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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Clomiphene to Natesto results
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<blockquote data-quote="madman" data-source="post: 192199" data-attributes="member: 13851"><p><strong>Discussion </strong></p><p></p><p>Hypogonadism is a common diagnosis in men presenting with a constellation of symptoms prompting an evaluation to initiate treatment. Testosterone levels may start to decline in men at 30 years of age. Once this decline in testosterone levels begins, there may be a decrease by 1-2% per year. 10 However, the prevalence of low testosterone in younger men is increasing, which complicates the treatment options. 1,2 <span style="color: rgb(184, 49, 47)"><strong><u>Classically, TRT has been the treatment of choice for hypogonadism, however; other long-acting TRT modalities suppress the hypothalamic-pituitary-gonadal (HPG) axis and thereby, downstream spermatogenesis, and result in testicular atrophy due to the diminishment of spermatogenesis</u>. 11 This makes TRT a poor choice for hypogonadal men trying to achieve a pregnancy or for those wanting to maintain fertility potential. 3,4</strong></span> <span style="color: rgb(26, 188, 156)"><strong><u>To avoid suppression of the HPG axis and spermatogenesis, CC is commonly prescribed off-label to increase serum testosterone levels in a manner that does not suppress spermatogenesis, and long-term studies on safety and efficacy on CC have been published</u>.6 <u>However, men on CC have demonstrated high rates of hyperestrogenemia necessitating co-administration of aromatase inhibitors</u>. <u>This is seen commonly in clinical practice and has been published in multiple studies. 6,12-14 CC can have other undesirable side effects such as gynecomastia, weight gain, and fatigue</u>.12</strong></span> </p><p></p><p>The cohort in this current study showed similar improvements in serum testosterone levels to eugonadal levels as previously published studies on CC. 12,13,15-18 <span style="color: rgb(26, 188, 156)"><strong><u>However, the concerns with the use of CC in this population of men include the common complaint of low libido on CC as well as the frequently reported rise in E2 levels</u>. <u>Dadhich et al published a study revealing that men on CC have a less robust symptomatic response, especially with libido, in comparison to men on direct TRT</u>. 7 <u>This is a common clinical complaint in practice when treating men with CC</u>.</strong></span> The long-standing challenge has been a treatment for hypogonadal men desiring to maintain fertility potential which could increase serum testosterone levels to eugonadal levels, not increase estradiol significantly, and offer the symptomatic response, particularly with libido, that TRT offers. </p><p></p><p><span style="color: rgb(44, 130, 201)"><strong>The current study suggests that Natesto is an alternative treatment for hypogonadal men desiring to maintain fertility potential in a manner that optimizes libido response and minimizes aromatization of testosterone to E2.</strong></span> <span style="color: rgb(44, 130, 201)"><strong><u>I</u></strong><u><strong>n</strong></u><strong><u> comparison to other forms of TRT, the more frequent and short-acting formulation of Natesto mimics the physiologic testosterone release which is the hypothesis for the potential to maintain gonadotropins and spermatogenesis</u>. 8,19,20 <u>It has been described that diurnal variation of serum testosterone levels and modalities of TRT with a short half-life, such as Natesto, more closely duplicate physiology</u>.</strong></span>21,22 In the current study, the lower levels of normal for FSH and LH in the reference laboratory were 1.5 IU/L and 1.2 IU/L respectively. While on Natesto, seven men (17%) had an FSH level of below 1.5 IU/L, only one of which suppressed below 1.0 IU/L, none of which became undetectably low. Only one of the men had LH suppress below 1.2 IU/L (2%). In that man, the LH was 1.0 IU/L. Although some men did suppress gonadotropins below the laboratory reference range cutoff for low, the majority did not, and of those who did, the gonadotropins remained detectable. <span style="color: rgb(184, 49, 47)"><strong><u>Having less profound LH suppression likely accounts for the maintenance of spermatogenesis even in these men, by allowing for intratesticular testosterone</u>. </strong></span></p></blockquote><p></p>
[QUOTE="madman, post: 192199, member: 13851"] [B]Discussion [/B] Hypogonadism is a common diagnosis in men presenting with a constellation of symptoms prompting an evaluation to initiate treatment. Testosterone levels may start to decline in men at 30 years of age. Once this decline in testosterone levels begins, there may be a decrease by 1-2% per year. 10 However, the prevalence of low testosterone in younger men is increasing, which complicates the treatment options. 1,2[U] [/U][COLOR=rgb(184, 49, 47)][B][U]Classically, TRT has been the treatment of choice for hypogonadism, however; other long-acting TRT modalities suppress the hypothalamic-pituitary-gonadal (HPG) axis and thereby, downstream spermatogenesis, and result in testicular atrophy due to the diminishment of spermatogenesis[/U]. 11 This makes TRT a poor choice for hypogonadal men trying to achieve a pregnancy or for those wanting to maintain fertility potential. 3,4[/B][/COLOR] [COLOR=rgb(26, 188, 156)][B][U]To avoid suppression of the HPG axis and spermatogenesis, CC is commonly prescribed off-label to increase serum testosterone levels in a manner that does not suppress spermatogenesis, and long-term studies on safety and efficacy on CC have been published[/U].6 [U]However, men on CC have demonstrated high rates of hyperestrogenemia necessitating co-administration of aromatase inhibitors[/U]. [U]This is seen commonly in clinical practice and has been published in multiple studies. 6,12-14 CC can have other undesirable side effects such as gynecomastia, weight gain, and fatigue[/U].12[/B][/COLOR][COLOR=rgb(44, 130, 201)][B] [/B][/COLOR] The cohort in this current study showed similar improvements in serum testosterone levels to eugonadal levels as previously published studies on CC. 12,13,15-18 [COLOR=rgb(26, 188, 156)][B][U]However, the concerns with the use of CC in this population of men include the common complaint of low libido on CC as well as the frequently reported rise in E2 levels[/U]. [U]Dadhich et al published a study revealing that men on CC have a less robust symptomatic response, especially with libido, in comparison to men on direct TRT[/U]. 7 [U]This is a common clinical complaint in practice when treating men with CC[/U].[/B][/COLOR] The long-standing challenge has been a treatment for hypogonadal men desiring to maintain fertility potential which could increase serum testosterone levels to eugonadal levels, not increase estradiol significantly, and offer the symptomatic response, particularly with libido, that TRT offers. [COLOR=rgb(44, 130, 201)][B]The current study suggests that Natesto is an alternative treatment for hypogonadal men desiring to maintain fertility potential in a manner that optimizes libido response and minimizes aromatization of testosterone to E2.[/B][/COLOR][B][COLOR=rgb(184, 49, 47)] [/COLOR][/B][COLOR=rgb(44, 130, 201)][B][U]I[/U][/B][U][B]n[/B][/U][B][U] comparison to other forms of TRT, the more frequent and short-acting formulation of Natesto mimics the physiologic testosterone release which is the hypothesis for the potential to maintain gonadotropins and spermatogenesis[/U]. 8,19,20 [U]It has been described that diurnal variation of serum testosterone levels and modalities of TRT with a short half-life, such as Natesto, more closely duplicate physiology[/U].[/B][/COLOR]21,22 In the current study, the lower levels of normal for FSH and LH in the reference laboratory were 1.5 IU/L and 1.2 IU/L respectively. While on Natesto, seven men (17%) had an FSH level of below 1.5 IU/L, only one of which suppressed below 1.0 IU/L, none of which became undetectably low. Only one of the men had LH suppress below 1.2 IU/L (2%). In that man, the LH was 1.0 IU/L. Although some men did suppress gonadotropins below the laboratory reference range cutoff for low, the majority did not, and of those who did, the gonadotropins remained detectable. [COLOR=rgb(184, 49, 47)][B][U]Having less profound LH suppression likely accounts for the maintenance of spermatogenesis even in these men, by allowing for intratesticular testosterone[/U]. [/B][/COLOR] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Clomiphene to Natesto results
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