TRT and Why it often Doesn't Work

Thread starter #22
Thanks for the links @Nelson Vergel I've never had a sensitive E2 test as I've never been to a Lab that offered them. I'm looking forward to getting the Test done at Discounted Labs when I'm in the US later this year.

I am a total convert to the benefits of E2. Below is what I wrote recently on Dr Crislers thread "TRT w/o the use of an AI". I wrote in a joking style but the sentiment was serious.

I'm a guy who loves his E2 - it's neuroprotective, maintains my bone and muscle mass, helps makes me an amazing lover and even assists me in completing the Times of London crossword each day.
I don't want anyone or anything inhibiting my aromatase.
So no use of AIs on my part.

Sure I know that DHT occupies the the E2 receptor (with 4x greater affinity as I recall). I'm old enough to remember the days before the modern AIs were available and guys used Proviron for that very purpose.

I've never thought, or said, that increased conversion to E2 is a problem. What's needed is a balance of the 2 metabolites.
What I was trying to establish essentially is the mechanism of action of the T Cream when applied to the Scrotum. There is a known systemic effect but is there a local effect, in tissue, from the Topical application?
 
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#23
Good point though it's crucial to explain the things that you can legally obtain and things that are basically illegal as no Dr worth anything is going to prescribe Mast/Pro to you. We're talking here about what is legal and can be prescribed. You are not.
Interesting.I know many guys in the UK (including myself) who were prescribed Proviron. I am on a different protocol now but I have since heard the rumour that Bayer are no longer producing Proviron and it is no longer available.
 
#24
I can imagine if you apply a lots of gel on you sack it might feel that they are burning up lol. But I have no problem when applying only two drops sized like to big peas of Testim.
 
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Thread starter #25
YBWV if a person injects 2x50mg/W or 100mg/W how would a mixed protocol (T gel and Cyp) look like more or less considering all levels are fine, DHT, TT, FT etc...
Just curious!
I suppose if levels were good at 100mg a week and say, for simplicity, that TT was around 1000ng/dl and if you were adding one sachet of a transdermal T Cream daily then you'd need to reduce the TCyp dose by the expected increase in TT from the cream.
So if the cream would give say 300ng/dl (30% of current TT) then you'd reduce the TCyp by 30% to 70mg.

It's a fairly inexact answer (you did say "more or less") as the reduction in TCyp dose likely wouldn't be linear to be he reduction in T level in serum. And you wouldn't know precisely the likely effect from the cream because absorbency varies.
The good thing with this mixed method of delivery is you're only using One pharmaceutical - Bioidentical T - so as long as you maintain adequate levels and the balance of E2 and DHT there's a good deal of flexibility in what ratio of the two methods you use to find what works individually.

Are you using a mixed protocol at present?
 
#26
Not really but since I have some tubes left of Testim (that I used before) I do apply some drops per week. But its not a protocol just to boost DHT a bit. I´m on 35-50mg Sustenon (mixed blends) + 2x500 HCG per week. However I should really test my DHT level before getting serious about a mix protocol. And after sometime on a mix protocol follow up with labs.Where I live there is not cream avaible so my best choice would be Testavan which is new on the market and seems to have really good absorvation compared to others.
 
Thread starter #27
Not really but since I have some tubes left of Testim (that I used before) I do apply some drops per week. But its not a protocol just to boost DHT a bit. I´m on 35-50mg Sustenon (mixed blends) + 2x500 HCG per week. However I should really test my DHT level before getting serious about a mix protocol. And after sometime on a mix protocol follow up with labs.Where I live there is not cream avaible so my best choice would be Testavan which is new on the market and seems to have really good absorvation compared to others.
Then you're in Europe? If so have you considered/used Proviron (mesterolone).
As you say you probably only need to boost DHT a bit.
Thanks, never heard of Testavan so I'll have a look.
 
#28
Yes I live in Europe. I believe Testacan is made in Switzerland and it is recently been introduced here where I live. And it seems to be a better option that the other gels on the market. However I don´t know much more about it.
 
#29
@YBWV, thanks for this really interesting, well-thought-out post.

I'm new to the world of TRT, and I was prescribed 200mg/ml T cream, which I plan to apply trans-scrotally starting this weekend. However, after reading your explanation, I am thinking a mixed approach may be superior.

My current prescription is 2 daily clicks (100 mg), working up to 4 (200 mg). As I'm a newbie, do you think adding some injectable T (perhaps once weekly) would be better? Any idea of what a good substitution dose would be? I know this may take some tinkering, but perhaps I could be a good case study.
 
#30
Interesting.I know many guys in the UK (including myself) who were prescribed Proviron. I am on a different protocol now but I have since heard the rumour that Bayer are no longer producing Proviron and it is no longer available.
Sorry but when locations aren't indicated we can't know that and probably 99% of the guys on this forum are US based any way.
 
Thread starter #31
@YBWV, thanks for this really interesting, well-thought-out post.

I'm new to the world of TRT, and I was prescribed 200mg/ml T cream, which I plan to apply trans-scrotally starting this weekend. However, after reading your explanation, I am thinking a mixed approach may be superior.

My current prescription is 2 daily clicks (100 mg), working up to 4 (200 mg). As I'm a newbie, do you think adding some injectable T (perhaps once weekly) would be better? Any idea of what a good substitution dose would be? I know this may take some tinkering, but perhaps I could be a good case study.
It sounds as though your prescribing Doctor has left the application site(s) of the T Cream up to you in which case my suggestion would be to initially split each daily application, say 50/50, between scrotum and another site. If you use too much of the product on scrotum you may send DHT higher than desirable and not achieve a good balance with E2.

The issue of what ratio of injectable to transdermal to use is going to be highly individual with the determining factor being efficacy.
Cost, convenience, absorbency and logistics may influence what is possible.

I think the main advantage of getting a significant proportion of T from injectables is the ability to maintain sufficiently high serum levels of T and E2 without the absorbency issues that may come with using a greater amount of the transdermals. There should normally be a cost saving too.

You will probably have bloods and a follow-up once you're into your therapy. If you're not getting the results you seek then you could discuss the mixed modality with your Doctor.
It may seem counterintuitive and unnecessarily complicated to many Doctors but the selling point should be that you can potentially achieve relief of symptoms with less of the pharmaceutical and thereby reduced risk of side effects.

Best of luck with your new therapy and yes, as you've offered, please do post up your results.
 
#32
"You State:
Give DHT equal importance to E2. (At least Consider that the DHT:E2 ratio, at adequate levels, is what counts)."

Will you explain and give example of what is considered a Good DHT:E2 ratio.
thanks
 
#35
It sounds as though your prescribing Doctor has left the application site(s) of the T Cream up to you in which case my suggestion would be to initially split each daily application, say 50/50, between scrotum and another site. If you use too much of the product on scrotum you may send DHT higher than desirable and not achieve a good balance with E2.
Thank you very much. Where would you recommend as a secondary site of application?
 
Thread starter #36
"You State:
Give DHT equal importance to E2. (At least Consider that the DHT:E2 ratio, at adequate levels, is what counts)."

Will you explain and give example of what is considered a Good DHT:E2 ratio.
thanks
In saying "ratio" I really mean the balance or relationship between DHT and E2.
I realise that Suggesting a numerical ratio wouldn't be of statistical relevance unless studied.

It does makes sense to me that a Ratio of DHT to E2, the 2 metabolites of T, would have significance in measuring function.

Individually, n=1, I know that my serum levels indicate a DHT:E2 ratio of 3 or 4:1 gives me good function: sexual, sporting & mood.
DHT in ng/dl and E2 in pg/ml.

That is where my DHT is 90 to 120 (top of range is 90) and E2 is around 28-33.
Unless I deliberately raise DHT it normally sits around 60 which is inadequate for me.

After approx 20 years of moderating my own hormones I know what numbers work for me. It seems natural to express that as a ratio once individual numbers are known.
 
#37
In saying "ratio" I really mean the balance or relationship between DHT and E2.
I realise that Suggesting a numerical ratio wouldn't be of statistical relevance unless studied.

It does makes sense to me that a Ratio of DHT to E2, the 2 metabolites of T, would have significance in measuring function.

Individually, n=1, I know that my serum levels indicate a DHT:E2 ratio of 3 or 4:1 gives me good function: sexual, sporting & mood.
DHT in ng/dl and E2 in pg/ml.

That is where my DHT is 90 to 120 (top of range is 90) and E2 is around 28-33.
Unless I deliberately raise DHT it normally sits around 60 which is inadequate for me.

After approx 20 years of moderating my own hormones I know what numbers work for me. It seems natural to express that as a ratio once individual numbers are known.
So how exactly do you manipulate your DHT?
 
Thread starter #38
I doubt he can come up with a DHT:E ratio, even the T:E ratio is a very flawed model to follow.
Agreed that T:E ratio is probably not a good indicator of overall function. As it happens if a guy reporting good function at a given T:E ratio knew his 5-ar conversion he would thereby know his DHT:E2 ratio which could be of more significance.

More importantly Friday afternoon hereabouts is all about Couscous and Siesta.
 
#39
Thanks for your reply.
Dr. Shippen put me on a protocol 2 years ago that looks very much like what this forum is about.
He put me on:
30mg. T. Cyp. E3D
HCG 100mg. Daily
1-Click T. Cream on Scrotum daily. (100mg/ml) each click = .25mg. for the DHT benefit.
25mg. DHEA
We always try to keep E2 around 30 and DHT around 100. So your ratio works with what I do. And I feel fabulous and have good libido at age 69.
 
Thread starter #40
Thanks for your reply.
Dr. Shippen put me on a protocol 2 years ago that looks very much like what this forum is about.
He put me on:
30mg. T. Cyp. E3D
HCG 100mg. Daily
1-Click T. Cream on Scrotum daily. (100mg/ml) each click = .25mg. for the DHT benefit.
25mg. DHEA
We always try to keep E2 around 30 and DHT around 100. So your ratio works with what I do. And I feel fabulous and have good libido at age 69.
I've seen mention of Dr Shippen here on Excelmale and he's clearly held in great esteem so good for you that you're working with him.

Those numbers work well for me too.
It's what puts the "sex" in we sexagenarians!
 
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