Yeah he seemed very knowledgeable and open minded to at least discuss the idea of Low T. Hence I was kind of taken back when he recommended the every two weeks protocol and rejected the idea of every day Shots to save whatever SHBG level that I have left while we try and investigate what’s causing it to be so low. When I brought up the every day SubQ injections he literally said if I’m going to put you on testosterone, we are going to do it the proper way of 100-150mg every two weeks IM. I’ll send him an email to see if he is still considering TRT for me after the lab results.
At least with all these labs and visits I’m sort of finding out what’s wrong inside me at an early age then waiting till I’m in my mid to late 40’s and then trying to deal with it at a later stage in life.
You need to put your foot down, ask for 100mg once weekly and just do 10-12mg daily.
These every two week protocols are not the proper way to do TRT, doctors just believe it is because that’s what the guidelines state. Whoever wrote these guidelines never understand things very well.
It’s bad enough because men either quit TRT as a result of these protocols or are forced to seek care somewhere else. These protocols create estrogen dominance in men, by the time testosterone is low estrogen is still high.
We men excrete testosterone at a faster rate than estrogen, this is why we need frequent injections, to keep testosterone higher in relation to estrogen.
This is the proper way to do TRT, yet doctors didn’t get the memo and are operating on bad info.
I still don’t understand why anyone smart enough (presumably) to write the guidelines could think every 2 weeks is a good idea on something with about a 1 week half life… so you’re down to 25% by the time you get to two weeks. It’s not like your body evenly takes that 200mg or whatever and uses 14mg every day or something but that seems to be how it’s been treated
Darn, Dr. Demoss got back to me before i could get out of the meeting this morning at work and ask him for 100mg/week dosage and put in the order for some Thyroid testing and possible E2 as well. Last month when my Estradiol was checked came out at 38pg/mL and that was on the high end lab ranges. Yesterday he didn’t put in the order for E2 and not sure if it’s needed.
Prolactin results just came in an hour after his email and they are:
PROLACTIN 4.3 ng/mL RANGE: 2.1 - 17.7 ng/mL seems on the low end of the range so not sure how to interpenetrate this results in the bigger picture. From quick reading, its the high levels of Prolactin cause low T and sexual dysfunction. Weird how my levels are low. Hopefully it’s not a stupid secreating tumer
I was reading some studies on Clomid vs TRT and seems like Clomid doesn’t really increase the labido, the energy, overall good happy feeling. It does increase the Sports Performance but I’m not really looking for the sports aspect of this. I want my labido back, i want energy and strength thought the day.
When we evaluated individual symptoms, men treated with TST showed significant increases in qADAM scores in libido (2.74–3.70, P ≤ 0.001), energy (2.54–3.35, P ≤ 0.001), strength (2.19–3.44, P ≤ 0.001), enjoyment (3.36–3.80, P ≤ 0.001), overall happiness (3.24–3.59, P = 0.011), erectile function (2.62–3.29, P = 0.001), work performance (3.37–3.68, P = 0.035), tendency to fall asleep (2.10–1.65, P = 0.003), and sports performance (2.86–3.20, P = 0.025). There were no differences in qADAM scores between the different TST modalities. Patients receiving CC only showed a significant benefit with respect to sports performance (3.14–3.57, P = 0.035). Remarkably, among the men who received CC, the qADAM subscore for libido was lower following treatment (3.75–3.2, P = 0.04), indicating that CC could have an adverse effect on libido in hypogonadal men.
reading some studies and seems like taking clomid will increase my SHBG levels but i’m not sure if higher SHBG levels will mess with my upper range Estradiol levels inversely vs just taking tiny daily dosage of Test and possibly keeping my SHBG low.
What do you guys think of Clomid at 50mg/day for 5 days a week with my current lab results. I know that the labs were done at almost mid-day so they are lower than what they should have been in the morning but would clomid work better with my SHGB and Estradiol levels or Test would suit me better?
Normally I’m against clomid, but clomid increases SHBG and is actually what you need, TRT will crush your SHBG. It is for this reason I would recommend attempting clomid first, there are a few reports of men never wanting to come off.
You’re in a unique situation where more SHBG is needed badly, however 50mg daily is way too much, more like 25mg ED or EOD. Just cut the pill in half and take it every day and if symptoms are encountered we can move to EOD.
I don’t know anyone who could tolerate 50mg daily unless they have chronically low estrogen. It would seem you have a lot of low readings across the board, you need IGF-1 measured.
Prolactin is not a concern, it’s not below range.
That’s pretty high in relation to your estrogen. Depending on your SHBG, you will not need very high levels. I feel optimal at a Total T of 500 because my SHBG is low, Free T high. Men with higher SHBG need more Total T to have sufficient Free T levels.
SHBG decreases, so does Total T, but then Free T increases.
It’s strange, Dr. Demoss is very knowledgeable in every way with regards to TRT expect proper TRT protocols. When I talked with him about wanting to check on fertility, he talked about HCG+FSH injections and how it could take the better part of 6 months to see sperm production rise from the ashes.
Dr. Demoss is not dumb, the problem is the guidelines.
Yeah I totally agree that Dr. Demoss is not dumb after speaking to him in person. I think maybe because I’m his new patient he might be just following the normal cookie cutter protocol/guidelines that might have been put in place before trying to adjust the base protocol to something custom catered to me and my body.
I’ll go get the Rx filled for Clomid and see where that leads me and retest in a month to see what directions SHBG/Total T and Free T move. Hopefully no need of AI while on Clomid in case my estrogen levels shoot up. I’ll cut the pills in 1/2 and just take 25mg QD instead of 50mg per his suggestion.
What symptoms should I be looking for while on the QD of Clomid to swap it over to EOD? I assume the biggest issue would be the possibility of developing gyno and bad acne. So if i encounter any one of those two things, just change it to EOD and/or lower it down to 1/4 of the pill to see if it improves.
Sorry don’t have any labs for lipids or cholesterol to review.
A typically response to clomid is good in the beginning followed by a decline even with perfect labs, clomid stimulates estrogen and blocks estrogen in the brain to increase LH. Symptoms will be feeling unwell, mentally and physically.
Clomid will not shut down the HPTA like TRT, it will increase LH and hopefully Total T, Free T while also increasing SHBG.
If you’ve never had gyno, probably do not have to worry unless you’ve had gyno before.
got ya. never had gyno and don’t know what type of feeling to look for. When we were talking about clomid yesterday, he did say that my chest muscles might feel tight or tender and my nipples probably might get sensitive. So i’ll look for that and for acne i never had any problems either so I’ll cross my fingers and won’t see those.
Clomid isn’t a lifelong treatment like TRT is correct? Should i stop taking clomid once my Total and Free T along with SHBG increase and back into normal range? Don’t really want to take clomid for life and screw up my liver with too much oral medication.
These were my LIVER FUNCTION PANEL results from Feb 2019
ALT 90 U/L Standard Range <=63U/L
ALKALINE PHOSPHATASE 70 U/L Standard Range <=125 U/L
BILIRUBIN, TOTAL 0.3mgd/L Standard Range <=1.0 mg/dL
I haven’t read every post as I don’t have time but I did see you mention elsewhere your doc thinks you’re prediabetic. If that’s the case you need to stay up on that. Blood sugar issues are common and should be one of the very first things dealt with, even before trt.
That’s a low free-T4 too. Personally, I would test my total t4, total t3 and free t3, and if ANY one was less than 1/2 the range I would add in some t4. Especially since you might be slightly overweight. That alone would be enough for me, but ymmv.
Just thought I’d add in a few points that are often missed as this is a T sight.
Cheers
My nipples did get hot on occasion on new TRT protocols, but was transient and didn’t last long.
Some men experience warm nippes and freakout, most never get gyno.
My liver function labs improved on TRT, stopped TRT and a week later liver function labs had worsened slightly. Actually TRT increased my SHBG, not common.
SHBG this low, I expect insulin resistance and elevated A1C.
It sounds like the doc is trying to do an actual restart, so you should take the Clomid as prescribed. Don’t screw around with the EOD half pill stuff. A restart should involve a good dose to kick it into gear, but watch for sides. The eye floaters should be an instant kill for it if you get them, they become permanent if you keep going. You have issues, you should not have low test and low SHBG, they should be opposite levels. And if you had a prolactin secreting tumour your prolactin number would be stupid high, not anywhere near in range.
