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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: 71316" data-attributes="member: 15691"><p>Dr Saya, </p><p>Another Pandora's box to open up. </p><p>Lets start with thyroid. We were all taught that giving too much thyroid would cause a person to become hyperthyroid and develop all the complications of Graves' disease. You just diagnosed hyperthyroidism in a patient with a free T 3 of 7 without knowing anything about them. You were able to do this by looking at a number. That's how we were both taught along with everyone else. Don't suppress the TSH and keep the T4 and T3 in a normal range or else they would be hyperthyroid. Well what we thought would occur has not occurred with high dose thyroid treatment. I have provided you with the articles in a previous post by Tammas Kelly and I would strongly recommend you read them as they are a fascinating read. The recent literature dispels all that we we taught regarding hyperthyroidism. High dose thyroid treatment is one of the most studied augmentations for refractory depression. High dose thyroid is also included in the major treatment guidelines for bipolar disorder. Armour thyroid has 9mcg of T3 in I grain (60 mg) and the average dose we use ranges from 2-3 grains but can be more. I personally take 2 grains twice a day and my free T 3 is over 5 and I'm not hyperthyroid. So if a patient is taking 3 grains then they are getting 27mcgs of T3. The dosages used in HDT can go up to 150mcg...Wow!!!. These patients are not becoming hyperthyroid and developing all the morbidities and mortalities of Graves' disease. They prescribe it as we would a NSAID and don't even worry about the levels. Once again wow!!! This is because it is now known that exogenous HDT is not the same as endogenous hyperthyroidism (Graves' disease). There is a autoimmune component to Graves' disease that does not occur with High dose thyroid therapy. High dose thyroid is also used to treat thyroid cancer without any of the complications people with actual Graves' disease have. You can remove the thyroid of someone with Graves' disease and they still have complications. Once again they have a autoimmune component. So this fear of thyroid is unwarranted and not supported by the literature. So a free T 3 level of 7 is not hyperthyroidism. Any hormone can have side effects and if a patient develops increased sweating or increased heart rate then the dosage is simply lowered. Isn't this why we all continue to try and learn and grow so that we can keep a open mind and sometimes learn that the way we were first taught may not be correct? Shouldn't our patients demand that of us? I also feared thyroid until I learned better and my patients thank us for it. I can't tell you how many "fibromyalgia" patients have had their symptoms resolve with High T and and thyroid treatment. So point is this, the fears we had with making people hyperthyroid and having all the complications of people with Graves' disease are unwarranted. </p><p> DHT? Why should I care what my DHT levels are? If my hair is not falling out then why should I be concerned? If my hair or my patient was losing hair then I would treat with the appropriate meds and switch to injections. That has not occurred yet but if it did that is how I would approach. I don't need to know my DHT levels if I am doing great and having no symptoms no more than I need to know my E2 levels when I am doing great with no symptoms</p><p> TRT. We can't ignore 5 decades of increasing a mans E2 with IM testosterone without adverse effects. We know the adverse effects of having low T. We know the spike in T after a injection and how that causes more issues with E2 excess than a transdermal route. Have you ever given yourself a injection of T cyp 200mg and measured you T levels hourly throughout that day and then daily for the next week? We have just for the hell of it to see what happened. Your head would blow up if i told you the T values the first day especially. It seems you are still caught up in the numbers such as 1500 and feel that is somehow dangerous just like the thyroid values. Remember that those values are based on the avg of a population and they aren't going out and measuring the levels of only the most healthy and fit. By the time we are 50 and above it becomes the avg of a population of sick people and the number is decided on by a pathologist in a lab that is not out in the world treating people. So would you rather your numbers be normal or optimal? Would our patients rather us treat a number on a piece of paper or their symptoms? The art of medicine has been lost in that we treat numbers and not a patients symptoms and then when we get uncomfortable with the number we then decide it must be something else . </p><p> I'm not sure it was probably best for me to join the forum in that I have been quietly treating patients and spending months of the year traveling and learning new information and finding that the way I had previously learned certain things were wrong or could be improved. I wasn't looking to treat thyroid when I started. I would have told you you were crazy if said I would be treating PCOS and menopausal women. I now think know why I am not running into a lot of the problems that I read about on this forum with regard to HRT. I am actually optimizing T and thyroid as by treating a patients symptoms without fearing a number and thank goodness I was willing to try every method myself until i found a program where we don't run into the E2 issues so many people seem to have.</p></blockquote><p></p>
[QUOTE="J. Keith Nichols MD, post: 71316, member: 15691"] Dr Saya, Another Pandora's box to open up. Lets start with thyroid. We were all taught that giving too much thyroid would cause a person to become hyperthyroid and develop all the complications of Graves' disease. You just diagnosed hyperthyroidism in a patient with a free T 3 of 7 without knowing anything about them. You were able to do this by looking at a number. That's how we were both taught along with everyone else. Don't suppress the TSH and keep the T4 and T3 in a normal range or else they would be hyperthyroid. Well what we thought would occur has not occurred with high dose thyroid treatment. I have provided you with the articles in a previous post by Tammas Kelly and I would strongly recommend you read them as they are a fascinating read. The recent literature dispels all that we we taught regarding hyperthyroidism. High dose thyroid treatment is one of the most studied augmentations for refractory depression. High dose thyroid is also included in the major treatment guidelines for bipolar disorder. Armour thyroid has 9mcg of T3 in I grain (60 mg) and the average dose we use ranges from 2-3 grains but can be more. I personally take 2 grains twice a day and my free T 3 is over 5 and I'm not hyperthyroid. So if a patient is taking 3 grains then they are getting 27mcgs of T3. The dosages used in HDT can go up to 150mcg...Wow!!!. These patients are not becoming hyperthyroid and developing all the morbidities and mortalities of Graves' disease. They prescribe it as we would a NSAID and don't even worry about the levels. Once again wow!!! This is because it is now known that exogenous HDT is not the same as endogenous hyperthyroidism (Graves' disease). There is a autoimmune component to Graves' disease that does not occur with High dose thyroid therapy. High dose thyroid is also used to treat thyroid cancer without any of the complications people with actual Graves' disease have. You can remove the thyroid of someone with Graves' disease and they still have complications. Once again they have a autoimmune component. So this fear of thyroid is unwarranted and not supported by the literature. So a free T 3 level of 7 is not hyperthyroidism. Any hormone can have side effects and if a patient develops increased sweating or increased heart rate then the dosage is simply lowered. Isn't this why we all continue to try and learn and grow so that we can keep a open mind and sometimes learn that the way we were first taught may not be correct? Shouldn't our patients demand that of us? I also feared thyroid until I learned better and my patients thank us for it. I can't tell you how many "fibromyalgia" patients have had their symptoms resolve with High T and and thyroid treatment. So point is this, the fears we had with making people hyperthyroid and having all the complications of people with Graves' disease are unwarranted. DHT? Why should I care what my DHT levels are? If my hair is not falling out then why should I be concerned? If my hair or my patient was losing hair then I would treat with the appropriate meds and switch to injections. That has not occurred yet but if it did that is how I would approach. I don't need to know my DHT levels if I am doing great and having no symptoms no more than I need to know my E2 levels when I am doing great with no symptoms TRT. We can't ignore 5 decades of increasing a mans E2 with IM testosterone without adverse effects. We know the adverse effects of having low T. We know the spike in T after a injection and how that causes more issues with E2 excess than a transdermal route. Have you ever given yourself a injection of T cyp 200mg and measured you T levels hourly throughout that day and then daily for the next week? We have just for the hell of it to see what happened. Your head would blow up if i told you the T values the first day especially. It seems you are still caught up in the numbers such as 1500 and feel that is somehow dangerous just like the thyroid values. Remember that those values are based on the avg of a population and they aren't going out and measuring the levels of only the most healthy and fit. By the time we are 50 and above it becomes the avg of a population of sick people and the number is decided on by a pathologist in a lab that is not out in the world treating people. So would you rather your numbers be normal or optimal? Would our patients rather us treat a number on a piece of paper or their symptoms? The art of medicine has been lost in that we treat numbers and not a patients symptoms and then when we get uncomfortable with the number we then decide it must be something else . I'm not sure it was probably best for me to join the forum in that I have been quietly treating patients and spending months of the year traveling and learning new information and finding that the way I had previously learned certain things were wrong or could be improved. I wasn't looking to treat thyroid when I started. I would have told you you were crazy if said I would be treating PCOS and menopausal women. I now think know why I am not running into a lot of the problems that I read about on this forum with regard to HRT. I am actually optimizing T and thyroid as by treating a patients symptoms without fearing a number and thank goodness I was willing to try every method myself until i found a program where we don't run into the E2 issues so many people seem 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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