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      This excellent lecture is recommended for clinicians and educated patients.

      From largest urology conference in the world (2015)


      Speaker 1: So without further ado, I'd like to bring Dr John Mulhall to the podium.

      Dr Mulhall: It's my pleasure to be here. There's no doubt that there's confusion, certainly among urologists about the evaluation and the management of a man with low testosterone. The reason for the confusion is largely based on the fact that we have very few guidelines, but they don't often assess some of the clinical challenges we have on a daily basis. They don't assess them and give a definitive recommendations because of the absence of randomized placebo-control trials.
      My job today is to run through therapeutic options and best practices. As I was thinking about this, I put this into the framework of decision making for you in your clinical practices on a daily basis. Whatever recommendations I will give you here, and I will try separate expert opinion from recommendations, are based on these separate guidelines. ...

      In theory testosterone replacement should approximate the body’s own natural production of the hormone. The average male produces 4 to 7 mg of testosterone a day with plasma levels in early morning and lower levels in the evening. Women produce around a 12th of those rates.

      Testosterone replacement is usually a life-long commitment. It is a decision that should not be made without a discussion with your health care provider. Starting and stopping testosterone can have negative effects on someone’s quality of life (more on this topic later).

      There are testosterone replacement products that require daily dosing (orals, buccal, and gels), once a week or two weeks dosing (injections), and once every three- to four-month dosing (long-acting testosterone undecanoate injections) or testosterone pellets).

      Males who are hypogonadal can be given continuous testosterone replacement therapy in a wide assortment of ways. These include: ...
      Article Preview Testosterone replacement therapy (TRT) is one of the most effective methods for treating hypogonadism, erectile and sexual dysfunction. Sadly, as with any treatment, a minority of men may experience hair loss.

      A small but concerning percentage of men (mostly under 45 years of age and with genetic predisposition to hair loss) undergoing TRT begin to notice that their scalp hair tends to thin drastically within 3 to 6 months of the hormone therapy. This isn't the case with all men, and it's still not quite clear WHY men undergoing TRT begin to lose their hair although some studies speculate that one of testosterone’s main metabolites, DHT, may exert negative effects on hair follicles. However, if you're unlucky enough to fall into the "going bald" category, you may be wondering what to do. After all, you can't stop the TRT, but you don't want to have to continue to lose your hair. It's like being caught between a rock and a hard place! What can you do?

      Many men turn to Rogaine (Minoxidil) or Propecia (Finasteride) as a means of combatting hair loss. These are the two most popular anti-balding topical drugs, the ones that receive the most media attention and advertising time.
      Article Preview
      ExcelMale.com Quick Guide:

      Diagnosis and Management of Hypogonadism


      Symptoms and signs suggestive of testosterone deficiency in men:

      A. More specific symptoms and signs

      • Incomplete or delayed sexual development, eunuchoidism
      • Reduced sexual desire (libido) and activity
      • Decreased spontaneous erections during sleep
      • Breast discomfort, gynecomastia
      • Loss of body (axillary and pubic) hair, reduced shaving
      • Very small (especially <5 ml) or shrinking testes
      • Inability to father children, low or zero sperm count
      • Height loss, low trauma fracture, low bone mineral density
      • Hot flashes, sweats ...
      Article Preview

      Higher dose testosterone can decrease HDL.

      Click here for background information:
      Why does testosterone therapy decrease HDL cholesterol in some men?

      HDL (High Density Lipoprotein cholesterol) particles are sometimes referred to as "good cholesterol" because they can transport fat molecules out of artery walls, reduce macrophage accumulation, and thus help prevent or even regress atherosclerosis. ...
      Thank you very much for commenting guys.

      I'll try to fill in the blanks:

      Diabetes - I have been diabetic for approx 14 years. 2.5 years ago I fired most of my doctors and took control of my own health. My endo had me on 4 shots of insulin daily plus metformin. My A1C was 13. Today my A1C averages 6.7. Yes that is still high but much better than it was. My morning number is ALWAYS high. I believe I have dawn phenomenon but recently have discovered that high cortisol, which I have at night, will cause my sugar level to rise at night. I am therefore trying to concentrate on controlling that cortisol and hoping my numbers will come down further.

      My diet is mostly on point. My cholesterol, triglycerides and everything is great. My LDL only rose slightly in that latest labwork....so I eat protein, good carbs and fats (except a cheat day or 2 here and there). ...
      Recently I had a really bad cold with a severe cough. It was so bad my doc put me on a bunch of stuff to reduce inflammation in my Bronchial and some cough trigger pills. He also had me stop using Lisinopril. It's one side affect in a drip and cough. I didn't take Lisinopril for BP, I toke it for migraines. So once my cold died and my cough settled he put me on Losartan(ARB). It's very similar to Lisinopril but the process in which it relaxes the blood vessels is a little different. Well today I went in for my 2 month blood donation. Well my hemoglobin was 15. It hasn't been that low since pre-TRT. I read that ARB's do lower your Hema and Hemo so I was wondering if I should skip donating for a while and then test again? This would be fantastic if this drugs keeps my migraines at bay and also keeps my Hemo and Hema at a good level without donating. ...
      Article Preview SLEEP IS ANABOLIC

      Dr. Mauro Di Pasquale, M.D.

      There are a lot of factors that impact on body composition including the two that are uppermost in most of our minds, the right kind of training and nutrition.

      While training and nutrition are important, they’re not going to do much for your body composition if your body’s not in a position to make the best use of them. ...
      Article Preview Excerpt from the book: Testosterone: A Man’s Guide

      Most men find that their sexual desire increases after they start testosterone replacement. Sexual dreams and nighttime/morning erections may be more readily achievable, but in some cases, testosterone alone does not make erections strong or lasting enough for satisfactory intercourse. So, some men need some extra help to make sure that their improved sex drive matches an enhanced and hard erection. ...
      Article Preview Price: $195


      Tests included:

      Prolactin: High levels have been linked to ED and low libido.
      Total and Free Testosterone: Low levels have been linked to ED and low libido.
      Article Preview
      It is suggested that you talk to your physician about the need for proper blood tests before and during testosterone.

      To find out how long it takes testosterone replacement to potentially show benefits, read this article.

      For affordable blood tests in most cities in the U.S. (Prescription provided): DiscountedLabs.com

      We also ...
      Anabolic steroids and testosterone shut down the body's Hypothalamic-Pituitary-Testicular Axis (HPTA) while people use them and for a few weeks after cessation of these compounds. However, some men's testosterone production does not recover back to baseline values. These men have testosterone deficiency and often have symptoms of hypogonadism (erectile dysfunction, lack of energy, low mood, etc).

      Some young men (under 35 years of age) are seeking help after they become hypogonadal after anabolic steroid use. The best post cycle protocol for these patients to normalize HPTA function has not been established but usually include HCG, clomiphene (Clomid), Tamoxifen, etc

      This study found that:

      1- Men under 50 were more likely to have used anabolic steroids
      2- More educated men used anabolic steroids more than less educated men (more disposable income and more research online may be good explanations)
      3- Men with fewer children used anabolic steroids in the past more than those with more children (younger age, more disposable income and time to exercise are good explanations)

      J Urol. 2013 Dec;190(6):2200-5.

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    • You have probably reached our site in your search for health and potency. Are you wondering who to trust with men’s health information in an online world full of scammers and deception? Well, you are in the right place!

      Welcome to ExcelMale.com, one of the largest and best moderated men’s health forums on the Internet focused on increasing health, potency and productivity in men. With over 13,000 members (as of April 2016) that include educated men, physicians, pharmacists, dietitians, exercise trainers, nutritional supplement experts, and other professionals in the field, ExcelMale is fast becoming a leader in the field. Our forum topics range from testosterone replacement therapy, Trimix injections use for ED, HCG use for better fertility and libido, estradiol management, thyroid function optimization, peptide information, exercise routines, best supplements for men, high protein diets, testosterone side effect management and much more. We also provide men’s health information via Interviews with experts, Videos, and webinars. Last but not least, our members share their reviews of hormone replacement clinics and doctors, compounding pharmacies, pharmaceutical products, supplements, and much more. Our great moderators review every post daily to detect spammers or abuse, so ExcelMale is a safe environment for all men. And since every man wants to help important women in their lives, we do not neglect female health information as we include a folder called “ExcelFemale” to post the latest on HRT in women.

      Search our content by typing your question here.

      Register here to join our community! Don’t be shy, ask questions by posting in any forum folder. We can help each other to regain our best selves!.

      Wishing you the greatest health,

      Nelson Vergel