I understand what you are saying.
More doctor abuse ;}
Lol. And the other end is there is some good to restrictions. Some of my counterparts are fucktards. Wouldn’t want them doing whatever they wanted. Best to have us all under some level of control .
I love your sense of humor. Reminds me of Monti Python’s abuse skit.
Oops, wrong door!
Labs hopefully in tomorrow Ill expect recommendations and evaluation dr kswan! You still haven’t told me your background. How did you get so knowledgeable on these topics!!! I’m clearly the fucktard on the topic of hormones but you had to have some training
Some labs in. Estradiol level high at 44. Total t 740 two days after injection. I’d .3 of a 200 per ml twice weekly. Magnesium normal. CBC fine. Lh and fsh quite low of course. Expected. Waiting for ACTH and igf
One other thing. If your take hcg aromase and t how do your levels not go through the roof.
I have two degrees in Mechanical Engineering. I have read medical, nutrition and science issues for decades. I suspected I had low T many years ago and started researching that. When I located an age management doc, part way through our 2 hour consult, he said that I knew more about the issues than almost all doctors. For me, its all cause and effect, lending itself, at least for me, to a systems approach.
I have done this work here for years and when guys come up with new issues, I research them. And as we build up this body of knowledge which gets indexed by Google, we have more guys landing here that match what we already have. This seems to create storms of new guys, for example, we current have a swarm of young men with problems. And what I can’t understand how the forum is selecting for cases where thyroid issues are found!
I have read books about adrenal fatigue, thyroid issues, hormones of course with a few books centered on male health, female hormones, books on the rolls of neural transmitters and steroid hormones on the male brain and the female brain. I read Masters and Johnson books when I was in high school.
I have also worked with a few women on hormone problems. I am convinced that most female cancers are caused by estrogen dominance, brought on by normal age related decline in progesterone; or by progestins that depress progesterone levels. So I recommend that all women use the 2% OTC progesterone cream that is readily available.
One other thing. If your take hcg aromase and t how do your levels not go through the roof.[/quote]
If you reduce E2 and thus reduce feedback on the HPTA, the HPTA is still shutdown. So no LH, but hCG fills in that gap. 250iu hCG SC EOD does increase T, if the patient is not primary. With older guys, hCG might increase T levels 15-20% above levels not using hCG. With young men who are secondary, their young testes may produce enough T from hCG to be a satisfactory monotherapy.
So, AI use does not increase T when on TRT.
hCG can create varying levels of T, T dose refinement takes care of that variable.
Many age management docs aim for TT in the 900-1000 range for older guys as their receptor response may be age limited, or some other weak link. SHBG increases with age, so you need more TT to get high normal FT. Note that lab ranges for FT are age adjusted. We want to refer to the levels of young men, not old men.
Some age management docs will take TT to 1500 or above. Whatever works for the patient. I recommend that levels not be higher than what is needed to achieve a strong libido, as one should reserve the dose headroom for needs that arise as years go by.
When a man has his libido go through the roof, this can be disturbing to a woman. Some of that increase in libido is transient and a once in a lifetime situation that wives should accommodate if they are informed about what is going on. Note that libido can be shut down in a few weeks if E2 is not managed. And later if elevated E2 is taken near E2=22pg/ml libido can bloom again.
When some women go to an age management doc and get their hormones fixed, including T, they will drag their husbands into the doctor’s office and say “fix him too!”.
Ok. Perfect. I’m going to get the remaining labs soon. Pass them along. Then get a good idea from you how to dose. I’m still probably going to end up getting things through mail order if I can’t find a good t doc but sure do appreciate the help. Now i think only issue will be whether or not to include hgh based on igf numbers. I had problems with acne trying to run at 1000. Suggestions my friend. Really amazing your crusade. I’m humbled
I see some ACNE as a welcome sign that ones metabolism is closer to the state when we were young and had pimples.
Can you give me the skinny on pregnenolone? How that is effected and its role ? I assume you are doing triple t therapy. Can you speak to how it’s made you feel compared to just straight t therapy?
Hey Doc thought I would throw in my .02 on your situation. Everyone poo poos the online clinics as just a rip off. but they are out there for a reason, they serve a niche. Look through this site and look at how many people complain about their doctor or how impossible it is to find one that prescribes the right things. These places will get you what you need and do it within the legal system, sure its going to cost more but some things are worth paying for including the convience. They aren’t all outrageous priced and no one says you have to follow their overprescribed protocol, follow the one you find on here. I have researched many and know of at least one that is about $600 per protocol, but that protocol would cover at least 5 months at a conservative 100 mg per week level. Many guys at TRT age like myself have reached a level in life where they can afford a little extra to get what they need without hassle. Also I am not connected with a clinic, but have talked to many. Just seems to me these guys should not be automatically eliminated in the decision making process but evaluated with all options.
Others have reported an improvement in mood with hCG and this is a transient effect, most good things are!
From there I did T+hCG SC both EOD.
Later added anastrozole. I had E2=37pg/ml and I had libido issues, moody, intolerant if sudden noises, short tempered. I think that for some, E2 rots the male brain; leading to mental confusion. In one week of 1mg/week anastrozole in EOD divided doses I was really noticing that I was feeling better. More energy, libido back very strong, less emotional and more of my typical analytical self. Nothing gets under my skin now.
We have referred to T+hCG+AI as the tripod. And E2 management is mission critical for libido and QOL. Unfortunately, there are some who have trouble getting that dialed in.
Made in the mitochondria everywhere. But it is thought that this activity is strong in the gonads. As you can see http://en.wikipedia.org/wiki/Steroid_hormone pregnenolone is the basis for the cascade of steroid hormones, so it makes sense that there would be origination in the testes. As shown in the link, pregnenolone is the substrate for conversion to DHEA in the adrenals. From there, in men and women there is some DHEA–>E2 and DHEA–>T inside the adrenals, outside of the HPTA/HPOA/HPGA control loop. In the testes/ovaries, DHEA is converted to T and E2.
When I started TRT, my DHEA-S level dropped, which is explained by reduced pregnenolone from the testes. By the time I had that lab work, my testes were quite small and mushy. It is thought that hCG supports pregnenolone production.
Given the roll of pregnenolone in the brain, it is not so surprising that guys who are shutdown feel better when hCG is introduced. Some times guys with low T can feel a boost from hCG alone.
And note that pregnenolone is the foundation for cortisol and the other related hormones.
I did try pregnenolone oral, 100mg/day. It absorbs very poorly and my lab work did not show much benefit. Pregnenolone in caps does not need an Rx. However, if made into a cream, the FDA considers that product a medical drug and it must be Rx. With either one, I did not notice it. But somethings are really hard to judge that way. Others on other BB’s have reported good results and have seen pregnenolone lift DHEA levels.
Maybe we need pregnenolone cypionate.
I do not use pregnenolone now.
Jesus. Thanks so much guys. Thanks wt. ACTH 17. Igf1s. Slightly high at 249. And again. Test level 740. Very low oh and fsh. Estradiol high at 44. Any other labs to draw?should I try hgh as well? Other advice? Could I trouble k for a list of what doses to start with. Had no libido issues on the t. Have after surgery but that’s expected and going away. No gyno. Was rock solid before the tear. Did get muscle pain though. Especially if I didn’t exercise. You guys have been so much help
I certainly wouldn’t be happy with that estradiol my chest and nips would drive me crazy at that level. Since you are already injecting twice a week u would probably benefit from an AI.
Anastrazole or aromsin for high estradiol, HCG for shrunken achy testicles and pregnenelone production, and HGH is a whole different piece of anti aging puzzle which I don’t have any experience but would like to. HGH really ups the ante on the cost of the program. Most clinics, at least the ones who even still offer it, will cost you $450- 1000 per month
I discussed role of pregnenolone in the brain, read this thru the end of the article: http://en.wikipedia.org/wiki/Progesterone#Role_in_aging In summary, it discusses newer understandings of progesterones vital role in the brain, as evidenced how it effects recovery from damage. Which I assume might have profound implications for changes in brain patterns following changes to T and T:E effects, as well as brain meds. I often refer to how the brain is plastic when TRT is started and encourage guys to have a positive mental outlook at that time as such can then be baked into the new brain patterns. I will have to assimilate these implications… where is my wife’s progesterone cream… BRB
hCG will also support progesterone levels that also support cortisol and related steroids. So the implications of TRT without hCG [T-hCG vs T+hCG] are now deeply profound with larger potential effects on the brain and cortisol levels. Maybe T-hCG contributes to some cases of adrenal fatigue. However, we do not know the effects of LH vs FSH VS hCG on testicular progesterone production.
Talk to compounding pharmacies asking about costs of 10,000iu vials of hCG. They deliver by mail. Have the product shipped dry, not reconstituted. Ask for a referral to a doctor who works with T, anastrozole and hCG. hCG from a compounding pharmacy can be a lot more affordable. Do not get Arimidex, get the generics. Many do not get anastrozole as a Rx.
Explain to the compounding pharmacy that you are a MD and seeking another MD to partner in your HRT, that may be advantageous.
You do not need rhGH, it will cost $10 per day is you are lucky, probably more. See how you feel with T+hCG+AI. Your neural steroids should improve, the hCG lift, and lower E2 can have a profound effect as well. If you feel great, you should not be chasing after the burden of HGH; save that for a few decades out.
Have a range for ACTH=17? If cortisol production is rate limited by lower pregnenolone–>progesterone-[ATCH]->cortisol, then from a mechanistic point of view, ATCH would drop in some circumstances.
Anastrozole dose: Try the basic 1mg/week in EOD divided doses if injecting T EOD, if injecting T twice a week, take 0.5mg at the time of injection. Do not front load. It takes 5-6 days to reach steady state serum levels. If you front load, that delay is reduced. But for those who are over-responders, front loading will deeply compound the misery of E2–>0.
This online pharmacy protocol includes arimidex and tamoxifen. Why would you need both