Ask The Urologist Anything (Dr Michael Rotman)

[MikeXL]

Dr. Rotman,
Several natural compounds have been investigated for prevention, and even potential treatment of Prostate Cancer (PCa). Soy, EGCG, pomegranate, lycopene, and sulforaphane. Antagonism of the androgen receptor (AR) has been proposed as the mechanism of action for each of these compounds.

My question is - If it is true that these natural ingredients work against PCa by antagonizing AR of in PCa cells, then is it fair to presume that these ingredients would also antagonize the AR in other tissues like muscle or bone?

 

[DrRotman]

I don’t really deal with ferritin levels in my practice , it is something the pcps in my area do monitor so I leave it to their expertise. I will though look into it further now that you ask this good question. Perhaps Nelson can add more info on this topic.

 

[DrRotman]

There are many compounders out there that can customize products if you ask. I don’t endorse any particular compounder but there are plenty on this forum and on internet that do good work.

 

[DrRotman]

I have not had any patients in my practice experience these symptoms from clomid that I can recall and I do have hundreds of patients on it. It could be possible but unlikely in my opinion.

 

[DrRotman]

Unfortunately the data is still sparse on the beneficial effects of these natural compounds so assumptions at this point are hard to make, an interesting hypothesis though.

 

[hotdog]

I have not had any patients in my practice experience these symptoms from clomid that I can recall and I do have hundreds of patients on it. It could be possible but unlikely in my opinion.

If you take a look at the following thread https://www.excelmale.com/forum/showthread.php?5847-Hi-everyone-new-member you will see a discussion where two of us share our bad experiences with Clomid. For myself I got excruciating pains in my left testicle that left me breathless and very frightened, I hung on to the wall and waited for what felt like 5 minutes. The other thing that went along with this was a numbness down my right side where I thought I was having a stroke. I had a brain MRI it was so bad! You will see a reference in theat thread to clomid and paresthesia. Try googling "clomid and parethesia" or "clomid side effects" and you will find a lot of information on nerve impact. I guess some people can have a sensitivity.

 

[DrRotman]

I certainly do not discount your symptoms, as any medication can cause various symptoms in people who take them. For example, testosterone has caused some patients to have exaggerated emotional responses causing some to have bouts of crying episodes.
I was just stating my personal experience with patients on clomid.

If you take a look at the following thread https://www.excelmale.com/forum/showthread.php?5847-Hi-everyone-new-member you will see a discussion where two of us share our bad experiences with Clomid. For myself I got excruciating pains in my left testicle that left me breathless and very frightened, I hung on to the wall and waited for what felt like 5 minutes. The other thing that went along with this was a numbness down my right side where I thought I was having a stroke. I had a brain MRI it was so bad! You will see a reference in theat thread to clomid and paresthesia. Try googling "clomid and parethesia" or "clomid side effects" and you will find a lot of information on nerve impact. I guess some people can have a sensitivity.

 

[DrRotman]

Hi guys, I have a question for all of you on or who have been on TRT at some point. Has anyone reading this not achieved normal or high normal levels when taking at least 200 mg testosterone weekly? Curious as I have reviewed a few patients labs lately and noticed an occasional lack of response even with high doses of testosterone. Thanks in advance for all your commentary.

 

[Nelson Vergel]

Sometimes it is difficult to assess true compliance to a protocol as patients self report and assure you that they are following your instructions. But, having said that, I have encountered 1 or 2 people who may be "hyper excretors" of testosterone (hypothesis).

 

[pauloal13]

Doctor what is the difference between the ways of using hcg, drops, sublingual, injectable?

 

[CoastWatcher]

Dr. Rotman,

I recently passed a number of kidney stones. Ct-scan confirms - finally - that no further stones are present. In the wake of this, I'm dealing with prostatitis-like symptoms (pain referred to the tip of the penis, heaviness in the scrotum, ache in the back). My urologist suggested I give it a few weeks before any testing or further intervention is undertaken. Then a psa will be scheduled if symptoms persist along with other follow-up. Have you seen what I describe? Is this a reasonable approach?

 

[DrRotman]

I have not utilized other forms besides injectables, but like other injectables, they tend to be much more effective

doctor what is the difference between the ways of using hcg, drops, sublingual, injectable?
doctor what is the difference between the ways of using hcg, drops, sublingual, injectable?

 

[DrRotman]

i would address the prostatitis like symptoms as these are not the norm after passing stones. Make sure your doctor does a 24 hour urine collections to assess your stone risk profile. Would not check psa for a while after passing stones or having acute symptoms.

Dr. Rotman,

I recently passed a number of kidney stones. Ct-scan confirms - finally - that no further stones are present. In the wake of this, I'm dealing with prostatitis-like symptoms (pain referred to the tip of the penis, heaviness in the scrotum, ache in the back). My urologist suggested I give it a few weeks before any testing or further intervention is undertaken. Then a psa will be scheduled if symptoms persist along with other follow-up. Have you seen what I describe? Is this a reasonable approach?

 

[stephanfresco]

hi dr rotman
i am on trt 160 TESTOTERONE ENANTHATE TWICE A WEEK...
i have tried many kind of arimidex protocol and when i do 0.5 ADEX TWICE A WEEK my e2 crash and feel bad...even at 0.25 TWICE A WEEK MY E2 CRASH ...if i dont use arimidex ,my e2 is around 45 ,i feel lethargic;libido down sometime high but ed...i m good at around 20 E2....
can you help me on this situation?
on this protocol my total testoterone is around 900 ...free test high...bioavailable test high aswell...
shbg around 20.
MAYBE i should take testoterone once a week with one a week ai???
its very hard to manage it,when its low i feel really weak....and high weak aswelll....

when i do the testoterone injection, few hours later i feel a bit nervous...is it a normal side effect?

thank you very much dr rotman

stephan

 

[Blades]

Hi, my last bloods: total T 14.1nmol/l...free T 0224 (low and in treatable range)...E2 144pmol/L...SHBG 46...cortisol 295...at 11.20 am ....at this level I started to experience low libido, anxiety issues...I started self admin trt 125mg of test enth per week in a bid to relieve my smyptoms, but this made my anxiety worse, I've since read that taking testosterone can cause pregnenolone to drop which can could of been the cause of my anxiety worsening, and possibly the cause pre trt...Ive since stopped taking the test, and would like to know if boron is really effective in lowering SHBG and E2 while increasing free T, also would supplementing with dhea and pregnelone help with adernal fatigue which I feel I have and lower anxiety..if so what doses would you suggest.

 

[DrRotman]

Hi, taking hormones without medical monitoring is never effective or safe. Data on boron is very weak and inconclusive. I suggest that you seek local medical advice for your low libido and anxiety issues as left unchecked could result in long term issues. This forum would not be sufficient advice to address all those issues. Good luck with all!

Hi, my last bloods: total T 14.1nmol/l...free T 0224 (low and in treatable range)...E2 144pmol/L...SHBG 46...cortisol 295...at 11.20 am ....at this level I started to experience low libido, anxiety issues...I started self admin trt 125mg of test enth per week in a bid to relieve my smyptoms, but this made my anxiety worse, I've since read that taking testosterone can cause pregnenolone to drop which can could of been the cause of my anxiety worsening, and possibly the cause pre trt...Ive since stopped taking the test, and would like to know if boron is really effective in lowering SHBG and E2 while increasing free T, also would supplementing with dhea and pregnelone help with adernal fatigue which I feel I have and lower anxiety..if so what doses would you suggest.

 

[zentech]

Dr Rotman,

I have been diagnosed with anabolic steroid induced hypogonadism (ASIH) at the age of 24, following several years of use as a competitive bodybuilder. My primary symptoms include low libido, ED, brain fog, and fatigue.

I am under the care of an endocrinologist in Australia who did the standard workup before I started HCG (prolactin, thyroid, e2, total and free test, LH, FSH, SHBG), and sent me for a pituitary MRI. My MRI results were normal, and my bloodwork revealed normal LH and FSH, low IGF-1 and growth hormone, as well as a total testosterone of 7.5 (12-32 reference range). Free test was 188 (280-720).

I haven't touched a steroid in over 12 months and have tried 3+ months of clomid monotherapy to no avail. I then tried 3 months of clomid and HCG combined (prescribed and monitored by the endo). At first the HCG worked wonders, and then one day it suddenly stopped working. Followup bloodwork revealed that my test had doubled, but was only 15 on a 12-32 range. Now he is talking about testosterone + HCG.

What are your thoughts? Is there any other way to recovery? I am struggling to find a single documented case like mine anywhere, even among message boards. I would also like to ask you whether you think Clomid could cause any of my symptoms, as it has been used continually for the past 6 months at 25mg a day.

 

[Blades]

Dr Rotman,

I have been diagnosed with anabolic steroid induced hypogonadism (ASIH) at the age of 24, following several years of use as a competitive bodybuilder. My primary symptoms include low libido, ED, brain fog, and fatigue.

I am under the care of an endocrinologist in Australia who did the standard workup before I started HCG (prolactin, thyroid, e2, total and free test, LH, FSH, SHBG), and sent me for a pituitary MRI. My MRI results were normal, and my bloodwork revealed normal LH and FSH, low IGF-1 and growth hormone, as well as a total testosterone of 7.5 (12-32 reference range). Free test was 188 (280-720).

I haven't touched a steroid in over 12 months and have tried 3+ months of clomid monotherapy to no avail. I then tried 3 months of clomid and HCG combined (prescribed and monitored by the endo). At first the HCG worked wonders, and then one day it suddenly stopped working. Followup bloodwork revealed that my test had doubled, but was only 15 on a 12-32 range. Now he is talking about testosterone + HCG.

What are your thoughts? Is there any other way to recovery? I am struggling to find a single documented case like mine anywhere, even among message boards. I would also like to ask you whether you think Clomid could cause any of my symptoms, as it has been used continually for the past 6 months at 25mg a day.

Hi zentech, did your blood test include dhea, also the YouTube channel isarms Dylan Gemeli has made some videos on why not to include HCG in a pct, you may want to look them up, it may be helpful, I seen a endo and she said it could take month or years for my hormones to rebound. Best of luck

 

[zentech]

Hi zentech, did your blood test include dhea, also the YouTube channel isarms Dylan Gemeli has made some videos on why not to include HCG in a pct, you may want to look them up, it may be helpful, I seen a endo and she said it could take month or years for my hormones to rebound. Best of luck

DHEA has been tested as part of an adrenal function test that I undertook some time ago. I am not sure if you are familiar with the DUTCH test? I would be more interested in measuring DHT or exploring the idea of testosterone + provirion to remedy the sexual issues I am experiencing.

 

[Blades]

DHEA has been tested as part of an adrenal function test that I undertook some time ago. I am not sure if you are familiar with the DUTCH test? I would be more interested in measuring DHT or exploring the idea of testosterone + provirion to remedy the sexual issues I am experiencing.

No I am not familiar with the Dutch test, I will look into it later.. are you wanting to raise your natural free testosterone by using priviron to lower SHBG, iam not sure if privoron will shut down LH/FSH...if dhea is low does or can that mean my adernal gland maybe fatigued, I ask this because after some anxiety and depression and i fould out that my total testosterone was low on the low side and my free T was low, I started taking testosterone when I felt better, and after I felt back to my old self, and the doctor told me to come off the test to have my hormones checked with a view for my doctor to treat it, but again my total came back lowish 14.1nmol and my free T 0.223, while coming off Test I started to feel the effects, and after 5 months started getting anxiety and depression back..but this time when I took test it didn't work for the depression, could this be that my DHEA and dht were low before starting the testosterone...I read dht and dhea are important hormones for calming the brain. And also dht is the hormone responsible for libido