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Can't say for sure if the culprit is estrogen or prolactin, but, again, by blocking conversion from T to DHT, there is more T available for conversion to E, and you note that this is indeed what you saw with your assays. Yes, low DHT, in and of itself, does not drive gynecomastia. A T cycle, if...

Hi eudes, you are very welcome. I can Skype with you if you like. Regarding your concern for your lipids, as long as you are not OVERsuppressing your estrogen, you should have no negative effect on your HDL. You can avoid gynecomastia (estrogen related) by keeping your E within normal limits...

Hi Fernando, Thank you and thank Nelson for this! And, for the videos, the credit goes to Dave "Mad Max" Bourlet (btw, we are now on Jay Cutler's channel/website) For my part, I am more than happy to help if I can. I do not see how an AI would lead to osteoporosis in a typical male. If one were...

Hi Galaxy, one of the main reasons for not "endorsing" sub Q injections of T was because it was relatively new (at least in terms of being main stream). I (arguably, we) just didn't have enough data/feedback, and, I had seen some pretty bad case of sub Q injections gone bad - mainly large blebs...

Hi eudes, There is no contraindication taking dutasteride with anastrozole (Arimidex). You may indeed get better results with dutasteride than finasteride. Gynecomastia is not driven by DHT but rather estrogen. If you take a 5-alpha reductase inhibitor such as finasteride or dutasteride and you...

That's a loaded question for many more reasons than legalities. There are so many, not just androgens, but steroids that have therapeutic value. To which therapeutic purpose(s) are you referring? For simple anabolic purposes, two anabolic steroids that are legal in the US are nandrolone and...

Hi lexer, Not sure if I answered your question, but it appears that at some point I hadn't. Sorry to you and others whose questions I haven't answered. I screwed up initially answering questions without tying them to each other (question with answer) so I frankly got lost in what had and hadn't...

Hi Blackhawk, I am still not convinced that PSA is a valuable screening tool. Even the supposed inventor of the PSA test believes it should not be used as such (https://www.nytimes.com/2010/03/10/opinion/10Ablin.html). The only group the adheres to its use still is the AUA. There are too many...

Hi Mike (Sully09), First, you are in good hands with Defy Medical. I actually founded Defy along with one of the current owners and Dr. Saya is very knowledgeable and competent. There is more than one way to skin a cat, so we may vary in our preferences for different Rx's and protocols, but...

Hi HanginOn, I use E2 (estradiol), sensitive for just that reason. Once I received a report with both and the E2 was 64 pg/mL while the E2, sensitive was 16 pg/mL on the same draw. This is typical because the simple E2 is not precise enough in the low range likely because the test was originally...

Hi Amacher, Of course, everyone is different, but the pituitary usually picks up where it left off pretty quickly. I refer to it as similar to a gas powered engine as opposed to a diesel. The length of time using HGH and one's age plays a very large role in the speed at which you regain your...

Hi blackebob, The bloat you experienced is most likely caused by excess estrogen generated using HCG. Did you take anything along with the HCG to block testosterone's conversion to estrogen or estrogen receptors? If not, try adding anastrozole (my preference because an aromatase inhibitor will...

No, dutasteride is "stronger" in that it works on all three receptors (rather than two as does finasteride) and has a much longer half-life (5 weeks!). So, if you have any unwanted SE's with finasteride, I would not use dutasteride. However, if you have know SE's with finasteride, but not enough...

Typically, your T levels will spike about 2.5 days after your injection of T Cyp, BUT, this average is wide, in my experience, meaning for some it is earlier and some later by a day or more. So, your DHT levels will spike in accordance with your T spikes because DHT is made from T and is fairly...

My first question is why did you switch from a daily topical to daily injectable? One of main ideas behind use of an esterified form of T is to avoid daily dosing, so I am always suspicious when I hear of daily injections. As for the HCG and bloating, it is most likely secondary to excess...

Great question and it concerns basic chemistry and stoichiometry. X + Y = Z. If you add more X, then you get more Z as long as Y is not a limiting factor is a very general interpretation. So, in your example, it is very possible that adding more progesterone/pregnenolone would lead to more...

"Risk" with high H/H refers to what would be my first question. Risk of stroke? I have one patient with polycythemia rubra vera from an autoimmune disorder who has come in with a hemoglobin of 26 g/dL (I don't remember the hematocrit) and was and is doing fine constantly fighting to keep his...

I have not seen aspirin or NSAID's affecting endogenous T levels in any of my patients, BUT, I can't say I have been looking for the effect of aspirin or NSAID's. If you are not receiving the benefits you are expecting with HCG, then obviously, you could try dropping the aspirin to see if that...

That's an easy one. You can certainly use Arimidex to lower your estrogen while taking finasteride.

Good question! Depends upon what "good on the T levels" means. If a patient has T free levels that are on the high end of normal, but still has symptoms of low-T then I would typically suggest reassaying T levels. Sometimes we catch a snapshot of T levels that are not representative. I have...

And one more consideration: if you are taking a 5-alpha reductase inhibitor, consider stopping at least temporarily (especially if these new symptoms coincided with starting same). Finasteride or dutasteride block conversion of progesterone to 5-DHP and 5-alloprogesterone, both of which are very...

Hi ta406, This is a tough question(s) because it is too complex to answer in a forum setting. Some general comments though that I hope may be helpful: You say you have to get serial therapeutic phlebotomies (or just volunteer)? If they are therapeutic, then I would question the reason for the...

Hi ERO, Yes, I see successful TRT in guys with low SHBG most if not all of the time. I typically however do not waste resources measuring SHBG as a general rule. I look directly to the free hormones (and of course to the patient first and foremost!).

Hi Marco, Your questions are a bit too extensive to tackle in a forum setting and without more information. However, a few comments: Please note that the clinical trial you reference re L-carnitine posts no study results. The papers you reference re suppression of thyroid hormone really do not...

Hi Orrin, Clomid and HCG work by very different MOA's. Clomid is a selective estrogen receptor blocker (so, eg, it blocks estrogen reception at the pituitary, but not at the liver) while HCG mimics the effect of LH on the Leydig Cells (testosterone producing) of the testes. The net result one is...

Hi 1Draw, A few ways that I know of to reduce SHBG are to lower your E2 (I prefer to use the "sensitive" assay) to a tipping point that I see around just over 20pg/ml. In addition, maintenance of a high (or at least adequate) protein diet, supplementing with nettle, and/or supplementing with a...

Hi Vince, With regard to chasing the elusive magic estradiol (E2) NUMBER, it can be difficult to hit because typically as one reduces E2, the SHBG is reduced which of course frees up more E2, which lowers SHBG, etc. This explains why many see a drop from say 55pg/ml to 28pg/ml of E2 with just...

Hi "HanginOn", I found this on the DFH website: http://catalog.designsforhealth.com/Magnesium-Chelate. It is just a bit stronger than what you have, but still 25%. It's tricky wading through the supplement world because of all the claims (the one's supported by studies) made that we read and...

Hi Vince, please help me with your question a bit: you have low SHBG and want to raise it? Your concern being that you have a free estrogen level that is too high (presumable with a free T level that is a high percentage of total T)? My initial response would be to simply reduce your estrogen...

Hi Marco, I have not seen suppression of thyroid production with the use of L-carnitine. I have seen L-carnitine used to increase time to exhaustion in both novice and well-conditioned athletes. The MOA appears to be the preferential use of fat over glycogen for use as energy. If you are using...

Hi "Built15", I do not know of any docs in Canada, but, you could certainly make use of docs here in the US via telemedicine. We have some doctors here in the US that have alot of experience with TRT: Dr. Saya, Dr. Lawson, Dr. Crisler and others, all of whom, to my knowledge, welcome...