Testosterone, steroids, etc.

[robblok]

9 minutes ago, TDCNINJA said:

I have no idea whatsoever what you are saying. Everyone needs to keep an eye on their estrogen levels. Levels can change. Health can change. My estrogen levels are currently at a level that my doctor approves. I still check them every 6 months when I do my labs. 

 

I will check my estrogen as well as my other labs for the rest of my life. I test those things that my doctor and other progressive, experienced TRT providers require their patients to test. 

 

The only way I would ever take an AI and the only reason that my doctor would put me on an AI is if I was not able to control my levels of estrogen (estradiol) via dosage reduction and increased injection frequency. And if he did put me on an AI it would be at the lowest possible effective dose and only for a very limited time. AI's are bad news. 

Why are AI's bad news if you use them to lower estrogen and check your levels. I would think they would only be bad news if they lowered your levels too much. But you exclude that risk by doing testing when you use them. I do half yearly tests (more if I change things)

[TDCNINJA]

6 minutes ago, Ks45672 said:

Not necessarily, they have their place 

It depends a lot on body composition, when you get your body fat into the teens and you will notice less aromatization but everyone is on a different dose, diet and exercise and sleep routine so there is no set of compounds or dosages that will work for everyone

2

2

I didn't say there was

Edited March 28, 2019 by TDCNINJA

[TDCNINJA]

1 minute ago, robblok said:

Why are AI's bad news if you use them to lower estrogen and check your levels. I would think they would only be bad news if they lowered your levels too much. But you exclude that risk by doing testing when you use them. I do half yearly tests (more if I change things)

It would be better if you took a look at Dr. Rob's interview with Jay Campbell:

 

 

[TDCNINJA]

Here is another great video of Dr. Rob on the use of Pregnenolone, Aromatase Inhibitors & Tesamorelin.

 

 

 

Edited March 28, 2019 by TDCNINJA

[mokwit]

1 hour ago, TDCNINJA said:

 

Thanks - good info based on large sample size and DEXA scans.

[TDCNINJA]

5 minutes ago, mokwit said:

Thanks - good info based on large sample size and DEXA scans.

You're welcome. I have learned so much good information from Dr Rob and Jay Campbell.

 

Anti-aging medicine is growing by leaps and bounds. The future will be exciting for those of us with the courage to explore it. 

[WaveHunter]

5 hours ago, TDCNINJA said:

...2) A healthy, non-obese 25-year-old male only produces between 4-10mg of testosterone daily. These are what are known as 'physiological' levels of testosterone. In accordance with this fact, almost every post in this entire thread is recommending people to take supra-physiological doses of testosterone. There are some factors involved in which a person might temporarily take supra-physiological levels of testosterone but for the vast majority of people, taking supra-physiological doses of testosterone is incredibly bad for you. ...

Regarding your negatively toned remark about "98% of the posts here, you've made some incredibly negative comments without being specific (i.e.: what serum levels of testosterone you consider to be optimal, or what dosages of TRT you consider to be optimal.) 

 

You also over-dramatize the negative aspects of TRT.

 

Most importantly, you are failing to distinguish between "normal" testosterone serum levels found in the male population as a whole vs what would be considered to be optimal levels in an individual.  They are two different things entirely!

 

For instance, your quote: 

..."In the US, the three major laboratory corporations have all lowered their ranges for what is considered 'normal' testosterone levels. ...

and

...Western males today now have average testosterone levels that are 2-3 times lower than for a western male during WW2. ...

 

Yes, these are both true statements but these do not infer that these lower values are recommended; rather they indicate that the male population is becoming more sub-optimal, and the reasons have to do with negative lifestyle changes that have occurred over time, and particularly during the 1950's and onward (i.e.: more sedentary lifestyle, poorer nutrition, etc)

 

The modern average serum testosterone level in the male population today is about 400 ng/dL.  100 years ago, it was closer to around 700 ng.dL.  The main reason for this is that we, as a population, exercise less and eat a much poorer diet.  In other words, it's NOT a good thing! 

(see http://jcem.endojournals.org/content/92/2/549.full)

 

So, there is a big difference between "normal" ranges and "optimal" ranges.  The "normal" ranges usually mentioned in studies is from a cross-section of the GENERAL male population.  That includes people with abnormally low testosterone (i.e.: TT under 300 ng/mL). So, naturally this skews the number down significantly.  Add to that the fact that historically, test levels have dropped due to poorer lifestyle, and those "normal" numbers are way, way down below what could be considered optimal.

 

The conservative goal of doctors when treating hypogonadism is to restore serum testosterone levels to within the mid-normal physiological range associated with the patient’s age group, generally considered to be between 400 and 700 ng/dL.  Most TRT doctors want an even higher level though if the goal is to improve quality of life, and so a serum level of 700 to even 1,000 is not considered detrimental at all.  In other words, the levels that existed 100 years ago!

 

Most people go on TRT when their serum levels are below 300 ng/dL.  The typical recommended dosage that will raise serum levels to 700+ ng/dL is typically somewhere around 100mg per week.  That is NOT supra-physiological by any stretch.  I have not seen one post on this thread from anyone advocating any dosages that would be considered dangerous as you infer.  

 

Furthermore, you mention this:".... I currently take daily, subcutaneous, physiological doses of testosterone cypionate..." 

 

Why on earth would you take DAILY injections considering that the half-life of test E is around 5-8 days.  The only Test that MIGHT require daily injections would be propionate but I doubt you are using that. And yes, I read the PDF you posted earlier...sorry but I don't buy it.  It's simply impractical to be trying to inject 1/7th of your dosage on a daily basis, and I think that study's results are skewed for self-serving purposes, though I'm not sure what they might be.

 

Your comment about controlling estradiol levels with anti-aromatase inhibitors as being dangerous in the long term is ridiculous.  The usual long-term dosage (if necessary) is around 0.25mcg (that is 1/4 pill) and I have seen no reports from credible sources indicating problems with that.

 

You concerns about excessive hematocrit levels is also unfounded.  Very few TRT patients have this problem but if they do, donating blood is all that's necessary to bring the level back to normal range.

 

Sorry, not wishing to pick a fight or anything like that but I think your reply was overly critical of this thread in reference to optimal serum testosterone levels and the TRT dosages that are being discussed.  Your comments about blood testing were of course on point.

 

Finally, your comments inferring that people contributing to this thread are "dumb asses" is just plain RUDE!  Try being a little more civil, OK?

Edited March 28, 2019 by WaveHunter

[WaveHunter]

4 hours ago, robblok said:

...I also don't understand the need of a dr once levels are stable and you keep doing your tests. ...

 

It does however require a lot of self study and half a brain, something many people are lacking.

I agree that once you have it dialed in and understand how to interpret blood tests you can self-manage but I still think it is wise to keep your doctor in the loop.  Since blood testing is so cheap in Thailand, I do them quarterly and forward a copy to my doctor each time.  I just think that is wise because she is far more adept at spotting something that might become a problem far earlier than I would be able to.  Just makes sense to me ????

 

[WaveHunter]

2 hours ago, TDCNINJA said:

I started taking HCG per my doctor at the same time I began TRT. Physiological doses of T can still cause testicular atrophy.

You are contradicting your earlier comment.  So, which do you mean; physiological doses do, or do not cause it to happen?  Just goes back to my criticism of that long post of yours; that you are not distinguishing between normal and optimal levels of serum testosterone or TRT dosages.

 

Fact is, effective TRT dosages will shut most guys down.  HCG counters this, but not doing HCG does not jeopardize your health.  It's only advantageous for cosmetic reasons, or if you're concerned about still being able to conceive in the future.

[TDCNINJA]

Wave hunter: Watch Dr. Rob's videos and read Jay Campbell's book that I put links in earlier. At least that way I won't have to repeat myself. 

[WaveHunter]

2 hours ago, robblok said:

Your contradicting yourself, first you talk about tests (these would show your E levels). I don't see why anyone (including me) would take anti E tablets if the estrogen was not shown to be above optimum levels (and of course too low is not good either but id assume if you do TRT you read up on things like that) 

 

I do everything based on my tests 

2 hours ago, TDCNINJA said:

I have no idea whatsoever what you are saying. Everyone needs to keep an eye on their estrogen levels. Levels can change. Health can change. My estrogen levels are currently at a level that my doctor approves. I still check them every 6 months when I do my labs. 

 

I will check my estrogen as well as my other labs for the rest of my life. I test those things that my doctor and other progressive, experienced TRT providers require their patients to test. 

 

The only way I would ever take an AI and the only reason that my doctor would put me on an AI is if I was not able to control my levels of estrogen (estradiol) via dosage reduction and increased injection frequency. And if he did put me on an AI it would be at the lowest possible effective dose and only for a very limited time. AI's are bad news. 

I think you are both saying the same thing LOL!  You both do periodic blood panels.  If your estridiol serum levels (E2) climb (which it surely will on effective dosages of TRT), AND they exceed the recommended range (i.e.: generally above 30 pg/mL) than an aromatase inhibitor is indicated to bring the E2 down.  There is nothing bad about using  an AI, considering the very small dosage required to deal with E2 responses to TRT; we're talking about a dosage of 0.25mcg typically.

 

It's kind of a no-brainer for your doctor to advise you, and once you are adept at interpreting blood tests, you can do it yourself.  AI's (like anastrozole, brand name Arimidex ) can be purchased at certain pharmacies (and for a lot less than hospitals charge).  Anastrazole work fast, so you can re-test a few weeks later so dialing in the correct dosage is pretty easy.  Of course it's smart to keep your doctor in the loop, providing him/her with copies of your blood tests.

 

I do it this way because my doctor is in Chinag Mai and I am in Pattaya now.  She is a VERY good and ethical doctor, and has no problem with working with me on this basis.

 

 

[mokwit]

Question for Wavehunter and TDCNINJA if I may - you are getting positive results, how old are you?

[WaveHunter]

1 hour ago, TDCNINJA said:

Wave hunter: Watch Dr. Rob's videos and read Jay Campbell's book that I put links in earlier. At least that way I won't have to repeat myself. 

I'm familiar with both.  Obviously if you misuse anastrozole and pay no heed to your estradiol levels (E2) than yeah, bad things WILL certainly happen.  I mean, some dopey guy taking 1mg of anastrozole a day (as Dr. Rob mentioned) would be insane, but WHO DOES THAT???

We're not talking about stupid people.  Most people on this thread are pretty intelligent and well informed.  They know that serum E2 levels that become too low from excessive AI use are just as bad as levels that become too high from TRT. 

 

Even the people who are uninformed are asking questions and trying to learn.  I think you are grossly underestimating most of us on this thread.

 

Proper use of anastrozole to keep E2 at around 30 pg/mL is not going to cause problems for the majority of people on a proper TRT protocol, and if they are running FULL blood panels at least a couple of times a year, they are going to know if something bad is happening for those rare people who are having some sort of negative reactions.

 

Sorry but I simply disagree that lowering E2 can be accomplished by increasing frequency of injection (especially to daily injections) considering the half-life of injectable test, and it would be self-defeating to lower TRT dosage to a level required to have no E2 response because that would mean testosterone is not doing anything at all. 

 

I mean, as men age their levels of aromatase increase thereby depleting free testosterone and increasing estrogen levels.  Injecting testosterone WILL further increase estrogen, AI's simply restore the balance and are indicated when E2 levels rise outside of the optimal range.  Further, the dosage required to restore the balance is VERY, VERY small.

 

I may be incorrect but I have seen no reputable studies that indicate otherwise, and I try to be pretty well-read in this area.

 

Finally, I just have to say that I take exception to these YouTuber guys like Dr Rob.  Most of them run TRT clinics and thus are not exactly unbiased sources of science-based information, and scare mongering videos are a great way to drum up business. 

 

I think it's best to get your information from reputable, unbiased sources.  Even a lot of academic studies can be flawed, especially if they are sponsored by companies or groups with self-serving interests.  You really have to do your research to get real answers.  The best thing is to find a doctor who you can personally feel confident in....easier said than done!

Edited March 28, 2019 by WaveHunter

[simon43]

i hope you’re running periodic blood panels though

 

Yes, every 3 months, checking my T, PSA and estradol, and then annually with a full blood-works check, exercise stress test, heart checks... the works!

[Destiny1990]

Seems most here want to lower their  estrogen levels  while i would like to raise mine estrogen level since it is rather lowish 11 ng/ml points only my score for estrogen is .Also my T levels both are on the lower side but my Europe doctor says starting with trt will only lead to more problems.?

I think the only way  to raise mine estrogen level  is to start with TRT?

Edited March 28, 2019 by Destiny1990

[TDCNINJA]

In Dr Rob's own words and I'm paraphrasing "when you take anastrozole you are crushing your estrogen metabolism, you're crushing your cardiovascular system, and for those that don't understand, estrogen is important for those free fatty esters that are generated from estrogen that help stop the oxidation of LDL - that bad cholesterol...so, you're screwing with your cardiovascular health, you're screwing with your brain health, and you're screwing with your bone and mineral metabolism..."

Edited March 28, 2019 by TDCNINJA

[TDCNINJA]

7 hours ago, WaveHunter said:

You are contradicting your earlier comment.  So, which do you mean; physiological doses do, or do not cause it to happen?  Just goes back to my criticism of that long post of yours; that you are not distinguishing between normal and optimal levels of serum testosterone or TRT dosages.

 

Fact is, effective TRT dosages will shut most guys down.  HCG counters this, but not doing HCG does not jeopardize your health.  It's only advantageous for cosmetic reasons, or if you're concerned about still being able to conceive in the future.

I was responding to a question where a person asked me why I take HCG if I take physiological doses? My response to that question was "Even on physiological doses, you can still have testicular atrophy." But an even better reason why I take HCG is that my doctor said to take it, so I do. 

 

My doctor doesn't do anything in his practice other than TRT and anti-aging medicine. I won't consult with any doctor - even one that is an endocrinologist unless their practice is solely dedicated to TRT/HRT. 

[TDCNINJA]

7 hours ago, WaveHunter said:

Regarding your negatively toned remark about "98% of the posts here, you've made some incredibly negative comments without being specific (i.e.: what serum levels of testosterone you consider to be optimal, or what dosages of TRT you consider to be optimal.) 

 

You also over-dramatize the negative aspects of TRT.

 

Most importantly, you are failing to distinguish between "normal" testosterone serum levels found in the male population as a whole vs what would be considered to be optimal levels in an individual.  They are two different things entirely!

 

For instance, your quote: 

..."In the US, the three major laboratory corporations have all lowered their ranges for what is considered 'normal' testosterone levels. ...

and

...Western males today now have average testosterone levels that are 2-3 times lower than for a western male during WW2. ...

 

 

 

My reasoning for bringing this into the conversation was to illustrate to the reader, very much in the way you responded, that what the major lab corporations say are "Normal,' aren't really normal. They lowered the levels, most likely under pressure from a lot of different groups, so that a billion men don't run into their doctor's offices saying "Hey my T is low." I'm not sure why you responded to me the way you did, because I strongly agree with your point.

[TDCNINJA]

8 hours ago, WaveHunter said:

Furthermore, you mention this:".... I currently take daily, subcutaneous, physiological doses of testosterone cypionate..." 

 

Why on earth would you take DAILY injections considering that the half-life of test E is around 5-8 days.  The only Test that MIGHT require daily injections would be propionate but I doubt you are using that. And yes, I read the PDF you posted earlier...sorry but I don't buy it.  It's simply impractical to be trying to inject 1/7th of your dosage on a daily basis, and I think that study's results are skewed for self-serving purposes, though I'm not sure what they might be.

 

 

1

As you are a knowledgable and responsible user of testosterone, I'm sure you would agree that there are almost as many different testosterone protocols as their are patients. What works for one doesn't work for another in terms of dosage and frequency. 

 

I will quote from Jay Campbell

"Patients are often prescribed what I believe to be inadequate 80-100 mg doses of cypionate or enanthate injected once every 14-21 days. This creates wide swings in serum androgen levels. As already mentioned above, the result is too many peaks and valleys of both testosterone and estrogen causing an emotional up and down feeling due to the lack of balance between the two hormones. Patients are then prescribed an aromatization inhibitor (AI) like Arimidex (Anastrozole) as a result to fix the problem of increased estrogen inadvertently created from the dosing schedule. It is very rare (except in specific cases of high body fat individuals or older men) that a patient should be started out on an aromatase inhibitor (AI). The need for estrogen control must be proven first. This is why follow up labs are crucial to understanding what is really going on in that individual's endocrine system as a response to using supplemental T."

Campbell, Jay. The Definitive Testosterone Replacement Therapy MANual: How to Optimize Your Testosterone for Lifelong Health and Happiness (pp. 61-62)

 

Further from Jay Campbell as published in the Testosterone optimization therapy bible:

 

"Recommended TOT Protocols:

 

Option 1A: 10-30 mg of Testosterone injected daily. This provides the most stable Testosterone levels (i.e. mimicking endogenous production of Testosterone as closely as possible), and it will also help to minimize aromatization and erythrocytosis.

 

Option 1B: 50- 70 mg of Testosterone injected every other day (EOD) This is a nice compromise between daily and twice-a-week administration if you cannot bring yourself to administer daily injections.

 

Option 2: 50-100 mg of Testosterone injected twice weekly (preferably every 3rd day) This option is the most popular choice (preferred by most patients due to the lack of injection frequency) and still more advantageous than once per week therapy.

 

The "right dosage" is an individual thing, and it will require collaborating with your doctor to regularly test your levels of Testosterone and estrogen in order to establish and maintain optimal hormonal balance. A general baseline upper range dosage limit is 200-250 mg every 7 days. Balance will correspond to the right hormonal levels, but it will ultimately come down to feeling great with little to no side effects.

 

The best TOT Doctors are big proponents of the minimum effective dosage principle (MED). Always start low and go slow."

 

So, to answer your question as to why I take daily injections, I will answer because my doctor said to do so.  I am an option 1A guy. 

 

No way in hell I'll ever take an AI.

Edited March 28, 2019 by TDCNINJA

[WaveHunter]

2 hours ago, Destiny1990 said:

Seems most here want to lower their  estrogen levels  while i would like to raise mine estrogen level since it is rather lowish 11 ng/ml points only my score for estrogen is .Also my T levels both are on the lower side but my Europe doctor says starting with trt will only lead to more problems.?

I think the only way  to raise mine estrogen level  is to start with TRT?

I think you should find another doctor.

[WaveHunter]

2 hours ago, TDCNINJA said:

In Dr Rob's own words and I'm paraphrasing "when you take anastrozole you are crushing your estrogen metabolism, you're crushing your cardiovascular system, and for those that don't understand, estrogen is important for those free fatty esters that are generated from estrogen that help stop the oxidation of LDL - that bad cholesterol...so, you're screwing with your cardiovascular health, you're screwing with your brain health, and you're screwing with your bone and mineral metabolism..."

All the multiple generalizations you just made are complete nonsense!  Perfect example of getting your information from an unreliable source.

 

Responsible use of Anastrozole for TRT is completely safe.

 

Try getting your information from reliable science-based sources instead of so called “gurus” on YouTube like your dear Dr. Rob.  Can’t you recognize these guys almost always have an agenda to push by promoting half-truths and outright mis-information.

 

Instead try getting information from somewhere like this for instance:

Aromatase inhibitors in men: effects and therapeutic options

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

Edited March 28, 2019 by WaveHunter

[Destiny1990]

46 minutes ago, WaveHunter said:

I think you should find another doctor.

Doctors that are in the business of selling T advicing me to begin to take it. Doctors that will be responsible for my Testosterone costs by insurance  are advicing me not to take it.

which doctor should i believe??

i have spoken with 4 doctors so far.

 

[TDCNINJA]

1 hour ago, WaveHunter said:

All the multiple generalizations you just made are complete nonsense!  Perfect example of getting your information from an unreliable source.

 

Responsible use of Anastrozole for TRT is completely safe.

 

Try getting your information from reliable science-based sources instead of so called “gurus” on YouTube like your dear Dr. Rob.  Can’t you recognize these guys almost always have an agenda to push by promoting half-truths and outright mis-information.

 

Instead try getting information from somewhere like this for instance:

Aromatase inhibitors in men: effects and therapeutic options

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

 

Those weren't my generalizations, they were Dr. Rob's. I simply transcribed his words.  Agenda? He certainly doesn't have a financial agenda by not prescribing AI's. 

 

As far as AI's we will have to agree to disagree. You'll never, ever, catch me using one.  YMMV. 

 

Oh and yes, once again, anyone who goes on TRT without the supervision of an experienced TRT physician is a dumbass.

 

Your study wasn't even on the use of AI's to combat increased estradiol as a result of exogenous testosterone aromatization. It was a study with a size population, of, wait for it, a grand total of SEVEN adults and 1 newborn who had PRIMARY, not secondary, estrogen deficiency. Clearly, academic research is not your strong suit.

 

How in the world is this study even remotely related to the use of AI's to manage increased estradiol levels related to exogenous testosterone usage?

 

And the 700lb gorilla in the room that no one wants to address, but I will, is that people who take physiological doses of testosterone almost never have estrogen problems, to begin with. It's always the roidheads who are taking massive doses of testosterone that have astronomical estrogen, hematocrit and hemoglobin levels. 

 

They usually have aggression social cohesion difficulty and personality disorders and throw down and insult anyone who preaches ethical and responsible TRT use because of their inner guilt over abusing steroids.

 

Which group do you belong?

Edited March 28, 2019 by TDCNINJA

[WaveHunter]

10 hours ago, Destiny1990 said:

Doctors that are in the business of selling T advicing me to begin to take it. Doctors that will be responsible for my Testosterone costs by insurance  are advicing me not to take it.

which doctor should i believe??

i have spoken with 4 doctors so far.

 

My 2 cents worth:  Stay away from doctors running "anti aging or TRT clinics"  Sorry to say that in my experience the majority of them are only in it for the money only and will advise you to do what is best for their bottom line, not for you. 

 

You really have to do some digging to find a good doctor for TRT, and generally speaking they will not be the ones with splashy websites and stock photos of compassionate looking doctors in medical garb, and unrealistic claims for the virtues of TRT!

 

Seriously, most of the good doctors offering TRT do NOT have professionally designed websites, expounding on the (unrealistic) virtues of TRT.  They are NOT doing "infomercials" with fake interviewers on YouTube answering scripted questions like, "Is it true my sex life will really improve on TRT?" or "Will I really feel younger and more energetic on TRT?", or the scare-monger videos that infer only that particular doctor understands the proper methods of administering TRT.  You know what I mean; the modern version of "snake oil salesmen".

 

At the same time, a really good TRT doctor will not advise against TRT simply because your serum level doesn't meet the criteria for clinical deficiency.  It's true that your insurance company might not pay if this is so, and you may have to pay out of pocket, but a doctor who really cares about your well-being will offer ways to make it as economical for you as possible, whereas the hucksters running the flashy clinics will find every way they can to get as much money out of you as possible, like telling you that you need all sorts of additional services, need to come in to their office for all your injections, and have unnecessarily frequent testing. 

 

Maybe it's just me but I can spot those huckster from a mile away, and it just makes me sick!

 

Sorry if I sound so negative but it's based on my experiences when I first started exploring this.  I lived in Tampa Florida at the time, and I swear there must be more TRT doctors there than anywhere else in the world LOL, and most of them were sleazy snake-oil salesmen, nothing more.  And if you can believe it, many of them aren't even run by real doctors!  They'll hire some third-rate doctor to act as figure-head but most of your contact will be with a nurse or physician assistant, and your initial contact will be with a non-medical SALES PERSON!

 

It took a long time before I finally found a good doctor, but it was well worth the effort.

 

The best way to find a good TRT doctor is by word-of-mouth referral from somebody you know and trust.  Second best way is to ask on forums like this for the area you live in.  The worst way is to just run a google search and just pick a doctor's website because he is telling you what you want to hear, or contact a doctor on Youtube that runs thinly veiled infomercials.

Edited March 29, 2019 by WaveHunter

[WaveHunter]

13 hours ago, TDCNINJA said:

As you are a knowledgable and responsible user of testosterone, I'm sure you would agree that there are almost as many different testosterone protocols as their are patients. What works for one doesn't work for another in terms of dosage and frequency. 

 

I will quote from Jay Campbell

"Patients are often prescribed what I believe to be inadequate 80-100 mg doses of cypionate or enanthate injected once every 14-21 days. This creates wide swings in serum androgen levels. As already mentioned above, the result is too many peaks and valleys of both testosterone and estrogen causing an emotional up and down feeling due to the lack of balance between the two hormones. Patients are then prescribed an aromatization inhibitor (AI) like Arimidex (Anastrozole) as a result to fix the problem of increased estrogen inadvertently created from the dosing schedule. It is very rare (except in specific cases of high body fat individuals or older men) that a patient should be started out on an aromatase inhibitor (AI). The need for estrogen control must be proven first. This is why follow up labs are crucial to understanding what is really going on in that individual's endocrine system as a response to using supplemental T."

Campbell, Jay. The Definitive Testosterone Replacement Therapy MANual: How to Optimize Your Testosterone for Lifelong Health and Happiness (pp. 61-62)

 

Further from Jay Campbell as published in the Testosterone optimization therapy bible:

 

"Recommended TOT Protocols:

 

Option 1A: 10-30 mg of Testosterone injected daily. This provides the most stable Testosterone levels (i.e. mimicking endogenous production of Testosterone as closely as possible), and it will also help to minimize aromatization and erythrocytosis.

 

Option 1B: 50- 70 mg of Testosterone injected every other day (EOD) This is a nice compromise between daily and twice-a-week administration if you cannot bring yourself to administer daily injections.

 

Option 2: 50-100 mg of Testosterone injected twice weekly (preferably every 3rd day) This option is the most popular choice (preferred by most patients due to the lack of injection frequency) and still more advantageous than once per week therapy.

 

The "right dosage" is an individual thing, and it will require collaborating with your doctor to regularly test your levels of Testosterone and estrogen in order to establish and maintain optimal hormonal balance. A general baseline upper range dosage limit is 200-250 mg every 7 days. Balance will correspond to the right hormonal levels, but it will ultimately come down to feeling great with little to no side effects.

 

The best TOT Doctors are big proponents of the minimum effective dosage principle (MED). Always start low and go slow."

 

So, to answer your question as to why I take daily injections, I will answer because my doctor said to do so.  I am an option 1A guy. 

 

No way in hell I'll ever take an AI.

I appreciate your concerns over dosage and administration and can see why you are impressed by once-a-day injections, but the simple fact of the matter is that testosterone enanthate has an elimination half-life of 4.5 days and a mean residence time of 8.5 days so there is no real-world advantage to daily injections because serum testosterone will NOT spike even if you only inject once a week. 

 

Furthermore, since serum testosterone level stays pretty much the same whether you inject once or twice, 3 times a week or daily, E2 response is about the same.

 

Now if you were a body-builder and your weekly dosage was 500mg, then yeah, you would want to go to three per week or even daily injections, but the typical TRT dosage is 100-125mg per week.

 

Personally I break my weekly dose into two sub-Q injections but the only reason I do that is to minimize the lumps under the skin that a larger (once-a-week) injection causes.  Going any further (3 times a week, or daily) offers no advantage in terms of maintaining stable serum testosterone, and does not minimize estrogen response any more than once-week injections.  There are plenty of science-based studies to support this.

 

As for AI's, I completely agree with you that it's better if you don't have to use them but if your E2 goes much above 30 pg/mL, the advantages of adding a small amount of anastrozole to bring back into range is much more healthy than letting E2 rise to an unsafe level, and it simply makes no sense to instead cut Test dosage if that's going to result in sub-optimal serum test levels.

 

I don't mean to berate your YouTube guys but they are pushing this idea based on half-truths and misinformation, not on science and real-world scenarios.

 

Finally let me apologize for the harshness of some of my posts.  I did not mean it as a personal affront.  I know you are serious and compassionate about your concerns, and I respect that.  I just get sort of hot under the collar when I see the result of half-truths and misinformation being spread on this subject by some of the YouTube gurus.  It just drives me crazy LOL!  So, nothing personal.  There's nothing wrong with healthy debate, and if you can prove me wrong I'm big enough to accept it! ????

 

Edited March 29, 2019 by WaveHunter

[Ks45672]

12 minutes ago, WaveHunter said:

I appreciate your concerns over dosage and administration and can see why you are impressed by once-a-day injections, but the simple fact of the matter is that testosterone enanthate has an elimination half-life of 4.5 days and a mean residence time of 8.5 days.  Test E is what most TRT user use here in Thailand.  For all intents and purposes, testosterone cypionate is similar.

 

So, there is no real-world advantage to daily injections because serum testosterone will NOT spike even if you only inject once a week

 

Personally I break my weekly dose into two sub-Q injections but the only reason I do that is to minimize the lumps under the skin that a larger (once-a-week) injection causes.  Going any further (3 times a week, or daily) offers no advantage in terms of maintaining stable serum testosterone, and does not minimize estrogen response any more than once-week injections.  There are plenty of science-based studies to support this.

 

Now if you were a body-builder and your weekly dosage was 500mg, then yeah, you would want to go to three per week or even daily injections, but the typical TRT dosage is 100-125mg per week so 50 or 60mg's is going to be well tolerated.

 

As for AI's, I completely agree with you that it's better if you don't have to use them but if your E2 goes much above 30 pg/mL, the advantages of adding a small amount of anastrozole to bring back into range is much more healthy than letting E2 rise to an unsafe level, and it simply makes no sense to instead cut Test dosage if that's going to result in sub-optimal serum test levels.

 

I don't mean to berate your YouTube guys but they are pushing this idea based on half-truths and misinformation, not on science and real-world scenarios.

Medicine is a business, whether you care to see it that way or not

 

You will never get trt unless you are really badly deficient in a govt funded hospital and even getting them to run the tests you want as frequently as you want might be difficult 

 

Sub optimal T is not ideal but neither is it a medical emergency when funds are tight so other things will be prioritised over some guy who has 300 which is arguably the low side of normal and wants  1000-1200

 

Private clinics and hospitals are much more willing to help you because they're making a profit or "in it for the money" as you state but like any big money business there are con artists that will overcharge you as much as possible but they are largely unnecessary if you are prepared to do your own research and not rely on what a guy in a white coat says 

 

Test itself is very cheap and so are the blood tests to check if you do the work yourself

[WaveHunter]

24 minutes ago, Ks45672 said:

Medicine is a business, whether you care to see it that way or not

 

You will never get trt unless you are really badly deficient in a govt funded hospital and even getting them to run the tests you want as frequently as you want might be difficult 

 

Sub optimal T is not ideal but neither is it a medical emergency when funds are tight so other things will be prioritised over some guy who has 300 which is arguably the low side of normal and wants  1000-1200

 

Private clinics and hospitals are much more willing to help you because they're making a profit or "in it for the money" as you state but like any big money business there are con artists that will overcharge you as much as possible but they are largely unnecessary if you are prepared to do your own research and not rely on what a guy in a white coat says 

 

Test itself is very cheap and so are the blood tests to check if you do the work yourself

Sad but true!  Could not agree more.  The only thing I'd argue is that, in the beginning, a good doctor is absolutely necessary.  After being frustrated in my search for a TRT doctor I was tempted to buy Test online and self-medicate (I was in the States at the time where Rx is required). 

 

I had no idea how important blood tests were in managing TRT, and to date I have never found all the necessary information online on how to interpret blood tests the way my doctor taught me to do. It's far more involved than just checking serum testosterone and estradiol.

 

Even now, when I consider myself fairly proficient at interpreting blood test results (12 in all), I still keep my doctor in the loop by forwarding all results to her simply because she knows more than I ever will and can spot a problem far earlier than I would.  TRT needs to be managed as perfectly as possible to avoid serious health problems.

 

I have to say that managing TRT here is Thailand is SO cost-effective, it's hard to believe!  No prescription required for Test and cost is about 50% less than in the States.  And blood testing...WOW!!!  In the states, a complete panel was billed to my insurance company for over $1400!  The same panel here in Thailand costs me around $150 and was every bit as reliable and accurate as the ones done in the good ole USA!

Edited March 29, 2019 by WaveHunter

[WaveHunter]

54 minutes ago, WaveHunter said:

...There's nothing wrong with healthy debate, and if you can prove me wrong I'm big enough to accept it! ????...

 

"“I never made a mistake in my life. I thought I did once, but I was wrong.”

quote by Charles Shultz

LOL ????

 

[mokwit]

22 minutes ago, WaveHunter said:

every bit as reliable and accurate as the ones done in the good ole USA!

As far as I know 'sensitive' Estrogen is not available here. Maybe you can get it sent to a lab in Singapore as I had to do with DHT test.

Edited March 29, 2019 by mokwit

[WaveHunter]

Interesting study for those interested:  High Estrogen in Men After Injectable Testosterone Therapy

 

Not much work has been done to understand better the role of estrogens in men. There has also been a distinction between work done on endogenous estrogens and also exogenous estrogens, be it given as estrogen itself or converted from testosterone. Our work in a large database of 34,016 patients represents one of the first attempts to understand the characteristics of exogenous estrogens, which in this case are aromatized from exogenous testosterone given to treat hypogonadism. From our study, it appears that age may be a determinant of the conversion of testosterone to estrogens, except for later years in life after 65 years. The clinical importance of high estrogen after TRT continues to be debated. In our study, high estrogen after TRT does not necessarily associate with low libido. However, AI and SERM were prescribed frequently (30% of cases). There are challenges in setting up a guideline for the threshold beyond which AI and SERM are to be used, as there are no evidence-based studies at this time to guide the practice. Normality based on standard deviation can be used, but our study reports that age in itself may cause variations in normal values. Although our study did not associate low libido with high E2 levels; there may be foreseeable dangers to exposure to high estrogen over a longer period of time (Lerchbaum et al., 2011). The use of AI and SERM should be individualized and carefully monitored. The common side effects of AIs include constipation, diarrhea, nausea, vomiting, upset stomach, loss of appetite, body aches and pains, breast swelling/tenderness/pain, headache, dry mouth, scratchy throat, increased cough, dizziness, trouble sleeping, tiredness/weakness, flushing and sweating (hot flashes/hot flushes), hair thinning, and weight change and should be communicated to the patent. Changes in diet such as eating several small meals may help lessen the chance of nausea and vomiting. More work such as a longitudinal, controlled study is needed to assess the role of exogenous estrogens from TRT and the need to treat this condition.

https://journals.sagepub.com/doi/full/10.1177/1557988314539000

Edited March 29, 2019 by WaveHunter