TRT and Why it often Doesn't Work

[JimBob]

YBWV, are/were you in the medical profession?

 

[goolapsh]

YBWV, so you’re in cream and injections? And are you also taking an e blocker?

 

[HarryCat2]

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 thought Dr. Shippen retired last year?

 

[YBWV]

YBWV, so you’re in cream and injections? And are you also taking an e blocker?

No, no use of an e blocker (aromatase inhibitor). Using a mixture of cream and injectable, appropriate for the patient usually avoids any need for an AI. (AIs have often been used when poorly designed protocols send Estrogens way high and out of balance with Androgens).

There is an excellent Search facility here on Excelmale. If you read the many posts relevant to this method of TRT, and you feel it could help relieve your symptoms, then perhaps speak with your Doctor.

 

[lemonflavor]

The prospects for many are a short lived, and possibly bewildering, "honeymoon period" (where androgens and dopamine predominate) followed by a crash where estrogens, prolactin and norepinephrine return with a vengeance.

I'd be interested in knowing more about the adrenaline component. I wonder if this is why I had to stop my first time around because of greatly increased anxiety, which I already suffer from chronically. This time around I've had to reduce the dose enough so that I'm not getting much benefit, but I'm able to stay on.

My first app't with Defy got cancelled this week, so we'll see what the doc says next week.

 

[ERO]

My contention is that TRT as it is widely practiced is failing many patients, gives sub-optimal results to others and oftentimes, where it does "work", works almost by default.

If a guy is symptomatic and is diagnosed as low T he is often started on a regimen of an aromatisable Testosterone (say injectable T Cyp). At a sufficient dosage most patients will quickly reach adequate levels of TT and E2, however many don't have relief of symptoms: their lack of 5-ar conversion means DHT levels remain too low.

Here's where it often all goes wrong: In order to achieve relief of symptoms the dosage of T Cyp is usually increased, often repeatedly. As the dosages are increased the need for an AI to "balance" levels increases too. Some, fortunate, patients will find relief early enough in this process and before TT has become too elevated. Others won't until their TT levels cause side effects - blood pressure, HCT, lipids, prolactin.

This type of regimen I would describe as balancing hormones from the top down - elevating E2 to excessive levels and then rebalancing to DHT with the use of AIs.
This is fundamentally wrong. Whatever happened to that basic tenet of good medicine: using the minimum efficacious dose for the relief of symptoms?
What symptomatic guys need is a sufficiency and balance of DHT and E2 the 2 metabolites of T. Surely that balance is better achieved by increasing DHT disproportionately to E2. ie balancing from the bottom up.

Guys that are symptomatic are low in androgens, some may have lacked androgens their entire existence: in the womb, at puberty and throughput adulthood. They start therapy and what are they prescribed - large doses of aromatisable T (perhaps topped off with hCG). The prospects for many are a short lived, and possibly bewildering, "honeymoon period" (where androgens and dopamine predominate) followed by a crash where estrogens, prolactin and norepinephrine return with a vengeance.

We know that T Cream, particularly when applied to the scrotum, will raise DHT disproportionately to other modalities. (There was the good news this week that Dr Crisler is introducing this therapy - others will surely follow). We also know that many guys, particularly over time, have absorbency problems with transdermals. We know too that a relatively small amount of injectable T will give us adequate levels of TT and E2.
What I conclude from those 3 facts is that a correctly dosed protocol of T Cyp conjunctive with T Cream has good prospects as an efficacious therapy. That is a weekly dosage of T Cyp (in suitably divided doses) and a daily dosage of T Cream.

A great advantage of this mixed modality of administering T, is the potential to keep a sufficiency of the sex hormones at all times yet allow DHT, and thereby the associated motivation/pleasure/reward neurotransmitters, a degree of diurnal variation.
Potentially a "best of both worlds" situation.

My suggestion to any guy starting therapy, or struggling with their current protocol, would be to consider the following:

Give DHT equal importance to E2. (At least Consider that the DHT:E2 ratio, at adequate levels, is what counts).

Don't be persuaded by the virtual demonisation of DHT as the "stuff that makes you go bald". (Sure raising the level of androgens will exacerbate and accelerate the balding process in those that are predisposed so if you believe or know that you have androgenic alopetia you may have a choice to make).

At the start of therapy ensure DHT is included in your bloods panel. Many providers don't routinely test for DHT as serum levels are though to be a poor indication of activity at receptor/in tissue. Personally I have found serum levels to be instructive.

Don't think of injectables/transdermals as an either/or option but potentially as "what dose of each" to get effective relief of symptoms.

100% agreement. Myself and a few guys I know personally all have had TRT basically fail to relive any of our Low-T symptoms.

 

[n2turbo2]

I should be the spokesmen for low t, it saved my life! I spent 5 years in depression and anxiety zero libido. It was a task to lift my ass off the coach. No energy at all, put on 100 pounds in 5 years. My life was shit, i am a successful business owner almost lost everthing. I spent 1000s trying figure out what was wrong with me. You name it ive tried it, right down to vodoo doctors.I couldnt put my family threw this, i was on so many meds.i took 20mg of ambien at night to sleep and 6 mgs of ativan during the day. To get threw life, I had heard of low t. But i looked into it and backed off because someone warned me that it will make my anxiety worse. So years went past, and i said to myself, why not get tested wont hurt. Got the test results total t 66 and free 2 e2 20. To make a long story short Started trt 8 or 9 months ago. Off all meds and leaving life again, and i have taken 40 lbs off.I have energy again and fell sure of myself again and handling lifes stresses like i use to. Just having bad problem with acne, i will take that any day.

 

[melanieb]

So what is your best recommendation for increasing DHT?

 

[SkiDaddy]

I thought Dr. Shippen retired last year?

As my post said he put me on that 2 years ago. Yes he retired in August and my last visit with him was this past June.