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Nearly all my patients get their HCG from Empower Pharmacy.

...always trying to save patients' money, too.

For those who don't wish to spend all that time fiddling around with their TRT each week, 500iu twice per week is nice. If they are on a test cyp split, I have them do it the day before their test shot each time.

That's just a starting dose. I start my guys at 100-150iu per day, and go up from there. I've had a lot of patients on TRT, fully suppressed, father patients on that protocol. Always great to hear! Still waiting for one of them to name their son after me though. LOL I'm trying to mimic, as...

You may feel things bouncing around the first few weeks, but I would hold off until you have been on at least a month before determining whether you have an elevated estrogen issue. Merely changing hormone levels can bring both positive and negative subjective reports as things are stabilizing.

It was only one that I have seen. I think Nelsen posted it here. But reading 24 hour urine panels, with concomitant serum labs all these years has proven to me the body will increase T excretion into the urine when serum androgen levels are rapidly accelerating (as when SHBG is low-er). And...

I'm more interested in the fact splitting the dose keeps things more even across the week; plus it produces a better zigzag pattern for serum androgen profile. It's tough trying to figure out what is going on with a patient who is injecting once per week, especially if he has labs done at the...

HCG, like LH (and ACTH) stimulates the P450scc enzyme, which converts CHOL to PREG. Its role is obvious in this respect, in order to provide the building blocks for downstream hormones. Its need in TRT medicine is similarly obvious to me, even outside its potential for maintaining fertility.

Yes, and IF it did work, it would be so easy to prove it. Two blood draws.

Spermatogenesis requires an environment of high testosterone.

Two simple facts. (1) When you administer TRT, you shut down the HPTA. This ceases LH production, and alters downstream hormones (2) There are LH receptors all over the body. They would not be there were there not good reasons. My clinical strategy has always been to normalize the pathways as...

Well said.

There are very interesting points made in Dr. Saya's paper, but n=2 does not have the power to drive dosing protocols.

100-150IU per day

With studies conducted for every drug, the dose administered must always be considered. Especially when claims of a given percentage of inhibition are derived. "The dose makes the poison"

Women get Alzheimer's when their estrogen is falling off, after menopause. Good estrogen levels are clearly needed for brain health in both men and women. That is why we must not lower it too far. Or at all, if possible.

That has been shown in every study looking at it in men so far. But what did every study do? Use, for instance, a milligram of anastrozole per day. A milligram a week is a fairly substantial dose for a man on TRT. Why would we use studies where they administered 7 times too much of a drug? Any drug.

I only run the valid LC/MS Estradiol assay, and do not see it above range.

We don't usually test Thyroid Binding Globulin, as we do SHBG.

I'm proud to say I have known Dr. Neal Rouzier for many years, and have never heard him speak on it.

Yes, we can usually make a good guess if we know sensitive E2 and SHBG. Given the constant variability of the hormones, and the extra expense, I am happy to run the Free E2 if the patient wishes, but don't otherwise.

The best way to take HCG is a smaller daily dose, as we are attempting to provide a similar profile as the LH which the body is used to seeing, but is now suppressed.

Adding a little testosterone cream to the scrotum can boost libido for patients. I usually ask my patients to have their blood drawn a few hours after they apply their cream or take a pill. That way I can compare what the labs say to what the patient says about how they feel.

I think taking an AI would be a mistake for you.

I want everyone to know I am reading all your posts.

Yes. I usually do not even think to add any dose of AI until follow-up labs are done. The body is going through many changes once TRT is initiated, and things need to even out first. Then only if the patient is suffering continuing elevated estrogen symptoms.

Another benefit of smaller, more frequent injecting is it is easier to load the syringe. I would be quite surprised if only 25mg of DHEA actually elevated your E.

With a Total T that low, and SHBG that high, your Free T is not good. I'm afraid I cannot create a TRT regimen for you without thoroughly reviewing your case.

As an Osteopathic physician, less drugs is better. To be clear, I wish we never had to add an AI to a gentleman's TRT regimen. Through this thread, let's explore this topic. I am especially interested in hearing from guys who previously were on an AI, then successfully discontinued it. At a...

Well thought out, and said. There are no studies, to my knowledge, showing very high estrogen (and/or DHT) levels are safe in adult men; much less where optimal benefits are to be found. All the studies I have seen just show what we already knew: driving estrogen too low is always bad. This is...

I've had a slide in my lecture set for years which states: "If the patient has no symptoms of elevated estrogen, I do not add an AI". If the patient feels good with a total E2 at 50-70, he probably is good. At least he hasn't been driven too low with inappropriately high AI dosing. Having...