Testosterone, steroids, etc.

[mokwit]

17 hours ago, hyku1147 said:

The link opens for me.

Google:

How to Raise Testosterone with Arimidex
roguehealthandfitness

 

Also:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143915/

 

Arimidex [anastrozole] works in 2 ways - first it increases T by blocking conversion of T to E thereby increasing the amount of absolute T through non conversion, secondly, as you have reduced/taken out E there is less E to act on the feedback loop and inhibit T production, so overall T goes up.

 

This is OK if you have high E in absolute terms OR it is the ratio of T:E that is out of whack but E is not low - the risk is that as Arimidex in adequate doses reduces oestrogen by 95%, if your levels are already low you risk taking them down to damaging levels - it is a suitable treatment for some, wrong in others, and requires monitoring of levels IMO. Doses would have to be highly tuned. I rule it out for myself for this reason. As you age you convert more T to oestrogen so the ratio can get out of whack but absolute E levels may still be low due to Less T substrate to convert.

 

"There are cases where T is adequate, yet E elevated or merely disproportionate. Elevated estrogen (in absolute value or proportion) can, in and of itself, explain hypogonadal symptomology. If E is elevated, controlling serum concentrations (usually with an aromatase inhibitor, which prevents conversion of T into E; or withdrawal of estrogen mimics such as soy or flax seed) may, in very rare cases, suffice in clearing the symptoms of hypogonadism." 

Dr. John Crisler

 

I recognise it may be a correct approach in certain cases i.e E high or Ok but ratio wrong. The fact that it is working for you suggests you may be of the "very rare cases" profile where it is appropriate but in older guys where e.g. bone mineral density may be an issue it may not be the safest way. Research I posted suggests that Clomid/Tamoxifen may boost T more with less risk of low E effects.

 

Note: In the above I am coming at it from an angle of LT i.e. multi year use in older guys. That said some bodybuilders in their 30's won't use Letrazole which reduces Oestrogen by 99%+ because of manifestation of low E side effects with Letrazole.

 

 

 

Edited July 17, 2018 by mokwit

[faraday]

Great posts mokwit, thank you.

 

What do think are the  'correct' or most therapeutic t/e ratios are?

Can you explain this more?

 

Thanks

[mokwit]

5 minutes ago, faraday said:

Great posts mokwit, thank you.

 

What do think are the  'correct' or most therapeutic t/e ratios are?

Can you explain this more?

 

Thanks

Identifying 'correct' or most therapeutic t/e ratios requires more specialist knowledge than I posses. Sorry, can't answer, my knowledge has limits. I have just picked up in my research that the ratio can be an issue but researchers/authors state that seemingly without identifying what the ratio is.

Edited July 17, 2018 by mokwit

[mokwit]

While I am here , here is an outline of TRT therapies and their advantages/disadvantages that I quoted from. Note, other Docs whose knowledge I respect say that the Gels are not much good for getting levels high enough - you basically absorb enough T to shut down your own T but not to increase T levels enough (some say this of Andriol also) Other Docs I respect say the opposite in both cases.....................

 

A possible explanation is that skin applied gels and Andriol convert to DHT in higher levels than injection (Andriol 50-60%) and this could lower SHBG and thus free up more T along with plasma DHT being high from gel/Andriol so TOTAL T might be lower but FREE T which is what matters is higher and DHT exerts direct effects.

TRT.doc

Edited July 17, 2018 by mokwit

[vinegarbase]

15 hours ago, hyku1147 said:

https://atpscience.com/dim-diindolylmethane-the-most-potent-plant-anti-androgen/

Very interesting, but there are some things pointed out in the article.

 

1. The research on DIM for this purpose is not adequate, with small groups and short durations and is far from convincing.

 

2. Very low doses of DIM as found as a component of foods with the necessary cofactors works in the gut and liver to manipulate estrogen detox and support healthy estrogen metabolite ratios to prevent estrogen dominance. ( This is what I was saying, DIM is not an estrogen blocker but just like eating broccoli help to metabolize estrogen which helps to lower it in your system) The article does admit this.

 

 

[mokwit]

13 minutes ago, hyku1147 said:

 

So, you have low  test? What is your solution?

Any of the solutions posted here - summary of options in doc in post #395. A choice between what is best for you/acceptable to you. If you meant my solution personally have described it in posts.

 

Injections are the most likely to work.

Edited July 17, 2018 by mokwit

[Destiny1990]

43 minutes ago, mokwit said:

Any of the solutions posted here - summary of options in doc in post #395. A choice between what is best for you/acceptable to you. If you meant my solution personally have described it in posts.

 

Injections are the most likely to work.

How about T injections with HCG for TRT? 

 

What would u prefer Nebido shots one time in two months  or each 7-12 days Test E injections? Just ur opinion and viewpoint I understand everybody in the end makes his own choices.

Edited July 17, 2018 by Destiny1990

[mokwit]

You would have to inject HCG every few (3???) days. Nebido sounds better but I gather 4ml in your glute is noticeable for a few days. Would probably start with Test E as have more control and if I responded well switch to nebido for convenience - more control with shorter acting - some bodybuilders use Test Propionate every 1-3 days for this reason - also claim subjectively that you feel it more with shorter acting.

 

Another option is SubQ 2x 1 week - has advantage not scar tissue in the muscle and released very slowly from SubQ fat so stable levels and no/less spiking which can raise E levels.

 

Others on this board have experience with injecting which I as yet do not ,so maybe can give better answers than me.

Edited July 17, 2018 by mokwit

[Hummin]

How to get prescription to bring Enanthate abroad? My hospital will not give me prescribed Enanthate, and only give shots at the hospital with nurse. 

 

So where can I get prescription? 

Any clinic will give?

Edited July 25, 2018 by Hummin

[Hummin]

An intersting article

 

A Harvard expert shares his thoughts on testosterone-replacement therapy

https://www.harvardprostateknowledge.org/a-harvard-expert-shares-his-thoughts-on-testosterone-replacement-therapy

[itsallmedia]

On 7/25/2018 at 8:34 AM, Hummin said:

How to get prescription to bring Enanthate abroad? My hospital will not give me prescribed Enanthate, and only give shots at the hospital with nurse. 

 

So where can I get prescription? 

Any clinic will give?

https://www.maximumclinic.com/ in Bangkok provide prescriptions and stuff you can take abroad. I've been using them for 2 months so far happily. 

[Destiny1990]

Is it true that with micro trt there will be less conversion to estrogen?

Whats a workable microdose for TRT just right above an medium T level?

is this 1-3 times a week?

[Hummin]

I experienced high potassium likely from using nebido! It is not to bad, but just above higher level.

 

Anyone else?

 

https://www.livestrong.com/article/300386-testosterone-replacement-potassium/

[mokwit]

17 hours ago, Destiny1990 said:

Is it true that with micro trt there will be less conversion to estrogen?

Whats a workable microdose for TRT just right above an medium T level?

is this 1-3 times a week?

I assume by micro you mean more smaller injections at frequent intervals rather than one big injection at larger intervals

 

Conversion to oestrogen is a function of absolute T levels and also the extent to which the T spikes above normal levels after injection. So yes the lower the dose the less oestrogen conversion and if you split the injections there will be less spiking. Injecting subcutaneously into the fat slows down release of T vs intramuscular injection so additional non spiking effect. As to doses, that depends on your body but from a medical text book:

 

"Intramuscular injections of 250 mg of testosterone enanthate every 2 weeks are the most commonly used dosage, keep the majority of patients within the physiological normal range, depending on how you define that (see previous chapter), and are usually sufficient to maintain the patient’s symptomatic
response."

Malcolm Carruthers MD

 

I believe one strategy is to use this something around this dose split into 4 over 2 weeks injected SubQ. Adjusting the dose to suit you requires blood tests and titrating the dose requires small adjustments up or down.

[Destiny1990]

23 minutes ago, mokwit said:

I assume by micro you mean more smaller injections at frequent intervals rather than one big injection at larger intervals

 

Conversion to oestrogen is a function of absolute T levels and also the extent to which the T spikes above normal levels after injection. So yes the lower the dose the less oestrogen conversion and if you split the injections there will be less spiking. Injecting subcutaneously into the fat slows down release of T vs intramuscular injection so additional non spiking effect. As to doses, that depends on your body but from a medical text book:

 

"Intramuscular injections of 250 mg of testosterone enanthate every 2 weeks are the most commonly used dosage, keep the majority of patients within the physiological normal range, depending on how you define that (see previous chapter), and are usually sufficient to maintain the patient’s symptomatic
response."

Malcolm Carruthers MD

 

I believe one strategy is to use this something around this dose split into 4 over 2 weeks injected SubQ. Adjusting the dose to suit you requires blood tests and titrating the dose requires small adjustments up or down.

Yes so could 4 shots of 60 mg equally divided over 14 days for TRT be more sensible to do then one single shot of 250 mg every 14 days?

[mokwit]

1 minute ago, Destiny1990 said:

Yes so could 4 shots of 60 mg equally divided over 14 days for TRT be more sensible to do then one single shot of 250 mg every 14 days?

I think that is the modern view as to what is best physiologically, but not popular with patients due to number of injections. It seems SubQ is increasingly regarded as better than intramuscular.

 

"In most cases, I start my guys out on either testosterone cream/gel 5mgs QD or testosterone cypionate 100mg per week. The IM test cyp must be administered in weekly injections, as opposed to taking twice the dosage every other week. Some physicians even dose every third or fourth week, producing wide swings in serum androgen levels. Where else in medicine do physicians dose medications completely void of consideration for the pharmacokinetics of same? This puts the patient on an emotional roller coaster, increases the risk of developing polycythemia, greatly accentuates aromatase activity (and therefore unnecessarily elevated E production requiring expensive aromatase inhibition), and actually leaves them lower than they were when they started for the last half of the injection “cycle”."

John Crisler, DO

 

[Hummin]

I got bloodtest resoults yesterday

 

Testosteoron 8,87 ng/ml

Estreadiol 104 pg/ml

Prolactin 17,4 ng/ml

electrolytes co2 18,8 mmol/l

 

this was after 10 first days on enanthate 250mg depot, and after 11 weeks of nebido 250. I will take another test next week to see if any changes. Seems i need to adjust timing a bit. 

 

And Im need advice concerning the e2

[faraday]

58 minutes ago, Hummin said:

I got bloodtest resoults yesterday

 

Testosteoron 8,87 ng/ml

Estreadiol 104 pg/ml

Prolactin 17,4 ng/ml

electrolytes co2 18,8 mmol/l

 

this was after 10 first days on enanthate 250mg depot, and after 11 weeks of nebido 250. I will take another test next week to see if any changes. Seems i need to adjust timing a bit. 

 

And Im need advice concerning the e2

Testosterone level is good, but E2 is too high.

 

Need to bring the E2 down as hyku says.

 

If it was me, I would consider Arimdex. Get another blood test next week, see how it is.

[Hummin]

My nuts shrinked after first Nebido shot, and yes my nipples was a bit exposed, but thats before. Now, no. I have goood libido as a 25 year old. 

 

So I will take new test next week before start on meds. I do not take any meds at all, except T. 

[sanuk711]

On 6/18/2018 at 6:32 PM, Tacuisse said:

My tested IQ was 138. However, I am open to the suggestion it has declined with age.

It depends on what test you took. If you got a score of 138 from an online test, it means nothing because those are not true, accurate IQ tests. If you took a test like WAIS/WISC or Stanford Binet and scored a 138, that is a very superior score and would put you at or near genius.  You should have working as a Nuro surgeon etc.

 

I take an IQ test every 18 months at Bond University in Australia. --Not so much because I want to , its to measure the amount that my dementia has increased/ decreased from the period before. They have found a "True" IQ Test can do this--IQ test must be a one on one with a professional, (not just sitting in a room with a piece of paper over 30% of the answers are verbal) and the test should take up to 90min--2 hours.

[faraday]

AHH.... that's why Sanuk has 711 after his TV name....

 

It's his IQ.......?

 

[mokwit]

 

On 7/31/2018 at 4:20 PM, hyku1147 said:

Will smaller doses still have a negative affect upon the HPTA? AKA testicular shrinkage.

I would guess yes -  Smoother levels 2x 1 week but if you are adding enough testosterone to materially boost your levels it is enough to suppress your own T. That said doing 2x 1 week in smaller doses spikes oestrogen less.

 

[Hummin]

56 minutes ago, mokwit said:

 

I would guess yes -  Smoother levels 2x 1 week but if you are adding enough testosterone to materially boost your levels it is enough to suppress your own T. That said doing 2x 1 week in smaller doses spikes oestrogen less.

 

I had no e2 peak on nebido, and I tested quite often, and the sensitiv nipples was due to T, and not e due to doctor. I also had a peak of cholestrol in beginning, but normal again now, so I hope the e2 also will stabalize after awhile on enathate. I read something about there have to be balance between t and e? Not only high t, and low e? 

[mokwit]

T:E ratio is something that is talked about but seemingly not quantified. High E relative to T is thought to be a factor in benign prostrate enlargement with aging. E should be in a range - too high causes problems, too low causes problems.

[Hummin]

20 minutes ago, mokwit said:

T:E ratio is something that is talked about but seemingly not quantified. High E relative to T is thought to be a factor in benign prostrate enlargement with aging. E should be in a range - too high causes problems, too low causes problems.

However all other tests I took, was in normal state, and only 10 weeks since last  bloodtest, but first time without dr telling me my status. I have asked a dr for E-mail consultation, who is specialist in anti aging, who can monitor me over time! Where I live, no dr have any clue what they are talking about neither educated for especially hormon treatment.

Edited August 2, 2018 by Hummin

[mokwit]

Key point about testing for oestrogen: "Unless you specify a ‘sensitive’ assay for your male patients, the lab will default to the standard estradiol designed for females, which is useless for our purposes here. I have run the standard assay and the sensitive assay concurrently on a number of my patients, and the two results may be as night and day. "

 

 

ESTRADIOL

 

There are several reasons why this assay is VERY important, and should not be ignored in ANY hypogonadism work-up (or subsequent regimen). First, you definitely need to draw a baseline. There are cases where T is adequate, yet E elevated or merely disproportionate. Elevated estrogen (in absolute value or proportion) can, in and of itself, explain hypogonadal symptomology. If E is elevated, controlling serum concentrations (usually with an aromatase inhibitor, which prevents conversion of T into E; or withdrawal of estrogen mimics such as soy or flax seed) may, in very rare cases, suffice in clearing the symptoms of hypogonadism. And finally, rechecking estradiol after beginning the initial dose of testosterone will give the astute physician valuable information as to how the patient’s individual hormonal system functions, as well as making sure estrogen does not elevate inappropriately secondary to testosterone supplementation. This provides a very rough form of receptor mapping, if you will.

E2 is the major player of interest in foundational TRT. Evaluation of the other members of the hormonal class “estrogen” (E1, E3, as well as other estrogen metabolites), via 24 hour urine panel, may help explain gynocomastia or water retention in the face of acceptable E2, indicate relative cancer risk, etc.

 

Unless you specify a ‘sensitive’ assay for your male patients, the lab will default to the standard estradiol designed for females, which is useless for our purposes here. I have run the standard assay and the sensitive assay concurrently on a number of my patients, and the two results may be as night and day. However, patient symptomology is best described by the sensitive assay. The reason is the bell curve from which the test is designed sits well within the “normal” range for females; therefore the hormonal concentration range appropriate to adult males falls on a very flat slope of said bell curve. The same holds for Total Estrogens. Laboratory testing is best when small changes in concentrations result in large changes in subsequent reported result.

 

Some practitioners believe it is only the T/E ratio which is significant, and therefore, as long as E only “appropriately” rises with elevations in T, all is well. However, the absolute concentration of E is of concern, too, especially in light of new information pointing to elevated estrogen as cause, or adjunctively encouraging, several serious disease processes, including numerous cancers, as well as significant potential for induction of sexual dysfunction (no matter the accompanying androgen load). Therefore T/E ratio is only useful for describing the cause of symptoms, not as a treatment goal.

 

Estrogen is absolutely necessary for our physical health. Of note, same also provides the emotional component of a mature gentleman’s sexual being. This is why estrogens must be evaluated and, when necessary, controlled. The “sweet spot” E concentration depends upon SHBG. Rule of thumb is mid-range for both.

John Crisler, DO

 

[Destiny1990]

12 hours ago, mokwit said:

Key point about testing for oestrogen: "Unless you specify a ‘sensitive’ assay for your male patients, the lab will default to the standard estradiol designed for females, which is useless for our purposes here. I have run the standard assay and the sensitive assay concurrently on a number of my patients, and the two results may be as night and day. "

 

 

ESTRADIOL

 

There are several reasons why this assay is VERY important, and should not be ignored in ANY hypogonadism work-up (or subsequent regimen). First, you definitely need to draw a baseline. There are cases where T is adequate, yet E elevated or merely disproportionate. Elevated estrogen (in absolute value or proportion) can, in and of itself, explain hypogonadal symptomology. If E is elevated, controlling serum concentrations (usually with an aromatase inhibitor, which prevents conversion of T into E; or withdrawal of estrogen mimics such as soy or flax seed) may, in very rare cases, suffice in clearing the symptoms of hypogonadism. And finally, rechecking estradiol after beginning the initial dose of testosterone will give the astute physician valuable information as to how the patient’s individual hormonal system functions, as well as making sure estrogen does not elevate inappropriately secondary to testosterone supplementation. This provides a very rough form of receptor mapping, if you will.

E2 is the major player of interest in foundational TRT. Evaluation of the other members of the hormonal class “estrogen” (E1, E3, as well as other estrogen metabolites), via 24 hour urine panel, may help explain gynocomastia or water retention in the face of acceptable E2, indicate relative cancer risk, etc.

 

Unless you specify a ‘sensitive’ assay for your male patients, the lab will default to the standard estradiol designed for females, which is useless for our purposes here. I have run the standard assay and the sensitive assay concurrently on a number of my patients, and the two results may be as night and day. However, patient symptomology is best described by the sensitive assay. The reason is the bell curve from which the test is designed sits well within the “normal” range for females; therefore the hormonal concentration range appropriate to adult males falls on a very flat slope of said bell curve. The same holds for Total Estrogens. Laboratory testing is best when small changes in concentrations result in large changes in subsequent reported result.

 

Some practitioners believe it is only the T/E ratio which is significant, and therefore, as long as E only “appropriately” rises with elevations in T, all is well. However, the absolute concentration of E is of concern, too, especially in light of new information pointing to elevated estrogen as cause, or adjunctively encouraging, several serious disease processes, including numerous cancers, as well as significant potential for induction of sexual dysfunction (no matter the accompanying androgen load). Therefore T/E ratio is only useful for describing the cause of symptoms, not as a treatment goal.

 

Estrogen is absolutely necessary for our physical health. Of note, same also provides the emotional component of a mature gentleman’s sexual being. This is why estrogens must be evaluated and, when necessary, controlled. The “sweet spot” E concentration depends upon SHBG. Rule of thumb is mid-range for both.

John Crisler, DO

 

So if i want to test my estrogen levels what do i need to tell the lab to measure?

[Destiny1990]

On 7/31/2018 at 2:19 PM, mokwit said:

I think that is the modern view as to what is best physiologically, but not popular with patients due to number of injections. It seems SubQ is increasingly regarded as better than intramuscular.

 

 

"In most cases, I start my guys out on either testosterone cream/gel 5mgs QD or testosterone cypionate 100mg per week. The IM test cyp must be administered in weekly injections, as opposed to taking twice the dosage every other week. Some physicians even dose every third or fourth week, producing wide swings in serum androgen levels. Where else in medicine do physicians dose medications completely void of consideration for the pharmacokinetics of same? This puts the patient on an emotional roller coaster, increases the risk of developing polycythemia, greatly accentuates aromatase activity (and therefore unnecessarily elevated E production requiring expensive aromatase inhibition), and actually leaves them lower than they were when they started for the last half of the injection “cycle”."

John Crisler, DO

 

But why it needs to change to Subq injections  if the dose becomes smaller? Why not ordinary  IM injections of 60 mg twice a week?

[Hummin]

43 minutes ago, Destiny1990 said:

But why it needs to change to Subq injections  if the dose becomes smaller? Why not ordinary  IM injections of 60 mg twice a week?

I believe after 3-4 shots regulary as prescribed you will have steady flow of T in your blood. I can not answer for clinicle test, vut thats how it was for me after 3 shots of nebido. Now I do enanthate and 2. Shot after 10 days, third will be 14 days, then 17 days and then measure the levels to see how Im doing. 

[faraday]

58 minutes ago, Hummin said:

I believe after 3-4 shots regulary as prescribed you will have steady flow of T in your blood. I can not answer for clinicle test, vut thats how it was for me after 3 shots of nebido. Now I do enanthate and 2. Shot after 10 days, third will be 14 days, then 17 days and then measure the levels to see how Im doing. 

Varying the time between injections, will make the amount of hormone in your body fluctuate too much.

 

The half-life of Enanthate is about 10 days.

 

I use 250mg Enanthate every 10 days, longer than that & I feel not as good, that is, normal.

 

I'm sure mokwit will give a detailed & better explanation.

 

 

 

 

Edited August 3, 2018 by faraday