Testosterone, steroids, etc.

[WaveHunter]

22 minutes ago, mokwit said:

As far as I know 'sensitive' Estrogen is not available here.

Not sure what that is; can you elaborate?  How is that different from checking estradiol levels in the blood (E2)?  Attached is my last test done in Chiang Mai in February.  All I see is the comment that the reference range was changed in 2015.

Edited March 29, 2019 by WaveHunter

[mokwit]

8 minutes ago, WaveHunter said:

Not sure what that is; can you elaborate?  How is that different from checking estradiol levels in the blood (E2)?  Attached is my last test done in Chiang Mai in February.  

Thai lab uses Immunoassay. AFAIK Immunoassay is not accurate at the low male level - below the threshold of accurate immunoassay - 'sensetive' uses mass spectrometry I think. 

 

What I have been told by a practitioner is with immunoassay results, the lower the level the more likely it is to be accurate so 5 is likely 5 but 50 is more likely 20

 

Note both techniques are applied to E in the blood

Edited March 29, 2019 by mokwit

[WaveHunter]

6 minutes ago, mokwit said:

AFAIK Immunoassay is not accurate at the low male level - below the threshold of accurate immunoassay - 'sensetive' uses mass spectrometry I think. 

Not really sure of its' relevancy to TRT management.  Can you elaborate? My doctor has always used 30pg/mL as a benchmark for E2 and she has never told me there was a need for greater accuracy than what these test provide. 

 

Not doubting your comment; just confused how relevant it is to TRT management.

Edited March 29, 2019 by WaveHunter

[mokwit]

3 minutes ago, WaveHunter said:

Not really sure what that means or its' relevancy to TRT management.  Can you elaborate? My doctor has always used 30pg/mL as a benchmark for E2 and she has never told me there was a need for greater accuracy than what these test provide.

If you are using Immunopassay results you don't know if your 30 is 30 or 20 or 40. If your results come back at 30 your doctor probably feels the real number is within range enough for it not to be an issue.

 

Mine came back at 50 and I was told by an experienced practitioner (Dr Tim Lopez BKK) that it was probably  actually around 20-30. Crisler says identical. If it came back at 15 say it might be worth paying for sensitive as e.g. males with osteoporosis typically have a level below 15 and a doctor might want to be sure in that case even though the inverse is not proven (less than 15 = osteoporosis)

[WaveHunter]

4 minutes ago, mokwit said:

If you are using Immunopassay results you don't know if your 30 is 30 or 20 or 40. If your results come back at 30 your doctor probably feels the real number is within range enough for it not to be an issue.

 

Mine came back at 50 and I was told by an experienced practitioner (Dr Tim Lopez BKK) that it was probably  actually around 20-30. Crisler says identical. If it came back at 15 say it might be worth paying for sensitive as e.g. males with osteoporosis typically have a level below 15 and a doctor might want to be sure in that case even though the inverse is not proven (less than 15 = osteoporosis)

Honestly, I think how you feel is the important indicator, assuming you are more or less in the acceptable range (I.e.: 25-40).  I know that when mine has gotten too high, I just feel crappy.  I know before testing that it is going to be too high.

 

When I moved to Thailand, I had to switch from Watson Test Cyp (200mg/ml) to Bayer (250mg/ml).  I kept dosage the same and within a month I felt crappy (bloating).  E2 blood test confirmed it; 83pg/ml!  So I cut dose of test and E2 quickly came down and all was good.

 

At any rate, what are ya gonna do? We’re in the magic kingdom of Thailand ????

 

[TDCNINJA]

Agree 1000%. No use in even doing an estradiol test in men unless it is a sensitive one.

[mokwit]

4 minutes ago, WaveHunter said:

I know that when mine has gotten too high, I just feel crappy.

Would be great if you could tell in as much detail exactly in what way you feel crappy and how long after reducing dose/using AI it takes to feel good again.

 

As mine came in at "50" I have been experimenting with anastrozole even though i do not really have clear symptons of high E. Note, one medical paper suggest the absolute cutoff for AI usage is 16 weeks after that risks to bone mineral density become possible - I stopped at 8 which may be too short a period for a hormonal change to register results.

 

[mokwit]

TDCNINJA and wavehuneter, while you are both here would like to know how old you are and howlong ago you started TRT

[WaveHunter]

53 minutes ago, mokwit said:

Would be great if you could tell in as much detail exactly in what way you feel crappy and how long after reducing dose/using AI it takes to feel good again.

 

As mine came in at "50" I have been experimenting with anastrozole even though i do not really have clear symptons of high E. Note, one medical paper suggest the absolute cutoff for AI usage is 16 weeks after that risks to bone mineral density become possible - I stopped at 8 which may be too short a period for a hormonal change to register results.

 

By crappy, I specifically mean bloating.  For me it gets real bad when estradiol rises significantly.  Changes in testosterone level or use of an AI quickly reduce estrogen though.  For me,  the bloating disappears in a matter of days, perhaps a week.

 

As for risks associated with Anastrozole, I (and my doctor) think the typical TRT dosage is safe.  What's more, osteoporosis and osteopenia associated with the use of an AI such as Anastrozole are far less frequent in men than in women.

 

Furthermore, what many do not realize is that low serum testosterone can, in itself,  lead to bone mineral deficiency and osteoporosis!

(see Effect of Testosterone Replacement Therapy on Bone Mineral Density in Patients with Klinefelter Syndrome). 

 

Of course, the other side of the coin is that even though most of the recent studies with aromatase inhibitors in men do not show major detrimental effects on bone mineral density, there are not any accredited long-term studies that I know of so there could be a possible concern. 

 

These are the type of scientific details that most YouTube "gurus" don't discuss, and many doctors don't keep up with.  IMHO, when it comes to knowing the truth about TRT, you really have to be diligent in researching topics and not just accept some guru's view on Youtube, or sometimes even your own doctor.

 

Based on these facts, I (and my doctor) feel that the benefits of using an AI outweigh the risks.  It's a personal decision that you have to make for yourself since there is no correct universal answer.

Edited March 29, 2019 by WaveHunter

[WaveHunter]

57 minutes ago, mokwit said:

TDCNINJA and wavehuneter, while you are both here would like to know how old you are and howlong ago you started TRT

I am 52 and I started TRT 3 years ago, but ask me what my "metabolic age" is...it is 42!  My new body scale not only measure all sort of things like body weight, body fat percentage, BMI, BMR, bone mass, muscle mass and a bunch of other things but it even measure metabolic age!  I never even heard of that before LOL!  The funny thing is; most of the other results are pretty accurate with what I know to be true from other sources, so I think I'll start telling everybody I'm really 42 Hahahah!!!

Edited March 29, 2019 by WaveHunter

[mokwit]

5 minutes ago, WaveHunter said:

I am 52 and I started TRT 3 years ago, but ask me what my "metabolic age" is...it is 42!  My new body scale not only measure all sort of things like body weight, body fat percentage, BMI, BMR, bone mass, muscle mass and a bunch of other things but it even measure metabolic age!  I never even heard of that before LOL!  The funny thing is; most of the other results are pretty accurate with what I know to be true from other sources, so I think I'll start telling everybody I'm really 42 Hahahah!!!

If I am getting a bit too close to the bone here ignore me, but how has libido/sexual ability improved- are you back to where you were at 42 with these? I note you are one of the few people claiming benefit who started AFTER the 48-50 age for falling off a cliff of these (hence my reason for asking). At 44 I was same as 24 sexually - did not last - things fell off a cliff 48-50 sexually but I look like a Greek God at 55* i.e 'body weight, body fat percentage, BMI, BMR, bone mass, muscle mass' are all OK.

 

*albeit one who has been attending a few too many of Zeus's feast days of late

[WaveHunter]

2 hours ago, mokwit said:

If I am getting a bit too close to the bone here ignore me, but how has libido/sexual ability improved- are you back to where you were at 42 with these? I note you are one of the few people claiming benefit who started AFTER the 48-50 age for falling off a cliff of these (hence my reason for asking). At 44 I was same as 24 sexually - did not last - things fell off a cliff 48-50 sexually but I look like a Greek God at 55* i.e 'body weight, body fat percentage, BMI, BMR, bone mass, muscle mass' are all OK.

 

*albeit one who has been attending a few too many of Zeus's feast days of late

At 42 I had no issues.  At the time I was heavily into martial arts (Okinawan Shorin Ryu Karate), and I was a madman, working out 6 days a week, sometimes two sessions a day in the dojo.  People referred to me as a "bulldog" because I never gave up, and my sensei told me he had never seen anybody with as much "spirit" (energy) as me.  I was always in the dojo, and just couldn't get enough of it!  I loved it, got my black belt in record time and was even teaching my own group of kids as a brown belt which is very rare.  This was a very serious dojo BTW; not one of those take-your-money and give with a black belt in a year dojos.

That all started changing when I was age 47-48.  My main complaint that got me into exploring TRT was mainly lethargy.  It started getting crazy bad!  I'd get up every day and just feel like I hadn't slept, even though I had slept well.  Days would just drag on and I just felt like I had no energy.  I tried everything to correct it, and nothing seemed to work. Even though I loved the dojo, I started going less and less and then not at all.

 

My second complaint was that I was starting to put on a lot of excess body fat.  At first I considered I was just too sedentary but was eating as though I was still The Karate Man.  However, even after I started to improve nutrition and was dragging myself into the gym, the situation didn't change.  I also didn't like how my muscle tone was starting to change for the worse even though I had started working out in the gym.

 

Regarding Libido/sexual ability; it was never an issue for me and has never really changed before, or after starting TRT.  I guess I'm lucky in that regard. 

 

Even after I started TRT, I was disappointed with the results...at first.  Like many, I expected results to occur too quickly.  I was very impatient in retrospect, and almost gave up on TRT after a couple of months.  I think it was around the six-month mark that I began to notice positive results, and that was highly motivating.  Things continued to improve even more as time went on.  Looking back over the past few years, I am SO glad I didn't give up on it!

 

What people, new to TRT, have to understand is that it isn't a magic bullet with results that happen overnight, or without a committed effort to improve your nutrition and exercise your body properly.  It takes time, patience, and a commitment to becoming a more healthy person.

 

Some people say a commitment to becoming a more healthy person is ALL it takes and TRT isn't necessary at all.  I strongly disagree.  I mean, let's face it; in our modern world, guys are already at a disadvantage with average serum testosterone levels that are almost half of what they used to be 100 years ago!  We've become a sedentary class of people living on junk food so it's no wonder the average serum Test has dropped to the mid 400's when a hundred years ago it was in the mid-700's!  That is a statistical fact!    What's more, testosterone levels naturally decline with age. 

 

That all may be a natural state, but who says we have to accept that?  Not me, and I'm guessing not anyone participating in this thread ????

 

Edited March 29, 2019 by WaveHunter

[Destiny1990]

Any tips while doing trt how to avoid retractable testicles or is it something to just live with? Is that condition  only during sex or is it 24/7?

Edited March 29, 2019 by Destiny1990

[WaveHunter]

10 minutes ago, Destiny1990 said:

Any tips while doing trt how to avoid retractable testicles or is it something to just live with? Is that condition  only during sex or is it 24/7?

 

Are you referring to "shrinkage" because TRT has shut down natural Test production?  If so, HCG (human chorionic gonadotropic hormone) injections can address that.  Discuss it with your doctor but it's generally safe and easy to do.  Here's a good science-based article that can provide more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087849/

Edited March 29, 2019 by WaveHunter

[Destiny1990]

1 minute ago, WaveHunter said:

 

Are you referring to "shrinkage" because TRT has shut down natural Test production?  If so, HCG (human chorionic gonadotropic hormone) injections can address that.  Discuss it with your doctor but it's generally safe and easy to do.  Here's a good science-based article that can provide more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087849/

I aware of the shrinkage but i also read that most guys getting a tight sack from trt.

will HCG improve that too?

[Destiny1990]

6 hours ago, WaveHunter said:

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.

I did some t test 3 years ago always in morning and without eating  t level were 6,6 and 7 and 6,8. Europe measurements calculations 

the recommended level for trt is everything under 8 gets u free t in my own country but i made these test in various countries including my own country all in high end hospitals.

then recently so 3 years later in my own country my test was 8,8 so now my t level went up while i aged 3 years? It was same hospital I visited 3 years ago.

also it seems my government  lowered the minimum t level  for free t from 8 to 7 points so they moving the goalposts.

now I don’t care wether its free or not but yeah it does make it more confusing. So they making lower levels more normal and no need to treating it because u still within their standard levels.

hope u can follow my brainstorm here????

[WaveHunter]

18 hours ago, TDCNINJA said:

 

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?

Look, I'm not trying to pick a fight here.  Firstly, Dr. Rob does indeed have an agenda.  By stating half truths about AI's, he's instilling fear into viewers and making them think he is the only doctor they should trust for TRT.  It's a classic scare-mongering technique used by many YouTube health guru's. 

 

Some of what he says might be true...IF SOMEONE IS ABUSING TESTOSTERONE AND AI's, but not for the typical TRT patient.  Ergo...half-truths!  To rule out AI use based on what he says is ridiculous. 

 

Maybe the study I hastily referenced wasn't really on target but it supported my view.  Here is one though that is PRECISELY on target:  Effect of Testosterone Replacement Therapy on Bone Mineral Density in Patients with Klinefelter Syndrome.

 

I am not arguing that there are not a lot of unknowns when it comes to possible negative health consequences of TRT.  Much of the long term effects have simply not been properly studied yet.  However, you have to weight the potential benefits vs the risks, based on what is known as fact now, not unscientific conjecture. 

 

In the case of AI usage, in my doctor's opinion (and therefore mine), E2 serum levels that get too high is a substantial and scientifically proven risk.  Using anastrozole responsibly to balance E2 has not been scientifically proven to be a risk, based on what is known now.  

 

The negative consequences of long term AI use at TRT doses have simply not been studied adequately BUT the shorter-term studies indicate it is not a significant risk, contrary to what Dr. rob states.  If the scientific community as a whole agreed with Dr. Rob, there would be plenty of accredited studies to back up what he says; there are NONE!

 

Secondly, I agree 100% that anyone trying to self-medicate with TRT is a dumbass, OK?  At least we agree on that I think. ????

 

Thirdly,  what in the world do you mean by "physiological" doses.  Are you talking about doses that would equate to the "normal" average serum levels for the modern male population, and that also include those who are clinically deficient (below 300 ng/dL)?  Or are you talking about doses that would equate to what the average serum levels were 100 years ago when men were much more healthy and robust?

 

I would choose the latter group whose average serum testosterone levels averaged around 700 ng/dL.  I would consider that to be a healthy average "physiological" level, but since it is only an average, my doctor (and I) felt that 900 ng/dL is a more appropriate "physiological" target.  Does this sound reasonable, or am I being a "Roid Head" with this reasoning?

 

To get that level requires 125 mg of testosterone per week for me.  It is accompanied by a rise in estradiol to unacceptable levels (> 50 pg/mL).  More importantly, the increased estrogen made me feel like crap.  Getting E2 down to acceptable levels could be accomplished by reducing exogenous testosterone but then my serum levels would become sub-optimal and defeat the purpose of TRT. 

 

Anastrozole gets the levels down to around 30 pg/mL and only requires a minute dose that is NOT going to have any adverse effects according to ALL published accredited studies that are currently available.  I mean, that is 0.25mg, twice a week (or one-half of a pill per week).

 

I have had this dialed in for over two years now, and feel great.  My blood panels are spot on every time they are tested, so all I can say is it works for me.

 

I'm not faulting you if you are opposed to using AI's.  Each to their own.  Truth is, I'm happy you have an opposing viewpoint.  There's nothing better for this type of thread than spirited debate.

 

However, I AM absolutely opposed to people like Dr. Rob who spout off half-truths and misinformation simply to drum up business for themselves and build their highly profitable TRT "business".  Those type of doctors are not in it to help people, they are in it to make money, and as much as they possibly can!

 

 

Edited March 29, 2019 by WaveHunter

[TDCNINJA]

13 hours ago, mokwit said:

TDCNINJA and wavehuneter, while you are both here would like to know how old you are and howlong ago you started TRT

53.  Almost a year. One of those crappy Low-T centers in my hometown offered a free deal where you could come in and they would test your total T. They said you could start the program if it was 350 or less. Mine was 320. They wanted me to start right away and I declined and said that I need to think and do some research. A couple of months later I paid for over $500 worth of labs and got a consultation with Dr. Justin Saya at Defy Medical in Tampa, Florida. My free T and DHT were clinically low and of course, my 'low normal' total T was still in the bucket. 

 

Look, I don't know everything about TRT but I can say that I have done a great deal of research on TRT and I'm learning every day.  

 

The best advice I can give to anyone interested in TRT is to go to a doctor (not a regional or nationwide branch TRT chain) who specializes in hormone replacement, get your levels tested and go from there. 

 

If you live in Thailand, you can still be a telemedicine patient at Defy Medical or similar places and just buy your product (s) in Thailand as well as doing your labs at a far discounted price by using Thai labs. 

Edited March 29, 2019 by TDCNINJA

[TDCNINJA]

8 hours ago, WaveHunter said:

LThirdly,  what in the world do you mean by "physiological" doses.  Are you talking about doses that would equate to the "normal" average serum levels for the modern male population, and that also include those who are clinically deficient (below 300 ng/dL)?  Or are you talking about doses that would equate to what the average serum levels were 100 years ago when men were much more healthy and robust?

 

2

I, too, have enjoyed our discussion.

 

By physiological dosing, I mean not putting any more testosterone into my body than what a normal, non-obese, lean male would naturally produce. The 'physiological' production of testosterone in a healthy, lean, non-obese, 25-35-year-old male is around 4-10mg of testosterone a day.  

 

A neuro-endocrinologist in Encino, California, named Dr. Mark Gordon, has over 2500 confirmed cases of successfully treating American war veterans who suffer from Traumatic Brain Injury(TBI), with physiological doses of testosterone, GH, pregnenolone, and DHEA. Dr. Gordon reviewed of a lot of old medical literature that showed that head trauma, and the ensuing inflammation in the brain, can alter hormone production resulting in not only testosterone deficiency but also deficits in growth hormone, DHEA, pregnenolone, and other needed body chemicals. 

 

Dr. Gordon found that by giving 'physiological' doses of hormones he was able to greatly enhance the quality of life and physical and emotional well-being of these veterans. Furthermore, Dr. Gordon found that he got better results with physiological doses versus supraphysiological doses. 

 

And Wavehunter, not you, but for those who think that TRT is bullshit, here is a wonderful article on  Dr. Gordon's great work with war veterans. 

https://www.lifeextension.com/magazine/2012/1/Using-Hormones-Heal-Traumatic-Brain-Injuries/Page-01

 

Gordon explains that conventional medical dosage for testosterone is at 200-300 milligrams per week, which he has shown is far too high!

 

"For example, a typical 25-35-year-old male naturally generates 4-10 milligrams per day or 60 milligrams per week. Using supraphysiological dosages of testosterone (as military doctors are doing) can have significant side-effects if not monitored closely. We can achieve similar benefits at one-quarter the dose without the risk factors."

Edited March 29, 2019 by TDCNINJA

[faraday]

Very interesting post. He's an Endocrinologist.

 

Is this the same chap?

 

https://www.researchgate.net/publication/328212680_A_paradigm_shift_in_the_diagnosis_and_treatment_of_symptomatic_Traumatic_Brain_Injury_aka_PTSPTSD

 

 

[TDCNINJA]

3 hours ago, faraday said:

Very interesting post. He's an Endocrinologist.

 

Is this the same chap?

 

https://www.researchgate.net/publication/328212680_A_paradigm_shift_in_the_diagnosis_and_treatment_of_symptomatic_Traumatic_Brain_Injury_aka_PTSPTSD

 

 

One and the same.

[WaveHunter]

7 hours ago, TDCNINJA said:

I, too, have enjoyed our discussion.

 

By physiological dosing, I mean not putting any more testosterone into my body than what a normal, non-obese, lean male would naturally produce. The 'physiological' production of testosterone in a healthy, lean, non-obese, 25-35-year-old male is around 4-10mg of testosterone a day.  

 

A neuro-endocrinologist in Encino, California, named Dr. Mark Gordon, has over 2500 confirmed cases of successfully treating American war veterans who suffer from Traumatic Brain Injury(TBI), with physiological doses of testosterone, GH, pregnenolone, and DHEA. Dr. Gordon reviewed of a lot of old medical literature that showed that head trauma, and the ensuing inflammation in the brain, can alter hormone production resulting in not only testosterone deficiency but also deficits in growth hormone, DHEA, pregnenolone, and other needed body chemicals. 

 

Dr. Gordon found that by giving 'physiological' doses of hormones he was able to greatly enhance the quality of life and physical and emotional well-being of these veterans. Furthermore, Dr. Gordon found that he got better results with physiological doses versus supraphysiological doses. 

 

And Wavehunter, not you, but for those who think that TRT is bullshit, here is a wonderful article on  Dr. Gordon's great work with war veterans. 

https://www.lifeextension.com/magazine/2012/1/Using-Hormones-Heal-Traumatic-Brain-Injuries/Page-01

 

Gordon explains that conventional medical dosage for testosterone is at 200-300 milligrams per week, which he has shown is far too high!

 

"For example, a typical 25-35-year-old male naturally generates 4-10 milligrams per day or 60 milligrams per week. Using supraphysiological dosages of testosterone (as military doctors are doing) can have significant side-effects if not monitored closely. We can achieve similar benefits at one-quarter the dose without the risk factors."

Completely agree that too high of a dose or too high of serum level testosterone can negatively effect health.  Are you saying that you consider a proper (physiological) range of weekly dosage to be 28mg-70mg?  What do you consider a proper (physiological) range for total serum testosterone level to be?

Edited March 30, 2019 by WaveHunter

[TDCNINJA]

33 minutes ago, WaveHunter said:

Completely agree that too high of a dose or too high of serum level testosterone can negatively effect health.  Are you saying that you consider a proper (physiological) range of weekly dosage to be 28mg-70mg?  What do you consider a proper (physiological) range for total serum testosterone level to be?

 

Well, this is where it gets tricky. On many levels, I consider what you posted to be a proper dose. However, SHBG (Sex Hormone Binding Globulin) plays a major role in determining how effective that 'proper' dose is. If the person has a high SHBG, it can bind to testosterone - leaving fewer free T in the body. Free T, as you know, is essential. If a person takes a 'proper' dose but has low available free T, he will have to increase his dosage. Or he can supplement with DHEA and/or pregnenolone along with a proper diet to lower SHBG so that physiological doses are optimal within his particular body chemistry. Too low SHBG is another headache that has to be worked out and 'dialed-in' with the patient and provider. 

 

This is a textbook example of why men need to be under the supervision of an EXPERIENCED physician when undergoing TRT. 

[WaveHunter]

I just want to post some basics about aromatase inhibitors (specifically anastrozole) since we've been talking a lot about this and I'm thinking maybe some have misconceptions about it.

 

Most who are participating in this thread don't dispute the beneficial effects of testosterone and TRT, and those benefits are widely acknowledged in accredited landmark studies.  However, there is not much in the way of long-term studies when it comes to possible risks of TRT, and more specifically the risks associated with the use of aromatase inhibitors when used in conjunction with TRT.  Furthermore, there have not been any studies that conclusively show whether high estradiol levels after TRT are even that harmful, as strange as that might sound!

 

It's important to realize that estrogen in males is not necessarily a bad thing.  The presence of estrogen in males is actually critically important to good health.  The question is whether or not too much is a bad thing, and if so, how much is too much.  The truth is, not much work has been done to understand better the role of estrogens in men.  So, the question of whether or not AI's are good or bad for TRT are also not conclusive.

 

In TRT, estrogen levels may rise as a result of the conversion of testosterone to estrogen through aromatization.  Aromatase Inhibitors such as Anastrozole are sometimes used in TRT to reduce levels of circulating estrogen when the estradiol level (E2) is raised to a level that is considered too high.  Presently, High estradiol levels are defined as ≥42.6 pg/ml.

 

Researchers are beginning to think that serum T/E2 (testosterone : estradiol) ratio may be more important than the respective individual hormonal levels when it comes to assessing the possible negative aspects of using AI's in TRT.

 

It's important to understand that aromatase inhibitors only do one thing; they control aromatization of testosterone to estrogen; they do not directly effect lipid profiles, inflammatory markers of cardiovascular risk, insulin resistance, or negative changes in bone mineral density.  To put it another way, possible negative health effects of using aromatase inhibitors in TRT are not due to the AI's themselves, and not even to the lower levels of estrogen that result from their use, but rather to the altered T/E2 ratio they cause.

 

To simply say that AI's cause negative health consequences is false logic.  They simply change the T/E2 ratio.  If the AI brings the T/E2 ratio back into a physiological stable level, that is a most likely good thing; if the T/E2 levels is allowed to go unchecked, that will probably be a bad thing, but it is the T/E2 that dictates the health outcome, not the AI.

 

The real issue in understanding the possible negative role of estrogen in TRT is that there is simply not any long-term research findings to go by.  Almost all of the research done to date with aromatase inhibitors is in the female population since Anastrozole is actually FDA-approved for the treatment of breast cancer in women after surgery. As such, its use in men on testosterone replacement therapy is considered to be off-labeled, and therefore there is very little funding to support long-term research.

 

Randomized controlled study would be needed over several years to understand if indeed high E2 after TRT may be beneficial or harmful, and to date, no such studies have been done.  It is therefore improper to say that AI's are beneficial or harmful. 

 

At the present time, how to deal with altered T/E2 ratios that result from TRT, or even if it's necessary to deal with them is unknown.  It is debatable what the best strategy should be in the absence of actual research, but my personal take on it is to try and maintain a balanced T/E2 ratio based on physiological norms while undergoing TRT. 

 

For many men on TRT, it is a moot point because their estrogen levels are unaffected by TRT.  For those that are however, IMHO, aromatase inhibitors provide a safe means of maintaining the T/E2 ratio provided responsible dosages are used.  There is no scientific evidence to counter this.

 

Some will point to adverse effects on bone mineral density as a result of using aromatase inhibitors in TRT but this is unfounded.  Most studies that note adverse effects on bone health due to AI’s are of females treated with AIs for breast cancer with dosages of 1mg per day.  There are no recognized studies that show this to be the case in men on TRT who are using the typically prescribed doses of 0.5mg per week.  BMD is mostly reserved for females, and are not seen in males. (https://www.ncbi.nlm.nih.gov/pubmed/27784593)

 

Anyway, I'm just scratching the surface here.  I'm not trying to give you a detailed overview, just prompt you to do your own research...use Google to find truth, not YouTube ????

 

Edited March 30, 2019 by WaveHunter

[WaveHunter]

1 hour ago, TDCNINJA said:

 

Well, this is where it gets tricky. On many levels, I consider what you posted to be a proper dose. However, SHBG (Sex Hormone Binding Globulin) plays a major role in determining how effective that 'proper' dose is. If the person has a high SHBG, it can bind to testosterone - leaving fewer free T in the body. Free T, as you know, is essential. If a person takes a 'proper' dose but has low available free T, he will have to increase his dosage. Or he can supplement with DHEA and/or pregnenolone along with a proper diet to lower SHBG so that physiological doses are optimal within his particular body chemistry. Too low SHBG is another headache that has to be worked out and 'dialed-in' with the patient and provider. 

 

This is a textbook example of why men need to be under the supervision of an EXPERIENCED physician when undergoing TRT. 

Ok but my question remains; Are you saying that you consider a proper (physiological) range of weekly dosage to be 28mg-70mg?  What do you consider a proper (physiological) range for total serum testosterone level to be?  I mean, for yourself.  Just curious ????

 

Edited March 30, 2019 by WaveHunter

[mokwit]

12 minutes ago, WaveHunter said:

Ok but my question remains; Are you saying that you consider a proper (physiological) range of weekly dosage to be 28mg-70mg?  What do you consider a proper (physiological) range for total serum testosterone level to be?

It's not just TT free T SHBG E and DHT conversion. There is another side to the equation that is never mentioned because it is not easily measured in a clinical setting and that is receptor density and sensitivity. One UK practitioner has 2000 subject data showing NO correlation between Total T levels FREE T levels and symptons. Understandable if T levels are just one side of an equation.

 

Manipulating SHBG levels reliably over a long period is very difficult to do.

 

Can reduce SHBG levels with Danazol which is used mainly I suspect because there is a lot of data from its use in women, and any 17 alpha alkylated oral steroid such as Oxandrolone (Anavar) or Staozolol (winstrol). DHT also does this. Oxandrolone is far preferable due to its much lower liver toxicity (uniquely low for 17aa compound). Any liver issues such as high alcohol use even in the past will also likely override and androgen based manipulation.

 

Alternatively you can free up Testosterone from SHBG by using Mesterolone (proviron) which binds more strongly to SHBG than T and displaces it, thus freeing it up.

Edited March 30, 2019 by mokwit

[mokwit]

27 minutes ago, WaveHunter said:

Well, this is where it gets tricky. On many levels, I consider what you posted to be a proper dose. However, SHBG (Sex Hormone Binding Globulin) plays a major role in determining how effective that 'proper' dose is. If the person has a high SHBG, it can bind to testosterone - leaving fewer free T in the body. Free T, as you know, is essential. If a person takes a 'proper' dose but has low available free T, he will have to increase his dosage. Or he can supplement with DHEA and/or pregnenolone along with a proper diet to lower SHBG so that physiological doses are optimal within his particular body chemistry. Too low SHBG is another headache that has to be worked out and 'dialed-in' with the patient and provider. 

 

This is a textbook example of why men need to be under the supervision of an EXPERIENCED physician when undergoing TRT. 

t's not just TT free T SHBG E and DHT conversion. There is another side to the equation that is never mentioned because it is not easily measured in a clinical setting and that is receptor density and sensitivity. One UK practitioner has 2000 subject data showing NO correlation between Total T levels FREE T levels and symptons. Understandable if T levels are just one side of an equation.

 

Manipulating SHBG levels reliably over a long period is very difficult to do.

 

Can reduce SHBG levels with Danazol which is used mainly I suspect because there is a lot of data from its use in women, and any 17 alpha alkylated oral steroid such as Oxandrolone (Anavar) or Staozolol (winstrol). DHT also does this. Oxandrolone is far preferable due to its much lower liver toxicity (uniquely low for 17aa compound). Any liver issues such as high alcohol use even in the past will also likely override and androgen based manipulation.

 

Alternatively you can free up Testosterone from SHBG by using Mesterolone (proviron) which binds more strongly to SHBG than T and displaces it, thus freeing it up. This last is most reliable, least toxic and if you stay at or below 75-100mg you get a free lunch as free T should be boosted but that dose won't cause counteracting suppression of T via HPTA axis suppression.

Edited March 30, 2019 by mokwit

[WaveHunter]

34 minutes ago, mokwit said:

It's not just TT free T SHBG E and DHT conversion. There is another side to the equation that is never mentioned because it is not easily measured in a clinical setting and that is receptor density and sensitivity. One UK practitioner has 2000 subject data showing NO correlation between Total T levels FREE T levels and symptons. Understandable if T levels are just one side of an equation.

 

Manipulating SHBG levels reliably over a long period is very difficult to do.

 

Can reduce SHBG levels with Danazol which is used mainly I suspect because there is a lot of data from its use in women, and any 17 alpha alkylated oral steroid such as Oxandrolone (Anavar) or Staozolol (winstrol). DHT also does this. Oxandrolone is far preferable due to its much lower liver toxicity (uniquely low for 17aa compound). Any liver issues such as high alcohol use even in the past will also likely override and androgen based manipulation.

 

Alternatively you can free up Testosterone from SHBG by using Mesterolone (proviron) which binds more strongly to SHBG than T and displaces it, thus freeing it up.

I hope you're not advocating the use any 17 alpha alkylated oral steroids to manipulate SHBG or free up bound testosterone.  It's like killing a mosquito with a sledge hammer, and more importantly,  any 17 alpha alkylated oral steroid is extremely toxic to the liver over time, and should only be used for limited periods of time (in the case of anavar, maximum of six weeks) so they are hardly appropriate for long-term TRT.

 

Don't kid yourself about oxandrolone; it is far more toxic to the liver than most people acknowledge.  Winstrol is no better.  Even worse, when you buy these steroids, you don't really know what your getting.  Anavar is very expensive and therefore often counterfeited.  More often than not, when you buy anavar, you're actually getting something like a low quality version of Metandienone (dBol) since it mimics Oxandrolone but is far cheaper to make!

 

Of all drugs you listed, the only one I would not have a problem with (and I use it myself as part of my TRT) is Proviron (not actually a steroid) because of it's propensity to free up bound testosterone and because it is not toxic to the liver.

 

If you do use these drugs you mentioned, I'm not saying anything negative about you.  They have their place for people who understand them and use them properly and responsibly. 

 

I'm just saying what I'm saying so that others who read this post don't do something stupid.  I mean, here in Thailand it's very easy to go to the pharmacy and buy these things, and a lot of people have the mindset that if you can buy something over the counter, it must be safe to use.  Here in Thailand, that is not true at all.  Any type of steroid, no matter how mild it is, is not the domain of an uninformed person.

Edited March 30, 2019 by WaveHunter

[mokwit]

19 minutes ago, WaveHunter said:

I hope you're not advocating the use any 17 alpha alkylated oral steroids to manipulate SHBG or free up bound testosterone.  It's like killing a mosquito with a sledge hammer, and more importantly,  any 17 alpha alkylated oral steroid is extremely toxic to the liver. 

That is exactly what I am advocating for myself, Having done my research coming from a background of BSc Neurophysoiology/Pharmacology/Endocrinolgy (albeit NOT medically qualified)  and having consulted with an endocrinologist that is exactly what i am doing on a trial basis in low doses and for short periods. Oxandrolone: as with everything there is conflicting data WRT liver toxicity and some of the enzymes looked at might not be the right one. It seems there is something unique to Oxandrolone (maybe the double bonded O2) that suggest much lower liver toxicity - uniquely it is almost entirely excreted in the urine UNCHANGED i.e unmetabolised by the liver. The major riks is that only UGL "Anavar" is readily available and the risk is that it is low dose Stanozolol which is demonstrably hepatotoxic.

 

I take your point about others reading this and not having done the research and risk:reward evaluation that I have done.

 

Agree re Proviron, but it is a steroid. It is methylated DHT

 

Danazol is used by medically qualified experienced TRT practitioners to reduce SHBG over periods of 2 years or more (low dose of 50mg/Ed vs much higher female dose which is short term use only). I regard Danazol as a messy drug with multiple unwanted actions and substituted anavar based on my research and advice from a practitioner.

Edited March 30, 2019 by mokwit

[WaveHunter]

30 minutes ago, mokwit said:

That is exactly what I am advocating for myself, Having done my research coming from a background of BSc Neurophysoiology/Pharmacology/Endocrinolgy (albeit NOT medically qualified)  and having consulted with an endocrinologist that is exactly what i am doing on a trial basis in low doses and for short periods. Oxandrolone: as with everything there is conflicting data WRT liver toxicity and some of the enzymes looked at might not be the right one. It seems there is something unique to Oxandrolone (maybe the double bonded O2) that suggest much lower liver toxicity - uniquely it is almost entirely excreted in the urine UNCHANGED i.e unmetabolised by the liver. The major riks is that only UGL "Anavar" is readily available and the risk is that it is low dose Stanozolol which is demonstrably hepatotoxic.

 

I take your point about others reading this and not having done the research and risk:reward evaluation that I have done.

 

Agree re Proviron, but it is a steroid. It is methylated DHT

 

Danazol is used by medically qualified experienced TRT practitioners to reduce SHBG over periods of 2 years or more (low dose of 50mg/Ed vs much higher female dose which is short term use only). I regard Danazol as a messy drug with multiple unwanted actions and substituted anavar based on my research and advice from a practitioner.

I stand corrected about proviron.  I guess I just think of it as a non-steroid because it poses none of the risks associated with most other steroids.  Also, I forgot that counterfeit anavar can also be winstrol. 

 

Regarding anavar though, it's always touted as a "safe" steroid by body builders.  I guess it is one of the more safer ones, but still, it can be dangerous, especially at the doses that some of those guys use.  I see lots of YouTube videos and just can't believe what some people advocate in them, and the thing is, there are a lot of impressionable, lazy people that will just take their word for it, and as I said, it's very easy to just to to a pharmacy and buy those things over the counter.  

 

Again, my replies was not directed at you since you obviously know what you're talking about; it was just for the less informed.

 

Personally I just try and keep my TRT as simple as possible.  Test-E, proviron, anastrozole, zinc picolinate, an assortment of vitamins, and good nutrition (well I try on that one at least LOL).  

Edited March 30, 2019 by WaveHunter