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GnRH has neuroprotective and anti-aging effects in mice. However, studies of men on TRT with suppressed GnRH do not show higher rates of dementia, nor do they show higher rates of all cause mortality. If the lack of GnRH is having negative effects then, it's either too subtle to affect health...

Compounded bioidentical / native testosterone in a lipid-based delivery vehicle, similar in that respect to Kyzatrex and the other oral TU products. The bioidentical testosterone is better tolerated than TU with fewer gastrointestinal side effects, and appears to be less suppressive of the HPT...

In the kyzatrex trial I mentioned, they started at 7 ng/dL free T and increased by 7 ng/dL to 14 ng/dL with the 200 mg bid dose. I would be looking to create a dramatic difference from your 10 ng/dL baseline with this experiment to ensure the results are noticeable, and targeting something more...

hCG will only complicate things - I would leave that out (at least initially). I work for Maximus so my bias is towards our oral testosterone, but with Kyzatrex, you will need much higher doses than 100 mg to move the needle. 200 mg bid only produced 14 ng/dL free T in their phase 3 trial. You'd...

Just curious: how did you manage to have four kids by age 30, having been in med school and residency the entire time? I feel like there's a story there.

I'll give you my less conservative perspective. Yes, I would experiment with increasing T levels, given your symptoms, which would produce a positive result on the ADAM questionnaire. Your levels, while not low, are not high enough to rule out the possibility that more T could improve the...

We have data showing no statistically significant suppression with once daily oral testosterone at Maximus which will be published soon on the website. The shorter half-life of bioidentical oral testosterone vs. testosterone undecanoate is likely responsible. Please see attached excerpts.

I don't have a trough level for my current protocol, but I took a midpoint level of 1230 ng/dL total, 28 ng/dL free, 30 pg/mL e2. This was on 35 mg test cyp EOD, and I took labs afternoon of the day after injection.

I'd be going alot higher with these labs. There's being careful, there's being very careful, and then there's just straight up wasting time. Straight to 100 mg if it were me, at least.

They suggest 25-50 mg a week, because above 50 mg it supposedly causes paradoxical estrogenic effects via conversion to 3b-androstanediol.

No, that looks amazing. So expensive though, wtf.

Most people who are still using test prop have been forced to switch to UGL suppliers.

Which alternative source for topical DHT do you suggest? There aren't exactly a plethora of options. That's the only product I'm aware of that has reliably worked for everyone who used it (including myself and RL friends). 100% DMSO would explain the skin rape though.

If continuous glucose monitors are available over-the-counter where you live, you should wear one for some time. If they aren't available OTC, see if your doctor will prescribe one for you. The minute to minute biofeedback on your glucose levels is invaluable for someone seeking to improve their...

If you liked the results of keto but not the effort involved, I would suggest carnivore is much easier. Twice a day, I throw a salted piece of meat into an air fryer. It cooks for 10-15 min, I put it on a plate, add some fat to correct protein/fat ratio if necessary, done. Perfect metabolic...

New doctor (either local or telemedicine TRT clinic) or go UGL.

Yes, 100% do this. I missed this in the initial post.

This is the type of lower fat, high refined carb, pseudo-healthy diet that most Americans are eating, resulting in 50% of the population being either prediabetic or diabetic. This is the direction you are also heading, unless you make significant course corrections. The ED you are dealing with...

I think you are focused too narrowly on the particulars of your protocol and need to investigate the root cause of your excessive aromatization. Your HDL and triglycerides are abysmal and suggest serious metabolic dysfunction. Insulin strongly promotes the expression of aromatase enzyme. Excess...

Looks like hypogonadal estradiol, which aligns with your symptoms, and which would cause the pituitary to release more LH as it tries to raise estadiol. Testosterone is actually pretty good, but you aren't aromatizing enough. If you want to stay natural and just do something OTC to bump up E2...

Skin becomes inflamed, feels irritated to the touch and breaks out with acne. Fasting glucose, fasting insulin, HbA1c, lipid panel (watch triglyceride:HDL ratio), uric acid (driven up by fructose, both a marker for and cause of metabolic dysfunction), and ALT / AST / GGT (screen for liver harm...

That is overcomplicating things - there is no need. Any change in the T/E2 ratio that occurs when you reduce dose will be minor and very temporary. You'll just throw everything more out of wack by introducing an AI.

I'm sure I would if I bothered to share that. I find doctors totally useless at solving anything there isn't a well known treatment algorithm for, so I see no value in discussing it. You would have better luck with ChatGPT at this point if you want creative medical problem solving.

This is confirmation of what I'm saying here, that OSA is really the larger factor, more so than the testosterone. So, if you want to run more testosterone, attack the OSA harder. And if you want more consistent levels, it is my opinion you'll get that with IM.

I would think E3.5D with IM is going to have peaks large enough to make a significant negative difference. I would not make that move while struggling with hematocrit. How are you tracking the effectiveness of your OSA treatment? I bet there is room for improvement. This is likely the real...

I personally find EOD IM with long esters to be a great compromise of stability and side effect management without having to poke yourself every day. I would be surprised if there were any substantial hematocrit difference between daily SC and EOD IM with cypionate at equivalent doses. Your...

May I suggest injecting into the muscle instead? You may be like many of us, where your subcutaneous tissue is like a black hole that mysteriously makes testosterone disappear.

Probably needs to drop more to make a significant difference in both numbers and symptoms. I would drop 20 mg to 130 mg.

I wouldn't run this experiment personally because I know the seed oil diet causes obvious problems for me. Oxidized LDL might be more sensitive as a marker for this. My most recent hs-CRP is 0.27 mg/L and oxidized LDL is 30 ng/mL on carnivore diet.

I would test one more time to make sure there wasn't a lab error or something. If your testosterone comes back low again, take more. Your first set of labs was quite high for your dose anyway, it would be the second result that makes more sense IMO.