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If you switch to conventional TRT—including injections or topical gels—then there's little point in continuing with enclomiphene. Your HPTA will still end up suppressed. There are alternatives that keep things going. The most proven is testosterone nasal gel (TNG). Even without enclomiphene it...

Ignore naysayers and give it a try. The lower dose is still giving you as much or more testosterone than the average healthy young guy makes. Just be aware of a transition period in which your body adapts to the new dose. I'm doing great on the equivalent of 5.25 mg TP daily. This wouldn't be...

It’s not quite as off-the-wall as it sounds. We know that as serum testosterone increases the 5α-reductase enzyme starts to saturate, leading to a reduced efficiency in DHT creation, illustrated thusly: Even so, with high testosterone a lack of DHT is not going to be a problem; there’s still...

I agree with @madman that this cookie-cutter protocol is far from ideal. Even less so with a possible diagnosis of primary hypogonadism. I am disappointed in Defy for prescribing it. There is an alternative treatment approach that may be better for your overall health than the current blast with...

It seems to help in some cases, likely due to increased variation in serum testosterone. However, short-lived honeymoon periods are also common. Yes and no. Testosterone applied to the scrotum does efficiently convert to DHT. However, this does not apply to testosterone enanthate. The reason...

I've found it's not an easy issue to overcome if you're injecting in a location that's prone to such leakage. You can try injecting more slowly and/or withdrawing the needle more slowly afterwards. You can also try injecting smaller amounts more often. Otherwise try different injection...

Yes. You should know him. He has posted here as "RobRoy" and previously as "J. Keith Nichols MD". He has quite an ego, and a temper that flares whenever he is questioned.

Dr. Nichols and presumably some others in the TOT crowd. ChatGPT says "Some of his discussions of TRT, while emphasizing a holistic approach, have included mentions that, in specific cases, higher T doses may be needed to optimize the ratio of T to E."

Absorption via injection is almost 100%. And once the testosterone gets into circulation your body can't tell if it was injected or manufactured in the testicles. At that point the only differentiation is in the pharmacokinetics—basically the serum concentration and how it changes over time. If...

That's basically argument from authority. They may simply be responding to the demands of their customers, who by and large have more-is-better thinking. I see that @Willyt has already mentioned Xyosted. Its success dispels the notion that supra-physiological doses are needed to ameliorate...

The protocol is effective, but requires a lot of motivation to sustain. That's why I've expressed enthusiasm for short acting testosterone, such as nasal gels. With these there is continued production of those upstream hormones, along with less downstream disruption.

There's the usual quibble that 105 mg TC/week is nowhere near micro-dosing. In any case, I've hypothesized that a SERM is needed in addition to cistanche to improve the odds of significant LH production under TRT. Ostensibly cistanche attenuates negative feedback from androgens at the...

That's not quite how it works. A reference range is supposed to be established by sampling the healthy portion of the subject population. Now you can argue on an individual basis whether the criteria for being considered healthy are sufficiently rigorous. But don't make a blanket statement...

High estradiol, whether absolute or relative, is a concern because the long-term effects are not well studied. There are at least some hints that it is problematic. Elevated estradiol levels result in vacuolization and increased glycoprotein production impairing Sertoli cell function. It also...

I'll begin with my usual admonitions: contrary to popular perception, 80 mg/week of TE is not a low dose, physiologically speaking. That's over 8 mg/day of testosterone, while typical natural production for healthy young guys is 6-7 mg/day. In some cases injecting twice weekly can make a dose...

Regarding the emotional blunting, high and/or steady testosterone levels can mess with the adrenal axis, which in turn can yield the emotional effects. There can also be effects on dopamine and serotonin. Here's an interesting statement I found earlier. Because circulating T normally...

Even if such upregulation occurs, the effect is clearly swamped by the SERM. That is, at typical doses, concentrations of the SERMs are more than enough to antagonize some additional estrogen receptors.

It is actually heightened sensitivity to estradiol at the pituitary or hypothalamus that can produce secondary hypogonadism. The SERM dulls this sensitivity by antagonizing the receptors. That is, the feedback is negative, so when reduced it yields a positive effect, a significant increase in LH.

A reasonable starting protocol is 40 mg twice a week, or 25 mg three times a week. This is one area where I criticize Defy. It's ridiculous to start somebody on a protocol that provides more than double high-end natural production of testosterone. That is, the normal range of testosterone...

It does seem likely that you have underlying metabolic dysfunction. Throwing TRT at this may or may not be useful. So far it is not clearly established that you are hypogonadal. You need to determine free testosterone before reaching a conclusion on that front. The Vermeulen calculation puts...

This work finds that DSIP can cross the blood-brain barrier. But it may be that nasal administration bypasses regulation of how much can get through. In all cases, we found intact peptide entering the CNS in excess of vascular markers. This clearly demonstrated that the small peptide DSIP could...

Percent free testosterone is not a useful parameter. Ignore it. In your case all it's reflecting is your above-average SHBG. Higher SHBG drives up total testosterone, while the important parameter, free testosterone, is relatively independent. While it's reasonable to supplement with modest...

I haven't seen a definitive answer to this, but I'll give you my take. Competitive inhibitors such as anastrozole may be less effective in the intratesticular environment, where testosterone concentrations are very high and hCG is acutely stimulating aromatase activity in Leydig cells. My guess...

Although lowish for your age, this isn't so low that I would worry much about heath issues. If you have symptoms such as reduced bone density or slow healing then you might consider trying one of the GH secretagogues. But if you're otherwise healthy then I would put it aside and continue with...

What do you think this means? Reiterating what I said: According to statistical norms the data do not demonstrate that IGF-1 has declined in the testosterone gel cohort. If you don't believe it then calculate the p-value. https://en.wikipedia.org/wiki/Statistical_significance

Look at the error bars. It's not statistically significant. 103 ± 46 --> 90 ± 34 mcg/L

This effect on IGF-1 is common, and it was observed in the clinical trials for enclomiphene as well. I've seen this in my personal use of enclomiphene. I've been using ipamorelin, 300 mcg daily. This has had a limited effect on IGF-1. YMMV. Ibutamoren is likely to be more potent, though perhaps...

It's a good illustration of risk versus reward. The oral 5ar blockers work the best, but do have that nontrivial risk of side effects. If you're one of the ones negatively affected then you would regret going this route. A compromise approach is to use transdermal formulations. There is getting...

This claim about SHBG is a misconception. The rate of absorption is what determines (free) serum testosterone — SHBG does not affect this rate. Rather, the absorption rate is determined by factors including the ester, the carrier oil, the excipients, the dose size, the type of tissue receiving...

A lab error is always possible, but I have encountered another individual whose test results also suggested unusually fast absorption of a longer ester—I believe it was cypionate in his case. If your results are accurate then it could be argued that IM administration and relatively small doses...

When I was administering PeakTestosterone there were no obvious commands for accessing PMs. However, I could backup the entire forum database to local storage. I think it was MySQL, so it might not have been too hard to see PMs if they were in there. Of course the SMF forum software is different...