Webinar with 3 Testosterone Book Authors this Wednesday, 8 pm ET

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Nelson Vergel

Founder, ExcelMale.com
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It is with great excitement we announce The Ultimate TRT Hangout with Nelson Vergel, Dr John Crisler and Jay Campbell.

Join the authors of the 3 of the best selling TRT books for a unique discussion on optimizing men's hormonal health.

Some of the topics for discussion:

-clomid therapy
-estradiol management
-finasteride syndrome
-HCG benefits beyond testicles
-peptides
-typical protocols he uses
-thyroid management

We will finish with Q & A. We encourage you to submit your questions ASAP.


Public Event Page Link (where people can sign up to watch)


https://plus.google.com/events/c9s7nkllj38lguauj3sgsr1bv7g


Youtube Link: (for watching later)
https://www.youtube.com/watch?v=P8wPlroSy4c&feature=youtu.be
 

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Defy Medical TRT clinic doctor

mike7

Member
Unfortunately I'll have to watch it afterwards on YT.

I'd like to know what everyone's thoughts are on FT levels and where the cut off should be for treatment? Do they treat the symptomatic person with low FT via TRT even if TT levels are "normal?"

Thank you!
 

maxadvance

Active Member
Looking forward to it, just read Jay's book and really connected to it. Learned a bunch of new stuff, just ordered 3 bottles of stinging nettle root lol
 

KeyserSöze

Member
I enjoyed the HangOut a bunch...

Was anyone else very intrigued by Dr. Crisler's call for patients willing to try the TestCyp and DHEA combo injection? It sounds like it would need to be taken much more frequently (maybe daily) than how most take TestCyp (2x per week). For those that are already taking HCG daily per Dr. Crisler's recommendation, are you as interested in this as I am?

My thinking is: I am already taking HCG every morning and DHEA 2x/day...I could just inject the TestCyp/DHEA combo with the HCG and not have to even worry about the troche.

Thoughts?
 

Helboi

New Member
I too am very intrigued by the Test/DHEA combo. Currently on the DHEA/Preg topical and daily HCG myself. I'm not quite 100% dialed in on my current protocol so I'm a bit reluctant to make a big change like that, but I'm sure interested based on what I saw in the hangout.
 
I had a few of my patients on the testosterone/DHEA combo a year or two ago. Unfortunately, they seemed to experience some of the E2 symptoms as well (with BIW dosing) similar to Dr Crisler's personal experience. I believe the ONLY way to successfully use the combo would be with smaller daily doses. This is also a necessity because the DHEA is NOT esterified (has no ester attached like the testosterone cypionate), thus the DHEA is released very rapidly in the body (and also cleared very rapidly) - another reason daily dosing would be needed.
 
Now if we could find a way for the pharmacy the make the DHEA in a lyophilized (powder) form similar to hCG...which could then be injected WITH the hCG with an insulin pin daily...now THAT would be great. Will update if we get to that point!
 

KeyserSöze

Member
I had a few of my patients on the testosterone/DHEA combo a year or two ago. Unfortunately, they seemed to experience some of the E2 symptoms as well (with BIW dosing) similar to Dr Crisler's personal experience. I believe the ONLY way to successfully use the combo would be with smaller daily doses. This is also a necessity because the DHEA is NOT esterified (has no ester attached like the testosterone cypionate), thus the DHEA is released very rapidly in the body (and also cleared very rapidly) - another reason daily dosing would be needed.

Thanks for your insight Dr. Saya. Is there any reason why you would continue to use Cypionate if the DHEA were to be combined with the Testosterone? Is there any advantage of compounding the DHEA with Propionate if moving to daily injections? As you know, a number of Dr. Crisler's patients already pin HCG daily, so a daily pin of Propionate/DHEA could be as simple as using the same syringe for a single daily pin.
 
The pharmacy only makes the DHEA combo with cypionate currently. They could theoretically make it with propionate, however with all of the current heightened regulations on compounding they would need to do additional studies on "beyond use date" and other variables prior to dispensing. Also, although with regards to the timing of release of testosterone from the propionate ester it lends itself better to daily injections, also keep in mind the propionate ester tends to cause much more discomfort/irritation (ESPECIALLY when injected SubQ). More discomfort per injection + daily injections = much more cumulative discomfort. The discomfort/irritation caused by various esters tends to correlate with the length of the carbon chain of the various esters, with SHORTER carbon chains generally causing more irritation. Cypionate = 8 carbons (relatively mild irritation), Enanthate = 7 carbons, Propionate = 3 carbons, Bee venom = 1 carbon. I am working with the pharmacy to compound lyophilized DHEA which may be injected daily with HCG for folks that can keep up with that routine (not everyone can). We will see if the pharmacists can pull it off, I believe they can (but, again, if they can there will be a delay in availability due to the testing requirements for new compounds).
 
Hi Vince - No one knows this answer for sure, all opinions are anecdotal. I suspect the difference, if any, is likely minimal. I can tell you the this: the half-life of hCG appears to be in the range of 24-36 hours. Let's use 24 hours for an example calculation. If you inject 500iu, then after 24hrs you will have 250iu remaining, after 48hrs 125iu remaining, after 72hrs 62.5iu and so forth (500iu -> 250iu @24hrs -> 125iu @48hrs -> 62.5iu @72hrs). The same can be calculated for other doses of hCG (300iu, 400iu, etc).

I personally use the degree of suspected PRIMARY HYPOGONADISM in my dosage decisions for hCG. In other words, the degree of suspected testicular failure. If I suspect a patient has a stronger primary hypogonadal component (less responsive or less capable testes), I dose slightly higher hCG for more stimulation of the "less capable" testes. If I suspect a patient has less of a primary hypogonadal component, I typically will dose hCG somewhat lower as the testes are more responsive/capable. This is why my hCG dosages often vary from patient to patient. I believe with hCG, as with all other areas of HRT that we have found, a cookie-cutter/one-size-fits-all approach is not ideal as some factors vary amongst patients.

The REAL question is how much is needed to keep the Leydig cells in the testes stimulated and to reap the other benefits of the hCG. Again, this is not fully known (we have some data on this for fertility - i.e. Lipshultz study, but not for other areas). I believe the goal should be to attempt to approximate hCG's endogenous equivalent LH. Now this is difficult as they have much different half-lifes (with LH being very short) and endogenous LH is only secreted in a pulsatile nature. I am currently working on a few case studies of patients to determine the quantitative beta hCG serum levels achieved at various times following various hCG dosages. I currently have two patients enrolled, after a 7 day washout to ensure all hCG is out of the body (and these are longtime TRT patients so endogenous LH is suppressed) one patient will inject a single hCG 150iu injection, the second patient will inject a single hCG 500iu injection (I'm trying to arrange another patient for a single 350iu injection as well). I will then measure quantitative serum hCG levels at various times - hour 0 ( before injection) -> hour 12 -> hour 24 -> hour 48 -> hour 72. This data will be very interesting especially in the sense that I want to try to compare the resultant levels of hCG at various times to the normal physiologic levels of its equivalent, LH. This may give a little more insight into what the "best" dose of hCG may be. I'll share once complete, likely 6-8 weeks...maybe sooner.
 
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