Andropause clinic visit yesterday

[Mister Fixit]

Following my previous posts, here  https://forum.thaivisa.com/topic/1209506-sidegra-kamagra-viagra-and-cialis/  and also 

 

 https://forum.thaivisa.com/topic/1216990-sidegra-kamagra-viagra-and-cialis-update/ 

 

 

I went to the andropause clinic at the Army hospital yesterday and they were very welcoming and helpful.  

Told the really nice 50-something doc about my pituitary adenoma and testosterone problems from 2004 and explained that I hadn't had a proper endocrine check-up for years. I told him that since my ED had worsened, I had reduced the interval between shots from 3 weeks to 2 weeks since early May, just until I saw him and to see if it would help the ED (it hasn't really).

 

He says that the reduced interval could increase my haematocrit but I showed him my test results from March when the haematocrit was already slightly below the minimum of the range, as was my haemoglobin. So he ordered a new CBC and gave me vitamin B12 complex and zinc tablets and I go back in 2 weeks, the 29th.

 

He told me off nicely for taking too much Kamagra but if I don't, then it's a problem maintaining an erection for long. He didn't do a physical exam, but I will ask him to check my testes next time as I think they are quite small now. Would anyone know if that would be due to the testosterone shots?

 

My testosterone on 7 May last month was 1.70 ng/mL with a range of 0.02-14.90 but I deliberately hadn't had a shot for 4 weeks, just to see how low it would be.

I have read in the other threads that a shot every three weeks is quite conservative as the half-life is only about 5 - 7 days. Any thoughts on dosage and intervals between shots or anything else? Anyway, I will keep you posted after the next visit.

 

Very cheap though - a CBC was 90 baht and the meds were 230 baht.  320 baht all in is not at all bad. I was expecting much more.

[faraday]

9 minutes ago, Mister Fixit said:

but I will ask him to check my testes next time as I think they are quite small now. Would anyone know if that would be due to the testosterone shots?

Yes it is, but @WaveHunter ???? could give you a better explanation.

 

https://www.menshealth.com/uk/building-muscle/a758780/will-steroids-shrink-my-balls/

[Mister Fixit]

16 minutes ago, faraday said:

Yes it is, but @WaveHunter ???? could give you a better explanation.

 

https://www.menshealth.com/uk/building-muscle/a758780/will-steroids-shrink-my-balls/

Yes, I'm hoping he'll respond soon.  

 

But as my testosterone is not being being produced by my body, it seems logical that with nothing to do, my two dangly bits will say 'Hey, thanks for the break' and just shut down.

Edited June 16, 2021 by Mister Fixit

[rcuthbert]

1 hour ago, Mister Fixit said:

Yes, I'm hoping he'll respond soon.  

 

But as my testosterone is not being being produced by my body, it seems logical that with nothing to do, my two dangly bits will say 'Hey, thanks for the break' and just shut down.

Research HPTA, it's shutdown/suppression. Also research the SERMS, clomiphene and tamoxifen.

Did you get your estrogen levels checked? Remember that the aromatase enzyme turns what it senses as excess testosterone into estrogen. Do you need an anti aromatase pill?

Frankly, we have discussed this before.

 

Cheers.

[Mister Fixit]

9 hours ago, rcuthbert said:

Research HPTA, it's shutdown/suppression. Also research the SERMS, clomiphene and tamoxifen.

Did you get your estrogen levels checked? Remember that the aromatase enzyme turns what it senses as excess testosterone into estrogen. Do you need an anti aromatase pill?

Frankly, we have discussed this before.

 

Cheers.

Yes, we have, and I had hoped for more than just a blood test and some vitamin pills, but this was the first visit and I can see that he just wanted to get some up to date baseline figures as the last were over 2 months old and I had been fiddling with my testosterone injection intervals since then.

 

I will be asking for a physical exam in 2 weeks and start discussing Oestrogen etc too.  I wasn't expecting a lot the first time, but at least things have started.  

 

 

 

[Mister Fixit]

12 hours ago, rcuthbert said:

Research HPTA, it's shutdown/suppression. Also research the SERMS, clomiphene and tamoxifen.

Did you get your estrogen levels checked? Remember that the aromatase enzyme turns what it senses as excess testosterone into estrogen. Do you need an anti aromatase pill?

Frankly, we have discussed this before.

 

Cheers.

@rcuthbert

I did read about HPTA when you posted last, but I had forgotten - a good sign of low testosterone!

I hadn't heard the term SERMs, but I have heard of Tamoxifen for breast cancer, and then clomiphene clicked into my brain because my first wife took it as Clomid when we were having problems with her getting pregnant between about 1974 -77.

She was put on the lowest dose and within 2 months she was pregnant!   Our first son arrived in February 1978.

 

What is an  anti-aromatase pill?  I mean what is the name of the substance, and what sort of dose?

 

As I said above, I will be getting a little pushy next visit so whatever ammunition I can get before then is always welcome.

 

I wonder if @WaveHunter will respond as well?

 

 

Edited June 17, 2021 by Mister Fixit

[eezergood]

Man 1.7 ng/dl is beyond Hypogonadal - you have castrated yourself, anything below about 50 is considered so. 

 

You have totally shut down your own production, due to telling your body that some exogenous hormone will be coming in to take care of it - then you just went cold turkey. At your age I SEVERELY doubt that natural production will return to any kind of significant level and for you own health & well being you will need/want TRT for LIFE! NOT DECA, some test. Levels will be very dependant, but between 75-150mig/ week

 

[jackdd]

18 minutes ago, eezergood said:

Man 1.7 ng/dl is beyond Hypogonadal - you have castrated yourself, anything below about 50 is considered so. 

He said he was at 1.7ng/ml, which is 170ng/dl, after not having an injection for a few weeks. Of course that's still too low.

 

38 minutes ago, Mister Fixit said:

What is an  anti-aromatase pill?  I mean what is the name of the substance, and what sort of dose?

That's not required when being on TRT, only relevant for people who run bodybuilding cycle dosages.

Edited June 17, 2021 by jackdd

[eezergood]

4 minutes ago, jackdd said:

He said he was at 1.7ng/ml, which is 170ng/dl, after not having an injection for a few weeks. Of course that's still too low.

 

That's not required when being on TRT, only relevant for people who run bodybuilding cycle dosages.

My bad, thanks for the correction - however 170 is still pretty low and I, as someone with naturally low T levels, would not want to be so low

 

My other comments about shut down still stand & yes he does not need an AI 

[Mister Fixit]

30 minutes ago, eezergood said:

Man 1.7 ng/dl is beyond Hypogonadal - you have castrated yourself, anything below about 50 is considered so. 

 

You have totally shut down your own production, due to telling your body that some exogenous hormone will be coming in to take care of it - then you just went cold turkey. At your age I SEVERELY doubt that natural production will return to any kind of significant level and for you own health & well being you will need/want TRT for LIFE! NOT DECA, some test. Levels will be very dependant, but between 75-150mig/ week

 

 

I'm not sure if you've read my previous threads that I linked to but I suggest that you do so you have the complete picture.

And it's also in my very first post above - did you not read it?

 

I get the impression you think that I am deliberately responsible for the need for exogenous testosterone, but in a nutshell, I am not.  
Reading the other threads carefully will tell you that in 2004, I discovered I had problems with ED and my useless UK GP did almost nothing to help, apart from prescribing sildenafil and after a lot of pushing, Androgel to rub on my chest - which was useless.
It was only after I came to Thailand that an excellent lady doc at Bumrungrad diagnosed hypogonadism and an MRI confirmed I had a pituitary adenoma.  She put me on testosterone enanthate injections every 3 weeks. 

Reading the other threads would have told you that, and that the ED has returned, even with Kamagra.

 

I'm also a bit confused about your figures for testosterone.  Glancing at the snip attached tells me that the normal range appears to be between 0.02 and 14.90 ng/mL.

Are those figures wrong and where did you get your figure of 50 being the minimum of the range?  50 what - are we talking of the same measurements or are you looking at something else?

 

And as @jackdd correctly pointed out, I had deliberately held off on a shot so that when I went last month, the level would be as low as possible and we would know whether or not to increase the dosage or reduce the frequency between shots.

 

Since that test I have reduced the interval to 2 weeks from 3  weeks and I do not know my current level, but in 2 weeks I will be asking for another test so we can see if it has worked or not.

 

 

Edited June 17, 2021 by Mister Fixit

[eezergood]

My first response I have corrected as you quote ng/ml not ng/dl (which normally the measurement used, my silly mistake) 

 

Normal ranges of Test are 500/1000 ng/dl so reduce that by a factor of 10 for ml - however these are very fluid and I would suggest that 350 ng/dl (ish) would be a base level of normalcy. However I have a mate that is 52 very natural and has levels about 1000 ng/dl, such is the variability. I am 42 with 335 is levels. 

 

My figure of 50 (again due to my misreading of the scale) was 50ng/dl which is technically castration levels. You are not in this category. 

 

I fully understand the reasons for lack of shots, so as to see a baseline - which is clearly telling us you have little to no natural production, again no surprises given your issues and age. As for shot frequency, given that enanthate has a half life of 4.5 days and an average residence life of 8-9 days( again slightly person dependant) increase frequency of shots would seem sensible. 

 

I am certainly not blaming you for the decreased t - that's nature and sometimes it just kicks you in the balls. 

[WaveHunter]

1 hour ago, Mister Fixit said:

@rcuthbert

I did read about HPTA when you posted last, but I had forgotten - a good sign of low testosterone!

I hadn't heard the term SERMs, but I have heard of Tamoxifen for breast cancer, and then clomiphene clicked into my brain because my first wife took it as Clomid when we were having problems with her getting pregnant between about 1974 -77.

She was put on the lowest dose and within 2 months she was pregnant!   Our first son arrived in February 1978.

 

What is an  anti-aromatase pill?  I mean what is the name of the substance, and what sort of dose?

 

As I said above, I will be getting a little pushy next visit so whatever ammunition I can get before then is always welcome.

 

I wonder if @WaveHunter will respond as well?

 

 

Without being overly technical, when you increase testosterone with TRT injections, you also increase your estrogen levels.  On blood tests it would indicated as estradiol or E-2.  For some men, the increase in E-2 is not an issue but for some it is. 

 

The acceptable range for E-2 in men on blood tests is  11-44 pg/mL .  Many experts in TRT feel that the optimal value, while on TRT should be 26-30 pg/mL.  In other words the optimal range with respect to TRT is very narrow.  Too low is just as bad as too high.

 

For me, my first E-2 blood test after 3 months of starting TRT was over 70 pg/mL..  Even before testing I knew something was wrong becuase I felt extremely bloated.  So, my doctor prescribed an aromatase inhibitor (what you called a anti-aromatase pill")

 

Aromatase inhibitors (AIs) are a class of drugs used in the treatment of breast cancer in women.  TRT Doctors use in off-label to counter the rise in estrogen associated with TRT.  Nothing wrong with using it off label like that BTW.

 

The most common type of AI used in TRT is anastrozole (Arimidex).  Dosage depends on individual and must be titrated to be determined based on blood tests so it can take a few months to really get it dialed in.  It's important to get it right becuase the optimal range of E-2 while on TRT has a very narrow range, and E-2 that is too low is just as bad as it being too high.

 

Just to give you an example of MY dosage:  I use 1/4 pill per injection of Testosterone Enanthate (i.e.: 0.25 mg per injection).  Like I said though, everybody is different so this is not a benchmark for you to self-prescribe, just an example.

 

Note: Arimidex, purchased from a hospital pharmacy is outrageously expensive.  I forget the price I was quoted but it was something like 700 THB per pill!  You are much better off purchasing it from a non-hospital pharmacy where the price can be about 10% of what the hospital pharmacy charges.

 

Bottom line, your physician should advise you.  If he/she doesn't acknowledge that E-2 levels can be important with your TRT, find another doctor because if you really want optimal TRT, your E-2 level is just as important as your testosterone level.

 

Hope that helps. ????

 

Edited June 17, 2021 by WaveHunter

[rcuthbert]

Mr Fixit,  by getting your estrogen levels checked you will know if your estrogen is high. High estrogen causes ED, and diminished libido. Research "Anastrozole"*

Testosterone is converted to estrogen by the aromatase enzyme. At the same time, the HPTA "senses" that you have adequate testosterone; consequently, chemical messengers stop being sent to the testes, and they stop producing testosterone and semen. So, get your estrogen checked.

Every time you get a shot, the  aromatase enzyme gets busy.  If you split your prescribed 2wk dose into 4 doses - Mondays and Thursdays, then you will create less estrogen.

 

 

 

 

* https://en.wikipedia.org/wiki/Anastrozole

Edited June 17, 2021 by rcuthbert

[rcuthbert]

26 minutes ago, WaveHunter said:

Without being overly technical, when you increase testosterone with TRT injections, you also increase your estrogen levels.  On blood tests it would indicated as estradiol or E-2.  For some men, the increase in E-2 is not an issue but for some it is. 

 

The acceptable range for E-2 in men on blood tests is  11-44 pg/mL .  Many experts in TRT feel that the optimal value, while on TRT should be 26-30 pg/mL.  In other words the optimal range with respect to TRT is very narrow.  Too low is just as bad as too high.

 

For me, my first E-2 blood test after 3 months of starting TRT was over 70 pg/mL..  Even before testing I knew something was wrong becuase I felt extremely bloated.  So, my doctor prescribed an aromatase inhibitor (what you called a anti-aromatase pill")

 

Aromatase inhibitors (AIs) are a class of drugs used in the treatment of breast cancer in women.  TRT Doctors use in off-label to counter the rise in estrogen associated with TRT.  Nothing wrong with using it off label like that BTW.

 

The most common type of AI used in TRT is anastrozole (Arimidex).  Dosage depends on individual and must be titrated to be determined based on blood tests so it can take a few months to really get it dialed in.  It's important to get it right becuase the optimal range of E-2 while on TRT has a very narrow range, and E-2 that is too low is just as bad as it being too high.

 

Just to give you an example of MY dosage:  I use 1/4 pill per injection of Testosterone Enanthate (i.e.: 0.25 mg per injection).  Like I said though, everybody is different so this is not a benchmark for you to self-prescribe, just an example.

 

Note: Arimidex, purchased from a hospital pharmacy is outrageously expensive.  I forget the price I was quoted but it was something like 700 THB per pill!  You are much better off purchasing it from a non-hospital pharmacy where the price can be about 10% of what the hospital pharmacy charges.

 

Bottom line, your physician should advise you.  If he/she doesn't acknowledge that E-2 levels can be important with your TRT, find another doctor because if you really want optimal TRT, your E-2 level is just as important as your testosterone level.

 

Hope that helps. ????

 

Well stated.

[rcuthbert]

15 minutes ago, rcuthbert said:

Mr Fixit,  by getting your estrogen levels checked you will know if your estrogen is high. High estrogen causes ED, and diminished libido. Research "Anastrozole"*

"Excess testosterone is converted to estrogen by the aromatase enzyme. At the same time, the HPTA "senses" that you have adequate testosterone; consequently, chemical messengers stop being sent to the testes, and they stop producing testosterone and semen. So, get your estrogen checked.

Every time you get a shot, the  aromatase enzyme gets busy.  If you split your prescribed 2wk dose into 4 doses - Mondays and Thursdays, then you will create less estrogen.

Also, if the HPTA "senses" that your estrogen is too low (Thanks AI) it with restart sending chemical messengers to the testes.**

**"The hypothalamic site of the action of estrogens has been demonstrated only recently in men by Hayes and colleagues, who compared healthy men taking a selective aromatase inhibitor (anastrozole) with men with IHH whose gonadotropic secretion had previously been normalized by long-term pulsatile GnRH therapy (6). Anastrozole led to the inhibition of estradiol synthesis and, consequently, a corresponding increase in mean levels of LH and FSH, both in normal and IHH men. Interestingly, the major increase was observed in normal subjects compared with men affected by IHH and also involved the frequency and amplitude of LH pulses (6). Such observations suggest that the aromatase inhibitor was more effective on the intact hypothalamus, thus supporting the hypothesis of a possible hypothalamic site of action for estrogens. In this view, novelty is represented by the idea that estrogens would exert their modulating action on gonadotropin secretion both at pituitary and hypothalamic level in the human male (6) (Fig. 1). Estrogen action on the hypothalamus has subsequently been confirmed in normal healthy men after pharmacologically-induced hypogonadism (5). Further evidence suggests that aromatization of estrogens may be required at the pituitary level for the control of gonadotropin feedback through men’s life (7–10). In fact, anastrozole lowered serum estradiol in young men aged 14–22 years, with a concomitant increase of both serum gonadotropins and testosterone concentrations (7). Furthermore, in the early and mid-pubertal phases, the administration of letrozole, another potent aromatase inhibitor, raised basal serum LH, the frequency and amplitude of LH pulses and the response of LH to a GnRH bolus, thus indicating that estrogens act at the pituitary level during the early phases of pubertal maturation (8). The same estrogen-related mechanism seems to operate even in adulthood and senescence (9), particularly on LH modulation in older men (9, 10)."
https://eje.bioscientifica.com/view/journals/eje/155/4/1550513.xml  

Quote

 

 

 

 

* https://en.wikipedia.org/wiki/Anastrozole

 

Edited June 17, 2021 by rcuthbert

[jackdd]

1 hour ago, WaveHunter said:

Without being overly technical, when you increase testosterone with TRT injections, you also increase your estrogen levels.

The purpose of TRT is to increase the testosterone to a normal level. If this could potentially require an AI, then there would be men who are completely natural who have high estrogen and would need an AI.
If those men would exist AI would be FDA approved for treatment of high estrogen. It isn't approved for this, because this condition just doesn't exist.

If you are on TRT and your Estrogen is so high that you suffer from side effects it means you are using too much testosterone and should lower this dose instead of using an AI.

 

1 hour ago, WaveHunter said:

Note: Arimidex, purchased from a hospital pharmacy is outrageously expensive.  I forget the price I was quoted but it was something like 700 THB per pill!  You are much better off purchasing it from a non-hospital pharmacy where the price can be about 10% of what the hospital pharmacy charges.

Arimidex is a controlled drug in Thailand, should only be available through a doctor.

Edited June 17, 2021 by jackdd

[Mister Fixit]

2 hours ago, eezergood said:

My bad, thanks for the correction - however 170 is still pretty low and I, as someone with naturally low T levels, would not want to be so low

 

My other comments about shut down still stand & yes he does not need an AI 

Apologies for my tetchiness earlier - I was having a grumpy morning!  ????

 

As has been posted further down, I had deliberately delayed one of my shots so there was a 7 week gap until I was tested in the morning and had a shot in the afternoon.  This is the timetable -

 

19 March        normal shot after 3 weeks

9 April – no jab, wait until see endo clinic

7 May              Saw endo doc, started 2 weekly

20 May            13 days

4 June              15 days

17 June            13 days

So between 19 March and 7 May = 7 weeks with no testosterone shot.

 

That gave me a baseline as to what my natural level was after no TRT - and of course, why it was low.

 

When I go back to the clinic on the 29th, I will be asking for another testosterone level test AND ASKING HIM TO TEST MY OESTROGEN.  

 

Out of interest, does anyone know where I could just go and get my oestrogen tested and nothing else - unless there's something else worth testing as well?  

 

My nice lady doctor who does my shots in her small clinic (just had one 2 hours ago) might be able to arrange one, because I have had my PSA, B12 and testosterone levels checked there before - she just sends the blood off to a lab and I go back a few days later.

[Destiny1990]

Warning : What i read from various platforms  like Nation, Excel etc is that lots of folks doing TRT are still having problems with ED. And that’s often the reason why they started with TRT. So it doesn’t in many cases fix that problem. Yeah they might feel more energized. Then they spending years on testing blood adjusting this and that but without satisfying results. Does it sound familiar? Then the negatives small testes, balding, hot flushes, still poor erections i doubt its worth the hassle and the money.

[jackdd]

28 minutes ago, Mister Fixit said:

That gave me a baseline as to what my natural level was after no TRT - and of course, why it was low.

It didn't give you your natural base line. Your testosterone was so low because you just stopped doing the injections. Your testicles didn't start working properly yet, so the result was to be expected.

To get your real natural level you would have to come off for 6 weeks or so, then do a proper PCT for a month, then wait a few more months, and then get your testosterone tested, this would then show your natural level.

[Mister Fixit]

3 hours ago, rcuthbert said:

Mr Fixit,  by getting your estrogen levels checked you will know if your estrogen is high. High estrogen causes ED, and diminished libido. Research "Anastrozole"*

Testosterone is converted to estrogen by the aromatase enzyme. At the same time, the HPTA "senses" that you have adequate testosterone; consequently, chemical messengers stop being sent to the testes, and they stop producing testosterone and semen. So, get your estrogen checked.

Every time you get a shot, the  aromatase enzyme gets busy.  If you split your prescribed 2wk dose into 4 doses - Mondays and Thursdays, then you will create less estrogen.

 

 

 

 

* https://en.wikipedia.org/wiki/Anastrozole

 

Well, there's been so much spoken of oestrogen here, that it's pretty bl@@dy obvious that I need to get it checked, so that and my testosterone levels are my next port of call in 2 weeks.

However, there are two points in your post - the first being semen volume.  I have always produced a significant amount of semen which my wife often comments on, even now.  We have our own joke about it which I probably can't say on here!

 

In my 20s my first wife and I tried for 3 1/2 years for a child but she had great difficulty conceiving and if she did, had numerous miscarriages.  We eventually found a fantastic Harley Street doctor in London who specialised in infertility.  He was brilliant.  

At our first visit he gave me a container and told me to come back next week and when on the train, to do the necessary when it was about 30 minutes from the station - that was a bit of a chore but I managed after a struggle!  ????

 

Anyway, when I handed it over, his eyebrows raised and he just said 'Wow, what a good  volume!'.  Then he opened a drawer and showed me a similar vial but only half full.  He also did AID and told me that it was from a 21 year old rugby playing medical student for a female patient later in the day and said he'd rarely seen such an ejaculate as mine.  Not bragging, just stating a fact.  Indeed, I have produced 10 children in my life, but my ex was very prone to miscarriages - she even had 2 at 6 months, that last one being twins.  That was a killer to experience for both of us.  I asked to see them (my ex was heavily sedated) and it's a sight I will never forget, but I am glad that I experienced it, as it made me realise what my ex had gone through.  ????

 

The second point is about the hypothalamus.  I am no expert on the brain, but I think I should mention that I discovered I have AD/HD in 1992.  I never had much luck with Ritalin (methylphenidate) or any other meds, tbh, but in March just gone I went to Sritanya psychiatric hospital near my home and got some.  I started first on 36 mgs Concerta for a month (too expensive) so changed to Ritalin 20 mgs twice daily, now increased to 30 mgs twice daily.  It's moderately effective, but nothing special.  It never was almost 30 years ago either, and I do have very mixed results and feelings about it.  

HOWEVER, I read yesterday that serotonin is involved in testosterone production, along with other enzymes, hormones, whatever, and I am starting to wonder if the methylphenidate may have had an effect on my ED.  My wife agrees with me that it's been since about March when I started on it that my ED problem worsened.

 

Is this a possibility?  Could methylphenidate be doing something with serotonin and interfering with testosterone production?

 

Side note on AD/HD - I discovered I had AD/HD in January 1992 and was the first adult in the UK to be diagnosed with it.  It affects almost all my family, males and females, to some degree or another.  My father was obviously ADHD and so was my my mother, so I have had a double whammy - my younger brother is in denial but is quite severe, I'd say worse than me, but then again I understand it.  

 

My useless British GP had no idea about it and he wasted 9 months of my life until in October I went to Russell Barkley's clinic in Worcester Mass. and was diagnosed and went to my first ever conference, in Chicago.  What an eye opener and how amazing all the attendees were to a Brit.  I can never thank them enough and will never forget them.

 

Ritalin never did much and my GP refused to prescribe it and foisted so many SSRIs, SNRIs and tricyclics on me that I could have started a pharmacy.  Never show me a venlafaxine tablet again!  It took weeks to get off. 

On my return from the US I started the first UK charity for AD/HD which grew to over 2,000 members in just over a year.  

I have had very little dealings with AD/HD until recently, so I am pretty rusty on the brain and the various associated systems so I need time to digest all the previous information.

 

Please bear with me - I promise I will get back to you!  ????

 

 

Edited June 17, 2021 by Mister Fixit

[Mister Fixit]

45 minutes ago, jackdd said:

It didn't give you your natural base line. Your testosterone was so low because you just stopped doing the injections. Your testicles didn't start working properly yet, so the result was to be expected.

To get your real natural level you would have to come off for 6 weeks or so, then do a proper PCT for a month, then wait a few more months, and then get your testosterone tested, this would then show your natural level.

What's a PCT?

 

[Mister Fixit]

51 minutes ago, jackdd said:

It didn't give you your natural base line. Your testosterone was so low because you just stopped doing the injections. Your testicles didn't start working properly yet, so the result was to be expected.

To get your real natural level you would have to come off for 6 weeks or so, then do a proper PCT for a month, then wait a few more months, and then get your testosterone tested, this would then show your natural level.

OK, I see and I get it.  But it was a step in the right direction, and it did at least show that my level was pretty low.  

 

Let's hope the new doc gets off his butt and once he sees my haematocrit level he was worrying about, he starts getting me sorted out.  

 

I do get the feeling he will take a conservative approach though, and that is not my way.  My AD/HD means that I tend to take the bull by the horns and I am usually very proactive, as I hope can be seen in my posts.

 

If I have to, I will just find somewhere which won't sting me too much and get to the bottom of all this.  It is not my way to lie on my back and kick my legs helplessly in the air and just accept things said by anyone.  Hence the correspondence on here.  

[jackdd]

34 minutes ago, Mister Fixit said:

What's a PCT?

 

Search for "post cycle therapy" on Google

[WaveHunter]

2 hours ago, jackdd said:

The purpose of TRT is to increase the testosterone to a normal level. If this could potentially require an AI, then there would be men who are completely natural who have high estrogen and would need an AI.
If those men would exist AI would be FDA approved for treatment of high estrogen. It isn't approved for this, because this condition just doesn't exist.

If you are on TRT and your Estrogen is so high that you suffer from side effects it means you are using too much testosterone and should lower this dose instead of using an AI.

 

Arimidex is a controlled drug in Thailand, should only be available through a doctor.

You need to research this a bit more.  You are absolutely wrong about the relationship between exogenous Testosterone injection and one's estrogen levels.

 

Exogenous testosterone at dosages typically prescribed for TRT can significantly raise estrogen levels, and the use of AI's like Arimidex, even though considered off-label usage, are indeep what doctors will prescribe to counter the rise in E-2.  The relationship between exogenous injections of testosterone and estrogen is very real.

 

Arimidex is indeed a controlled drug but since your doctor will have given you a prescription, you are free to buy it wherever you wish, and many pharmacies will offer a much lower price than a hospital pharmacy.  I can assure you of that.

[WaveHunter]

1 hour ago, Mister Fixit said:

What's a PCT?

 

Nothing you need to be concerned with as far as TRT goes.  PCT is only for those who use Testosterone intermittently and at extremely high doses for dramatic performance enhancement (i.e.: body builders). PCT stands for Post Cycle Therapy.

 

Bodybuilders commonly will do a "cycle" of steroids including Testosterone as the backbone drug, and at doses FAR higher than you would ever use for TRT for a number of weeks.  During this time, their natural testosterone production shuts down completely.

 

When they discontinue their cycle, the purpose of a PCT is to kick start the production of natural testosterone again. 

 

With TRT, your natural production is pretty much shut down as well however, the dosage of exogenous Testosterone you are using is so low, that returning your natural production to its pre-TRT levels does not really require a PCT becuase the pre-TRT level was already quite low, and won't be improved at all with a PCT, compared with just letting it (as well as your other altered hormone levels) return without PCT assistance.

 

I intentionally go off TRT for a month or so every year just to see what my "natural" hormone balance is in blood tests.  I can assure you that I've never noticed any side effects from this that would require use of a PCT.

[jackdd]

52 minutes ago, WaveHunter said:

You need to research this a bit more.  You are absolutely wrong about the relationship between exogenous Testosterone injection and one's estrogen levels.

 

Exogenous testosterone at dosages typically prescribed for TRT can significantly raise estrogen levels, and the use of AI's like Arimidex, even though considered off-label usage, are indeep what doctors will prescribe to counter the rise in E-2.  The relationship between exogenous injections of testosterone and estrogen is very real.

The first study which shows up on Google leads me to believe that you are wrong: https://pubmed.ncbi.nlm.nih.gov/29561193/

The purpose of the study was obviously another, but if what you say were correct, this study should have shown a high estrogen level, but they were all in normal range.

I suggest you do some more research.

 

13 minutes ago, WaveHunter said:

Nothing you need to be concerned with as far as TRT goes.  PCT is only for those who use Testosterone intermittently and at extremely high doses for dramatic performance enhancement (i.e.: body builders). PCT stands for Post Cycle Therapy.

It's relevant for everybody who wants to come off TRT, which is what OP wanted to do.

 

13 minutes ago, WaveHunter said:

I intentionally go off TRT for a month or so every year just to see what my "natural" hormone balance is in blood tests.  I can assure you that I've never noticed any side effects from this that would require use of a PCT.

Assuming that you use testosterone enanthate: It isn't out of your system after a month, your testicles haven't started working yet. So there is no point in what you are doing, of course you will have low T levels if you do this, you are measuring the remains of your injections. If you want to measure your natural levels you need to come off way longer, and should do a PCT to get your natural production going. I really think you should do some more research.

Edited June 17, 2021 by jackdd

[WaveHunter]

3 hours ago, jackdd said:

The first study which shows up on Google leads me to believe that you are wrong: https://pubmed.ncbi.nlm.nih.gov/29561193/

The purpose of the study was obviously another, but if what you say were correct, this study should have shown a high estrogen level, but they were all in normal range.

I suggest you do some more research.

 

It's relevant for everybody who wants to come off TRT, which is what OP wanted to do.

 

Assuming that you use testosterone enanthate: It isn't out of your system after a month, your testicles haven't started working yet. So there is no point in what you are doing, of course you will have low T levels if you do this, you are measuring the remains of your injections. If you want to measure your natural levels you need to come off way longer, and should do a PCT to get your natural production going. I really think you should do some more research.

You are seriously misinformed so please stop spreading BS.  I am undergoing TRT from a reputable and well informed physician so I know the facts first-hand. 

 

Anyone even casually familiar with TRT knows that injectable testosterone can cause a significant rise in estradiol (the male form of estrogen).  If you need to see proof of that, check this:

https://pubmed.ncbi.nlm.nih.gov/24928451/. 

 

I know first-hand that TRT raises estradiol levels becuase my estradiol readings shot up dramatically (over two times the acceptable level) after 3 months of TRT, as I explained in my previous post, and then came back down to the optimal range once arimidex was prescribed.

 

As for how long it takes for testosterone enanthate to effectively clear your system it has an elimination half-life of 4.5 days and a mean residence time of 8.5 days...so you are wrong once again. 

 

My doctor knows far more than you do; no offense intended.  My 30 day breaks from TRT every year are done on his advice and not something I just arbitrarily decided to do on my own.

 

It has nothing to do with measuring my natural levels of Test.  It has to do with letting my endocrine system return to a baseline and seeing what ALL blood panels look like in the absence of exogenous testosterone. 

 

It is just a safeguard that MY DOCTOR suggests to maintain a safe TRT protocol.

 

You obviously are self-teaching yourself endocrinology, and as the saying goes, "a little knowledge is often worse than no knowledge at all" 

 

It is admirable that you want to learn about endocrinology, but since you are not a physician, have not been mentored by one, and are not even undergoing TRT, it's kind of stupid to argue with someone who has been doing all of this  for over 6 years, and has taken an active interest in learning everything they can about it FROM THEIR DOCTOR.

 

I don't mean to come off so harshly but when you spread false information, you end up misleading people on this thread about a subject that is a pretty serious one.

 

Edited June 17, 2021 by WaveHunter

[jackdd]

33 minutes ago, WaveHunter said:

Anyone even casually familiar with TRT knows that injectable testosterone can cause a significant rise in estradiol (the male form of estrogen).  If you need to see proof of that, check this:

https://pubmed.ncbi.nlm.nih.gov/24928451/. 

That's no proof, because they didn't take into account on what testosterone dosages these people are. It's a well known fact that "TRT clinics" often put their patients on quite high dosages, no surprise that these people then have high estradiol readings. You would have to provide a study where it's certain that people are actually on "TRT" and not an "all year round mini cycle".

 

33 minutes ago, WaveHunter said:

I know first-hand that TRT raises estradiol levels becuase my estradiol readings shot up dramatically (over two times the acceptable level) after 3 months of TRT, as I explained in my previous post, and then came back down to the optimal range once arimidex was prescribed.

What is your dosage? How often do you inject? How many days after the injection did you get your blood tested?

 

33 minutes ago, WaveHunter said:

As for how long it takes for testosterone enanthate to effectively clear your system it has an elimination half-life of 4.5 days and a mean residence time of 8.5 days...so you are wrong once again. 

The "standard" (I don't recommend this) injection interval for Test-E is 3 weeks. After three weeks there is definitely still something of it left in your system (which is how they came up with the 3 weeks interval), which means your testicles haven't started to work yet. So in this case the instruction leaflet which comes with Test-E proves you wrong.

 

33 minutes ago, WaveHunter said:

My doctor knows far more than you do; no offense intended.  My 30 day breaks from TRT every year are done on his advice and not something I just arbitrarily decided to do on my own.

 

It has nothing to do with measuring my natural levels of Test.  It has to do with letting my endocrine system return to a baseline and seeing what ALL blood panels look like in the absence of exogenous testosterone. 

You should consider finding a more competent doctor. After a month your system hasn't returned to any baseline, you are simply Hypogonadal and your endocrine system is in a bad state, don't need to do any test to know this.

 

33 minutes ago, WaveHunter said:

and has taken an active interest in learning everything they can about it FROM THEIR DOCTOR.

So you have all your information from one single source. A source which seems to provide you with quite some wrong information.

Relying on a single source is generally a bad idea.

Edited June 17, 2021 by jackdd

[WaveHunter]

18 minutes ago, jackdd said:

That's no proof, because they didn't take into account on what testosterone dosages these people are. It's a well known fact that "TRT clinics" often put their patients on quite high dosages, no surprise that these people then have high estradiol readings. You would have to provide a study where it's certain that people are actually on "TRT" and not an "all year round mini cycle".

 

What is your dosage? How often do you inject? How many days after the injection did you get your blood tested?

 

The "standard" (I don't recommend this) injection interval for Test-E is 3 weeks. After three weeks there is definitely still something of it left in your system (which is how they came up with the 3 weeks interval), which means your testicles haven't started to work yet. So in this case the instruction leaflet which comes with Test-E proves you wrong.

 

You should consider finding a more competent doctor. After a month your system hasn't returned to any baseline, you are simply Hypogonadal and your endocrine system is in a bad state, don't need to do any test to know this.

 

So you have all your information from one single source. A source which seems to provide you with quite some wrong information.

Relying on a single source is generally a bad idea.

Look buddy, I think we're done here.  You obviously have never been on TRT, nor have you even taken the time to properly research it, or you would make make all the wild and erroneous claims that you have made. 

 

In short, you are clueless about physician administered TRT protocols, and like most self-proclaimed experts I guess you think you know more than they do. 

 

Worse though, you try to mislead others on this thread with all of your nonsense.  That is extremely irresponsible of you, and that's all I have to say to you.  GOODBYE!

Edited June 17, 2021 by WaveHunter

[jackdd]

7 minutes ago, WaveHunter said:

Look buddy, I think we're done here.  You obviously have never been on TRT, nor have you even taken the time to properly research it, or you would make make all the wild and erroneous claims that you have made.  In short, you are clueless about TRT, but worse, you try to mislead others with all of your nonsense.  That is very irresponsible of you, and that's all I have to say to you.  GOOD BYE!

I provided a proof for the two claims that I made, the only thing you have is "my doctor said it" ????

So follow your own advice, stop misleading people with your hear say.

Edited June 17, 2021 by jackdd