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Exercising common sense is generally in one’s best interest!

I read the article when originally published years ago. If you find a long term study of men with DHT levels >400ng/dL please post it here for everyone’s benefit. I haven’t found any.

No one can claim the position of right or wrong when discussing persistent DHT levels several times the upper range of physiologic (as opposed to “modestly elevated” as discussed in article)…it has never been studied.

Always insightful posts readalot. The bell curve for our patients lies mostly between 100mg - 180mg weekly, with the mean right around 140mg estimated. Of course there are outliers above and below, but this would account for the majority.

Hi Dom - I apologize for your frustration. Our electronic tracking system certainly isn’t perfect and I know there are times when it can get out of sync for various reasons. I forwarded this to my management team to look into and someone should reach out to you within a couple days to hopefully...

I’m very sorry you feel that way, goolapsh. Low SHBG guys are always a unique challenge, but I’ve probably successfully treated more than most other practitioners. With that said, I certainly don’t have a perfect batting average. Wish I could have helped you more.

We haven’t seen any cases of priapism (up to now) with concurrent use of trimix and PT-141, but that’s not to say it can’t happen. As always, the dose of trimix should start low and go slow as this will be the primary risk factor for priapism. I would recommend ordering and having on hand the...

Indeed folks, the only thing we cannot provide/perform via telemedicine is a physical exam. Consequently, we rely on a surrogate (your local practitioner, clinic, urgent care, etc) to perform this service. A basic physical exam (such as an annual wellness exam, sports physical, etc) is all that...

Indeed. As we all know, however, a SERM is only #1 on the fertility list when used without the HPTA suppression of TRT.

I don’t know any specific locations in Oregon, but local hematologist offices are usually a good source for local knowledge. The finger stick HgB tests are notoriously variable. The lab test (CBC) is much more reliable.

Most of us do need to drink more water :)

Fantastic Madman! Something we’ve “known” for a long time, but good to see data to support. Fascinating to see the disparity in DHT comparing hCG/rFSH with T treatment and then baseline...despite higher T levels in the hCG/rFSH arm, DHT was significantly lower.

Lots of factors to consider, but below 30 gives me pause for the potential implications of iron deficiency. Above 250 and you start considering if systemic inflammation is at play (ferritin is well known as an iron storage indicator, but is also an “acute phase reactant” = increases during...

I would have suspected lower, as in most cases this explains the discrepancy. Nonetheless, not high. I would expect you’ll run 80-90 range on MCV consistently.

I would suspect this apparent discrepancy could be reconciled with the explanation that your MCV (mean corpuscular volume = “average size of RBCs”) is likely on the lower/smaller side...I would guess low to mid 80s. This smaller size means the RBCs essentially “take up less space” in the...

Fantastic and congrats! Can’t tell you how many times I’ve heard similar stories, but it never gets old. Children are indeed a gift.

Congrats!

ExcelMale community - Please join me in welcoming my colleague at Defy Medical to the forum, @Dr Caleb Calkins ! Dr Calkins has been a trusted provider on our team and has really honed his skills over the past few years under my supervision to become the highly skilled and extremely personable...

Low free testosterone AND low estradiol is a recipe for feeling miserable. For your reference, the female range for free testosterone goes up to 4.2 (vs yours 2.1). This is due to high SHBG. That should provide some perspective for your results. Unfortunately, many traditional guidelines only...

...and we’re happy you did ;-) Agree with all said.

As an FYI to assist patients during these unprecedented times (COVID-19), we have temporarily loosened some requirements for patients needing to transfer their HRT/TRT care from traditional physical locations to our remote telemedicine model. I will not elaborate here, but anyone seeking more...

While that may be true of some in this field/industry, come on fellas...you know that’s not how we operate. To the OP - you would benefit from a comprehensive lab evaluation and consultation (full thyroid, SHBG, LH, prolactin in addition to the basics). Not much can be determined without same.

Checked junk folder and sure enough your email from earlier today was there...something must have triggered the filter. Nonetheless, I wouldn’t worry. Your medication and some components of HRT are CYP 3A4 substrates, but not significant inhibitors or inducers. You shouldn’t have any issues.

Didn’t get the message just yet, but came across your post. Your new medication is an inducer or inhibitor of CYP450 3A4? T cyp and anastrozole are metabolized (hydroxylated for anastrozole) by CYP450 3A4.

If LabCorp has it listed for four consecutive days they are wrong. All 4 should be drawn on the same day: sample 1 upon waking, sample 2 typically around 12-1PM, sample 3 around 4-5PM, and sample 4 close to bedtime.

Success is always worth a cheer! Happy for you riverside.

Will do. Will take time for a fair assessment.

We have recently established a relationship with Tailor Made Pharmacy and have been working through a few logistical hiccups with preliminary trial orders. Issues have been largely resolved and our team will be updating patients on current status soon.

Perhaps... :) You, Gman, are a prolific poster in your own right. I’m motivated by your commitment to helping others.

Indeed, Cataceous has everything except the MD after his name. Always solid advice supported by data. Your work certainly doesn’t go unnoticed Cat! There are a few others on EM at this level as well. All advancing the cause.

The problem is that E2 does not follow T in an equal/identical fashion in all men. In other words, some men have higher aromatization than others. Additionally, some men seem more clinically sensitive to E2 (as levels rise) than others. Thus, my answer is yes - some men do need to pump the...