Intriguing....thanks RobRoy. Based on these protocols, can you provide daily peak/trough TT / fT ranges at 100 mg and 200 mg 2x per day test cream to the scrotum? Does Dr. Nichols have targets for these metrics to have his patients optimized?
He treats symptoms and is not caught up in the numbers game you seem to be
So no numbers? He doesn't follow up with regular blood work on the usual tests? How is dose adjusted based on free T level you mentioned above without bloodwork?
Symptoms first and foremost along with free T It’s that simple. Of course he is optimizing all the other hormones as well. But like I said he is not caught up in the number. If your free is 35 ng/dl for instance and you are still symptomatic he will give you the option of raising the dose to treat those symptoms. You can’t measure everyone’s AR sensitivity (CAG repeat length) or their exposure to EDCs that affect their response to testosterone (many competitively compete for the receptor). As he has said if every parameter of health improves what is the danger of of having a free of 50? Men seem to have a fear of a number even on this forum or a opinion that men “only need” a certain amount and anything above that is abuse.
Can you share TT / fT on your protocol (peak trough) along with dosing? May be useful for OP to compare numbers you get vs model I provided. For science and OPs benefit?
He measures 5 hours after application. 1600. Free 53. Feel better than ever and ever thing we can measure had improved. So when it is all said it’s what makes me healthier not what makes you happy or your opinion based on not treating 1 single patient
So this example is for 100 mg test cream twice daily (5 hr trough roughly)? Thanks in advance.
Sounds good. There is no real trough with a 2x daily application. If you Look at the pharmacokinetics there’s about a 23% decrement 12 hours after application. Creams are not treated like injections with regard to through measurements. Levels differ in every man but for the most part 100 mg twice a day get most optimal some need less and some more it all depends on symptoms and free T levels. He measures at five hours after application because he finds that levels and symptom resolution correlate very well but this is based on clinical experience. Some measure at a different time frame but he measures at the five hour mark.
Thanks for the information. Understood on the 5 hr sampling point and I'll compare the TT you shared above with the PK model results I shared earlier for everyone's benefit. If you are OK with it I'll share this analysis over at T Nation as well.
That is Just one lab example there are hundreds of lab examples which run the gamut from much higher than that ito lower than that. Each man responds differently with regard to absorption, consistency of application, consistency of shaving etc…so it is individualized to each patient. We are treating symptoms not numbers The cream dosage is Adjusted based on the individual symptoms and free testosterone. It is individualized to their needs. Some men will get a level of 2200 and a free of 85 with that same dosage it once again is individualized. But Rouzier and the likes are not shackled by the opinion that a man only needs so much and anything more than that is abuse. Some men simply need more than others and some less. What do you need to take away from the cream is that it works as good As injections. They both work. There is no roadmap and clinical experience goes along way. Some clinics use the cream once a day some clinics use injections and only give them once every two weeks. So there are different methods of treatment.
Understood. The free T numbers you are quoting...calculated or measured via ED/UF? Perhaps we can collaborate on a parity comparison of calculated vs measured fT if you have the ED data along with TT and SHBG. In particular I'm interested in cfTV vs truT vs ED measurement for both women and men. HRT women offer a unique data set as sometimes they are running supraphysiologic a couple hours after application.
All measurements are done via ultrafiltration. A HRT bases use But several bases will work well. HRT works great and to be used for men and women. We don’t find a need to measure SHBG since we are following symptoms first and foremost along with free testosterone. Free testosterone is measure to ensure compliance with treatment as well as to ensure adequate absorption is occurring and we are getting desirable levels. No one is aiming for a specific number but we are also not afraid of any specific number. For instance if a man feels great with a free testosterone of 25 in there it is, if he has a free of 35 and feels great then their good as well, if he has one at 55 or even 65 And is doing well then his numbers are left alone. I’m in the process of moving at the present time so I don’t have the time to outline the history of hormones such as Thyroid And Testosterone but I would if I had the time. Remember that thyroid has been used for over 100 years and it was used based on clinical response as the TSH test wasn’t available until the 1970s. Testosterone was also used based on clinical signs and symptoms without measuring lab test such as sex hormone binding globulin, total testosterone, pre-testosterone, estradiol etc. labs were expensive not readily available for testosterone. Testosterone was used to treat symptoms. In fact that was the good all days and yet they were treating men With testosterone without any labs to follow and yet there was no increase risk of heart attacks strokes blood clots etc. I’m glad you’re trying to help men out but I really don’t have the time for forums But I do enjoy helping and I’m glad that you’re out there trying to help me out as well. My patients will make me aware when I name is mentioned or topic comes up They feel should be addressed.
To be clear, I did not burn my bridges with the nurse. I simply requested more time to research HRT.
Have you through about just seeing Dr Nichols yourself? Dr Howell is a wealth of knowledge in androgens but doesn’t have the ability to treat Why not just set up a free consult with Rouzier or Nichols and problem solved
You should be able to get a refund and use the money towards treatment. For the most part all clinics offer free consults and telemedicine including Dr Nichols
www.excelmale.com
If you considering going on TRT which is a potentially lifetime commitment, then this thread really is required reading and guys should spend the time. I've debated sometimes very intensely with Danny Bossa and yeti308 on the other forum and appreciate RayBob providing his thoughts. I wish to continue this constructive dialogue with the TOT folks so that prospective patients can go in informed before they decide how they will start treatment.@JimBob — It's a long thread, but worth skimming to read some of Dr. Saya's concerns about this non-physiological dosing:
Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?
Let's try to clear up some confusion here. No need to debate what the E2 level in a young male going through puberty would be but yes it can run >70. This is not the point. The point is that a level of 70 is not harmful to men. The harm to men is with blocking estrogen. After 50 years of...
Not wanting to open up that can of worms but Dr. Sayas Concerns are not based on current medical literature. There are 3TRT myths that are continually propagated. The first myth is that it causes prostate cancer. It is also a myth that it worsens prostate cancer in men with prostate cancer. The second myth is that you have to control estrogen. No available literature shows that blocking estrogen is beneficial but in fact there is plenty of medical literature to show the harm. The majority of testosterones benefits come From its conversion into estradiol. Dr. Rouzier and physicians like him that treat men and don’t block estradiol don’t have patients with so-called estrogen symptoms. With increasing androgens the androgen to estradiol ratio increases or said another way the Estradiol To Testosterone ratio decreases. That is because there’s only so much aromatase enzyme in each man and there comes a point where the increase in androgens the enzyme is fully saturated and reaches its v max. So estradiol reaches a point that it cannot rise any further because the aromatase enzyme is fully saturated but the androgen level will continue to increase with increasing dosages.@JimBob — It's a long thread, but worth skimming to read some of Dr. Saya's concerns about this non-physiological dosing:
Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?
Let's try to clear up some confusion here. No need to debate what the E2 level in a young male going through puberty would be but yes it can run >70. This is not the point. The point is that a level of 70 is not harmful to men. The harm to men is with blocking estrogen. After 50 years of...
