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Appreciate your kind words Gunga

Judochop - Is that necessary? bbex2014 - yes Empower third party tests. We’ve requested third party batch testing on multiple occasions in the past and they’ve always obliged with the results.

Hi Tony, I remember our consult and this is one of those times where 1 + 1 doesn’t always = 2...as happens occasionally with the many moving parts of hormone treatment. Since you haven’t tried PDE-5 inhibitor (viagra/cialis) yet, for your benefit, as we discussed, I wanted you to try that as a...

Very happy for you zat954! I’m a family man myself (wife and I are high school sweethearts and have 4 beautiful children), so can definitely relate to your joy. It’s always an honor to touch the lives of others. All the best!

Indeed.

They’re constantly trying to pinch the compounding pharmacies. As noted above, important distinction between 503a and 503b. The reputable 503b pharmacies (and most of their respective products) aren’t going anywhere, though they are under constant pressure from multiple angles (essential copy...

You’re on a TRT dosage on the upper end of the bell curve, so I would suspect your T is around 1000-1200 or so. Assuming that, you’re E is arguably proportionate. The prevailing wisdom at this time dictates that in the absence of symptoms, your E2 level should be fine.

See here for a related thread which gives an idea of my thoughts: Scrotal TRT Cream Application - A Precautionary Tale I appreciate your kind words bbex2014. Though I didn’t watch the podcast you referenced, the statement above that I bolded doesn’t offer any logical reasoning. It is the...

What was your DHT? If it wasn’t tested you should monitor it with that application technique.

In this case it’s closer to 7x upper reference range, though we all know the limitations of “reference ranges” this is still undoubtedly quite “supraphysiologic”. To your point, we don’t know...uncharted waters. At some point, however, we have to use common sense and follow the most fundamental...

Most guys (majority of the bell curve) will require between 500-1000iu per week cumulatively to prevent or reverse atrophy. 250iu BIW on the lower end of that range, but within the range nonetheless. Can work your way up if that dosage proves inadequate.

Sides - your advice and insight in this thread is on point. If remaining on TRT, then HCG + FSH would be more effective than HCG + clomid (due to the competing negative feedback from TRT). If OFF of TRT, then clomid is typically quite effective from a fertility perspective.

^^^ This requires attention. Discuss with your doc. Agree with your cautionary tale. As I’ve noted multiple times on this forum, particularly for patients applying full replacement TRT doses (or close to it) directly to the scrotum, it is not uncommon for DHT levels to go quite high (500s as...

The addition of FSH to TRT/HCG will regain fertility (to varying degrees) in most patients assuming the Sertoli cells are functional/capable. If this fails, then off of TRT and onto clomid is a more extreme step.

Excellent advice here. The transdermal would actually INCREASE risk of your wife being exposed (finasteride can be transferred in semen as well).

Sad, but unfortunately not surprising.

Few issues with that study linked below (which was conducted in 1988) - only 5 participants, only applied 10-15mg of testosterone directly to scrotum, DHT wasn’t 10 times physiologic concentrations. Transdermal Testosterone Therapy in the Treatment of Male Hypogonadism *

You should have become a urologist, Blackhawk.

BPH, not prostate cancer. Male pattern baldness. Guys applying an entire testosterone replacement dose directly to the scrotum can have well-above physiologic DHT levels.

I understand Vince. I just want to make sure that although the distinction between erythrocytosis and polycythemia vera is a real one (and a significant one), that those focusing on that one debate point don’t lose sight of the forest for the trees and extrapolate to assume that erythrocytosis...

Careful with that line of thinking Vince. You’re swinging the pendulum too far in the opposite direction from the practitioners and lay public whom mistakenly equate elevated HCT (erythrocytosis) to polycythemia vera. True increase in HCT is not polycythemia vera and should never be mistaken for...

Agree with Zooka above, will not likely lower BP as effectively as the telmisartan. Would have to monitor for low BP if using combo, as combining drugs will often have a cumulative effect. Talk to your GP and get his take on it.

You can stop the clomid having taken it for 3 weeks as you describe. You may or may not be experiencing some sides of the estrogen agonist/antagonist action, but your system has had some push for restart now and will continue the process, albeit more gradually. Clomid simply accelerates the...

Doxazosin has a half-life of about 22 hours. Best if taken daily, but the serum levels wouldn’t completely dissipate after a single missed day/dose.

As noted doxazosin dampens the vasoconstriction from the sympathetic nervous system (norepinephrine). Norepinephrine vasoconstricts (reason for cold hands, clammy skin, no erection/shriveled up penis/scrotum, etc) when the sympathetic nervous system tone is heightened...stress, anxiety...

Any alpha 1 blocker can potentially result in erectile improvement via smooth muscle (for example in the intima of arteries) relaxation.

+1

Happy you’re responding well Geauxbears! Doxazosin is considered an escalation from the traditional ED treatments (PDE-5i and nitric oxide enhancers).

Wouldn’t have too high of hopes regarding metformin from a fertility perspective. With that said, there are other potential benefits and it is, as far as pharmaceuticals go, fairly well tolerated.

That’s a strong response. Certainly on the farther end of the bell curve.

Can stretch the FSH to 50iu TIW, but beyond that and it’s not really worth taking. Clomid doesn’t often raise LH/FSH for those already HPTA suppressed on TRT, but occasionally can...everyone is unique. It will, however, often raise SHBG and the subjective response to the mixed...