Andropause clinic visit yesterday

[rcuthbert]

1 hour 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 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!

Some time ago, I put jackdd on ignore.

[WaveHunter]

11 hours ago, rcuthbert said:

Some time ago, I put jackdd on ignore.

Some people seem to get a kick out of trying to derail a thread with deluded nonsense that is not helpful to anyone. This is just another one of those guys. 

 

Nothing irritates me more than someone with no real knowledge or first hand experience about TRT trying to convince others that they are experts on TRT, when in fact they are not.

 

It really surprises me that they don't realize how silly their remarks sound to someone who is actually undergoing treatment and has an in-depth understanding of the underlying science. 

 

In my case I have been under successful TRT treatment for over 6 years, and I've been mentored to really understand the underlying science by an expert in the field of TRT, unlike this poster who can only come up with bits and pieces of information that he doesn't even fully understand.

 

As the saying goes, "a little information is often worse than no information at all", and some the posts here have certainly proved that to be true.

 

Anyway, I think I've made my point about this character, and won't be interacting with him anymore since that would only further derail this thread.

Edited June 18, 2021 by WaveHunter

[BigStar]

2 hours ago, WaveHunter said:

Some people seem to get a kick out of trying to derail a thread with deluded nonsense that is not helpful to anyone. This is just another one of those guys. 

 

Agreed.

[Destiny1990]

How about instead of TRT take DHEA mono?

[eezergood]

On 6/20/2021 at 5:35 AM, Destiny1990 said:

How about instead of TRT take DHEA mono?

Far less efficacious and can have POTENTIAL issues/sides 

[eezergood]

On 6/18/2021 at 9:49 AM, WaveHunter said:

Some people seem to get a kick out of trying to derail a thread with deluded nonsense that is not helpful to anyone. This is just another one of those guys. 

 

Nothing irritates me more than someone with no real knowledge or first hand experience about TRT trying to convince others that they are experts on TRT, when in fact they are not.

 

It really surprises me that they don't realize how silly their remarks sound to someone who is actually undergoing treatment and has an in-depth understanding of the underlying science. 

 

In my case I have been under successful TRT treatment for over 6 years, and I've been mentored to really understand the underlying science by an expert in the field of TRT, unlike this poster who can only come up with bits and pieces of information that he doesn't even fully understand.

 

As the saying goes, "a little information is often worse than no information at all", and some the posts here have certainly proved that to be true.

 

Anyway, I think I've made my point about this character, and won't be interacting with him anymore since that would only further derail this thread.

Who & at which facility is your Dr based? would be great to have a refence for "quality" Dr's

 

 

[WaveHunter]

3 hours ago, eezergood said:

Who & at which facility is your Dr based? would be great to have a refence for "quality" Dr's

 

 

The doctor who set up my TRT protocol is in the United States.  When I moved to Chiang Mai from the US, I selected a GP through the local hospital to oversee my treatment after determining she was well qualified and very knowledgeable about TRT.

 

These days, due to TRT popularity in the population, it is no longer the sole domain of endocrinologists.  A GP is just as likely to be able to offer you excellent treatment as a specialist would.  It's not always easy to find a good GP for TRT, but they are out there.

 

Even though I now live in Pattaya, she is still my TRT doctor.  I have my periodic blood tests down here and email them to her for analysis.  So far it's worked out just fine.

 

Visiting your local hospital in this manner would be my advice to you.  Find a doctor who understand TRT, but just as importantly, has the enthusiasm to genuinely interact with you in a positive way.

 

Staying away from dedicated TRT clinics would be my other advice.  Many of those "clinics" are pretty scammy and seem more interested in getting as much money from you as they can, while dispensing questionable advice.

Edited June 21, 2021 by WaveHunter

[eezergood]

1 hour ago, WaveHunter said:

The doctor who set up my TRT protocol is in the United States.  When I moved to Chiang Mai from the US, I selected a GP through the local hospital to oversee my treatment after determining she was well qualified and very knowledgeable about TRT.

 

These days, due to TRT popularity in the population, it is no longer the sole domain of endocrinologists.  A GP is just as likely to be able to offer you excellent treatment as a specialist would.  It's not always easy to find a good GP for TRT, but they are out there.

 

Even though I now live in Pattaya, she is still my TRT doctor.  I have my periodic blood tests down here and email them to her for analysis.  So far it's worked out just fine.

 

Visiting your local hospital in this manner would be my advice to you.  Find a doctor who understand TRT, but just as importantly, has the enthusiasm to genuinely interact with you in a positive way.

 

Staying away from dedicated TRT clinics would be my other advice.  Many of those "clinics" are pretty scammy and seem more interested in getting as much money from you as they can, while dispensing questionable advice.

And trying to prescribe me levels I neither need nor want! 

 

i dont need my T levels to be close to 1000ng/dl

[WaveHunter]

23 minutes ago, eezergood said:

And trying to prescribe me levels I neither need nor want! 

 

i dont need my T levels to be close to 1000ng/dl

I think that 1000 ng/dL is a benchmark many trt doctors use.  That's what my doctor used, and it is the level that I've tested at for over 6 years, with no adverse effects showing up in comprehensive blood panels,  and only what I perceive as positive health benefits. 

 

Why would you not want levels in that range.  Just curious if you have any specific reasons?

Edited June 21, 2021 by WaveHunter

[Destiny1990]

5 hours ago, eezergood said:

Far less efficacious and can have POTENTIAL issues/sides 

What i read on the internet the sides from TRT can be more problematic then from DHEA, anyway how about pregnenolone?

[jackdd]

4 hours ago, WaveHunter said:

I think that 1000 ng/dL is a benchmark many trt doctors use.  That's what my doctor used, and it is the level that I've tested at for over 6 years, with no adverse effects showing up in comprehensive blood panels,  and only what I perceive as positive health benefits. 

 

Why would you not want levels in that range.  Just curious if you have any specific reasons?

On the previous page you said that your E2 is too high and you need to take an AI, so obviously not everything in order.

1000ng/dL is no TRT dosage, actual TRT dosages don't require an AI. TRT would be somewhere at 500-700, you are 50-100% over that, no surprise that your E2 is high.

I understand that you have no clue and just listen to your doctor, who also has no clue.

Find a new doctor, seriously, and stop trying to advise people here to take unnecessary drugs which can have serious side effects.

Edited June 21, 2021 by jackdd

[WaveHunter]

18 hours ago, jackdd said:

On the previous page you said that your E2 is too high and you need to take an AI, so obviously not everything in order.

1000ng/dL is no TRT dosage, actual TRT dosages don't require an AI. TRT would be somewhere at 500-700, you are 50-100% over that, no surprise that your E2 is high.

I understand that you have no clue and just listen to your doctor, who also has no clue.

Find a new doctor, seriously, and stop trying to advise people here to take unnecessary drugs which can have serious side effects.

Oh man, here we go again.   More of your false narrative!

 

Hopefully, others reading this thread, who really want an objective and science based understanding of TRT will recognize that you are far from the expert you claim to be, and will simply use Google search to easily verify that you simply do not know what you are talking about, and so I write this reply not for your benefit, but for theirs.

 

You don't seem to understand that reading bits and pieces of information from the internet or listening to snippets from self-proclaimed health gurus on YouTube does NOT make you the TRT expert you claim to be.

 

No offense intended but you personify the old saying by the philosopher Andrew Pope, "A little knowledge is a dangerous thing"

 

As for the actual truth...

It is well known that men with Low-T who use exogenous testosterone will have a corresponding rise in their estradiol level.  Exogenous T converts to estradiol.   Estrogen is simply a breakdown product of testosterone.  That's just the way it is, no matter how much you protest to the contrary.

 

As men age testosterone production declines and the ratio of estrogen to testosterone rises in favor of estrogen.  This is just a physiological fact that even a highschool student of Biology could easily appreciate.

 

Men who are administered testosterone in any formulation  (injection, topical gel, topical cream, pellet, or patch) or any amount will have a corresponding rise in estradiol levels.

 

Therefore,  monitoring and managing estradiol levels is paramount to optimizing testosterone therapy results, and an aromatase inhibitor like Arimidex is the safe and effective drug used by almost every single TRT physician. 

 

What you seem unable to grasp is one very simple fact that someone who actually is receiving TRT from a competent physician readily appreciates, and it is this:

 

The efficacy of TRT is not reliant on reaching a specific serum level of testosterone.  Efficacy is measured by how the subject feels.  In other words, efficacy is subjective, not objective.  

 

If you have a clinically low T of say 200 ng/dL, and you raise it to 500 with exogenous T, you will feel no difference in general well being, nor will you see any difference in body composition. 

 

The optimal range for most aging TRT subjects is between 700-1000 ng/dL, and "optimal" is strictly defined by how the subject feels and how his body composition looks, not by reaching some arbitrary serum level. 

 

With most aging men, sarcopenia (the age-related loss of muscle mass) will not be countered by a T serum level of 500 ng/dL, but it will be countered by a serum level in the 700-1000 ng/dL range after 12-18 months of therapy, and since avoiding sarcopenia is a primary goal for most TRT subjects, that's why most TRT doctors will shoot for this range. 

 

Assuming the subject has no pre-existing conditions that would contraindicate TRT, there is NOTHING dangerous about having a serum level in this range, if blood tests are properly monitored periodically and effectively managed with an aromatase inhibitor (for estradiol)  and with blood donation if hematocrit levels rise too high. Of course other blood values also need to be monitored but rarely are out of range as a direct result of TRT.

 

If you were an ACTUAL TRT subject, you would know all of this, and so that's why it's obvious to me that  you have no real world knowledge of TRT, and your studied knowledge of it is incredibly lacking.

 

Edited June 22, 2021 by WaveHunter

[jackdd]

2 hours ago, WaveHunter said:

It is well known that men with Low-T who use exogenous testosterone will have a corresponding rise in their estradiol level.  Exogenous T converts to estradiol.   Estrogen is simply a breakdown product of testosterone.  That's just the way it is, no matter how much you protest to the contrary.

I did actually never protest this.

Of course it converts to Estradiol, and if you inject supraphysiological levels of Testosterone you will have supraphysiological levels of Estradiol. Which is why you with your 1000ng/dl have high Estradiol.

 

2 hours ago, WaveHunter said:

Men who are administered testosterone in any formulation  (injection, topical gel, topical cream, pellet, or patch) or any amount will have a corresponding rise in estradiol levels.

Indeed, but if you stay in the natural range the Estradiol levels will also be in the natural range.

 

2 hours ago, WaveHunter said:

The efficacy of TRT is not reliant on reaching a specific serum level of testosterone.

Actually that's exactly what TRT is. The purpose of TRT is to have natural normal levels of Testosterone.

 

2 hours ago, WaveHunter said:

Therefore,  monitoring and managing estradiol levels is paramount to optimizing testosterone therapy results, and an aromatase inhibitor like Arimidex is the safe and effective drug used by almost every single TRT physician. 

Instead of relying on an AI it would be way easier and safer to just lower the Testosterone dose until you are at a normal natural level, then your Estradiol level would also be normal.

 

The main problem here is that you aren't actually on TRT but don't grasp it.

I assume you are out of your early twenties since quite a while, so most likely nobody at your age is at 1000ng/dl naturally.

So what you are actually doing is that you are abusing testosterone to achieve supraphysiological levels, not actual TRT.

With your abuse come certain side effects, high Estradiol level, and now you conclude that anybody who uses Testosterone will have this side effect. But that's just wrong, if somebody is on actual TRT dosage, he won't have high Estradiol.

Edited June 22, 2021 by jackdd

[eezergood]

On 6/21/2021 at 2:41 PM, Destiny1990 said:

What i read on the internet the sides from TRT can be more problematic then from DHEA, anyway how about pregnenolone?

Do not know enough to comment sorry, however if it was so efficacious why don't medical practitioners use it?  

[eezergood]

On 6/21/2021 at 2:19 PM, WaveHunter said:

I think that 1000 ng/dL is a benchmark many trt doctors use.  That's what my doctor used, and it is the level that I've tested at for over 6 years, with no adverse effects showing up in comprehensive blood panels,  and only what I perceive as positive health benefits. 

 

Why would you not want levels in that range.  Just curious if you have any specific reasons?

HI, 1000 is (was?) the benchmark as the very upper levels of T - based I believe on a bell curve, so they simply opt for the highest. As my body has been used to (relative to me) lower levels of Test for the last 40 years (I have kids, a beard should I desire, masculine voice) I don't think trebling my levels from 300ish to 1000 would needed or smart - the general mode of thinking for me (and others I have spoken to ) is to use the least amount needed. Going from 300 - 1000 would invite a whole lot of sides, as I know I am prone to aromatisation so why bother. 

 

My use of TRT will be purely for longevity, health and recovery. 

[WaveHunter]

16 minutes ago, eezergood said:

HI, 1000 is (was?) the benchmark as the very upper levels of T - based I believe on a bell curve, so they simply opt for the highest. As my body has been used to (relative to me) lower levels of Test for the last 40 years (I have kids, a beard should I desire, masculine voice) I don't think trebling my levels from 300ish to 1000 would needed or smart - the general mode of thinking for me (and others I have spoken to ) is to use the least amount needed. Going from 300 - 1000 would invite a whole lot of sides, as I know I am prone to aromatisation so why bother. 

 

My use of TRT will be purely for longevity, health and recovery. 

Well I agree with you in that TRT is a VERY subjective thing.  Everybody is different.  The thing that most people who only read about TRT but are not really involved with it don;t understand is there are really no hard and fast rules or benchmarks that apply to everyone.  O)nly a really knowledgeable doctor that keeps up with the latest science is qualified to guide you. 

 

Selecting the right doctor is critical.  There are plenty of endocrinologists that stopped learning on the day they graduated from medical school, and there are some GP's who are voracious about studying and learning about the very latest research...so credentials really don't matter as much as how current the doctor is on the latest science.

 

Some of the worst advice I've heard come from some very credentialed endocrinologists, especially the ones you run into on YouTube, or that run TRT clinics...so you really have to be careful in picking your doctor.

 

A good TRT doctor will always be extremely interested in you as the subject, and your goals for TRT, and then very carefully titrate dosage over a number of months, making adjustments based on blood tests, but just as importantly based on your subjective evaluation of "how you feel"

 

A doctor that is only concerned with benchmarks number he learned in medical school or medical literature is not going to be the best TRT doctor.

 

So, getting everything dialed in correctly as far as dosage goes really take about six months (at least that was what it was in my case.)

 

Again, everybody is different and everybody's goal with TRT are different too.  For me, I've always been very athletic, and as I got older I wanted to do maintain my athletic fitness levels as much as possible.  Things were getting pretty bad at one point as far as strength & endurance went, and it was much more than would be expected from simply getting older.  When My TT tested around 280 ng/dL, that's when my doctor suggested TRT.

 

The initial dosage brought it to 550 ng/dL, and I "felt" nothing at all in terms of improvement.   The next titration brought it to 720 ng/dL after a couple of months, and I felt better but wanted to push it further, so my doctor increased dosage brought it up to 1400 ng/dL (even though the dosage increase was not double as you might think).  I felt great at that point, and it E2 was still being managed with the same anti-aromatase dosage as before, and hematocrit had not been raised.   Even so, my doctor reduced dosage until he got it dialed in at around 1,000 ng/dL where it's been since, and as I've said, over the six years that it's average around 1,000 ng/dL and my blood is tested periodically and all has been just fine.

 

I should add that in addition to TRT, I am also a big fan of other metabolic modalities.  TO be honest, I'm VERY MUCH into biohacking with such things as low carbohydrate nutrition, and periodic long-term water fasting, which have a big effect at optimizing serum Testosterone (as well as a lot of other endocrine factors, such as Growth hormone levels and IGF-1, maintaining low insulin, etc...and so my actual dosages of exogenous testosterone are usually very low, but can vary widely depending on things like whether I'm fasting. 

 

BTW, My water-only fasts are 10 day fasts, once or twice a year, which a lot of people might think is really shocking and dangerous.  It is not, if properly managed.  In fact, it has tremendous health benefits which science is now proving to be very real ...but I digress.

 

I'm only saying all of this to make a point that TRT is not all about the numbers; the subjective effects of TRT are what really matter, and only a really good doctor can make the judgement calls of what is safe and what is not.

[eezergood]

On 6/28/2021 at 12:52 PM, WaveHunter said:

Well I agree with you in that TRT is a VERY subjective thing.  Everybody is different.  The thing that most people who only read about TRT but are not really involved with it don;t understand is there are really no hard and fast rules or benchmarks that apply to everyone.  O)nly a really knowledgeable doctor that keeps up with the latest science is qualified to guide you. 

 

Selecting the right doctor is critical.  There are plenty of endocrinologists that stopped learning on the day they graduated from medical school, and there are some GP's who are voracious about studying and learning about the very latest research...so credentials really don't matter as much as how current the doctor is on the latest science.

 

Some of the worst advice I've heard come from some very credentialed endocrinologists, especially the ones you run into on YouTube, or that run TRT clinics...so you really have to be careful in picking your doctor.

 

A good TRT doctor will always be extremely interested in you as the subject, and your goals for TRT, and then very carefully titrate dosage over a number of months, making adjustments based on blood tests, but just as importantly based on your subjective evaluation of "how you feel"

 

A doctor that is only concerned with benchmarks number he learned in medical school or medical literature is not going to be the best TRT doctor.

 

So, getting everything dialed in correctly as far as dosage goes really take about six months (at least that was what it was in my case.)

 

Again, everybody is different and everybody's goal with TRT are different too.  For me, I've always been very athletic, and as I got older I wanted to do maintain my athletic fitness levels as much as possible.  Things were getting pretty bad at one point as far as strength & endurance went, and it was much more than would be expected from simply getting older.  When My TT tested around 280 ng/dL, that's when my doctor suggested TRT.

 

The initial dosage brought it to 550 ng/dL, and I "felt" nothing at all in terms of improvement.   The next titration brought it to 720 ng/dL after a couple of months, and I felt better but wanted to push it further, so my doctor increased dosage brought it up to 1400 ng/dL (even though the dosage increase was not double as you might think).  I felt great at that point, and it E2 was still being managed with the same anti-aromatase dosage as before, and hematocrit had not been raised.   Even so, my doctor reduced dosage until he got it dialed in at around 1,000 ng/dL where it's been since, and as I've said, over the six years that it's average around 1,000 ng/dL and my blood is tested periodically and all has been just fine.

 

I should add that in addition to TRT, I am also a big fan of other metabolic modalities.  TO be honest, I'm VERY MUCH into biohacking with such things as low carbohydrate nutrition, and periodic long-term water fasting, which have a big effect at optimizing serum Testosterone (as well as a lot of other endocrine factors, such as Growth hormone levels and IGF-1, maintaining low insulin, etc...and so my actual dosages of exogenous testosterone are usually very low, but can vary widely depending on things like whether I'm fasting. 

 

BTW, My water-only fasts are 10 day fasts, once or twice a year, which a lot of people might think is really shocking and dangerous.  It is not, if properly managed.  In fact, it has tremendous health benefits which science is now proving to be very real ...but I digress.

 

I'm only saying all of this to make a point that TRT is not all about the numbers; the subjective effects of TRT are what really matter, and only a really good doctor can make the judgement calls of what is safe and what is not.

Agree on almost all - yes in general calorie restriction ( by means of fasting or otherwise) is TREMENDOUSLY beneficial and has a HUGE impact on lifespan, this is backed up by many studies in both human and animals. 

 

Low carb - has its place, however true keto (and ketones) are not a panacea, the way I explain to people is the difference between gasoline or diesel both are fuels and both have their relative drawbacks and advantages. 

 

 I agree people are individuals so this is the ultimate variability, personally I want to perform optimally with the least (external chemical/hormonal) input so would  not wish to introduce an anti e (or similar) if not needed - just a shot or two per week of T