Hey guys. I’ve been asked to post how we approach TRT initially in my practice. Here it goes
When a patient ends up with me, during our first consultation I get a very detailed background of health history and environmental history. Work history etc. I want a detailed look at potential exposure to chemicals. During this assessment I do a full blood panel, liver and kidney function, lipids etc. also during this assessment the patient is sent home with a DUCTH collection kit (this is hugely important). DUTCH is dried urine Colleciton. This reveals dramatically more than blood. It shows your hormones over a full day as well as (.more importantly) how they are metabolized downstream. This is hugely important. It tells me whether they are favoring healthy elimination pathways or unhealthy which then tells me how to proceed with treatment. Blood testing for hormones doesn’t tell us shit. It’s like flashing a light in a cave. It’s a snapshot at that moment. Hormones can change by 50% in value every day. So I want to see a total days production. Also they have homework to record seven days of food intake, alcohol, supplements and workouts for when they return. If Dutch shows weird cortisol numbers I usually Order a pituitary MRI just to check I also run a blood based food sensitivity test.
On the next visit we go over all of this data. I spend about an hour with each new patient doing this FYI. The typical beginning treatment is 50mg test injected twice a week. We roll this protocol six weeks and retest and more importantly go off patient feedback. At this point we adjust up or down depending on their feedback. As you guys are noticing - estrogen management is done by liver health - NOT AI. After my patients feel great, I instruct them to SLIGHTLY alter their protocols every other week. So if it’s 50mg x2 a week, I advise them to go 60mg x2 a week for two weeks then back to 50 then up to 60 etc. this works WONDERS.
I Have patients on dosages from 100 a week to 400 a week (above that level the DEA gets nosy). Some my patients use tamoxifen at 20mg a day, but that is highly individual. Almost no one uses HCG. These initial protocols and assessment have been used for over 10k patients over the last five years. Our total patient load between doctors now is around 30k from all over the world. So there is a ton of empirical evidence that the way I treat works
So this is the essence of the beginning haha.