Hahah I do sound like I'm getting a little close to this so called doctor's dick than I'd like to be, but I agree with you on everything other than HCT + HGB. When I said check testosterone levels, I obviously was referring to checking total and free T. You're right about the E2 possibly being too low, even if his free T looks good. So I would check E2 as well, while on TRT. I personally check regular E2, sensitive E2, and free E2, every time I get labs done. Was just saying that you don't really have to fear elevated E2. Low E2, however, could be an issue, and would just be solved simply by increasing your dose. I don't really see the need to check HCT + HGB. HCT rarely goes over 55% with guys, and even if it does, it's not necessarily an issue. There's plenty of people that live at elevation that have HCT levels in the mid to high 50's, that have no issues. It's the mixture of high HCT, high white blood cells, and high platelets, all at the same time, that you have to worry about. But most guys will not have a HCT level high enough to worry about, and will not have platelets and white blood cells all elevated at the same time. It's worth checking, but I was just trying to let him know that 99% of the time TRT is very simple, and you don't have to check HGB/ HCT, E2 and DHT if you don't want to.
Advice and opinions needed/should I or shouldnt I?
- Thread starter Coltsblue1844
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Hahah I do sound like I'm getting a little close to this so called doctor's dick than I'd like to be, but I agree with you on everything other than HCT + HGB. When I said check testosterone levels, I obviously was referring to checking total and free T. You're right about the E2 possibly being too low, even if his free T looks good. So I would check E2 as well, while on TRT. I personally check regular E2, sensitive E2, and free E2, every time I get labs done. Was just saying that you don't really have to fear elevated E2. Low E2, however, could be an issue, and would just be solved simply by increasing your dose. I don't really see the need to check HCT + HGB. HCT rarely goes over 55% with guys, and even if it does, it's not necessarily an issue. There's plenty of people that live at elevation that have HCT levels in the mid to high 50's, that have no issues. It's the mixture of high HCT, high white blood cells, and high platelets, all at the same time, that you have to worry about. But most guys will not have a HCT level high enough to worry about, and will not have platelets and white blood cells all elevated at the same time. It's worth checking, but I was just trying to let him know that 99% of the time TRT is very simple, and you don't have to check HGB/ HCT, E2 and DHT if you don't want to.
Been on the cream 2 weeks. Just had total and free T drawn yesterday. Will report back with my labs when they come in. And feel about the same so far with the cream, maybe a little less sex drive. I think my numbers are currently too low. I'm currently not applying any cream to the scrotum, just to see how effective the cream is on the back of the knees and forearms. I will most likely be adding a click or two, or more, depending on what my labs come back at. If you're not afraid of hair loss, and/ or possible issues from very elevated DHT, there seems to be a very high success rate with men applying the cream to their scrotum. Injections can definitely work and get the job done though. It's all a matter of preference.
madman
Super Moderator
Regardless of symptoms thicker blood is thicker blood and puts undue stress on the cardiovascular/endothelial system in the long term.
-just because one is not experiencing any negative effects from higher hematocrit levels presently does in no way mean having more viscous blood is healthy in the long term.
Here is an older thread with a post from Dr. Saya that is very sound advice regarding erythrocytosis.
High T and High red blood count Q
madman
Super Moderator
There are many of you that speak so hatefully of some doctors and different ways of thinking. Yet you seem to worship this one doctor and his mouthful of analogies and ideas that are based on as little science as you claim about the others. It’s funny how you all seem to be constantly chasing numbers( that are not scientifically based) and most people on here don’t seem to be feeling well and are constantly changing protocols.
madman
Super Moderator
Your beloved DR has disrespected this forum and some members on here!
Need to look at both ends of the spectrum.
No one chasing numbers here but you need to keep in mind that one needs to use them as a guide when managing a protocol.....regarding not only what TT/FT level is achieved on such T-dose and whether there is improvement or lack there of in ones low-t symptoms but also how it effects ones overall health markers.
There is such a thing as too high or too low and you should very well know that it comes down to achieving a healthy FT which results in relief/improvement of low-t symptoms and the beneficial effects on ones overall health.
If you truly understood the newer research regarding SHBG:T binding you would see that one does not need to attain an extremely high TT level to attain a healthy FT level even in cases of men with higher SHBG.
Most can easily hit a high FT level with a TT 1000-1200 ng/dL.....others much less!
Doubtful one needs to be running a TT 1500-2000 ng/dL to benefit from trt as such level would have ones FT through the roof.
Most men do well having FT in the 30-30+ ng/dL range.....doubtful anyone needs to be 50-50+ ng/dL (almost double the top end).
Too many variables as to why many are constantly changing protocols/feeling unwell.....and I would say that many truly have no idea where their FT levels sits as it may be too low or too high due to relying on piss poor testing methods when getting blood work!
Top it off with the fact that anytime one start trt or tweaks protocol as in tweaking dose (increasing/decreasing) hormones will be in FLUX during the weeks leading up until blood levels stabilize and even than once levels have stabilized it can take 2-3 months for the body to adapt to the new T levels let alone estradiol to truly gauge how one feels!
Too many expect after 6 weeks to feel great and if they do not.....jump the gun and tweak/switch protocol.....blaming this,that or the other!
The thing is people like to take sides. It all goes back to being part of a tribe. Being part of a tribe allowed us to survive. We still have this tribal way of thinking, unfortunately. The fact is, all these top doctors are amazing, and all have amazing insight into how to manage HRT properly. However they choose to manage it must clearly be working for the majority of their patients, otherwise they wouldn’t be doing it that way. The key is to use critical thinking, and learn from all these doctors, regardless if their methods are different or not. There’s multiple ways to achieve success on HRT. But I do agree, in my research, men do tend to be having a pretty significant increase in success with transscrotal cream than any other method. Especially in regards to libido and erections, which seem to plague quite a few men on injections. But every method of testosterone application has been proven to work, just for the record.
madman
Super Moderator
F*** this not scientifically based.....no healthy young male has a TT 1500-2000 ng/dL let alone absurd FT levels!
The underlying principle is that with most hormonal parameters that have been studied, having values well outside of normal ranges is associated with higher mortality. Thus there's a substantial burden of proof on anyone coming along to claim otherwise.
We just have to respect that we are all different. On the TOT roundtable fb group there are more guys than I can keep track of that still had symptoms when their free T was at the top of the range (even with the tru-T calculator) and didn’t have complete symptom resolution until their free T was almost double, if not double the top of the range. Then there are plenty of guys throughout the years that I’ve seen report they only achieved success when they lowered their dose. So again, we just have to respect that we are all very different, and may require different protocols to achieve symptom resolution.
madman
Super Moderator
Your infamous DR did state that most of his patients do well with their FT in the 30+ ng/dl range.....again doubtful that one needs FT double the top end of the range and in many cases thyroid/adrenals would be sub-par!
As you know at least he tests FT using the gold standard Equilibrium Dialysis.
Never stated that one might need FT slightly over top end.....again highly doubtful one needs absurdly high levels to benefit.
Young men tend to have lower SHBG levels, and have less testosterone resistance on a cellular level, and therefore require less total testosterone to achieve healthy free T levels.
He says 30-50. Everyone’s different man. Wish we could all just get ourselves into a unanimously specified range, and all achieve success, but it’s just unfortunately not the case.
madman
Super Moderator
This testosterone resistance few speak of may hold true in older men or possibly men who have used/abused testosterone/AAS in high doses.....for the average man doubtful!
Are there some some references on "testosterone resistance"? I'd like to know how it's defined and what research there is behind the concept.
madman
Super Moderator
So where would that 50 ng/dL at trough have ones peak on....once weekly or twice weekly protocol?
First of all madman, I have allegiance to no doctor and don’t deal with any of aforementioned doctors. So sorry you’re butt hurt that some doctor hurt your feelings or someone on this board. I don’t think that ending all of your sentences in exclamation points, berating me and others helps anyone.
Accepting this at face value, I'd still question whether the treatment is appropriate, as it may simply be overriding other imbalances at the risk of long-term harm. A little like finding relief from GI upset with daily antibiotics rather than an improved diet. More specifically, if a guy's problems lie in too much estradiol, prolactin, etc., is swamping them with testosterone and DHT really the best solution? I don't know. But the tradeoffs should be discussed.
madman
Super Moderator
There are many of you that speak so hatefully of some doctors and different ways of thinking. Yet you seem to worship this one doctor and his mouthful of analogies and ideas that are based on as little science as you claim about the others. It’s funny how you all seem to be constantly chasing numbers( that are not scientifically based) and most people on here don’t seem to be feeling well and are constantly changing protocols.
Take it as you will.....you called me out did you not?
Couldn’t agree more with everyone you just said.
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