Newbie confused by prescription, help please

[RobRoy]

If you considering going on TRT which is a potentially lifetime commitment, then this thread really is required reading and guys should spend the time. I've debated sometimes very intensely with Danny Bossa and yeti308 on the other forum and appreciate RayBob providing his thoughts. I wish to continue this constructive dialogue with the TOT folks so that prospective patients can go in informed before they decide how they will start treatment.

With all due respect @RobRoy, I catch a lot of heat for my time on the forums and if I chose to disclose who I am or what I do then you'd understand I don't have a lot of time for the forums either. But I make time for the persons who want a better understanding of the details. So thanks to all the guys who make the time!

I hope you get your money's worth @JimBob. I think you have both here and at the other forum. Best wishes.

Everyone knows who you are Joseph Hearnshaw

 

[tareload]

Everyone knows who you are Joseph Hearnshaw

Wow, I don't know this guy. Had to look him up. I'm hurt @RobRoy, he only has a MSc. I kid, I kid.

I'll have to review his body of work.

 

[JimBob]

@JimBob — It's a long thread, but worth skimming to read some of Dr. Saya's concerns about this non-physiological dosing:

Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?

Let's try to clear up some confusion here. No need to debate what the E2 level in a young male going through puberty would be but yes it can run >70. This is not the point. The point is that a level of 70 is not harmful to men. The harm to men is with blocking estrogen. After 50 years of...

www.excelmale.com

I remember this mega-thread. I'll revisit it. More reason I think to consult Dr. Howell.

 

[tareload]

I remember this mega-thread. I'll revisit it. More reason I think to consult Dr. Howell.

Tell Scott I said Hi! And tell him when he gets time to go refute my Hct thread over at T-Nation or the one on here. I'd love a practitioner in the TOT field to provide constructive feedback on the pro/con discussion I reviewed on elevated Hct.

@RobRoy , come on, I can't be this guy, I've been very consistent that there's no definite answer on clotting and Hct. I think @Dr Justin Saya MD covered that pretty well. It's not clotting it's long term wear and tear and endothelial dysfunction. Very different with a young fit guy running high viscosity vs an older more obese gentlemen. Anyway great we can all provide food for thought to interested folks. Have a great night.

Take care everyone and stay safe.

Oh yeah @JimBob , please realize Dr Scott has a PhD (take a read of his dissertation). He is not an MD and thoughtful people with PhDs really don't go by Dr unless they are German or in a lecture hall. It's somewhat misleading to laypersons. Why don't you find an MD who specializes in this area?

 

[RobRoy]

Tell Scott I said Hi! And tell him when he gets time to go refute my Hct thread over at T-Nation or the one on here. I'd love a practitioner in the TOT field to provide constructive feedback on the pro/con discussion I reviewed on elevated Hct.

@RobRoy , come on, I can't be this guy, I've been very consistent that there's no definite answer on clotting and Hct. I think @Dr Justin Saya MD covered that pretty well. It's not clotting it's long term wear and tear and endothelial dysfunction. Very different with a young fit guys running high viscosity vs an older more obese gentlemen. Anyway great we can all provide food for thought to interested folks. Have a great night.

Take care everyone and stay safe.

Wow really. You mean long term like for decades? You mean like the decades Testosterone has been used and hasn’t been shown to cause this? Like Rouzier says there might be a man on Mars but there’s not but people will say there might be but guess what there’s not. You can continue To try to find harm where there’s not the problem S the body of medical literature that spans decades and thousands of studies that doesn’t show it but you can keep trying. Dr. Howell Nora really have time for you we are too busy changing men’s lives while you’re too busy staying on the forums trying to convince them of a danger that doesn’t exist. You completely ignore all the other positive benefits on the bachelor tour with TRT I’m not gonna go into the details because that would be giving you too much information and Dr. Howell’s already written a chapter on it. So you continue to focus on hematocrit as if the human body was a glass viscometer laugh out loud. Please tell us we are now able to review studies were men have been on testosterone for over a decade or more and yet it doesn’t cause hypertension it doesn’t cause blood clots it doesn’t cause strokes in fact it protects against it all. Do you like clinical experience but if you were in a clinic that I’ve been treating men for over a decade or more you would see the positive affects testosterone has at the so-called super physiologic levels. Every parameter of health improves blood pressure goes down, inflammatory cytokines decreased, visceral fat goes away, insulin resistance improves, type two diabetes is reversed and prevented, and the list goes on. But wait a minute less ignore all of that and focus on an increase in hematocrit. You can’t see the forest for the trees and that’s the problem for a lot of guys. You will never get away from the fact that testosterone has been used and abused by millions of men worldwide for decades and none of what
You fear will happen has happened. So this is exactly why Dr. Rouzier never did forums and instructs all of his providers to avoid forms but some of us just can’t help to want to teach but we always learn a lesson in a matter of a day or two. So account deleted

 

[tareload]

Wow really. You mean long term like for decades? You mean like the decades Testosterone has been used and hasn’t been shown to cause this? Like Rouzier says there might be a man on Mars but there’s not but people will say there might be but guess what there’s not. You can continue To try to find harm where there’s not the problem S the body of medical literature that spans decades and thousands of studies that doesn’t show it but you can keep trying. Dr. Howell Nora really have time for you we are too busy changing men’s lives while you’re too busy staying on the forums trying to convince them of a danger that doesn’t exist. You completely ignore all the other positive benefits on the bachelor tour with TRT I’m not gonna go into the details because that would be giving you too much information and Dr. Howell’s already written a chapter on it. So you continue to focus on hematocrit as if the human body was a glass viscometer laugh out loud. Please tell us we are now able to review studies were men have been on testosterone for over a decade or more and yet it doesn’t cause hypertension it doesn’t cause blood clots it doesn’t cause strokes in fact it protects against it all. Do you like clinical experience but if you were in a clinic that I’ve been treating men for over a decade or more you would see the positive affects testosterone has at the so-called super physiologic levels. Every parameter of health improves blood pressure goes down, inflammatory cytokines decreased, visceral fat goes away, insulin resistance improves, type two diabetes is reversed and prevented, and the list goes on. But wait a minute less ignore all of that and focus on an increase in hematocrit. You can’t see the forest for the trees and that’s the problem for a lot of guys. You will never get away from the fact that testosterone has been used and abused by millions of men worldwide for decades and none of what
You fear will happen has happened. So this is exactly why Dr. Rouzier never did forums and instructs all of his providers to avoid forms but some of us just can’t help to want to teach but we always learn a lesson in a matter of a day or two. So account deleted

Come on don't leave. There's room for TRT and all it's positive benefits while also allowing room for caution in terms of blood viscosity. You and I both know there's a big difference between a man with an Hct of 54 with high plasma viscosity vs low plasma viscosity. In fact I have mentioned that TRT may assist inflammatory markers and help plasma viscosity which would counteract the Hct rise. It's complex and individual.

Don't straw man me, we can debate in a friendly, constructive way. Don't delete your account. Let's continue to dialogue.

 

[JimBob]

Tell Scott I said Hi! And tell him when he gets time to go refute my Hct thread over at T-Nation or the one on here. I'd love a practitioner in the TOT field to provide constructive feedback on the pro/con discussion I reviewed on elevated Hct.

@RobRoy , come on, I can't be this guy, I've been very consistent that there's no definite answer on clotting and Hct. I think @Dr Justin Saya MD covered that pretty well. It's not clotting it's long term wear and tear and endothelial dysfunction. Very different with a young fit guy running high viscosity vs an older more obese gentlemen. Anyway great we can all provide food for thought to interested folks. Have a great night.

Take care everyone and stay safe.

Oh yeah @JimBob , please realize Dr Scott has a PhD (take a read of his dissertation). He is not an MD and thoughtful people with PhDs really don't go by Dr unless they are German or in a lecture hall. It's somewhat misleading to laypersons. Why don't you find an MD who specializes in this area?

Yeah, I know who he is. If a person earns a PhD, and goes by "Dr", then he's not thoughtful? A tad bizarre.

Anyway, I am not consulting Howell to manage my hormones. I want an academic who is up on this stuff to give me his take on what we've been discussing here. I'm confident he'll be up to it.

 

[tareload]

Yeah, I know who he is. If a person earns a PhD, and goes by "Dr", then he's not thoughtful? A tad bizarre.

Anyway, I am not consulting Howell to manage my hormones. I want an academic who is up on this stuff to give me his take on what we've been discussing here. I'm confident he'll be up to it.

Here's a good summary if you want a decent review regarding use of the title Dr:

Should Ph.D.s call themselves “doctor” in everyday life?

UPDATE: At the libertarian website Reason, legal scholar Eugene Volokh has a different take, based partly on what he sees as the overly lax and non-scholarly nature of Jill Biden’s Ed.D. ____…

whyevolutionistrue.com

Excerpts...

Judith Martin, better known as the columnist Miss Manners, said her father, who had a Ph.D. in economics, insisted on not being called Dr. and implored his fiancée, Ms. Martin’s mother, to print new wedding invitations after the first version included the title.
“As my father used to say, ‘I’m not the kind of doctor who does anybody any good,’” Ms. Martin said in an interview on Saturday. “He didn’t feel it was dignified. I am well aware that this is a form of reverse snobbery.”

Still, Ms. Martin said, “I don’t tell people what to call themselves and I’m aware that women often have trouble with people who don’t respect their credentials.”

I’m pretty much on board with both her and her father here, though I’d take issue with saying my refusal to call myself “Doctor. Coyne” is reverse snobbery. Rather, it’s part of my lifelong desire not to be seen as better than other people just because I got a fancy education. I remember that when I got my first job at the University of Maryland, I was given an empty lab on the second floor of the Zoology Building. But it was in a box containing all the application folders for everyone who had applied for the job I got. After a few days of resisting, I peeked into my own folder to see my letters of recommendation. And I’ll always remember Dick Lewontin’s letter, which, though highly positive, added something like this, “If Jerry has any faults, is that he is too self-denigrating, always underselling himself.” Well, that may be true, but it’s better to undersell yourself than oversell yourself! I’ve always detested the pomposity of accomplished academics. Other academics think it lends cachet to their books (even “trade books”) by using “Dr.” in the title. More power to them, but I could never bring myself to do that.

One other interesting point: the AP Style Manual agrees with Epstein about the use of “Dr.” According to the Newsweek piece:

The AP stylebook, a writing guide used by major U.S. publications including Newsweek, also suggests that the term doctor should not be used by those with academic doctoral degrees.
Its latest edition reads: “Use Dr. in first reference as a formal title before the name of an individual who holds a doctor of dental surgery, doctor of medicine, doctor of optometry, doctor of osteopathic medicine, doctor of podiatric medicine, or doctor of veterinary medicine.”
It adds: “Do not use Dr. before the names of individuals who hold other types of doctoral degrees.”

So you could say Epstein was adhering to that rule, but the tone of his piece is snarky and condescending. The opprobrium he’s earned for it is largely deserved.

END Excerpt.


I was trying to add a little humor to the thread.

Good luck with your consult! It's commendable you are doing your research, and ask Scott if he agrees with the blanket statement that elevating Hct is harmless.

 

[JimBob]

Here's a good summary if you want a decent review regarding use of the title Dr:

Should Ph.D.s call themselves “doctor” in everyday life?

UPDATE: At the libertarian website Reason, legal scholar Eugene Volokh has a different take, based partly on what he sees as the overly lax and non-scholarly nature of Jill Biden’s Ed.D. ____…

whyevolutionistrue.com

Excerpts...




I’m pretty much on board with both her and her father here, though I’d take issue with saying my refusal to call myself “Doctor. Coyne” is reverse snobbery. Rather, it’s part of my lifelong desire not to be seen as better than other people just because I got a fancy education. I remember that when I got my first job at the University of Maryland, I was given an empty lab on the second floor of the Zoology Building. But it was in a box containing all the application folders for everyone who had applied for the job I got. After a few days of resisting, I peeked into my own folder to see my letters of recommendation. And I’ll always remember Dick Lewontin’s letter, which, though highly positive, added something like this, “If Jerry has any faults, is that he is too self-denigrating, always underselling himself.” Well, that may be true, but it’s better to undersell yourself than oversell yourself! I’ve always detested the pomposity of accomplished academics. Other academics think it lends cachet to their books (even “trade books”) by using “Dr.” in the title. More power to them, but I could never bring myself to do that.

One other interesting point: the AP Style Manual agrees with Epstein about the use of “Dr.” According to the Newsweek piece:


So you could say Epstein was adhering to that rule, but the tone of his piece is snarky and condescending. The opprobrium he’s earned for it is largely deserved.

END Excerpt.


I was trying to add a little humor to the thread.

Good luck with your consult! It's commendable you are doing your research, and ask Scott if he agrees with the blanket statement that elevating Hct is harmless.

When I speak to him, how shall I refer to you? readalot?

 

[JimBob]

Tell Scott I said Hi! And tell him when he gets time to go refute my Hct thread over at T-Nation or the one on here. I'd love a practitioner in the TOT field to provide constructive feedback on the pro/con discussion I reviewed on elevated Hct.

@RobRoy , come on, I can't be this guy, I've been very consistent that there's no definite answer on clotting and Hct. I think @Dr Justin Saya MD covered that pretty well. It's not clotting it's long term wear and tear and endothelial dysfunction. Very different with a young fit guy running high viscosity vs an older more obese gentlemen. Anyway great we can all provide food for thought to interested folks. Have a great night.

Take care everyone and stay safe.

Oh yeah @JimBob , please realize Dr Scott has a PhD (take a read of his dissertation). He is not an MD and thoughtful people with PhDs really don't go by Dr unless they are German or in a lecture hall. It's somewhat misleading to laypersons. Why don't you find an MD who specializes in this area?

What MD do you suggest?

 

[tareload]

When I speak to him, how shall I refer to you? readalot?

Sure or don't refer to me at all. I'm no one, just an internet stranger.

Do show him this video and ask him to point out the errors therein:

Also ask him about the blanket statement I mentioned above...elevating Hct is harmless.

And pin him on WHY without going down the clotting and PCV distractions. Ask him if there are other concerns besides clotting.

Finally, if you start TRT then I hope you don't have to worry about erythrocytosis. However, I find it's a good topic to screen the intellectual curiosity and critical thinking of a potential provider of medical services or advice.

 

[Cataceous]

... The second myth is that you have to control estrogen. No available literature shows that blocking estrogen is beneficial but in fact there is plenty of medical literature to show the harm. The majority of testosterones benefits come From its conversion into estradiol. Dr. Rouzier and physicians like him that treat men and don’t block estradiol don’t have patients with so-called estrogen symptoms. With increasing androgens the androgen to estradiol ratio increases or said another way the Estradiol To Testosterone ratio decreases. That is because there’s only so much aromatase enzyme in each man and there comes a point where the increase in androgens the enzyme is fully saturated and reaches its v max. So estradiol reaches a point that it cannot rise any further because the aromatase enzyme is fully saturated but the androgen level will continue to increase with increasing dosages.
...

So basically an aromatase inhibitor is used to control estrogen, but it's ok because it's a natural one—DHT. Never mind that levels of T, DHT and E2 may end up higher than those seen naturally and non-pathologically.

It would make for an interesting study in long-term safety, comparing a group with these supraphysiological levels of natural hormones to a group with physiological levels who use a synthetic AI as needed to maintain a normal E2:T ratio.

 

[JimBob]

Sure or don't refer to me at all. I'm no one, just an internet stranger.

Do show him this video and ask him to point out the errors therein:

Also ask him about the blanket statement I mentioned above...elevating Hct is harmless.

And pin him on WHY without going down the clotting and PCV distractions. Ask him if there are other concerns besides clotting.

Finally, if you start TRT then I hope you don't have to worry about erythrocytosis. However, I find it's a good topic to screen the intellectual curiosity and critical thinking of a potential provider of medical services or advice.

I will try and fit in a single question for you, but I won't be asking him to watch a video. I only have 30-mins, and he tends to give long, detailed answers.

So, what would be your question?

 

[JimBob]

Here's a good summary if you want a decent review regarding use of the title Dr:

Should Ph.D.s call themselves “doctor” in everyday life?

UPDATE: At the libertarian website Reason, legal scholar Eugene Volokh has a different take, based partly on what he sees as the overly lax and non-scholarly nature of Jill Biden’s Ed.D. ____…

whyevolutionistrue.com

Excerpts...




I’m pretty much on board with both her and her father here, though I’d take issue with saying my refusal to call myself “Doctor. Coyne” is reverse snobbery. Rather, it’s part of my lifelong desire not to be seen as better than other people just because I got a fancy education. I remember that when I got my first job at the University of Maryland, I was given an empty lab on the second floor of the Zoology Building. But it was in a box containing all the application folders for everyone who had applied for the job I got. After a few days of resisting, I peeked into my own folder to see my letters of recommendation. And I’ll always remember Dick Lewontin’s letter, which, though highly positive, added something like this, “If Jerry has any faults, is that he is too self-denigrating, always underselling himself.” Well, that may be true, but it’s better to undersell yourself than oversell yourself! I’ve always detested the pomposity of accomplished academics. Other academics think it lends cachet to their books (even “trade books”) by using “Dr.” in the title. More power to them, but I could never bring myself to do that.

One other interesting point: the AP Style Manual agrees with Epstein about the use of “Dr.” According to the Newsweek piece:


So you could say Epstein was adhering to that rule, but the tone of his piece is snarky and condescending. The opprobrium he’s earned for it is largely deserved.

END Excerpt.


I was trying to add a little humor to the thread.

Good luck with your consult! It's commendable you are doing your research, and ask Scott if he agrees with the blanket statement that elevating Hct is harmless.

As an aside, I just noticed in his email signature the letters "MD" after his name. May I refer to him as Dr now? lol

 

[tareload]

As an aside, I just noticed in his email signature the letters "MD" after his name. May I refer to him as Dr now? lol

News to me....maybe a different Scott Howell? Even Dr. NICHOLS aka RobRoy above mentioned Scott Howell PhD (who he used to work with) didn't have the ability to treat patients.

Call him whatever you like. Good luck.

 

[JimBob]

@JimBob — It's a long thread, but worth skimming to read some of Dr. Saya's concerns about this non-physiological dosing:

Should We Be Managing Estradiol and Hematocrit in Men on Testosterone Replacement?

Let's try to clear up some confusion here. No need to debate what the E2 level in a young male going through puberty would be but yes it can run >70. This is not the point. The point is that a level of 70 is not harmful to men. The harm to men is with blocking estrogen. After 50 years of...

www.excelmale.com

Skip to 1:14 where someone asks Rouzier about problems with elevated DHT. Dr. Saya mentioned a connection between elevated DHT and BPH in that thread on managing estradiol.

 

[goolapsh]

If you don’t mind being bald then scrotal cream is great.

 

[JA Battle]

Correct in qualitative if not completely quantitative way. If you go to the thread I linked above the OP even states the Provider is shooting for 1500-2000 ng/dl TT (he actually provided a copy of the Provider notes) right off the bat. The PK data linked in that thread implies T absorption is not linear with dose and falls off slightly as you go to higher dosages.


View attachment 16104

View attachment 16106


View attachment 16105


Nevertheless, your point is clear and these creams are compounded this way obviously to mimimize the cream applied per application for Providers who like to do "TRT" instead of TRT.


Behold! Doesn't everyone win with the Rouzier/Keith Nichols "TRT" experience? No tradeoffs, just run your TT high.

View attachment 16107

Is there a rough estimation of the daily peaks and troughs from 2x dosing with 50mg?

 

[tareload]

Is there a rough estimation of the daily peaks and troughs from 2x dosing with 50mg?

Graph for scrotal cream:

100 mg Test 1x per day vs 50 mg 2x per day (700 mg/week of Testosterone)

Half life absorption ~ 1hr
Half life apparent elimination ~ 12 hr
Distribution volume ~ 13 kL

 

[goolapsh]

Graph for scrotal cream:

100 mg Test 1x per day vs 50 mg 2x per day (700 mg/week of Testosterone)

View attachment 17753

Half life absorption ~ 1hr
Half like apparent elimination ~ 12 hr
Distribution volume ~ 13 kL

I can verify these are the exact numbers I got when doing 2x vs 1x