Ask Dr Rand McClain

[Nelson Vergel]

Looks like we need an ask Dr Strum thread where he can intro himself and field questions.

Good idea. This thread is only for Dr McClain.

Welcome Dr Strum. Could you please email me at [email protected] ? Thanks

 

[eudes]

thanks a lot doctor , for all your informations !
you have a lot of patient who take dutasteride with no issue of gynecomastia ?

the combination of aromasin and dutasteride appears safe to you ?

and sorry i made a mistake in my previous post , what i meant is that the sides effect gynecomastia )were caused by the high oestradiol .

My goal is to keep my hair with the use of a DHT inhibitor and to prevent the sides ( with an aromatase inhibitor )

 

[stephanfresco]

hi dr rand

i tried to change the protocol by doing 1 injection per week of 160MG OF TESTOTERONE ENANTHATE.
AFTER about 3 days i started to feel dizzy , no energy for sport,heavy feeling...i took O.5adx 24 hr after the shot then check my e2 AND IT was at around 9...next injection i took 0.25 ADX and my e2WAS AT ARD 19....but no energy and still felt fatigue and like you said no 'joie de vivre' i check cbc as well and it was at hemog;16/9 AND HEMATOCRIT 50.8...the doc told me its ok but i had all the symptome of high hematocrit ..specially one difficulty to breath,like asthma...since that i donate blood 3 DAYS AGO and feel much better !!!! the air is ok... but now i back to lower dose with 50 TEST ENANTHATE EVERY 3 DAYS WITHOUT AI AND MY E2 IS around 40....ald, other lab dht thyroid etc are excellent....feel ok but soft erection... do you recommend me to back at one injec per week?

3 DAYS after inject 160 MG WEEK my test total was at 1450///THE DAY OF THE NEXT SHOT 870....when the test peaked i felt really no energy...
i m confuse....

and doc here are only agree to do 1 shot every 3 week and of course no ai... and even with the symptome of quiet little bit high hemoglobin the doc sais that i m in range.

thanks alot dr rand

stephan

 

[HanginOn]

Dr. Rand,
Hello again and I hope you are able to answer these sooner rather than later.

I have heard some doctors say it's time to donate when your Hematocrit gets above 54. Do you agree with this or do you advise at another value?

From my battery of testing over the last few yrs, I think my acne is caused by elevated DHT...I think I just convert a lot to DHT because my E2 even when in check...I get acne. The only thing that halts the oil production, acne, and cystic like acne is low dose accutane. 20mg/day for 6-8 months works wonders. Is there another way I can best curb DHT without taking a hit to my sex drive?

I re-read my notes from your old videos and you said you have many athletes taking 2grams of mag glycinate with dinner. (We already discussed some of this earlier) but now that the highest potency CAPSULES are 150mg...do you really have guys taking 12-14 of these in a sitting? Would Magnesium Glycinate be better spaced out through the day or does it not matter if it's a bolus consumption?
I also noted you try to keep your athletes above 2.2 for Magnesium. I assume this is the Magnesium, Serum test....which I have heard there might be better ways of testing magnesium? Mine is at 2.4 and slightly above the top range of 2.3. I am assuming this is not an issue? Please advise.

I am drawing bloods tomorrow for a ton of things, but I have been using Boron at 9mg AM and PM the last 2 months. It is said to boost free test levels, so I will be able to answer that in the next week. I am also testing for SHBG to see if that is the way levels climb. Do you know of anything as or more effective than Boron at raising free test? I am also having an IGF-1 test too to evaluate Ibutamoren.

I am certain I am forgetting other things at the moment but will add as they come to me. Thank you for your time and expertise as you are one of the only people I trust for their educated opinion.

 

[Lacosanostra]

Hi Dr. McClain,

Right now I am 32 y.o., taking 500 mg of test E weekly and 25 mg of Aromasin every 3.5 days. I plan on continuing to do so for 12 weeks. I also plan on taking HCG weeks 11-14 and begin PCT week 15. My PCT will include Aromasin, Clomid, and Nolvadex.

My hopes are that this is something I can continue to do once per year to maintain results. I realize this is a supra-physiological dosage and I technically don't have low T (~611 ng/dL). While I believe I have some low T symptoms (mainly fatigue), I do this mainly for performance and aesthetic purposes.

I had a few questions in harm reduction I was hoping you can answer...

1. What are the long term effects of mild "cycling" as described above? Particularly if lipid, CBC, hormonal, and other blood tests are done consistently. It seems to me the only guys dropping dead are the ones clearly abusing. Am I wrong?

2. My understanding is testosterone, AI's, oral steroids, etc. will increase LDL/triglycerides/total cholesterol while lowering HDL. Besides diet and exercise, is there anything that can be done to reverse these effects? Are there any EFFECTIVE over-the-counter supplements that can be used? (Emphasis on effective as it seems there are a lot of things thrown out there without much science behind it) I am currently using fish oil (1g/day), krill oil (3g/day), and niacin (250-500 mg/day).

I have considered trying something like Anavar, which I don't expect you to endorse, but the impact on the lipids scares me.

Thank you!

 

[sjswift83]

Hot Flashes

Hi Dr. Rand,
I’m 34 and currently taking a total of 180mg of test cyp. per week split into two injections. As a result, I am suffering from horrible hot flashes that is impacting my job and my social interactions. Had my E2, hematocrit & thyroid levels checked and only my E2 levels came back elevated at 41pg/dL. Started taking anastrozole and brought the E2 down to the low 20’s but the hot flashes remain. Now as a result of the anastrozole (I believe) my cholesterol levels have sky rocketed 60 points in less than 6 months. Also have elevated liver (ACT) levels. I need help understanding what is causing the hot flashes and how I can remedy it. I have searched endlessly with no answer.

My weight has remained unchanged (6ft 6”, 250lbs), workout 6 days a week and eat clean. Do not drink or smoke.

I would greatly appreciate your help

Thanks

 

[HanginOn]

Dr. Rand McClain,
Attached is a picture of the back of a Doctor's Best bottle of Magnesium Glycinate powder. It reads that one serving is 200mg Elemental Magnesium from 2,000mg(2gr) Magnesium Glycinate. When you were talking in an old video of many of your athletes taking 2gr Magnesium Glycinate with their biggest meals...were you referring to 2g of elemental or 2g actual Magnesium Glycinate? Would you be referring to 1 scoop with the biggest meal or 10 scoops with the biggest meal?

 

[Blazing60]

Please give me advice to help me

Dr Rand, I am 43 years old an have contemplated TRT for 5 years now. I went to a urologist that injected me and started me on TRT before I could even think about it. He ran blood work and didn't even look at the results before injecting me. Turns out I was at 537 total T. I did not get my second injection and stop. 5 months later my T was at 256. I waited another 5 months and went up to 568 when I was 41. In the last two years I've gotten another three blood work test and the results were, 419, 343 and then I did 4weeks of HCG and got tested 5 days after my last injection and came out to 320. It is weird that being this the only thing I have done and my levels drop from the 500s to the 300s from age 41 to 43 currently. I feel tired and have low libido and want to feel good again but my wife keeps telling me it's all in my head and all I need to do I work out and she is certain that my number will come back up. I have been curious for a long time and want to feel young and full of energy again but don't want to mess myself up for life if it doesn't yeild the result I want. I am also concern of messing any other aspect of my healthy body. I have no diabetes, to blood pressure problems I am 6ft and 194lbs and just want to feel young again. The curiosity is killing me. My job is very stressful, I have 3 kids and need to be able to handle my life better. I do have uncontrollable mood swings and get angry but don't know if it is because of stress. I also have brain fog and sometimes can't concentrate but I push through everything cause I've always been head strong. Please give me advice on if you feel I should start TRT. One last thing, I get faint went I take out blood and am scared to have to donate. I don't thing I can handle that.

 

[Amacher]

So my doc has scheduled me to get some blood work done to see if my current dose of Genotropin at 0.3mg is sufficient enough so I am stable, or whether the blood results would warrant an increase. My pituitary gland is damaged due to unknown reasons. The eight individual GHST all had values of Human Growth Hormone <0.05 ng/mL.


My question is whether my current gh dose (0.3mg) has now stabilized my growth hormone levels so that it is in the acceptable range for hgh levels when I get the blood results back. My goal is for the doc needs to increase it. I don’t pay a dime for mine, which is awesome! My natural gh levels are in the tank, so I know if I stopped taking my Genotropin, it would go back to where it used to be.


However, here is my dilemma, if I stopped taking my growth hormone a week (or possibly even two weeks) before my labs are scheduled, would my natural growth hormone go back to being extremely low (outside of the normal range, below <0.05 ng/mL)? Or do I need to stop the injections even earlier? Obviously, the goal for me is to have my endo keep increasing the Genotropin at no cost so I don't have to pay for more out of pocket. For example, if I started gh injections for six weeks before my next Human Growth Hormone test, when would I need to stop injecting 0.3mg daily to be certain that my next blood work will match the very first GHST results, so she increases the gh dose to maybe 0.6mg or even 0.9mg.


Right now, I am 28 years old, former college football player at the University of Oregon, 6'2" 360 (27.3% bf) and on a steady dose of 250mg of Test Cyp (TRT) and 0.3mg of Genotropin rhGH. I would to be on at a minimum of 1.2mg of rhGH daily (4IUs) or max out at 1.6-1.8mg (5-6IUs) of rhGH daily for the near future. What kind of results should I expect with a clean diet and running test and pharm grade gh at those doses?

 

[Marco N Cognito]

So my doc has scheduled me to get some blood work done to see if my current dose of Genotropin at 0.3mg is sufficient enough so I am stable, or whether the blood results would warrant an increase. My pituitary gland is damaged due to unknown reasons. The eight individual GHST all had values of Human Growth Hormone <0.05 ng/mL.


My question is whether my current gh dose (0.3mg) has now stabilized my growth hormone levels so that it is in the acceptable range for hgh levels when I get the blood results back. My goal is for the doc needs to increase it. I don’t pay a dime for mine, which is awesome! My natural gh levels are in the tank, so I know if I stopped taking my Genotropin, it would go back to where it used to be.


However, here is my dilemma, if I stopped taking my growth hormone a week (or possibly even two weeks) before my labs are scheduled, would my natural growth hormone go back to being extremely low (outside of the normal range, below <0.05 ng/mL)? Or do I need to stop the injections even earlier? Obviously, the goal for me is to have my endo keep increasing the Genotropin at no cost so I don't have to pay for more out of pocket. For example, if I started gh injections for six weeks before my next Human Growth Hormone test, when would I need to stop injecting 0.3mg daily to be certain that my next blood work will match the very first GHST results, so she increases the gh dose to maybe 0.6mg or even 0.9mg.


Right now, I am 28 years old, former college football player at the University of Oregon, 6'2" 360 (27.3% bf) and on a steady dose of 250mg of Test Cyp (TRT) and 0.3mg of Genotropin rhGH. I would to be on at a minimum of 1.2mg of rhGH daily (4IUs) or max out at 1.6-1.8mg (5-6IUs) of rhGH daily for the near future. What kind of results should I expect with a clean diet and running test and pharm grade gh at those doses?

[FONT=&quot]Just curious - What was the GHST you had done? [/FONT][FONT=&quot]Glucagon?
[/FONT]
[FONT=&quot]What is your IGF-1 level?[/FONT] Are you using the Genotropin Miniquicks?

 

[Amacher]

Just curious - What was the GHST you had done? Glucagon?

What is your IGF-1 level? Are you using the Genotropin Miniquicks?

Thank you for the reply sir!

Yes, I took Glucagon before the GHST, and all eight GHST values were >0.5mg/mL. The IGF-1 level was at 78 ng/mL. I am using the Genotropin 5mg pens.

 

[Marco N Cognito]

Thank you for the reply sir!

Yes, I took Glucagon before the GHST, and all eight GHST values were >0.5mg/mL. The IGF-1 level was at 78 ng/mL. I am using the Genotropin 5mg pens.

So I assume you were diagnosed with AGHD as documented by your tests and symptoms? The tough part is getting insurance to cover even with a clear cut case of AGHD, but you probably already knew that. Other question I'm curious to know: have you had a brain MRI to determine if you have ESS (empty sella syndrome)? In some cases, it can mimic hypopituitarism. How are your other hormones (thyroid, estrogens, prog, preg, prolactin, FSH/LH)?

 

[Amacher]

So I assume you were diagnosed with AGHD as documented by your tests and symptoms? The tough part is getting insurance to cover even with a clear cut case of AGHD, but you probably already knew that. Other question I'm curious to know: have you had a brain MRI to determine if you have ESS (empty sella syndrome)? In some cases, it can mimic hypopituitarism. How are your other hormones (thyroid, estrogens, prog, preg, prolactin, FSH/LH)?

Yes, I got the full diagnosis from my endocrinologist. My insurance pays for 100 percent of the rhGH. Lucky me! MRI results on my pituitary gland came back negative. I am on TRT 200mg/week and 125mcg of Synthroid ED, along with 0.3mg of somatropin. The goal is to increase the rhGH to at least 1.2mg or even 1.8mg ED. I need to do a follow up blood test in mid-July. So to get an increased dose of my Genotropin, how long before should I stop taking my usual dose of 0.3mg to get my rhGH levels in my blood below >0.5ng/mL?

 

[Marco N Cognito]

Yes, I got the full diagnosis from my endocrinologist. My insurance pays for 100 percent of the rhGH. Lucky me! MRI results on my pituitary gland came back negative. I am on TRT 200mg/week and 125mcg of Synthroid ED, along with 0.3mg of somatropin. The goal is to increase the rhGH to at least 1.2mg or even 1.8mg ED. I need to do a follow up blood test in mid-July. So to get an increased dose of my Genotropin, how long before should I stop taking my usual dose of 0.3mg to get my rhGH levels in my blood below >0.5ng/mL?

Specifics as to dosing should be addressed with your endocrinologist.

 

[Amacher]

Specifics as to dosing should be addressed with your endocrinologist.

Well it is obviously I am not going to discuss this with my endo, because I want to get prescribed more rhGH. If my insurance is paying the full cost, it should not matter if I am on 0.3mg or 2.0mg of Genotropin. What I want to do (this was my question in the first place) is stop taking my medication 10-14 days before my next blood draw, so it would ensure my rhGH and IGF-1 levels would drop down far enough, thus warranting a reason for an increase in rhGH.

 

[Nelson Vergel]

I will start deleting posts that have nothing to do with questions for Dr McClain.

If you want to discuss or expand on topics, start a new thread in any of the other forum topics we have available.

Every time someone posts in this thread, Dr McClain gets an alert email. So, focus on questions for him!

Thank you.

 

[Amacher]

I will start deleting posts that have nothing to do with questions for Dr McClain.

If you want to discuss or expand on topics, start a new thread in any of the other forum topics we have available.

Every time someone posts in this thread, Dr McClain gets an alert email. So, focus on questions for him!

Thank you.

Here is my question to Dr. McClain: if I stop taking my prescribed dose of rhGH Genotropin at 0.3mg E.D. right before I go to bed (been on for one month straight so far), how long will it take for my Human Growth Hormone serum and IGF-1 level serum to go back to my normal baseline which is >5ng/mL (rhGH serum) and 78 ng/mL (IGF-1)? One week, two weeks? I want to know how long it will take since I have a growth hormone deficiency.

Thank you!

 

[Sully09]

Hi Dr McClain -

I discovered this site recently, thanks for all that you do (MI YouTube videos you did are awesome).

Im in unknown waters .. am I on the right track:

32, 14 years of weight training and martial arts, natural and always had a grasp of tracking diet and periodizing training. As the career (sales) years kicked in, stress goes up a bit but the last few years everything feels heavy, I’m lethargic, and the low T typical symptoms continue ... Up about 10lbs in a year (195 from 185) without any major diet changes. Feeling fluffy and less muscular, weaker, and less sexual drive.

Question:
Am I on the right track with trying HCG Monotherapy before jumping into T (I’m getting married in Feb ‘19, kids are in the plans)? I had blood done at one clinic (they told me not to fast strangely so my cholesterol #’s are off) only for them to try and sell me on every drug under the sun. Adios to them and thankfully new clinic (Defy) seems to care about their patients / great experience so far, but various folks ( other forums) are getting in my head about their opinions hence why I’m asking this here.

Total T - 543 ng/DL
Free T - 7.9 ng/DL or 1.5%
SHGB - 53.9 nmol/L (57 is upper limit)
FSH - 3.3 mIU/mL
LH - 1.2L mIU/ML
E2 - 18 pg/ML (I can’t say if it was a sensitive test or not)
VitD - low
DHEA - under 250

Everything else (blood, thyroid, PSA, etc in range)

The PA and I chatted, seems my SHGB is high and doesn’t want to try Clomid (that could raise SHGB?). We concluded a secondary type issue, my E2 has room to increase with elevated T as a hopeful result of HCG Monotherapy. Being LH was already low (don’t recall concussions or anything but did hit my head / stiches at 8yo followed by life of dirt bike wrecking and karate matches), he felt this was a simple place to start before going at lengths of T etc.. 3 small doses weekly to limit E increase, various minerals etc to clean some things up and perhaps lower SHGB (I hear nettle is good too). Anastrozole he said to use if I feel symptoms of high E in next few weeks, but don’t need to start day 1.

Is HCG mono a short term hope or sustainable?

The Rx

BEGIN HCG 350 iu SQ Three times weekly to increase testosterone free
BEGIN Anastrozole 0.125 mg twice weekly as needed per E2 symptoms (reviewed with Pt.)
BEGIN DHEA 25 mg one by mouth every night
BEGIN Fish Oil 2grams every day for HDL support
BEGIN Zinc Picolinate 50mg One by mouth every day to reduce SHBG and E2/Raise DHT
BEGIN magnesium glycinate 400mg One every day to Decrease SHBG
BEGIN Boron 10mg every day to aid in Test levels and decrease SHBG
BEGIN Milk Thistle 500mg One every day for liver support
BEGIN Vitamin D 5000IU QD

Follow up 8weeks with limited labs Testosterone Free and Total, LH, Estradiol, SHBG, Vitamin D, Cholesterol Panel, CBC, CMP

I okay or worse case scenarios to be aware of?!

Many thanks, sorry for the novel!

Mike

 

[Rand McClain DO]

Happy Easter Doc!

I switched to daily .1ml injections of Cyp from a cream compound at the end of December 2017. I also started HCG in mid January. I had good testical recovery from daily injections of 125ml HCG, but the bloat was pretty severe. I stopped taking the HCG four weeks ago, and the bloat has decreased. Is there a way to minimize the bloat for HCG, is there a time frame when it should resolve it self? If I am going to react to it, is there a minium dosage you have found to still activate the testicals?

Thank you for your time.

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 spare the main thing you are trying to generate, testosterone, by blocking its conversion to estrogen.

 

[HanginOn]

Dr. McClain,
Do you test E2 or estradiol sensitive? Recently I tested both simultaneously and had a 34 e2 but a 19 sensitive estradiol.
Is this typical and appropriate?

Also,
Ive done 2 courses of 7 months of low dose accutane to clear my skin. Once in 2010 and another in 2017. It's the only thing that clears my oily skin that tends to break out and sometimes includes painful cystic acne. Low dose meaning 20mg daily and this last run, the fiballroom 2 months were @40mg daily.
However, now 9 months post run, the oily skin and blemishes have come back...to a lesser degree.
Most importantly, I've always had issues with zits/cystic type acne on the neck and the back of the head along the hairline and a few inches above. This is the one thing I wish I could permanently change or take care of...it's a real *****. Any suggestions?