Trt protocal - advice needed

[FunkOdyssey]

The whole E2 side effects convo is still a very fascinating one to me. I’m not sure what to make of it, tbh. Both sides have good points. And even though I put WAY more weight into real life anecdotes, than studies and/ or what science tries to explain what should be going on, I will admit that it’s not easy for anyone to try and extrapolate what’s going on in these anecdotes of men taking an ai and seeing objective improvements in sexual function, and also improvements in other areas, such as mood and energy, for examples. There’s absolutely no denying that many men have had this experience, and relatively quickly once they take the ai. This is not disputable. It’s happened hundreds and hundreds of times to men on HRT, and again, just can’t be denied. Obviously doesn’t happen everytime, but I’ve read with my own eyes hundreds and hundreds of anecdotes over the years of men taking an ai and seeing improvements in areas such as sexual function, mood, energy, sleep, well being, etc. There’s just no way all these anecdotes can be chalked up to coincidence or dumb luck or what not

What I’m interested in is the why this occurs. What exactly is happening in the body that gives some men improvements when they take an ai. Is it as simple as their E2 comes down a bit, while androgens remain the same, thus improving their T to E ratio, and then consequently feeling better and/ or seeing sexual improvements? I want it to be this simple, but I’m really not sure if it is. I’m legit dying to know tho, I can tell u that! Lol

Another thing to consider, which hopefully might help narrow down what’s going on, would be the fact that it’s extremely common to see men take a DHT derivative, mainly masteron, primobolan and/ or Proviron, and see moderate to drastic improvements in libido, and often times erections as well, but mainly libido. It’s undeniable that DHT derivatives have the reputation to improve sexual function, and often times well being and energy. The question is, however, what mechanism of action from these compounds are causing these improvements? Is it mostly the lowering of E2, or at least the minimizing of E2 effects, while either keeping total androgens the same, or with certain DHT derivatives actually increasing total androgens? Is it mostly the fact that they can give the person similar effects as increasing their DHT level would give them? Is it the combo of lowering E2/ decreasing E2‘s effects, increasing total androgens, and giving the person DHT like benefits all at the same time? Obv there’s a big difference in the mechanism of action between an ai and a DHT derivative, but I can’t help but try to connect what they both might have in common, and why they can sometimes result in similar effects with some guys. Obv not always. I just wonder how much of the sexual improvements from both come from their shared quality of lowering E2. That’s obv the only thing they have in common, as far as I know.

Doss anyone know whether an ai can increase DHT or not? Like if anastrozole deceases the amount of test that gets converted into E2, does that mean there’s more test available to be converted into DHT? Or would the amount of test that’s being converted into DHT remain the same?

Thinking along the lines of androgen/E2 ratio, it is interesting that the docs who seem to see the most success without E2 management are also using cream, which skews the ratio of these hormones (in serum at least) heavily towards androgens. You might argue the serum levels are meaningless, and perhaps for certain tissues (prostate for example) this is true, but I don't I buy it as a universal truth.

 

[Gman86]

Thinking along the lines of androgen/E2 ratio, it is interesting that the docs who seem to see the most success without E2 management are also using cream, which skews the ratio of these hormones (in serum at least) heavily towards androgens. You might argue the serum levels are meaningless, and perhaps for certain tissues (prostate for example) this is true, but I don't I buy it as a universal truth.

Ya I feel the same exact way. Sometimes people can be too smart for their own good, and it can blind them to looking at things for what they are (sometimes way simpler and less complicated than people make them out to be) I see this happening with the people that focus solely on the fact that estrogen works in a paracrine fashion, and therefore serum levels of E2 are basically irrelevant as far as being a useful diagnostic tool. This might be true, when looking at it strictly from a scientific POV. But ime, my serum E2 level has correlated with my symptoms, at times. How could this be if a man’s serum E2 level is basically a useless measure of what’s going on within the body? When I went through a period where I was getting literal hot flashes multiple times per day, my E2 was extremely low, due to taking too much ai. I’d say my E2 level correlated pretty well with what was going on in my body at the time. A serum E2 level probably doesn’t paint the whole picture, but I think it does seem to still be useful as a diagnostic tool, to use along with the person‘s symptoms and how they’re feeling and other diagnostic markers that could help paint the bigger picture of what’s actually going on

Js that sometimes we can be too smart for our own good, and focus too much on what studies and science and biology tells us what should be happening, instead of looking at things on a simpler more straight forward POV, while using good critical thinking skills and common sense to figure out what the best solution/ plan of action should be in a given scenario, based on the information at hand. But just like with everything in life, I always believe a balanced approach is the optimal approach. So a mix of both methods is most likely ideal

 

[TLR]

The individual has a choice. You're blaming it on estradiol but it's not. It's just a surrogate number that you're following but when you take testosterone and raise levels and levels of estradiol, testosterone, and DHT, along with serotonin and others etc. What a man's levels get too high too quickly then we can see some erectile dysfunction initially. That is treated by either lowering the dose until it resolves and then SLOWLY raising the dose. Firstly, if the patient was doing well at the lower dose with strong directions and symptomatic improvement there's no need to raise the dose to super physiologic levels. Secondly if he does have symptoms that may improve with increasing testosterone then you would raise it very slowly. The problem is a lot of men even though they hate doctors basing treatment on levels they themselves tend to aim for levels which they may not need for symptomatic resolution. One man may need a very high level to resolve symptoms and another very little. Second way to overcome the erectile dysfunction you're getting is to just give it time. It typically will resolve in in a few months at most but most men will not have the patience to give it that time. It happened to me and I trusted in my provider and I just gave it time to work an it couldn't be any better.
So a man can just either lower his dose and then move up slowly if necessary (daily testosterone no matter what the delivery) or simply give it time (1-3 months)to resolve on its own which it always does once the body acclimates to the new levels.
Lastly, make sure you're not aiming for a number yourself and that you're raising your levels that will realistically resolve remaining symptoms. Too many men want to use testosterone to resolve every symptom they have and it's not going to do that. It will only resolve symptoms related to deficient testosterone in that individual. Some men are extremely responsive to testosterone and a little bit goes a long way while others take a lot to go a little way

I will be the first to admit that patience is not a strong suit of mine, especially in the erection department. I’m at the age where the old adage “never waste a hard on” rings truer than ever, so I want it fixed right now!