Those people would be menopausal women. Minimum effective level is >60

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Really???I mean really??? i dont have the time to teach you everything but the mere fact you get your information from ExMale says a lot. The inmates really run the asylum there for sure.
#2 Why do men with the worst heart conditions such as heart failure do better when given testosterone ? These men certainly have compromised cardiovascular systems.
Why has testosterone not caused a heart attack,stroke, or clot in ANY STUDY done EVER??? Not one study. It has been used and abused for over 70 years. Why evidence do you have to support #2? i will tell you…absolutely positively nothing. Your #1 and #3 are just as bad.
You yourself do not understand about blood viscosity. Just look at the literature…

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I wish it was that simple with HCH but its not. Most men feel awful on it unfortunately :frowning: Otherwise when start TRT i will also try to keep my balls running if I can handle the damn thing. Daily injections together with the test small doses after the first six weeks is what i will try…

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Thanks right most do better without Hcg than on it. It is not identical to LH and can cause a lot of side effects. Its a substance used to maintain fertility…it doesnt mean its good for you or makes you feel better

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I read a number of sites. In this particle case, I was providing information to that forum, not getting it.

Hey if you find anything factually inaccurate in that work, please let me know. Given the importance of the information and the issue with linking to another site here, I may have to reproduce the entire thread over here. I haven’t seen any posts where someone goes to the trouble of discussing plasma viscosity and its importance when discussing Hct and serum viscosity. But like I said, if you are down for scientific critique of my review rather than ad hominem of an entire forum, be my guest.

Let’s say I’m secondary and for a number of reasons I’m on exogenous T instead of hCG. 3 months in my testicles are soft and atrophied. They ache really bad. What shall I do?

What do you think of dhea s levels being low normal? Or preg being low?

And not being patient when first going on trt.

Like I did, we just don’t give our body enough time to adjust to the new found liquid gold. So what do we do we throw an AI at it that puts you on a never ending Rollercoaster. And blame everything in e2.

I also think it’s not useful to start a guy that’s been low t for many years with a dose greater than 120 MG. It will create to many symptoms on the onset

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He will advise you to supplement both dhea start 25mg preg - 100mg sustained

And this has what to do with men having Caridac issues while on testosterone? Nothing.

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I was replying to your comments on my 3 points. You trashed all 3 by lashing out and also misread my comments regarding point 2.

Point 1, vast majority of young males are not walking around with estradiol levels of 75-100. That’s it. Would be easy to just come out and educate folks on that in a podcast. Assuming patient is doing a good job with body composition, I can see where most would do fine without an AI.

Point 2 has to do with risk of CVD with Hct (Hct exhibits a typical U-shape with morbidity). I didn’t mention testosterone in point 2. You misread it. I am bringing up the concern of erythrocytosis secondary to the use of TRT. You immediately jump to accusing me of saying testosterone causes cardiac issues. It takes work to identify and discuss primary, secondary, tertiary effects.

Point 3 has to do with use of minimum effective dose of hCG for TRT induced organ failure.

I really struggle on these forums as reading comprehension seems to be a challenge on here for many. But, these are important topics that have significant health implications for men. Feel free to correct my facts on blood viscosity.

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Men having their Hb and Hct Raised by testosterone for over 80 years but yet No heart attack strokes or blood clots. Your theory is just that. A theory that sounds reasonable but doesn’t pan out in reality or medical studies.

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Optimize all your hormones as they all have their own beneficial effects

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Never seen it. Really I’ve never had anyone complain of it. My response if I did would be to give it time. Let me tell you this though. Look at every study you can find on testosterone. Seriously no joke. I can send you as many as you would like as well. You won’t read that in any of the articles. In none of the studies showing the benefits of testosterone in over 80 years did they use testosterone except to preserve fertility. Hcg is not bioidentical. The beta unit is different than LH.

@readalot there is still a statement of yours from way up above that I will address (ranges). I believe @yeti308 has probably clarified several things.

There is no better individual on this entire forum to teach you this stuff. None. I’ll bet my life on it.

Heading back to my office now and I’ll reply there.

I didn’t say it was bioidentical but thanks for clarifying. I am very familiar with the chemical structure and therapeutic utility of hCG. Your clinical experience seems to differ from those of your peers. You’ve never had a patient complain of testicle pain while on TRT, especially a patient who is secondary? Wow. Thanks for weighing in.

@roscoe88 - yes, it is. In one or two if his posts he had info at the bottom with his name and contact info.

Feel free to correct my errors on blood viscosity. It’s not my theory, just relevant physics and clinical experience. I actually listened to a podcast a few months ago where suggestion was made to shoot for Hct of 55. Insanity, patient beware.

The systemic vascular resistance response: a cardiovascular response modulating blood viscosity with implications for primary hypertension and certain anemias

Therapeutic implications

The implications of the systemic vascular resistance response for the treatment of several anemias have been discussed above. It is also worthwhile mentioning that increased blood viscosity is easily treated with therapeutic phlebotomy [Holsworth et al. 2014]. This intervention has great potential because increased blood viscosity is seen in association with all major risk factors for atherosclerotic cardiovascular disease [Sloop et al. 2015]. Therapeutic phlebotomy is not an obsolete modality from medieval times. Sir William Osler used it in treating pneumonia at Johns Hopkins Hospital. This quote is from the 1921 edition of his classic textbook, The Principles and Practice of Medicine :

We employ [therapeutic phlebotomy] much more than we did a few years ago, but more often late in the disease than early. To bleed at the very onset in robust, healthy individuals in whom the disease sets in with great intensity and high fever is good practice. Late in the course marked dilatation of the right heart is the common indication [Osler and McCrae, 1921, p. 102].

The benefit observed by this eminent clinician was probably due to a decrease in elevated blood viscosity caused by the acute phase reactant fibrinogen, which would improve vascular congestion as well as decrease pulmonary vascular resistance in cor pulmonale. Therapeutic phlebotomy was used for angina pectoris at Charity Hospital in New Orleans in the 1960s [Burch and Depasquale, 1965]. Those patients reported a general feeling of improvement in wellbeing after phlebotomy. Additional reports of the efficacy of therapeutic phlebotomy in angina pectoris were published in 1970 [Parker et al. 1970] and 1994 [Piccirillo et al. 1994]. Most recently, a prospective, randomized trial of therapeutic phlebotomy in metabolic syndrome resulted in significant decreases in serum glucose and blood pressure [Houschyar et al. 2012]. Systolic blood pressure decreased from 148 ± 12.3 mmHg to 130 ± 11.9 mmHg in subjects and from 144.7 ± 14.4 mmHg to 143.8 ± 11.9 in controls. Serum glucose decreased from 110.7 ± 29.4 to 98.5 ± 24.0 mg/dl in subjects and from 109.1 ± 39.4 to 107.3 ± 33.6 mg/dl in controls. Furthermore, blood donation is also associated with a reduced risk of myocardial infarction [Salonen et al. 1998]. Although prospective data on therapeutic phlebotomy, blood donation and blood viscosity on the risk of atherosclerotic cardiovascular disease are still either limited or not widely appreciated, hemodynamics must obey the laws of physics: perfusion is inversely proportional to blood viscosity, and without a response to maintain homeostasis, blood viscosity will increase systemic vascular resistance. Reduced blood viscosity will increase blood flow to skeletal muscle, increase glucose utilization, and improve hyperglycemia. Therapeutic phlebotomy will decrease systemic vascular resistance and blood pressure, whatever the cause.

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Let me just address the important one. The erythrocytosis from testosterone is not dangerous (it’s beneficial) and has never caused a problem in the
History of testosterones use. The physiologic erythrocytosis has never caused a problem. That’s my point.

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