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Very good topic and, as one might say, the million dollar question. So many cases are idiopathic in respect to a single etiology, but the true causation likely lies in the cumulative effect of the vast array of factors that can impact endocrine function (thus multifactorial).

Well one of those explains a lot more than the other...just kidding bud! Couldn’t resist, you know you’re a pal Vince.

Sourced from Australia, but specifics beyond that were not disclosed to my team.

I’m impressed that you came back 2 years later to close the loop and update your thread. Very happy you are doing well seaexplorer!

DHEA was also a game-changer for my dear pal PeakT, founder of PeakTestosterone. I added it to his protocol during his first consult with me based on some residual anxiety, which didn’t resolve with his baseline TRT, and it was the missing piece of the puzzle for him. He did a great job of...

Mooseman - the widowmaker has it’s name for good reason, so thank heavens you are okay! There is some data suggesting that oral corticosteroids (prednisone, etc) can increase risk of myocardial infarction (heart attack), with higher doses presenting higher risk...

Drug rights with or without FDA approval is a complex legal arena. Anyhow, the pharmacy assumes most liability when it comes to drug rights, whereas prescribing practitioner assumes liability for any adverse reactions (particularly without FDA approval). I’m having my team look into the...

Exactly right. Can only be used when HPTA is already suppressed (for example on TRT with very high SHBG). Careful with dosing. I’ve seen danazol reduce SHBG from 150 down to 40. On the opposite side of the spectrum, I recently had a LOW SHBG guy who spent some time overseas and started taking...

Of note Repros is now a subsidiary of Allergan.

Unfortunately no. As we know it is going through the arduous FDA approval process, but Repros has rights to it. Anyone dispensing (or less likely prescribing) could end up with liability if Repros and/or the FDA discovers.

Great post readalot! The non-linear relationship of hematocrit to blood viscosity is lost in the weeds to many (think 10% increase in hematocrit = 20% increase in blood viscosity). An astute researcher will also note that the slope of the blood viscosity curve starts increasing right around the...

Add to above T cream/gel applied to an area with adequate subcutaneous fat —> aromatase exposure while absorbing through the fat. Also transdermal applied directly to scrotum - gets more attention for increased DHT conversion, but also has more intra-testicular aromatization.

Blackmar401 - it’s always frustrating to hear such misinformation being propogated...especially from a professional. Maxadvance - believe it or not, just this week I had a patient with one teste (lost one early in life from surgical removal of undescended teste), present with an endogenous...

It would take much longer to “build up” with smaller/more frequent doses of Nebido, but you should eventually attain similar levels/results.

Nebido is not approved in the US for home administration, not sure outside of the US. With that said, the reason for requiring injection in office is primarily due to the above-mentioned risk. In theory the risk of pulmonary microembolism should be far less (if any at all) with a subcutaneous vs...

This is Empower’s position as relayed to me: The cream is pretty stable and should withstand freezing then thawing. There is a slight possibility of separation, so have the patient look at the cream once thawed to see if there is any separation. It will sort of look like an oil emulsion...

Yes that is true. Monitoring moving forward is key for trending.

Indeed.

I’ve since seen a few cases where LH and FSH were not fully suppressed and/or the patient noticed some perceived benefit in regards to testicular size. Overall, however, it does appear the suppression of TRT outweighs the stimulation from clomid when used concurrently.

Very happy to see you back CoastWatcher and impressed by the courage to share your story!

Your future self (heart and vessels) will thank you. See bolded above. This is the concern I’ve repeated in the past with higher HCT. Thicker fluid in the pipes = higher pressure. Now vasodilation can counteract, to some extent, but vasodilation is much more transient/variable...whereas the...

Any number of reasons that can be gleaned from the clinical experience (and pattern recognition) of our team practitioners treating over 20,000 men in the past 5 years that leads to a valid clinical determination that E2 is going to (or already is) creating issues. This relates to the provider’s...

I posted a long post a while back summarizing thoughts on the subject. Unfortunately, it was part of a thread where a member became hostile to other members and the entire thread was subsequently deleted. In essence it all boils down to two words: SYMPTOMS and BALANCE Symptoms indicate and...

Unfortunately sounds like you may have some suffering in your future if you proceed down the aforementioned path. “Making bigger gaps” between the injections serves no useful purpose and it sounds as though she is simply looking to eventually get you off of TRT...but through a slow and prolonged...

I have said many times that there is an epidemic of birth control-induced hormone suppression in young females. Birth control is great for its intended use...to suppress the ovaries (analogous to the testes in males) and prevent pregnancy. Unfortunately, hormone suppression (sex hormones -...

Many potential reasons for variation in T levels, with leydig cell desensitization (per your concern) being a very unlikely one at your doses. Variation in timing of T injection or variable leydig response to individual HCG injections are possibilities. My opinion would be to hold steady on...

Welcome and kudos to you for seeking to expand your knowledge!

THIS is a great point and one often overlooked when only viewing the hormonal landscape superficially. The complexity of the hormonal landscape is appreciated by most, but when one takes into consideration that we are monitoring serum levels as just one indicator...then you dig deeper and think...

Wouldn’t change anything until we see the semen analysis. Certainly wouldn’t take anastrozole with the current E2 level. We may transition to TRT and discuss where to go with exemestane, but would hold steady for now since you are planning the SA and consult in the very near future.

Hi zat954 - I recall your case as somewhat unique, particularly regarding the enclomiphene sourcing and predefined regimen you came in on. You’re discussion points are accurate in that many men can maintain *some* degree of fertility while on TRT and some combo of HCG (and FSH if budget allows)...

Convenient for them, but concerning not knowing what is going into your body (or in this case of transdermal hCG, what is NOT going into your body...but draining your wallet nonetheless).