In the short term you will have success but rarely have I seen patients do well on HCG alone. I have some seen some patients do well on Clomid alone but its about 50/50 or less. I have not seen patients on clomid and HCG together. I would consider a lower Test Cyp injection in combination with HCG to see how hematocrit responds.
Ask The Urologist Anything (Dr Michael Rotman)
- Thread starter Nelson Vergel
- Start date
buggies100
New Member
Thank you, are you saying that with hcg i might be able to use a lower dose of T cyp and still have similar results?
Hi, I of course like the trough to be above the referenced normal level , but what's more than the number is assessing the patients symptoms. So I don't look for any absolute number or range.
tthomas922
New Member
Hey Dr. Rotman, I wanted to update you on what has happened since we last messaged. I got a second opinion from another urologist on 3/27. At that point I had been off TRT for close to two months and had been off the levoquin (2 week dosage) for 3 weeks. The levoquin cleared up the prostate infection and I never did go on the avodart. The second urologist said he would have never prescribed the avodart that my prostate size and symptoms didn't warrant it (like you had said). He ordered blood work for PSA and testosterone and the PSA went down to 1.2 from 2.4 in 1/2017. The infection must have been lingering for awhile because in 8/2016 it was 1.9. Testosterone though is down to 136. The second urologist said I could go back on TRT and I just started that this week. Anyway, thanks to you and Nelson I was able to have educated discussions with my doctors and be proactive in my TRT. The second urologist said that prostate infections are not unusual for older men and that testosterone was not the sole culprit. Thanks you for help!
Great news! Love to hear stories like this.
Hi Tadeo,
​As, a first step you should seek consultation with a medical professional to have a complete physical examination and subsequently have a urological consultation to investigate this further. The source of the problem must first be determined and using a pump like yours is not a good solution for someone your age.
sportsfan8724
Member
Hi doctor. In response to ur reply about trough levels how often do you generally recommend patients inject? To have a patient above normal reference range on average how many milligrams weekly does that take? Lastly if the patient exhibits no systems do you believe in just letting the sensitive estradiol numbers go high or is there a cutoff number where you definitely recommend an ai?
Hi, the majority of my patients are on once weekly unless they are experiencing high estradiol levels or significant peaks and troughs. I have many patients on 100mg weekly in combo with hcg and have great results in the majority. In terms of estradiol, I don't have a strict cutoff but I analyze each case individually to assess needs for an AI.
Vince
Super Moderator
I'm surprise you don't use twice weekly of testosterone and HCG on your patients.
sportsfan8724
Member
Thanks great answers! So I'm gathering you don't really feel there is an estradiol level that is considered unsafe in men? I know some doctors say that past a certain point no matter how the patient feels high or slightly high estradiol is unsafe for the prostate and could increase clotting risk.
Dr. Rotman,
Is this a plausible scenario: Straining during heavy weightlifting (squats and deadlifts) causes urine to backflow into prostate tissues. Bacteria in urine causes infection in prostate. PSA elevates and does not respond to a 3 week course of Bactrim DS.
If my biopsy comes back negative for cancer, am I correct to assume that I have a prostate infection only? Would I then start another course of antibiotics, and continue taking them until PSA drops?
Is this a plausible scenario: Straining during heavy weightlifting (squats and deadlifts) causes urine to backflow into prostate tissues. Bacteria in urine causes infection in prostate. PSA elevates and does not respond to a 3 week course of Bactrim DS.
If my biopsy comes back negative for cancer, am I correct to assume that I have a prostate infection only? Would I then start another course of antibiotics, and continue taking them until PSA drops?
Help
Dr. Rotman,
I am a 54 year old male who has been suffering with low t and ed/libido issues for about 5 years. I started feeling badly, depressed, no libdo, ed, etc, and my T was right at the low limit around 300. I also have only one testicle, having lost one due to torsion when I was 14.
After some resistance since my T level was right on the low normal limit, I was started on gels first, ultimately at 3 pumps of Axiron per day. On gels, after I first started, I felt really good, had good libido, no ed, etc, for about 3 days. Then all that stopped and I never felt any better. My urologist had no clue what was going on and I ultimately stopped TRT after 8 months or so.
I went about a year without TRT, and felt marginal, but still had libido/ed issues. I started to become very depressed to the point I didn't want to do anything but lay on the couch.
I found another urologist who started me first on 25mg clomid every day. This really didn't help my libido/ed issues at all.
I then tried Testopel, 6 pellets. Much like the gels, after every insertion I felt really good with good libido/no ed for about 2 days shortly after implant of the pellets, and felt marginal for the rest of the first month, and felt terrible for the last 2 months. My estradiol was checked somewhere along the line and it was in the mid-high range. My T was getting up in the 600 range shortly after implantation and dropping off to around 300 at the end of 3 months. I stayed on Testopel for at least 3 or 4 implantations and I finally said I can't stand the 2 months of feeling miserable. While on Testopel, I actually started to feel a little better right at the end of the 3 month period.
I then went on Depo-Testosterone injections. I started first at 75mg/week. I felt pretty bad at this dosage. I went up to 100mg/week for a few months and felt essentially like I did before starting TRT, but my T levels were in the 600 range when tested.
I have now been prescribed 100mg/every 5 days (I am injecting 60mg every 3 days) and after about 3 weeks I am starting to feel a little better, but still not how I think I should feel. My hemoglobin has also been increasing rapidly, which I am afraid won't be able to be controlled by blood donations every 58 days. My doctor is a little perplexed that it is taking this dose of testosterone for me to have any perception of feeling better. He has asked me if I have ever thought there was more wrong with me than just low T.
I'm thinking to really feel like I want to feel, I am going to end up with injections of around 200mg/week, which seems to be on the very high end of what is normal. Is this a normal weekly injection range?
Also, I know this is a long post, but in the year or so I was off TRT, my dermatologist prescribed Methotrexate for me to see if it would clear up some minor psoriasis that I have had most of my life. For the first 2 months of taking methotrexate, I felt outstanding. I had high libido and no ed issues at all. My GP, urologist or dermatologist could not explain why methotrexate would have this affect on me. Unfortunately after 2 months, I was back to no libdo and ed.
Can you offer any advice for me on how to proceed with treatment?
Dr. Rotman,
I am a 54 year old male who has been suffering with low t and ed/libido issues for about 5 years. I started feeling badly, depressed, no libdo, ed, etc, and my T was right at the low limit around 300. I also have only one testicle, having lost one due to torsion when I was 14.
After some resistance since my T level was right on the low normal limit, I was started on gels first, ultimately at 3 pumps of Axiron per day. On gels, after I first started, I felt really good, had good libido, no ed, etc, for about 3 days. Then all that stopped and I never felt any better. My urologist had no clue what was going on and I ultimately stopped TRT after 8 months or so.
I went about a year without TRT, and felt marginal, but still had libido/ed issues. I started to become very depressed to the point I didn't want to do anything but lay on the couch.
I found another urologist who started me first on 25mg clomid every day. This really didn't help my libido/ed issues at all.
I then tried Testopel, 6 pellets. Much like the gels, after every insertion I felt really good with good libido/no ed for about 2 days shortly after implant of the pellets, and felt marginal for the rest of the first month, and felt terrible for the last 2 months. My estradiol was checked somewhere along the line and it was in the mid-high range. My T was getting up in the 600 range shortly after implantation and dropping off to around 300 at the end of 3 months. I stayed on Testopel for at least 3 or 4 implantations and I finally said I can't stand the 2 months of feeling miserable. While on Testopel, I actually started to feel a little better right at the end of the 3 month period.
I then went on Depo-Testosterone injections. I started first at 75mg/week. I felt pretty bad at this dosage. I went up to 100mg/week for a few months and felt essentially like I did before starting TRT, but my T levels were in the 600 range when tested.
I have now been prescribed 100mg/every 5 days (I am injecting 60mg every 3 days) and after about 3 weeks I am starting to feel a little better, but still not how I think I should feel. My hemoglobin has also been increasing rapidly, which I am afraid won't be able to be controlled by blood donations every 58 days. My doctor is a little perplexed that it is taking this dose of testosterone for me to have any perception of feeling better. He has asked me if I have ever thought there was more wrong with me than just low T.
I'm thinking to really feel like I want to feel, I am going to end up with injections of around 200mg/week, which seems to be on the very high end of what is normal. Is this a normal weekly injection range?
Also, I know this is a long post, but in the year or so I was off TRT, my dermatologist prescribed Methotrexate for me to see if it would clear up some minor psoriasis that I have had most of my life. For the first 2 months of taking methotrexate, I felt outstanding. I had high libido and no ed issues at all. My GP, urologist or dermatologist could not explain why methotrexate would have this affect on me. Unfortunately after 2 months, I was back to no libdo and ed.
Can you offer any advice for me on how to proceed with treatment?
Hi Joej85,
It seems you have been introduced to many forms of therapy but never been treated the way the majority of properly treated TRT should be. You probably needed a combination of T and Hcg and that would give you consistent benefits and little side effects. I think you should locate a center that uses this approach to optimize your care. Also I have never had a TRT patient not respond to phlebotomy and/or dose adjustment for his elevated hemoglobin values. Find someone you trust who uses this combination in his/her practice and you will see results. Good luck to you!
It seems you have been introduced to many forms of therapy but never been treated the way the majority of properly treated TRT should be. You probably needed a combination of T and Hcg and that would give you consistent benefits and little side effects. I think you should locate a center that uses this approach to optimize your care. Also I have never had a TRT patient not respond to phlebotomy and/or dose adjustment for his elevated hemoglobin values. Find someone you trust who uses this combination in his/her practice and you will see results. Good luck to you!
Dr. Rotman
If one is not experiencing acne, hair loss, or an elevation in PSA, is it useful to measure DHT? Could elevated DHT cause negative issues that don't cause symptoms? Or would you say that if blood work is in check and the patient is asymptomatic, then measure DHT is of no use? Thanks
If one is not experiencing acne, hair loss, or an elevation in PSA, is it useful to measure DHT? Could elevated DHT cause negative issues that don't cause symptoms? Or would you say that if blood work is in check and the patient is asymptomatic, then measure DHT is of no use? Thanks
Apologies for late response , contact Nelson Vergel the moderator of this board and he can certainly assist you in this matter.
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