Ask The Urologist Anything (Dr Michael Rotman)

[ALMSGT502]

Dr Rotman
Besides PDE-5 inhibitors are there any otc supplements that can strengthen erections? Thanks

 

[Formula364]

Dr Rotman
Does hCG increase VEGF (Vascular Endothelial Growth Factor)?
And, do PDE5 Inhibitors increase VEGF, also?

What are the advantages/dangers for using both together?

Thanks

 

[Tiago]

Hi, doctor.
I am 38 yo, healthy, have 2 kids, but last 2 years y have poor sexual drive and my analisis showed low test (total test 241 and free test 8) with the other parameters in normal range. I exercise 4 days a week, 1,80m and 80kg, with 13% bf. I started clomid 50mg ED two weeks ago, but no improve. I want to preserve fertility, but i think maybe i need TRT? What is your opinion, doctor? Thank you very much

 

[ERO]

Dr. Rotman-


Have you ever had a positive TRT outcome in a patient with very low SHBG (single digits to teens) that was NOT obese, diabetic or pre-diabetic? Those issues seem to always be mentioned as comorbidities/issues with low SHBG along with the treatment suggestions of losing weight, using Metformin, etc… But I myself along with a few guys here on the forum have low SHBG without any of those accompanying issues and speaking for myself only, TRT to me feels no different than “Low T” – all the usual symptoms remain and are unimproved by TRT. Low to no libido, low energy, unable to recover properly from exercise, unable to effectively lose weight, etc.

Thank you in advance, and thank you as well for your participation in this forum!

 

[Gianluca Bonetti]

Hello Doc

I was a patience of your till about a year an half a go through LowT.com I find my self in NYC now and I need to do a therapeutic phlebotomy as my hematocrit is up at 51.1, unfortunately I can't donate, Do you know any place I could get that done?

thank you

 

[DrRotman]

Dr Rotman
1- do you think DHT is a protagonist in PCa?
2- do you think estrogen is a protagonist in PCa?
3- what do you think is the reason as to why finasteride and dustasteride were associated with higher rates of Aggressive PCa in the trials ?

1- No I do not

2- No i do not believe it is

3- Those studies upon further analysis were deemed to be faulty but the government warning was published prior to the corrected studies

 

[DrRotman]

No , there are really no supplements that work. Some are contaminated with generic forms of PDE5 inhibitors so be careful.

 

[DrRotman]

I am not aware of any clinically significant effect on VEGF. No, there is no issue with using both together .

 

[DrRotman]

Hi, doctor.
I am 38 yo, healthy, have 2 kids, but last 2 years y have poor sexual drive and my analisis showed low test (total test 241 and free test 8) with the other parameters in normal range. I exercise 4 days a week, 1,80m and 80kg, with 13% bf. I started clomid 50mg ED two weeks ago, but no improve. I want to preserve fertility, but i think maybe i need TRT? What is your opinion, doctor? Thank you very much

If the clomid is not effective , there are other options including TRT while preserving fertility. Clomid frequently has a paradoxical effect.

 

[DrRotman]

Hello Doc

I was a patience of your till about a year an half a go through LowT.com I find my self in NYC now and I need to do a therapeutic phlebotomy as my hematocrit is up at 51.1, unfortunately I can't donate, Do you know any place I could get that done?

thank you

Hi Gianluca,

Good to hear from you. Contact me at my office at 2126893155 and we can discuss this in detail.

 

[ALMSGT502]

Dr Rotman
Do you use HCG(testicular Atrophy) with TRT also do you use a compounding pharmacy and do you accept insurance or are cash based
Thanks

 

[DrRotman]

Hi, I do use HCG with TRT and yes they are frequently prescribed from a compounding pharmacy. I do accept select insurances in my practice for medical conditions such as hypogonadism, in addition to consulting for Primebody, one of the board sponsors.

 

[Tiago]

If the clomid is not effective , there are other options including TRT while preserving fertility. Clomid frequently has a paradoxical effect.

Thanks, Dr Rotman Just one question, what do you mean by "paradoxical effect"? Can i do something like this protocol: TRT (sq injections of 100mg of testoviron two times/week) + 500 u.i. HCG 3 times a week? I saw some scientific articles sustaining this protocol. Thanks again !

 

[DrRotman]

Thanks, Dr Rotman Just one question, what do you mean by "paradoxical effect"? Can i do something like this protocol: TRT (sq injections of 100mg of testoviron two times/week) + 500 u.i. HCG 3 times a week? I saw some scientific articles sustaining this protocol. Thanks again !

Paradoxical here meaning that your numbers may improve to normal or high normal yet your symptoms do not improve. There was one abstract from Baylor that used that protocol in past with succcess in maintaining sperm function in patients on TRT. Thanks

 

[Zooka15]

DrRotmon, at what level do you become concerned with or treat estradiol?

 

[CoastWatcher]

DrRotmon, at what level do you become concerned with or treat estradiol?

As answered by Dr. Rotman earlier in the week.

"I try to use ultrasensitive estradiol and try to maintain a level within range. I rarely encounter very high levels when someone is using TRT appropriately. Likewise, low levels are not commonly seen in my practice with appropriate treatment. I do believe, as recent studies have shown, that a slightly high level is much more desired than a low level."

 

[Gianluca Bonetti]

Doc. thank you very much for the help given and for recommending Doc. George Liakeas, I'm very pleased by the office visit I had with him

 

[Dr Justin Saya MD]

Thrilled to see you participating here Dr Rotman! Keep it up, this is a great community only made better by physician participation.

 

[DrRotman]

Thrilled to see you participating here Dr Rotman! Keep it up, this is a great community only made better by physician participation.

Thank you Dr Saya! I have been following this forum for quite some time and have seen and learnt quite a bit from your contributions. I am always happy to contribute to a forum with with patients that are so well educated and who ask such pertinent questions.

 

[andre]

Dr Rotman
Do you ever prescribe finastride for hairloss prevention for patients on TRT? maybe use it first three days after injection since that is when DHT is at its highest?
Thanks in advance