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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?
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<blockquote data-quote="J. Keith Nichols MD" data-source="post: 71274" data-attributes="member: 15691"><p>Thanks for your post. There is always a spike after a IM injection. If you measure your levels 1, 2, 3 ,4 hours and so on after a injection you wll see a most significant spike( all of us that have labs in office have probably done this just to see the values) compared to a lidoderm cream. It is this spike that some believe cause the increased E2 symptoms seen mor frequently with injections. You also don't see the symptoms (or at least I haven't ) such as hostility and irritability with the compounded creams that I did see with the injections</p><p> Let me give you a brief history so you can better understand my methods. I went through the miserable experience of low T. I have done pellets, injections, gels, and creams. I have taken on a regular basis AIs in order to keep my estrogen controlled. When I first began practicing I provided my patient with injections and regular AIs (anastrozole 2x weekly) and monitored their estrogen levels and kept their T 1200 to maybe 1500 at most but not many as well as keep their free T 20-30 at most as well. I was following what I read and was taught by those that had been taught by others etc...I was not seeing the consistent results that I wanted in myself or my patients. They were good but not what I would consider optimal. As I began researching more and more and understanding the literature and then seeing that what I was doing was based on accepted principles that didn't always have the literature to support it. As I treated more And more women and the literature associated with them I began to rethink the whole estradiol issue. I saw the studies on how beneficial it was in both men and women. How important it was to so many body systems but especially that it was E2 not T that was responsible for decreasing visceral body fat and vital for sexual function in males. So I slowly and reluctantly started make some changes. I went to a max concentration compounded cream initially applying to chest or inner thighs and I continued the AIs in my patients but discontinued it in myself. I began to slowly allow myself to not fear the T or free T numbers and treated until symptoms resolved (of course optimizing thyroid as well) and optimal. I noticed a significant change in myself. My libido improved, stronger erections, every morning erections, no fatigue or irritability, increased strength and endurance etc...). I was having to apply 11/2 grams bid which brought my levels to 1800 with a free T in the 40s. E2 level 75 with absolutely no symptoms at all. I decided that in order to have even better absorption and use less cream I began applying to the testicles. Dosage was cut in half 3/4 gm bid and levels were 2000 and >50 wirh still no symptoms of E2 excess. Cut dose to 1/2 gm bid and continue that to this day</p><p> So, I began same regimen with my patients. Lectured them on the importance of E2 and the potential problems with blocking it. All were switched to testicular application bid and all their dosages were at least cut in half with all of their free Ts kept around 40 or greater. I began not to fear the numbers. I did not and have not had a single issue with a patient complaining of E2 excess so I quit even measuring it. I could not have a happier patient population. Everyone that came in on injections wanted to try it this way because their friend was on it "and doing great". I have not had one ask to go back to injections. I no longer advertise. It is all by word of mouth. </p><p> The point to all this is I have tried it all, but once I was willing to take a hard look at the medical literature and a</p><p>was just willing to experiment with something different I have been able to make a dramatic change in myself, friends, family, and patients. Injections are great but I just don't have the issues with my </p><p>patients now that I used to have</p></blockquote><p></p>
[QUOTE="J. Keith Nichols MD, post: 71274, member: 15691"] Thanks for your post. There is always a spike after a IM injection. If you measure your levels 1, 2, 3 ,4 hours and so on after a injection you wll see a most significant spike( all of us that have labs in office have probably done this just to see the values) compared to a lidoderm cream. It is this spike that some believe cause the increased E2 symptoms seen mor frequently with injections. You also don't see the symptoms (or at least I haven't ) such as hostility and irritability with the compounded creams that I did see with the injections Let me give you a brief history so you can better understand my methods. I went through the miserable experience of low T. I have done pellets, injections, gels, and creams. I have taken on a regular basis AIs in order to keep my estrogen controlled. When I first began practicing I provided my patient with injections and regular AIs (anastrozole 2x weekly) and monitored their estrogen levels and kept their T 1200 to maybe 1500 at most but not many as well as keep their free T 20-30 at most as well. I was following what I read and was taught by those that had been taught by others etc...I was not seeing the consistent results that I wanted in myself or my patients. They were good but not what I would consider optimal. As I began researching more and more and understanding the literature and then seeing that what I was doing was based on accepted principles that didn't always have the literature to support it. As I treated more And more women and the literature associated with them I began to rethink the whole estradiol issue. I saw the studies on how beneficial it was in both men and women. How important it was to so many body systems but especially that it was E2 not T that was responsible for decreasing visceral body fat and vital for sexual function in males. So I slowly and reluctantly started make some changes. I went to a max concentration compounded cream initially applying to chest or inner thighs and I continued the AIs in my patients but discontinued it in myself. I began to slowly allow myself to not fear the T or free T numbers and treated until symptoms resolved (of course optimizing thyroid as well) and optimal. I noticed a significant change in myself. My libido improved, stronger erections, every morning erections, no fatigue or irritability, increased strength and endurance etc...). I was having to apply 11/2 grams bid which brought my levels to 1800 with a free T in the 40s. E2 level 75 with absolutely no symptoms at all. I decided that in order to have even better absorption and use less cream I began applying to the testicles. Dosage was cut in half 3/4 gm bid and levels were 2000 and >50 wirh still no symptoms of E2 excess. Cut dose to 1/2 gm bid and continue that to this day So, I began same regimen with my patients. Lectured them on the importance of E2 and the potential problems with blocking it. All were switched to testicular application bid and all their dosages were at least cut in half with all of their free Ts kept around 40 or greater. I began not to fear the numbers. I did not and have not had a single issue with a patient complaining of E2 excess so I quit even measuring it. I could not have a happier patient population. Everyone that came in on injections wanted to try it this way because their friend was on it "and doing great". I have not had one ask to go back to injections. I no longer advertise. It is all by word of mouth. The point to all this is I have tried it all, but once I was willing to take a hard look at the medical literature and a was just willing to experiment with something different I have been able to make a dramatic change in myself, friends, family, and patients. Injections are great but I just don't have the issues with my patients now that I used to have [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?
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