Testosterone, steroids, etc.

WaveHunter · April 10, 2019

You have to consider that there sometimes can be a BIG difference between theoretical lab science and real-world therapy, when it comes to efficacy and safety, and convenience. That’s why good TRT doctors exist...to bridge the gap.

That’s the trouble with those who self-medicate, basing their treatment on YouTube Gurus’ interpretations of this study or that, or reading a study yourself and misinterpreting it.

A really good doctor to guide you is worth his/her weight in gold! THAT should always be the true starting point in TRT. We should really start a thread on how to find a good TRT doctor because that’s certainly no easy task!

mokwit · April 10, 2019

50 minutes ago, WaveHunter said:

Clomiphene’s primary effect is on FSH, not LH. In TRT, the only thing that will restore LH is hGC.

This is completely wrong. Clomiphene acts to stimulate both LH and FSH at the Hypothalamus/Pituritary. There are no end of studies showing Clomiphene increasing T and it does so via an increase in LH which then acts on the Testes to stimulate T production from the Leydig cells in the testes. I was told to reduce my clomiphene doses as my LH was near outlier levels. HCG does not restore LH it is an analog (mimic) of LH and thus acts to stimulate the same receptors as LH in the testes. There is even some speculation that being an anolog of LH HCG might actually act to suppress LH via a feedback loop in the brain. Note the high levels of T in the Testes required for fertility/stimulation of sertoli cells cannot be mimicked by injected T it has to come from the bodies own pathway and this pathway is stimulated via LH/FSH - hence Clomiphene is used to boost T when fertility is important as it boosts LH and FSH rather than shut them down which is what exogenous T does.

I have seen a few other things you have posted that seem plain wrong to someone who has sat through lectures on this at university given by an endocrinologist - until now I decided I would be better off not commenting.

As for the paper being old, yes it is but they had Immunoassays, NMR, Mass spectroscopy, and High pressure liquid chromatography in those days so one can assume the levels were measured reliably. I would have thought the small sample size would be something to home in on. The reason I saved the paper for my own reference was because it shows that for some reason blocking estrogen receptors can also stop suppression of T by compounds that do not act as agonists at the E receptor. My hypotheses is that blocking of E receptors overrides any suppression by T and DHT derivatives, this was confirmed by an endocrinologist I spoke with and by this paper. I posted it because the same paper also shows what I highlighted in a previous post - but this was peripheral to the main rationale of the study..

Edited April 10, 2019 by mokwit

mokwit · April 10, 2019

Just now, WaveHunter said:

You have to consider that there sometimes can be a BIG difference between theoretical lab science and real-world therapy, when it comes to efficacy and safety, and convenience. That’s why good TRT doctors exist...to bridge the gap.

That’s the trouble with those who self-medicate, basing their treatment on YouTube Gurus’ interpretations of this study or that, or reading a study yourself and misinterpreting it.

A really good doctor to guide you is worth his/her weight in gold! THAT should always be the true starting point in TRT. We should really start a thread on how to find a good TRT doctor because that’s certainly no easy task!

I absolutely agree with this. People cite papers without any training in scientific methodology that would allow them to critically evaluate the extent to which results can be viewed as "facts".

None of this stuff is certain - if you go deep into original papers which I have done twice you find there seems to be as much for and against and scientific theory which is accepted often has huge holes and contradictions - the theory with the least of these is set forward even though it clearly has them.

A friend who was head of reproductive endocrinology at a prestigious teaching hospital told me "If you read an undergraduate medical textbook you would think we understood the endocrine system perfectly and could manipulate it this way or that way - I'm one of the foremost authorities in the country and I can tell you it is just not that well understood"

For me I would place less weight on scientific paper and be most interested in the opinion of a practitioner with the theoretical background and years of looking at bloodwork - they will tell you they have seen things that are the opposite of theory.

WaveHunter · April 10, 2019

28 minutes ago, mokwit said:

This is completely wrong. Clomiphene acts to stimulate both LH and FSH at the Hypothalamus/Pituritary. There are no end of studies showing Clomiphene increasing T and it does so via an increase in LH which then acts on the Testes to stimulate T production from the Leydig cells in the testes. I was told to reduce my clomiphene doses as my LH was near outlier levels. HCG does not restore LH it is an analog (mimic) of LH and thus acts to stimulate the same receptors as LH in the testes. There is even some speculation that being an anolog of LH HCG might actually act to suppress LH via a feedback loop in the brain. Note the high levels of T in the Testes required for fertility/stimulation of sertoli cells cannot be mimicked by injected T it has to come from the bodies own pathway and this pathway is stimulated via LH/FSH - hence Clomiphene is used to boost T when fertility is important as it boosts LH and FSH rather than shut them down which is what exogenous T does.

I have seen a few other things you have posted that seem plain wrong to someone who has sat through lectures on this at university given by an endocrinologist - until now I decided I would be better off not commenting.

As for the paper being old, yes it is but they had NMR, Mass spectroscopy, and High pressure liquid chromatography in those days so one can assume the levels were measured reliably. I would have thought the small sample size would be something to home in on. The reason I saved the paper for my own reference was because it shows that for some reason blocking estrogen receptors can also stop suppression of T by compounds that do not act as agonists at the E receptor. My hypotheses is that blocking of E receptors overrides any suppression by T and DHT derivatives, this was confirmed by an endocrinologist I spoke with and by this paper. I posted it because the same paper also shows what I highlighted in a previous post.

OK, yes, you’re right; hCG does not truly replace LH, but it mimics LH almost perfectly, and no other drug is capable of that.

Two different TRT doctors I’ve been a patient to both said that hCG is the primary treatment and for 70% of men that was all that was needed. For the remaining 30% a SERM might be needed if FSH levels were problematic. Everything I’ve read concurs with their advice. I have never heard of Anastrozole being prescribed for this purpose.

Personally I don’t consider it an issue so I don’t take anything but Anastrozole, and that is ONLY for the purpose of keeping my T/E2 balanced.

To be honest, I think this whole thread is getting a little out of control and I’m as much to blame as anyone because it’s fun to exchange information, points of view, and have interesting debates BUT SERIOUSLY, TRT should not be all that confusing, complicated or so convoluted.

My own TRT protocol is a simple one, not much more involved than taking vitamins. I have quarterly blood tests done, my doctor reviews them, and if any adjustments to the protocol SHE tells me; I don’t decide on my own, and I don’t seek advice from a forum.

Its fun and engaging to explore the science, and I love a good feisty debate ALWAYS, but honestly, the real treatment should be in the hands of a qualified physician, not faceless individuals on a forum.

Would you agree?

Edited April 10, 2019 by WaveHunter

Destiny1990 · April 10, 2019

55 minutes ago, WaveHunter said:

Well, the study you cited is very old (1979) and I can’t even see the discussion or conclusion of the study, but it seems to be a theoretical study specifically of what role clomiphene may play, not that it will restore LH. I’d love to see the whole study though if you could send me a link to the full PDF ????

Clomiphene’s primary effect is on FSH, not LH. In TRT, the only thing that will restore LH is hGC. SERMS and AI’s may help some men in which FSH must be addressed but it’s effects are not going to fully restore LH, nor will Anastrozole. Only hGC can do that.

Regarding daily vs weekly or twice-a-week injections. You bring up a good point. Yes, daily injections will more properly mimic the body’s natural delivery and that would be important in a theoretical study...but the question remains, is such frequent delivery actually necessary in real-world TRT? Does it improve efficacy or minimize side-effects in TRT?

I have yet to see any reputable science-based proof that supports daily injections over weekly or twice-a-week when it comes to REAL-WORLD TRT for the reasons I outlined earlier today.

Furthermore, most doctors I’ve spoken with and the vast majority of people undergoing TRT I know, opt for weekly or twice-a-week injections, not daily injections.

You have to consider that there sometimes can be a BIG difference between theoretical lab science and real-world therapy, when it comes to efficacy and safety, and convenience. That’s why good TRT doctors exist...to bridge the gap.

Hi well but why is it when doctors talking about TRT gels creams these always have to been taken daily ?

plenty of doctors btw prefer T gels over injections.

WaveHunter · April 10, 2019

42 minutes ago, mokwit said:

I absolutely agree with this. People cite papers without any training in scientific methodology that would allow them to critically evaluate the extent to which results can be viewed as "facts".

None of this stuff is certain - if you go deep into original papers which I have done twice you find there seems to be as much for and against and scientific theory which is accepted often has huge holes and contradictions - the theory with the least of these is set forward even though it clearly has them.

A friend who was head of reproductive endocrinology at a prestigious teaching hospital told me "If you read an undergraduate medical textbook you would think we understood the endocrine system perfectly and could manipulate it this way or that way - I'm one of the foremost authorities in the country and I can tell you it is just not that well understood"

For me I would place less weight on scientific paper and be most interested in the opinion of a practitioner with the theoretical background and years of looking at bloodwork - they will tell you they have seen things that are the opposite of theory.

Yes, we’re absolutely in the same page here. A good MD is a real rarity these days, much less one with TRT knowledge and experience. I’ve been lucky enough to find one when I lived in the States, and also one (a woman) when I lived in Chiang Mai. Now I’m living outside of Pattaya and am having a tough time finding one so my doctor in Chiang Mai is still working with me and it seems to work well, me having my bloods done here and sending her results. So far, so good ????

The big problem with doctors today is they just don’t seem interested in keeping up with science, and seem content to just sit back, listen to your complaints and reach for their Rx pad. It’s even worse if you approach one about TRT!

My doctor in Chiang Mai is a GP and does not seek to be known as a TRT practice, yet she is incredibly knowledgeable on the subject.

The problem with finding a good TRT doctor is that most of the ones who you hear about from a google search of your geographic area are clearly only in it for the money.

They have a splashy website, expounding on the (highly unrealistic) virtues of TRT with stock photos of vibrant, athletic looking 50-something men with a beautiful woman standing next to him....LOL, it’s so phony!

I checked out a couple of them when I first became interested in TRT, and both doctors I met reminded me of used car salesmen more than doctors. It was creepy!

A GENUINELY good TRT doctor is worth his/her weight in gold. We should start a thread on the good ones we know of here in Thailand!

Edited April 10, 2019 by WaveHunter

Destiny1990 · April 10, 2019

15 minutes ago, WaveHunter said:

Yes, we’re absolutely in the same page here. A good MD is a real rarity these days, much less one with TRT knowledge and experience. I’ve been lucky enough to find one when I lived in the States, and also one (a woman) when I lived in Chiang Mai. Now I’m living outside of Pattaya and am having a tough time finding one so my doctor in Chiang Mai is still working with me and it seems to work well, me having my bloods done here and sending her results. So far, so good ????

The big problem with doctors today is they just don’t seem interested in keeping up with science, and seem content to just sit back, listen to your complaints and reach for their Rx pad. It’s even worse if you approach one about TRT!

My doctor in Chiang Mai is a GP and does not seek to be known as a TRT practice, yet she is incredibly knowledgeable on the subject.

The problem with finding a good TRT doctor is that most of the ones who you hear about from a google search of your geographic area are clearly only in it for the money.

They have a splashy website, expounding on the (highly unrealistic) virtues of TRT with stock photos of vibrant, athletic looking 50-something men with a beautiful woman standing next to him....LOL, it’s so phony!

I checked out a couple of them when I first became interested in TRT, and both doctors I met reminded me of used car salesmen more than doctors. It was creepy!

A GENUINELY good TRT doctor is worth his/her weight in gold. We should start a thread on the good ones we know of here in Thailand!

Probably just a view around and likely they are contradicting eachother same as people doing on this thread.

Seems to me most figure out themselves what works best for them and gain knowledge from google instead of from some doctor in some shop selling sups makes sense to me.

Edited April 10, 2019 by Destiny1990

mokwit · April 10, 2019

16 minutes ago, WaveHunter said:

They have a splashy website, expounding on the (highly unrealistic) virtues of TRT with stock photos of vibrant, athletic looking 50-something men with a beautiful woman standing next to him....LOL, it’s so phony!

Dr Tim Lopez's operation (Maximum Performance Wellness Centre) seems (seems) to be in that category to the point of being offputting from the outside/web presence, but he actually does know his stuff. I have been to see him twice. I went to see him based on interviews he gave with a bodybuilder in which it was clear to me he knew his stuff. There is just no way I would have walked through the doors of his clinic if the view from outside was all I had to go on.

As there are 2 in Pattaya I assume he is maybe one you met. I did not feel any pressure to sign up - I saw him once to run what i was doing past him, and another time he went through my bloodwork. Personally I am happy to recommend him - the only others I would feel confident of are in US, London, Brussels.

TRT is simple except for those presentations when it is not and it is a lifetime learning. I have pretty much given up doing my own research against that backdrop, despite my background.

His pricing structure is controversial on these boards so I am posting a link.

https://www.whatclinic.com/doctors/thailand/bangkok/maximum-performance-wellness-center-bangkok

Edited April 10, 2019 by mokwit

WaveHunter · April 11, 2019

20 hours ago, Destiny1990 said:

Hi well but why is it when doctors talking about TRT gels creams these always have to been taken daily ?

plenty of doctors btw prefer T gels over injections.

Transdermal delivery is simply not as effective as injection so gels need to be used daily. Most doctors who prescribe gels do it as a conservative first step. My doctor gave me that option but made the point that it wa a conservative approach, and also pointed out drawbacks, the chief one being that if you have close contact with others (I.e.: wife, your kids) that could have potentially serious health consequences for them.

WaveHunter · April 11, 2019

19 hours ago, mokwit said:

Dr Tim Lopez's operation (Maximum Performance Wellness Centre) seems (seems) to be in that category to the point of being offputting from the outside/web presence, but he actually does know his stuff. I have been to see him twice. I went to see him based on interviews he gave with a bodybuilder in which it was clear to me he knew his stuff. There is just no way I would have walked through the doors of his clinic if the view from outside was all I had to go on.

As there are 2 in Pattaya I assume he is maybe one you met. I did not feel any pressure to sign up - I saw him once to run what i was doing past him, and another time he went through my bloodwork. Personally I am happy to recommend him - the only others I would feel confident of are in US, London, Brussels.

TRT is simple except for those presentations when it is not and it is a lifetime learning. I have pretty much given up doing my own research against that backdrop, despite my background.

His pricing structure is controversial on these boards so I am posting a link.

https://www.whatclinic.com/doctors/thailand/bangkok/maximum-performance-wellness-center-bangkok

Actually, the negative comments I made about scammy TRT doctors were about ones I encountered when I lived in Florida USA.

Thanks for providing feedback on Lopez. Pricing is indeed very high, and I’d be a little concerned considering he is not an MD.

That’s the issue I ran into in Florida where the “wellness clinics” offering TRT were run by people without a medical degree. They had MD’s acting as consultants and writing prescriptions, but they were not the people administering your treatment. It was all very legal, but IMO, quite unethical.

One of them even went as far as telling me HGH was something I should consider and not to worry about it’s normally high cost because he could order it for me directly from China at half the cost. Needless to say, I kept looking for a good TRT doctor.

Edited April 11, 2019 by WaveHunter

mokwit · April 11, 2019

11 minutes ago, WaveHunter said:

Actually, the negative comments I made about scammy TRT doctors were about ones I encountered when I lived in Florida USA.

Thanks for providing feedback on Lopez. Pricing is indeed very high, and I’d be a little concerned considering he is not an MD.

That’s the issue I ran into in Florida where the “wellness clinics” offering TRT were run by people without a medical degree. They had MD’s acting as consultants and writing prescriptions, but they were not the people administering your treatment. It was all very legal, but IMO, quite unethical.

One of them even went as far as telling me HGH was something I should consider and not to worry about it’s normally high cost because he could order it for me directly from China at half the cost. Needless to say, I kept looking for a good TRT doctor.

Fair comment, but IMO he does know his stuff.

Edited April 11, 2019 by mokwit

WaveHunter · April 11, 2019

21 hours ago, mokwit said:

This is completely wrong. Clomiphene acts to stimulate both LH and FSH at the Hypothalamus/Pituritary. There are no end of studies showing Clomiphene increasing T and it does so via an increase in LH which then acts on the Testes to stimulate T production from the Leydig cells in the testes. I was told to reduce my clomiphene doses as my LH was near outlier levels. HCG does not restore LH it is an analog (mimic) of LH and thus acts to stimulate the same receptors as LH in the testes. There is even some speculation that being an anolog of LH HCG might actually act to suppress LH via a feedback loop in the brain. Note the high levels of T in the Testes required for fertility/stimulation of sertoli cells cannot be mimicked by injected T it has to come from the bodies own pathway and this pathway is stimulated via LH/FSH - hence Clomiphene is used to boost T when fertility is important as it boosts LH and FSH rather than shut them down which is what exogenous T does.

I have seen a few other things you have posted that seem plain wrong to someone who has sat through lectures on this at university given by an endocrinologist - until now I decided I would be better off not commenting.

As for the paper being old, yes it is but they had Immunoassays, NMR, Mass spectroscopy, and High pressure liquid chromatography in those days so one can assume the levels were measured reliably. I would have thought the small sample size would be something to home in on. The reason I saved the paper for my own reference was because it shows that for some reason blocking estrogen receptors can also stop suppression of T by compounds that do not act as agonists at the E receptor. My hypotheses is that blocking of E receptors overrides any suppression by T and DHT derivatives, this was confirmed by an endocrinologist I spoke with and by this paper. I posted it because the same paper also shows what I highlighted in a previous post - but this was peripheral to the main rationale of the study..

Ok...I owe you something of an apology. I’ve never been concerned about infertility as a result of TRT so my understanding of various ways of dealing with it are not well researched, other than what my doctors told me in a cursory way when I first started TRT, and casual reading here and there.

Now that we’ve been debating this, I’ve done some research. It turns out that neither of us is entirely correct or or incorrect about CC ( Clomiphene) vs HCG (human chorionic gonadotropin) or even TRT vs CC!

TRT vs CC was an eye-opener for me because I always viewed the use of Clomid only as an off-label use of the drug in male bodybuilders for the purpose of restoring indigenous T production AFTER being shutdown from a T cycle.

Like many things when it comes to hormone therapy, it ALL DEPENDS ON THE PARTICULAR PATIENT. In certain cases, my view is more correct; in others, your view is more correct; and in still others, neither of us is entirely correct! ????

This research paper (survey of current research as of 2014) is what changed my mind, and I mean it seriously has me questioning CC vs TRT.

I’ve got a lot more reading to do, and a talk with my doctor...but this is why I like participating in threads like this...it makes you look at different perspectives and question the Status Quo.

Check it out: Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419134/

BTW, I forget who said what on this thread about how AI’s like Anastrozole fit in to this but I still feel strongly that they should NOT be considered to be effective or safe on their own to raise T or deal with negative changes in LH or FSH. This paper touches on that.

Edited April 11, 2019 by WaveHunter

mokwit · April 11, 2019

In interpreting the papers on CC you need to ask questions like

1) Were the men in the study Eugonadal or Hypogonadal or random i.e. not selected on that basis.

2) If Hypogogonadal were they pre selected for Type 2 Hypogonadism?

3) Were they young men or old men?

4) Were the men given Clomiphene which contains two isomers with different actions in different tissues (enclomiphene and Zuclomiphene) or the isolated enclomiphene isomer alone?

5) Is this published in a peer reviewed Journal?

It is not unusual for CC to double TT from hypogonadal levels in type 2 hypogonadal young men, but in older men 30% would be a good result - presumably as the low T levels are from degradation/desensitising throughout the HPTA. There have been studies with supraphysiological doses of HCG that have failed to meaningfully increase T levels in older men, indicating that with increasing age it is degradation/desensitisation of the Leydig cells that is responsible for low T more than low LH levels from Pituritary.

Edited April 11, 2019 by mokwit

NightSky · April 11, 2019

I’ve been doing my own research daily on danazol. I’m actually now using danazol and tamoxifen.

this is the best study I’ve found so far on comparing different types of trt. It also mentions provirin somewhere in the study..

an interesting read..

https://patents.google.com/patent/EP1079836B1/en

mokwit · April 11, 2019

1 minute ago, NightSky said:

I’ve been doing my own research daily on danazol. I’m actually now using danazol and tamoxifen.

this is the best study I’ve found so far on comparing different types of trt. It also mentions provirin somewhere in the study..

an interesting read..

https://patents.google.com/patent/EP1079836B1/en

Carruthers was seeking a patent so may have overstated efficacy as that is a requirement for a patent. He uses Danazol in his clinical practice (I have his book as well as that interesting patent application).

Would be very interested if you could tell me how you FEEL with Danazol as well as any measured effect e.g on SHBG, Free T

WaveHunter · April 11, 2019

44 minutes ago, mokwit said:

In interpreting the papers on CC you need to ask questions like

1) Were the men in the study Eugonadal or Hypogonadal or random i.e. not selected on that basis.

2) If Hypogogonadal were they pre selected for Type 2 Hypogonadism?

3) Were they young men or old men?

4) Were the men given Clomiphene which contains two isomers with different actions in different tissues (enclomiphene and Zuclomiphene) or the isolated enclomiphene isomer alone?

5) Is this published in a peer reviewed Journal?

It is not unusual for CC to double TT from hypogonadal levels in type 2 hypogonadal young men, but in older men 30% would be a good result - presumably as the low T levels are from degradation/desensitising throughout the HPTA. There have been studies with supraphysiological doses of HCG that have failed to meaningfully increase T levels in older men, indicating that with increasing age it is degradation/desensitisation of the Leydig cells that is responsible for low T more than low LH levels from Pituritary.

If you read the paper you’ll see it is a survey of studies performed between period of 1989-2014, not an original study itself. It’s well documented with footnotes and references.

My take on the survey is that CC in older males is not nearly as effective at raising T beyond 500 as conventional TRT using endogenous T. Not saying that is necessarily good or bad. I’m just saying that seems to be the consensus from several different studies cited.

BTW, several studies discuss enclomiphene citrate specifically.

Edited April 11, 2019 by WaveHunter

NightSky · April 11, 2019

20 minutes ago, mokwit said:

Carruthers was seeking a patent so may have overstated efficacy as that is a requirement for a patent. He uses Danazol in his clinical practice (I have his book as well as that interesting patent application).

Would be very interested if you could tell me how you FEEL with Danazol as well as any measured effect e.g on SHBG, Free T

I will let you know. I’ve only had 10 days of danazol so far so too early to see effects.

I began tamoxifen yesterday off my own back without doctors approval because I’m not confident danazol will be enough to reverse gyno symptoms alone even though there are some studies on it. I didn’t jump into testosterone replacement straight away either for various reasons mainly not to agitate gyno and also I want fertility testing at some point and also I want to test true baseline levels once vitamin d is back into normal ranges.

I plan to have new blood panel in the next 4-6 weeks.

The expectation is lower lh and fsh from high numbers with increased free t % and consistent plasma t and e

One question I have is does anyone get free t blood test in Bangkok or are only overall plasma t tests available? I believe my free t levels weren’t tested but assumed based on all the other results.

Edited April 11, 2019 by NightSky

mokwit · April 11, 2019

45 minutes ago, WaveHunter said:

If you read the paper you’ll see it is a survey of studies performed between period of 1989-2014, not an original study itself. It’s well documented with footnotes and references.

My take on the survey is that CC in older males is not nearly as effective at raising T beyond 500 as conventional TRT using endogenous T. Not saying that is necessarily good or bad. I’m just saying that seems to be the consensus from several different studies cited.

BTW, several studies discuss enclomiphene citrate specifically.

I assumed from what you wrote that you were going to go back to original papers. I have already done my research on Clomiphene over the last 5 years so just skimmed through the content of the paper rather than critically evaluate - especially as I recognised some of the research cites as papers where I had read the original.

Note that enclomiphene Citrate is not available other than to researchers so you are stuck with the mixed isomer Clomiphene - key point is extrapolating doses from enclomiphene studies to clomiphene doses requires a little adjustment = from memory, some say Clomiphene is 70% enclomiphene but the actual percentage of each seems not to be definitive..

Edited April 11, 2019 by mokwit

mokwit · April 11, 2019

22 minutes ago, NightSky said:

One question I have is does anyone get free t blood test in Bangkok or are only overall plasma t tests available? I believe my free t levels weren’t tested but assumed based on all the other results.

Your Free T is calculated from Total T, SHBG and Albumin levels.

http://www.issam.ch/freetesto.htm

Free T tested directly is more expensive if available (I think not from Bangkok Labs but maybe can be sent to Singapore). As calculated free T levels correlate very closely with directly measured free T most see little point in measuring it directly. I asked as my calculated free T levels are screwed up by Proviron (Danazol too will have this effect I believe) but was told not available or prohibitively expensive - can't remember.

What is your Danazol dosage?

Edited April 11, 2019 by mokwit

NightSky · April 11, 2019

33 minutes ago, mokwit said:

What is your Danazol dosage?

100mg twice daily (total 200mg daily)

Higher dosages I think can cause total shutdown of hormone production in a male whereas smaller dosage is meant to be enough to regulate. I think that’s the plan the doc has in mind anyhow since my Lh and fsh were both high.

i think the expectation from my drug is to lower SHBG so more t is free to be used elsewhere providing the effect of more available t. There are also some anti estrogen effects and mild androgenic effects but too higher dose can cause shutdown of total hormone production I think. It’s not an alternative for testosterone but might help borderline cases like me with certain symptoms.

This is meant to be a short term measure most likely then re evaluate down the road.

Edited April 11, 2019 by NightSky

WaveHunter · April 11, 2019

1 hour ago, mokwit said:

I assumed from what you wrote that you were going to go back to original papers. I have already done my research on Clomiphene over the last 5 years so just skimmed through the content of the paper rather than critically evaluate - especially as I recognised some of the research cites as papers where I had read the original.

Note that enclomiphene Citrate is not available other than to researchers so you are stuck with the mixed isomer Clomiphene - key point is extrapolating doses from enclomiphene studies to clomiphene doses requires a little adjustment = from memory, some say Clomiphene is 70% enclomiphene but the actual percentage of each seems not to be definitive..

I have really been digging into this over the past 24 hours. As I mentioned in a previous post today, my interest was peaked when I became aware that clomiphene citrate can be an effective alternative mono-therapy to TRT after it was pointed out the other day by you and others on this thread, and after I started surveying studies on the subject.

My take on what I've learned so far, and also after just consulting with my doctor is that, FOR ME (based on my age and my blood values), clomiphene citrate or hCG as a mono-therapy replacement to TRT would simply be a waste of time.

I know that anecdotally, through trial and error at different serum levels, I feel best when they are between 700-1000. I am able to reach those values with 125mg/week of exogenous T on TRT. At that dosage I have to use 0.25 mg of anastrozole twice a week to control estradiol, which is no big deal. All other "red flag" blood markers have always been in the normal range while on TRT, so, at the present time, it is working just fine for me.

For my age group, it's unlikely my serum T will rise much above the 500's with CC as a mono-therapy. Only TRT can bring my serum levels into the range that make me feel best.

(see Testosterone supplementation versus clomiphene citrate for hypogonadism: an age matched comparison of satisfaction and efficacy.)

It is true that in certain subsets, CC may be an effective therapy but from everything I've read, this is so mainly for men much younger than me (I am 52) BUT it results in serum levels that are significantly lower than TRT. Lower levels may or may not be a big deal; it depends on how the individual feels more than anything. For me, mid-500's is not going to work. it's as simple as that.

(see Outcomes of clomiphene citrate treatment in young hypogonadal men.)

So, while for younger guys, CC as a mono-therapy might work, for me, I think TRT is just fine.

Personally, I see no need to restore natural T at this point in life; I mean, I'm not planning on having more kids, and I don't care about the cosmetics of minor shrinkage, and in terms of long-term health implications, I see nothing at all that is negative in my present TRT protocol. And finally most research indicates that if I did change my mind about this in the future, being shut done isn't necessarily a permanent situation.

I want to be clear, I am talking about ME, and not advocating for or against TRT, CC mono-therapy or HCG mono-therapy. I am only posting this to make a point that dealing with hypogonadism is entirely based on the individual and it a very subjective thing since it is how you feel that really counts more than anything. We shouldn't just be talking about lab studies or theory, we should really be concerned with real-world happiness and wellness.

Edited April 11, 2019 by WaveHunter

ncc1701d · April 11, 2019

On 4/10/2019 at 3:57 PM, mokwit said:

Dr Tim Lopez's operation (Maximum Performance Wellness Centre) seems (seems) to be in that category to the point of being offputting from the outside/web presence, but he actually does know his stuff. I have been to see him twice. I went to see him based on interviews he gave with a bodybuilder in which it was clear to me he knew his stuff. There is just no way I would have walked through the doors of his clinic if the view from outside was all I had to go on.

As there are 2 in Pattaya I assume he is maybe one you met. I did not feel any pressure to sign up - I saw him once to run what i was doing past him, and another time he went through my bloodwork. Personally I am happy to recommend him - the only others I would feel confident of are in US, London, Brussels.

TRT is simple except for those presentations when it is not and it is a lifetime learning. I have pretty much given up doing my own research against that backdrop, despite my background.

His pricing structure is controversial on these boards so I am posting a link.

https://www.whatclinic.com/doctors/thailand/bangkok/maximum-performance-wellness-center-bangkok

Interesting that he doesn’t have anything in the description for “treatment and prices” for full AAS cycling. Not everyone wants just trt.

mokwit · April 11, 2019

7 minutes ago, ncc1701d said:

Interesting that he doesn’t have anything in the description for “treatment and prices” for full AAS cycling. Not everyone wants just trt.

? AAS cycling from Bt11,000 on both prices pages. Agree no description.

Edited April 11, 2019 by mokwit

WaveHunter · April 12, 2019

Just downloaded a PDF book called "The Testosterone Optimization Therapy Bible", written by Jay Campbell and Jim Brown. I think somebody has mentioned Jay Campbell in this thread; can't remember who, and I think I reacted negatively to Jay Campbell because of his YouTube videos, but this book is pretty good).

This is indeed a HUGE resource of information (almost 600 pages long !!!). While the title sounds a little bit "scammy", and I don't agree with everything in it, it's still a great resource because it discusses almost every topic you can imagine that is associated with TRT in a way I've not seen in any other single reference, and most of it does seem pretty science-based, so definitely worth getting.

Unlike most books on TRT, it's not just about interventional endocrinology (though it does explore this aspect VERY deeply), but also discusses related topics that come into play like nutrition and exercise, for instance. The format is very well thought out, and presented clearly and concisely without being overly technical.

It sells on Amazon for US$30 and seems highly rated and positively reviewed there. YOU CAN VIEW AND DOWNLOAD IT FOR FREE (use a desktop computer if you want to download/save as a PDF so you can view in Adobe Reader and easily search, cut & paste to your notes, or highlight).

I'm not sure how long this link will stay active, so download it NOW! You do not have to provide your email BTW; this is the direct download link.

https://iflychat-files.s3.amazonaws.com/c87a522bbafe29e239b7cfadfeb8ca50/2018/3/11/22/The+TOT+Bible+Email_1520807089087.pdf

Edited April 12, 2019 by WaveHunter

Ks45672 · April 12, 2019

On 4/10/2019 at 1:21 AM, DaRoadrunner said:

I can probably outrun everyone on this forum and have never taken any of this stuff. I have other uses for my nuts.

Shouldn't you be off running somewhere? Just be careful you don't run of road.....

WaveHunter · April 12, 2019

On 4/11/2019 at 3:19 PM, mokwit said:

? AAS cycling from Bt11,000 on both prices pages. Agree no description.

I think “AAS Cycling” refers to bodybuilders’ use various steroids and combinations (stacks) so there are many different cycle options. He probably consults and puts together various cycles, and that would be his minimum fee.

Bodybuilders from all around the world come to Thailand, and Pattaya in particular to train, primarilily because many steroids are legal here.

Edited April 12, 2019 by WaveHunter

Ks45672 · April 12, 2019

On 4/11/2019 at 1:43 PM, NightSky said:

I will let you know. I’ve only had 10 days of danazol so far so too early to see effects.

I began tamoxifen yesterday off my own back without doctors approval because I’m not confident danazol will be enough to reverse gyno symptoms alone even though there are some studies on it. I didn’t jump into testosterone replacement straight away either for various reasons mainly not to agitate gyno and also I want fertility testing at some point and also I want to test true baseline levels once vitamin d is back into normal ranges.

I plan to have new blood panel in the next 4-6 weeks.

The expectation is lower lh and fsh from high numbers with increased free t % and consistent plasma t and e

One question I have is does anyone get free t blood test in Bangkok or are only overall plasma t tests available? I believe my free t levels weren’t tested but assumed based on all the other results.

Tamoxifen will not "reverse" gyno but it will stop it getting any worse

Letrozole is probably a better bet

Depends how much gyno you have though, arimidex and reducing body fat helps but surgery is usually the only way to get rid of it after a certain point

WaveHunter · April 12, 2019

On 4/11/2019 at 12:43 PM, NightSky said:

...One question I have is does anyone get free t blood test in Bangkok or are only overall plasma t tests available? I believe my free t levels weren’t tested but assumed based on all the other results. ...

You can easily get Free T tested anywhere blood tests are done in Bangkok (or anwhere in Thailand for that matter). If they don’t actually run the analysis (which very few labs do), they simply send it to a lab that does. My lab in Chiang Mai did that.

Edited April 12, 2019 by WaveHunter

ncc1701d · April 12, 2019

3 hours ago, WaveHunter said:

Just downloaded a PDF book called "The Testosterone Optimization Therapy Bible", written by Jay Campbell and Jim Brown. I think somebody has mentioned Jay Campbell in this thread; can't remember who, and I think I reacted negatively to Jay Campbell because of his YouTube videos, but this book is pretty good).

This is indeed a HUGE resource of information (almost 600 pages long !!!). While the title sounds a little bit "scammy", and I don't agree with everything in it, it's still a great resource because it discusses almost every topic you can imagine that is associated with TRT in a way I've not seen in any other single reference, and most of it does seem pretty science-based, so definitely worth getting.

Unlike most books on TRT, it's not just about interventional endocrinology (though it does explore this aspect VERY deeply), but also discusses related topics that come into play like nutrition and exercise, for instance. The format is very well thought out, and presented clearly and concisely without being overly technical.

It sells on Amazon for US$30 and seems highly rated and positively reviewed there. YOU CAN VIEW AND DOWNLOAD IT FOR FREE (use a desktop computer if you want to download/save as a PDF so you can view in Adobe Reader and easily search, cut & paste to your notes, or highlight).

I'm not sure how long this link will stay active, so download it NOW! You do not have to provide your email BTW; this is the direct download link.

https://iflychat-files.s3.amazonaws.com/c87a522bbafe29e239b7cfadfeb8ca50/2018/3/11/22/The+TOT+Bible+Email_1520807089087.pdf

Awesome. Thanks. Will read through and send to my old man. He went and sheepishly asked a doc about trt and was told it was worthless. So he’s been put off it. Wish some doctors weren’t such ignorant douchche bags.

WaveHunter · April 12, 2019

2 hours ago, ncc1701d said:

Awesome. Thanks. Will read through and send to my old man. He went and sheepishly asked a doc about trt and was told it was worthless. So he’s been put off it. Wish some doctors weren’t such ignorant douchche bags.

It amazes me how little most doctors know, or worse yet, how little they care to know., but there are some that really care. It takes work to find them but the effort is well worth it.

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