Beginner , TRT with Anastrozole and Enclomiphene

[tnap]

This isn’t a common occurrence, it’s questionable whether clomid will do anything while on TRT, because TRT has a strong suppressive effect on your HPTA.

Your protocol is terrible with regards to the aromatase inhibitor, 1 mg AI per week when you had low estrogen pre-treatment, is a recipe for disaster. A lot of men run higher on the estrogen on TRT and not everyone is going to have a problem.

So prescribing an AI right away before they are problems is just plain wrong.

The clomid has synthetic estrogen that competes for the same receptor as estrogen, even particularly blocking the effects of estrogen. Clomid has a bad side effects profile and may prevent you from experiencing symptom relief on TRT.

Normally when guys on TRT want kids, TRT is stopped and clomid is started, or hCG and FSH are added to the TRT protocol. This is how it’s been done for decades.

This TRT clinic is just trying to increase profits by prescribing these drugs alongside TRT.

Excellent advice.

 

[Cataceous]

... The majority of men have mixed hypogonadism, a combination of secondary, primary failure but is still classified as secondary.

In eight years of studying this field I have never run across this claim. Can you provide any evidence, or did you just make it up? Can you point to anyone who has been definitively diagnosed with both? A guy unlucky enough to have both conditions would have low gonadotropins, which would mask the primary hypogonadism. Only if the secondary hypogonadism were corrected would the primary condition be detected.

 

[tareload]

did you just make it up?

WTF? GREAT question!

Testosterone Okay, Other Values Puzzling: Opinions, Please

I am 51 years old, fit, and physically active. BMI is 19.3. Body fat is 9.8%. Health is okay, but I am quite thin and the hardest of "hard gainers" in the gym. Sleep is rather poor (3-6 hours a night). Blood pressure is borderline high (134/80). I am going through a divorce and stressed about...

www.excelmale.com

How many patients have you "seen" Dr. @Systemlord ? ROFL.

 

[Systemlord]

In eight years of studying this field I have never run across this claim. Can you provide any evidence, or did you just make it up?

Hypogonadism and metabolic syndrome - Journal of Endocrinological Investigation

Background: The relationship between metabolic syndrome (MetS), male hypogonadism and their possible interaction in cardiovascular (CV) risk stratification are not completely understood. Aim: We reviewed relationships between testosterone (T) and MetS emphasizing their possible interaction in...

link.springer.com

A mixed (primary and secondary) hypogonadism could be then considered one of the many adverse consequences of overweight and obesity.

Index 15:49 ->70% of men with unknown cause of low-T, have metabolic syndrome/obesity

 

[tareload]

Hypogonadism and metabolic syndrome - Journal of Endocrinological Investigation

Background: The relationship between metabolic syndrome (MetS), male hypogonadism and their possible interaction in cardiovascular (CV) risk stratification are not completely understood. Aim: We reviewed relationships between testosterone (T) and MetS emphasizing their possible interaction in...

link.springer.com

Index 15:49 ->70% of men with unknown cause of low-T, have metabolic syndrome/obesity

claim

The majority of men have mixed hypogonadism, a combination of secondary, primary failure but is still classified as secondary

Care to answer the question posed?

Textbook use of ....

Association fallacy - Wikipedia

en.m.wikipedia.org

 

[tareload]

Draw the Euler diagram for tonight's homework:

Euler diagram - Wikipedia

en.m.wikipedia.org

 

[Cataceous]

A mixed (primary and secondary) hypogonadism could be then considered one of the many adverse consequences of overweight and obesity.

The linked abstract says nothing of the sort. What you fail to mention about the video is that the 70% of hypogonadal men with diabetes, obesity or metabolic syndrome are already in the subcategory of secondary hypogonadism, with no mention of concurrent primary. If overweight and obesity had substantive links to primary hypogonadism then you'd think they would make the lists of causes. Still awaiting tangible support for your claim.

Causes of primary hypogonadism include:

• Certain autoimmune disorders
• Genetic and developmental disorders
• Infection
• Iron excess (hemochromatosis)
• Liver and kidney disease
• Radiation (to the gonads)
• Surgery
• Trauma

Acquired conditions that affect your testicles and can lead to primary hypogonadism include:

• Testicle injury or removal.
• Orchitis, which is inflammation of one or both testicles. This is most often the result of a bacterial infection, such as a sexually transmitted infection, but it can be due to viral infections, such as mumps.
• Chemotherapy or radiation therapy to your testicles.
• Certain types of tumors.
• Anabolic steroid use.

1,2

 

[Fortunate]

My intuition tells me that secondary is more common than primary because of our unhealthy society. Does anyone happen to know? Just curious.

 

[Systemlord]

My intuition tells me that secondary is more common than primary because of our unhealthy society.

Mixed hypogonadism is still considered under the secondary category, too many men come here with low to mid normal LH and low-T.

Men with Type 2 diabetes have lower gonadotropin-releasing hormone secretion, you would think this is the case with obesity which is a form of metabolic syndrome.

The majority of men with secondary hypogonadism show nothing wrong with the pituitary.

 

[Cataceous]

My intuition tells me that secondary is more common than primary because of our unhealthy society. Does anyone happen to know? Just curious.

Speculation: There are multiple avenues for negative feedback at the hypothalamus, providing more opportunities for inappropriate signaling. Or perhaps the relevant brain areas could be viewed as more fragile than the gonads.

Mixed hypogonadism is still considered under the secondary category, too many men come here with low to mid normal LH and low-T.
...

You have yet to show where "mixed hypogonadism" is defined in the literature, let alone exists as a common condition. It's like creating a new condition called "coldflu" that occurs when you happen to have cold and flu viruses simultaneously. Then without evidence you claim that "coldflu" is more common than a cold or flu alone.

 

[tareload]

some case reports.

Myotonic dystrophy type 1 with diabetes mellitus, mixed hypogonadism and adrenal insufficiency - PMC

Myotonic dystrophy type 1 (DM1) is an autosomal dominant multisystem disease affecting muscles, the eyes and the endocrine organs. Diabetes mellitus and primary hypogonadism are endocrine manifestations typically seen in patients with DM1. ...

www.ncbi.nlm.nih.gov

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2265.2011.04161.x

 

[tareload]

Speculation: There are multiple avenues for negative feedback at the hypothalamus, providing more opportunities for inappropriate signaling. Or perhaps the relevant brain areas could be viewed as more fragile than the gonads.

Elevated Body Mass Index Is Associated with Secondary Hypogonadism among Men Presenting to a Tertiary Academic Medical Center

Masterson JM, et al. World J Mens Health. 2019 Jan;37(1):93-98. https://doi.org/10.5534/wjmh.180047

wjmh.org

 

[tareload]

Fun plot:

Prevalence of hypogonadism in males aged at least 45 years: the HIM study - PMC

The Hypogonadism in Males study estimated the prevalence of hypogonadism [total testosterone (TT) <300 ng/dl] in men aged ≥45 years visiting primary care practices in the United States. A blood sample was obtained between 8 am and noon and assayed ...

www.ncbi.nlm.nih.gov

Nice to see all those 1500 ng/dl natty beasts!!

 

[tareload]

Hypogonadism and metabolic syndrome - Journal of Endocrinological Investigation

Background: The relationship between metabolic syndrome (MetS), male hypogonadism and their possible interaction in cardiovascular (CV) risk stratification are not completely understood. Aim: We reviewed relationships between testosterone (T) and MetS emphasizing their possible interaction in...

link.springer.com

Index 15:49 ->70% of men with unknown cause of low-T, have metabolic syndrome/obesity

From the paper you referenced. If behind a paywall you have to call out the relevant portion. Authors speculate on existence not that it is most prevalent form.

 

[Cataceous]

It is true that untreated diabetes can mess a guy up in many ways.

The metabolic disorders caused by diabetes can lead to various complications, including dysfunction of the male reproductive system. In patients with diabetes, long-term hyperglycemia results in diabetic vascular neuropathy, oxidative stress injury, abnormal zinc metabolism, and insulin resistance syndrome. In addition, insulin deficiency and resistance in diabetes can damage the hypothalamus, pituitary gland, gonads, and perigonads. This can reduce the secretion of sex hormones including gonadotropin-releasing hormone, follicle stimulating hormone, luteinizing hormone, and testosterone, and can lead to testicular atrophy, stromal cell atrophy, seminiferous tubule damage, spermatogenic cell damage, and other structural injuries of the male reproductive organs. ...​

[R]

Interestingly, "Metformin ameliorates testicular damage..."[R]