Ask The Urologist Anything (Dr Michael Rotman)
- Thread starter Nelson Vergel
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Liver disease e.g. alcoholism, hyperthyroidism, malnutrition, and some medications.
Two questions about HCG monotherapy with high doses like 5000 iu per week:
1) From what I've realized by researching, the guys often have problems with aromatization during high doses HCG mono and difficulties in dealing with the situation. In your experience, what would be the best ways to deal with it?? Make use of an AI?? If so, what would be the best type, dosage etc??
2) I also noticed that the guys have troubles in getting off of high doses hcg monotherapy, with hormone imbalances (like too much drop in testosterone etc). What is the best way to get off of hcg monotherapy?? Do some pct?? If yes, what would be the best pct in that case??
1) From what I've realized by researching, the guys often have problems with aromatization during high doses HCG mono and difficulties in dealing with the situation. In your experience, what would be the best ways to deal with it?? Make use of an AI?? If so, what would be the best type, dosage etc??
2) I also noticed that the guys have troubles in getting off of high doses hcg monotherapy, with hormone imbalances (like too much drop in testosterone etc). What is the best way to get off of hcg monotherapy?? Do some pct?? If yes, what would be the best pct in that case??
Hi, doctor, I'm interested in your view of this study, where Testosterone on PC patients caused INHIBITION of prostate-cancer cells proliferation.
"Dr. Khera presents results from his own research, showing that at lower androgen concentrations than the optimal level, increasing androgen concentration promotes proliferation of prostate cancer cells. However, at the higher concentrations, further increasing androgen concentration results in a dose-dependent inhibition of proliferation.[31] He introduces an RCT currently in progress that his team got FDA approved (NCT00848479), which will investigate the safety of testosterone replacement therapy starting 3 months after radical prostatectomy."
link to article> http://www.agelessforever.net/anti-...-on-testosterone-prostate-cancer-and-bph-luts
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507510/
"Dr. Khera presents results from his own research, showing that at lower androgen concentrations than the optimal level, increasing androgen concentration promotes proliferation of prostate cancer cells. However, at the higher concentrations, further increasing androgen concentration results in a dose-dependent inhibition of proliferation.[31] He introduces an RCT currently in progress that his team got FDA approved (NCT00848479), which will investigate the safety of testosterone replacement therapy starting 3 months after radical prostatectomy."
link to article> http://www.agelessforever.net/anti-...-on-testosterone-prostate-cancer-and-bph-luts
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507510/
Last edited:
savedguysaver
New Member
Dr. Rotman,
Thank you again! I'll repeat how great it is of you to participate in this forum and he'll those of us trying to take reasonability for our health.
I'm​ 42 and have been on TRT for around 8 years. Beginning in January I actually changed from the 2ml every 2 week protocol, to a more reasonable .4ml every 3.5 days subq. 2 weeks ago I began .5 mg anastrozole the day after my shot to deal with the (sensitive) 70 e2 level I have struggled with.
My question is what could be possible causes of urination issues including weak stream and not emptying that show up with increasing severity leading up to the day of my shot then go away completely for around 24 hours following my shot then began to build again. I only began to notice them the last month or so but may just be because I'm paying attention now.
My last PSA was between 1 and 2. I'm going to have another panel ran in 4 weeks or so to quantify the protocol changes I have made.
Thank you again!
Thank you again! I'll repeat how great it is of you to participate in this forum and he'll those of us trying to take reasonability for our health.
I'm​ 42 and have been on TRT for around 8 years. Beginning in January I actually changed from the 2ml every 2 week protocol, to a more reasonable .4ml every 3.5 days subq. 2 weeks ago I began .5 mg anastrozole the day after my shot to deal with the (sensitive) 70 e2 level I have struggled with.
My question is what could be possible causes of urination issues including weak stream and not emptying that show up with increasing severity leading up to the day of my shot then go away completely for around 24 hours following my shot then began to build again. I only began to notice them the last month or so but may just be because I'm paying attention now.
My last PSA was between 1 and 2. I'm going to have another panel ran in 4 weeks or so to quantify the protocol changes I have made.
Thank you again!
Tommy Wall
Member
Dr Roman, I always had a too short frenulum that causes somd discomfort when my penis is erected. I´ve been considering to have cut. However I see that there are big veins under and around it. It is a risky to have cut?
Elevated PSA
I am 56 years old, on TRT for 9 years. My PSA has always been 2.3 - 2.4. In the last year, it's jumped to 3.6. My urologist wants to do a prostate biopsy which I am not looking forward to at all. Is there any way to lower PSA? I've read that if you do not ejaculate for 48 hours or more prior to blood draw, the result may be lower. (Incidentally, in the last year I've had more sex than I've ever had in my entire life. Could this be the cause of the elevated numbers?) Do you have any thoughts about this? Thanks.
I am 56 years old, on TRT for 9 years. My PSA has always been 2.3 - 2.4. In the last year, it's jumped to 3.6. My urologist wants to do a prostate biopsy which I am not looking forward to at all. Is there any way to lower PSA? I've read that if you do not ejaculate for 48 hours or more prior to blood draw, the result may be lower. (Incidentally, in the last year I've had more sex than I've ever had in my entire life. Could this be the cause of the elevated numbers?) Do you have any thoughts about this? Thanks.
Hi Everyone , thank you for your wonderful questions some of which have stumped me and some of which I cannot answer as we don't know everything there is about this evolving field. I have been away on meetings for a couple weeks and have had an extensive operative schedule. I will sit down this weekend and answer all open questions to the best of my ability. Thank you for your patience and your insight.
Dr R
Dr R
A frenulectomy does cause some bleeding but in a good urologists care, this should not be a problem. We do use hemostatic techniques to prevent bleeding etc. I also perform this procedure in my office under anesthesia which makes the patient much more comfortable.
PSA elevation is something I deal with on a daily basis. In your situation, I would certainly not be sexually active for a few days nor have any examination the day of the blood draw. Generally TRT will raise PSA 0.3-0.6 but being that you have been in it for many years, it may not be a factor. Repeat the test and if it remains elevated, make a combined educated decision with your urologist on how to proceed. Good luck
Hi,
Your urinary issues are not likely related to timing of injection. We know TRT does cause prostate enlargement but your symptoms are suggestive of an underlying prostate issue. I would recommend seeking out a urologists evaluation.
The study you quote was done in patient with castrate resistant prostate cancer so it is very specific. These are very advanced prostate cancer patients with a poor long term prognosis. Now, giving patients who had prostate cancer and are cancer free is an area where a few urologists including myself are selectively treating hypogonadal patients. This is being done at major cancer centers as well such as Memorial Sloan Kettering.
Hi Doctor, wow, so much good info on this board. I'm fairly new here but my question deals with HCG. I started Androgel in 2012, my doctor didn't know a lot about hcg or an AI and in fact my estradiol levels were never checked until recently. Due to a job/insurance change I recently switched to T Cyp injections (120mg/wk) which are so much better, wish I had done it earlier. I was also prescribed hcg at 500 iu a week (low, I know). We are done having children so my only goal is to reverse testicular atrophy and get my testicles back to their, hopefully, former glory. My questions are;
1. For someone who was on trt for roughly 5 years without, what would be your hcg protocol?
2. I know everyone is different but what could be expected as far as seeing results, and is it even likely?
Thanks for your time!
1. For someone who was on trt for roughly 5 years without, what would be your hcg protocol?
2. I know everyone is different but what could be expected as far as seeing results, and is it even likely?
Thanks for your time!
Hm, so it is possible to cure cancer with androgen deprivation therapy and then, when it's cured to continue with TRT safe without cancer coming back ? I thought that patients on Androgen Deprivation Therapy has to be for life on it.... Which is very bad quality of life....
Thanks DOC for fast replays. My last question wasn't related to this study. I'm interested in what's your experience with PC patients and TRT after they are cured with ADT for example ?
Is it safe for them to be on TRT after they are cured ?
Sorry if I ask too many questions, but this area is very interesting for me. I was at a lecture last week and my professor of pharmacology (I'm dental student) talked that estrogen is used for PC patients, as ADT. I thought that kind of therapy is not used anywhere anymore in the world as chemical castration but rather GNRH agonists or antagonists.
Hi, patients are NOT cured with androgen deprivation therapy (ADT), it is used either as adjuvant therapy to radiation/surgery or as solo therapy to keep prostate cancer silent via lowering the testosterone level. Estrogen in the form of DES has been used similar to ADT but is not accepted as standard of care due to side effect profile.
buggies100
New Member
Dr Rotman,
i am 54 and have been on t cyp flr almost 3 years. I had to come off early feb as my hct had reached very high levels. Since i have been off and done several blood donations, things are lookimg good. The interesting thing is that 2 weeks afo my total t had come up to 364 and LH at 3.4. I was running about mid 400 when i was on 200mg every two weeks.
i meet my trt dr soon. I was wondering if there is a possibility that a clomid/hcg protocol might boost my endogenous T up high enough to not need T cyp. I can go back on T shots and manage with donations, but if i can support it otherwise that might be easier on my system than constant donations.
I do not see too many success stories with such a protocol
i am 54 and have been on t cyp flr almost 3 years. I had to come off early feb as my hct had reached very high levels. Since i have been off and done several blood donations, things are lookimg good. The interesting thing is that 2 weeks afo my total t had come up to 364 and LH at 3.4. I was running about mid 400 when i was on 200mg every two weeks.
i meet my trt dr soon. I was wondering if there is a possibility that a clomid/hcg protocol might boost my endogenous T up high enough to not need T cyp. I can go back on T shots and manage with donations, but if i can support it otherwise that might be easier on my system than constant donations.
I do not see too many success stories with such a protocol
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