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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="Dr Justin Saya MD" data-source="post: 71324" data-attributes="member: 12687"><p>We are on the same side of the spectrum when it comes to "normalizing" vs "optimizing", but our definitions and tolerance for risk for our patients appears fundamentally different. </p><p></p><p>The concern with free T3 levels (as you stated up to 7) comes not from sticker shock with the comparable reference ranges, but from real world experience seeing fitness athletes, bodybuilders, etc taking high doses with the resultant high levels and most DO in fact have various hyperthyroid symptoms- I have counseled and helped many as patients (elevated HR, sweating, grinding teeth, jitteriness/anxiousness, insomnia, etc). Further, IMO, if one is increasing HR drastically with elevated thyroid levels (higher HR = more workload for heart) AND you are not concerned when blood viscosity (HCT) increases to higher levels (more viscous blood = more workload for heart)...higher HR + thicker blood = double whammy for cardiac workload, especially longterm.</p><p></p><p>Not monitoring DHT, especially with the route of administration being high doses to the scrotum...you mentioned hair, what about the prostate? You also mentioned if a male had high DHT symptoms (of which you only mention hair...again think about prostate) that you would prescribe the appropriate medication. Not finasteride I hope, especially without monitoring DHT levels.</p><p></p><p>Not monitoring E2, but would treat temporarily with an AI if patient had high E2 symptoms- again flying blind. How would you know how aggressive or conservative to be with the AI without first checking E2 levels.</p><p></p><p>You mentioned you have not run into a patient yet that needed HCG. Don't take his the wrong way, but that would give the impression that you have a comparatively very small patient population at this point or a VERY select group of patients. Fertility, testicular atrophy, etc haven't been important considerations for ANY of your patients?</p><p></p><p>We are of similar ideologies in some ways (I am FAR from the traditional PCP, urologist, endocrinologist that prescribes useless and antiquated protocols), but at the same time have some important differences in opinion. I am not here to tell you your approaches are incorrect, as you are not to mine, but I do feel that you are taking the ideology of "treat symptoms not JUST numbers" (which I agree with) to the extreme by not even bothering to check some of the relevant levels. In my opinion, BOTH numbers and symptoms need to be taken into consideration to have the overall picture, otherwise you're charting a course with only half of the data available to you.</p></blockquote><p></p>
[QUOTE="Dr Justin Saya MD, post: 71324, member: 12687"] We are on the same side of the spectrum when it comes to "normalizing" vs "optimizing", but our definitions and tolerance for risk for our patients appears fundamentally different. The concern with free T3 levels (as you stated up to 7) comes not from sticker shock with the comparable reference ranges, but from real world experience seeing fitness athletes, bodybuilders, etc taking high doses with the resultant high levels and most DO in fact have various hyperthyroid symptoms- I have counseled and helped many as patients (elevated HR, sweating, grinding teeth, jitteriness/anxiousness, insomnia, etc). Further, IMO, if one is increasing HR drastically with elevated thyroid levels (higher HR = more workload for heart) AND you are not concerned when blood viscosity (HCT) increases to higher levels (more viscous blood = more workload for heart)...higher HR + thicker blood = double whammy for cardiac workload, especially longterm. Not monitoring DHT, especially with the route of administration being high doses to the scrotum...you mentioned hair, what about the prostate? You also mentioned if a male had high DHT symptoms (of which you only mention hair...again think about prostate) that you would prescribe the appropriate medication. Not finasteride I hope, especially without monitoring DHT levels. Not monitoring E2, but would treat temporarily with an AI if patient had high E2 symptoms- again flying blind. How would you know how aggressive or conservative to be with the AI without first checking E2 levels. You mentioned you have not run into a patient yet that needed HCG. Don't take his the wrong way, but that would give the impression that you have a comparatively very small patient population at this point or a VERY select group of patients. Fertility, testicular atrophy, etc haven't been important considerations for ANY of your patients? We are of similar ideologies in some ways (I am FAR from the traditional PCP, urologist, endocrinologist that prescribes useless and antiquated protocols), but at the same time have some important differences in opinion. I am not here to tell you your approaches are incorrect, as you are not to mine, but I do feel that you are taking the ideology of "treat symptoms not JUST numbers" (which I agree with) to the extreme by not even bothering to check some of the relevant levels. In my opinion, BOTH numbers and symptoms need to be taken into consideration to have the overall picture, otherwise you're charting a course with only half of the data available to you. [/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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