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We do have androgen receptors, literally, all over the body. They are important, and many body mechanisms rely of their action. But it's very clear many of the benefits of TRT actually come because when you administer testosterone, you subsequently raise estrogen. When T is too low, so is E...

The variable is everyone is so different.

I just got my old pal Dr. Shippen an invite to speak at the April 2019 AMMG conference in Miami. He is going to speak on HCG monotherapy and estrogen management. So we will have new lecture material to post from him.

I was wrong. Anastrozole DOES cross the BBB, but not nearly as well as the other AI's.

Yes, the brain thinks so much of estrogen, it makes its own. This is also another reason men need enough testosterone--to be converted into estrogen. BTW, the aromatase inhibitor anastrozole, which I use in my practice, does not cross the Blood Brain Barrier, do does not interfere with estrogen...

Good point. And that is one of the benefits of regular HCG use for men on TRT. Having said that, it is not good for men to supplement PROG. Doing so is both highly feminizing, and inflammatory.

I can find no sense in this.

An IGF-1 over the average is only a problem is there is not a matching IGFBP-3. And this is why injecting IGF-1 is insane. BTW, "The average" are old and sick. NOT good enough for my patients.

Don't waste that good Man Gel by applying it with your hands. It won't soak through the thick skin on the palms to reach the bloodstream. Instead, apply directly to the forearms, and rub them together. Then finish off by going up and down the flanks. Absorption is improved by doing so within...

That is called "orthostatics", and can be a sign of an Adrenal issue. When they took your blood pressure, do you know what it was?

MALE BIRTH CONTROL PILLS: This is a REALLY bad idea. http://ktla.com/2018/03/20/male-birth-control-pill-a-step-closer-to-reality-as-study-finds-experimental-contraceptive-is-safe/ Yes, and Thalidomide was “safe and effective” as treatment for nausea during pregnancy, too. If you don’t know...

Ya, besides a complete denial of half-life, clinical response as well. LOL ...and simple common sense.

I did not know that. Another example of why I always say I am the one (and so my patients) get more back from the 'boards.

I wish I could use it; but it's not approved here in the States.

I didn't even know that study existed until you posted it. It's great!

GREAT post. At first, I was wondering if this is true only for the (invalid for hormones) old immunoassay laboratory methodology. But then I remember the lab director of a urinalysis company telling me to hold B vitamins the day before collection, and he uses GC/MS.

It's getting to be pretty well accepted that if you are on TRT, and not "Backfilling" your pathways, in time you will neither be as healthy or happy. That is because TRT shuts down your system. Sticking in HCG, DHEA and even PREG helps start the flow again. Dr. Mark Gordon is teaching this in...

VERY nice. Thank you!

Sometimes elevated levels are from the hemoconcentration of dehydration. Especially when the patient is fasting. A BUN/Creatinine >20 is usually indicative of dehydration--but not in our patient population. That is because we tend to eat lots of protein, and that also elevated BUN. ...but this...

I have a number of patients who take their AI only when they feel high E Sx. Or they may take 0.5mg at once, instead of 0.25. There are a number of influences which alter E levels, and across a week. And I only treat E when a patient has symptoms of same. For those who take once per week...

Since it is the same weekly dose, the numbers should be the same. Having said that, I do believe SQ results in less urinary excretion of the T, so levels may rise over time, as happened with you. But some patients have reported to me their subjective benefits dropped a bit at first, so maybe it...

TD's stabilize, at an even daily dose, in 3 days. QOD shots build to a steady state, for sure. Variables, for a given weekly dose, and comparing once per week, twice per week, and QOD, include lessening urinary excretion the shorter the injection interval. You also tend to get less estrogen...

That's a great report on half-lives! Having said that, the "strategy" of TRT trumps half-life. And the tissue level of the medication, in relation to T concentration, also really counts. As an example, if you are injecting Test cyp once per week, you may just need some anastrozole to help get...

Great question. I want to "Backfill the Pathways" in all my TRT patients. That means HCG, and DHEA, and often, Pregnenolone. Whether or not they need an aromatase inhibitor, or other estrogen control (just to bend the pathways) is highly patient specific.

You are indeed correct: most of my patients do use the injections. Transdermals are not for everyone. When when they are, there are numerous advantages to them. But it is a decision the patient makes; I am there to give him the information he needs to make the best decision for himself.

ESPECIALLY if you have low(er) SHBG. Because if you do, you will be excreting more of your weekly T dose in your urine. Injecting at even shorter (than once per week) intervals will keep more of it in your body.

Well said.

HCG is a mimic of LH; that is why men on TRT should take it.

Which part can I explain more for you?

I tried it in a few patients. Succeeded in the first, so I tried it with others. Then the first patient crashed again, and it really didn't work in the others. So I abandoned it.

Giving TRT to those with primary testicular failure induces secondary hypogonadism. The now absent LH is missed by the LH receptors all over the body.