Royal Men’s Medical destroyed my Estradiol!!! Beware!!

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720 is a misleading number while on injectable T. There is a significant difference in the T level from day 1 after the injection to days 7-10, so I am unsure what day your level was drawn after your previous injection. Nonetheless, that's the problem I see with injectable T. The values go supraphysiologic right after the injection to what I would consider low (720) at day 7-10 ( a roller coaster effect). The free T is the number you should be focusing on, but at 720 total it would not be that great. I only use a compounded cream applied 2x per day at a 200mg/gm concentration which is the strongest concentration you can make due to it crystallizing at any higher concentration ( 10x the concentration of androgen) Dosage is adjusted based on symptom improvement, but I can tell you most men in our clinic feel best around 1500 with a free T between 40-50. The cream maintains a constant level around 1500 without the rolller coaster effect seen with injections and without the high spikes in E2. . Injections also cause a adverse effect on your lipid profile that the transdermal cream does not.
Now with E2, you do not want to block it. We don't even measure it in our male patients any longer as all studies where E2 is blocked it is harmful to men. If you develop mastalgia or then we give a AI for a few weeks until symptoms resolve and then it is discontinued. Have not had to do this in hundreds of patients. E2 is just as important o men as it is for women, we just don't need as much. It is vital for cognition, protection of Alzheimer's disease, sexual function, Bome strength, decreased visceral body fat, cardiovascular protection, and very importantly it is apoptotic to prostate cancer cells. It helps protect the prostate. If fact, it used to be used for the treatment of prostate cancer before casodex and lupron. In studies that show cardiovascular harm with high estradiol level they are baseline studies. The men died of heart attacks secondary to their obesity and other risk factors for MIs. Their E2 was high from the obesity but the E2 got blamed but it was a passive bystander. Now look at the interventional studies where men are actually give T (>E2) and don't block E2 and there is only beneficial effects. The increase in E2 from obesity is quiet different from raising E2 with TRT.
Lastly, a lot of the confusion comes from the bodybuilding community where T is abused in extremely high doses. This is not medical TRT. The T abuse will result in E2 levels that a premenstal women would have and the subsequent symptoms which would require a AI. Medical TRT and performance enhancement T abuse are apples and oranges. If you are on medical TRT based on evidence based medicine by a well trained physician, then quit worrying about your E2 levels. The higher the better for the reasons mentioned abone. If you are one of the few that develop mastalgia then take a AI for a short time until symptoms resolve. My E2 was 75 when I checked it last just to make sure it was in that range and not in the lower range. When you were 20-25 your E2 was anywhere form 50-75 or so and you were probably doing great.
Bottom line....don't block your estrogen
 
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Defy Medical TRT clinic doctor
720 is a misleading number while on injectable T. There is a significant difference in the T level from day 1 after the injection to days 7-10, so I am unsure what day your level was drawn after your previous injection. Nonetheless, that's the problem I see with injectable T. The values go supraphysiologic right after the injection to what I would consider low (720) at day 7-10 ( a roller coaster effect).

With all due respect Dr, this can easily be fixed by shortening the frequency of injections. E3.5D is common by the most informed clinicians, and for good reason, it allows levels to remain within a tight range while maintaining the lowest cost, inconvenience, and best absorption rate.

but I can tell you most men in our clinic feel best around 1500

So you're not a fan of injections because levels can transiently rise above physiological range(with no mention of adjusting frequency) but support supraphysiological levels from transdermals??

Injections also cause a adverse effect on your lipid profile that the transdermal cream does not.

How can that be?

We don't even measure it in our male patients any longer as all

E2 is just as important o men as it is for women

So you don't even measure E2 but claim it's important?

The increase in E2 from obesity is quiet different from raising E2 with TRT.

How so?

If you are on medical TRT based on evidence based medicine by a well trained physician, then quit worrying about your E2 levels. The higher the better for the reasons mentioned abone

That is most certainly not the case for many men on these boards, and will not be a popular opinion here.

When you were 20-25 your E2 was anywhere form 50-75 or so and you were probably doing great.

I have never seen a study that indicates E2 levels are 50-75 in 20-25 year old men, and I doubt you'd be able to provide a source for this unsubstantiated claim.

I am concerned for your patients.
 
If you want low HDLs then do injections. If yo want to improve your lipid profile then do transdermal. That's evidence based medicine and supported in the literature. If you want fluctuating levels do injections. We have measured levels from day 1 to day 14 daily with injections and you see a roller coaster effect. I'm not knocking injections it's just that there is actually a better way with more consistent levels and just as good of absorption. With regard to levels, we are aiming for the high range of normal (in a young male) using the free T level. We usually do not see those levels obtained until the total is in the 1500 or so range. I'm not treating 20 year olds. We are treating men 40 and older. We're also treating symptoms. We don't measure E2 because we don't need to. If your free T is in a optimal range then your E 2 is going to be just fine. If you were following evidence based medicine you would not be asking about the difference in lipid profiles. Everything I posted is directly from the medical literature. Please provide me with just one radomized control trial where blocking estrogen was good. Just one. I can gladly show you how bad it is to block it. My patients love their T to be optimal 24/7 and understand the importance of not blocking estrogen. They are provided with the literature on why transdermal over injectables, the danger of blocking E2, and what optimal is. You guys are so focused on a number. There is no magic number. If my patients symptoms resolve and their free T is high so be it. Their total may be 1800. I'm treating the patient and their symptoms. You keep drinking this cool aid that keeps getting propagated without the medical literature to support it. Look at the newest you tube video by excel male with the urologist. He is totally wrong on reporting the dangers of estrogen. He uses the womens health initiative where they used Premarin and provera. None of the adverse effects he cites has ever been found in any RCT to date with E2.
Im just telling you what the medical literature says. Sorry if if differs from what you have been told.
 
If you want low HDLs then do injections. If yo want to improve your lipid profile then do transdermal. That's evidence based medicine and supported in the literature. If you want fluctuating levels do injections. We have measured levels from day 1 to day 14 daily with injections and you see a roller coaster effect. I'm not knocking injections it's just that there is actually a better way with more consistent levels and just as good of absorption. With regard to levels, we are aiming for the high range of normal (in a young male) using the free T level. We usually do not see those levels obtained until the total is in the 1500 or so range. I'm not treating 20 year olds. We are treating men 40 and older. We're also treating symptoms. We don't measure E2 because we don't need to. If your free T is in a optimal range then your E 2 is going to be just fine. If you were following evidence based medicine you would not be asking about the difference in lipid profiles. Everything I posted is directly from the medical literature. Please provide me with just one radomized control trial where blocking estrogen was good. Just one. I can gladly show you how bad it is to block it. My patients love their T to be optimal 24/7 and understand the importance of not blocking estrogen. They are provided with the literature on why transdermal over injectables, the danger of blocking E2, and what optimal is. You guys are so focused on a number. There is no magic number. If my patients symptoms resolve and their free T is high so be it. Their total may be 1800. I'm treating the patient and their symptoms. You keep drinking this cool aid that keeps getting propagated without the medical literature to support it. Look at the newest you tube video by excel male with the urologist. He is totally wrong on reporting the dangers of estrogen. He uses the womens health initiative where they used Premarin and provera. None of the adverse effects he cites has ever been found in any RCT to date with E2.
Im just telling you what the medical literature says. Sorry if if differs from what you have been told.

If you want low HDLs then do injections. If yo want to improve your lipid profile then do transdermal. That's evidence based medicine and supported in the literature

What literature? You can't just refer to it without citing it. I even cited evidence that is opposite of your alleged evidence.

We have measured levels from day 1 to day 14 daily with injections and you see a roller coaster effect.

You're creating quite the straw man here, I agree, E14D injections are horrible. That's not what I'm advocating, and you seem to have ignored most of my talking points, including the ones where I reference "E3.5D" injections.

we are aiming for the high range of normal (in a young male) using the free T level

Right, but on what range? Labcorp's free testosterone range is usually 9-26 or so depending on age, 40-50 is significantly above range. There are a few others, one with a range of 50-150 or so, but I doubt you'd be "aiming" for 40-50 on that range.

Calculated free testosterone ranges are usually 9-26 as well.

We don't measure E2 because we don't need to. If your free T is in a optimal range then your E 2 is going to be just fine

I am not sure how to respond to this. There are many members here, including physicians(Dr. Saya help) that will directly support this not often being true.

If you were following evidence based medicine you would not be asking about the difference in lipid profiles

So instead of showing me this evidence, you mock my questioning of it?

Everything I posted is directly from the medical literature

You keep saying this, but have yet to post ANY of this evidence.

Please provide me with just one radomized control trial where blocking estrogen was good. Just one

Now you ask me to post evidence, while not posting any yourself, of a notion I never supported? You are quite the logical person...

You keep drinking this cool aid that keeps getting propagated without the medical literature to support it

You're becoming a little hostile here, this is common with lackofevidencitis, a known condition that invariably leads to cognitive decline in most that are not treated. A common symptom of it is to not be aware of one's disease state.

Im just telling you what the medical literature says. Sorry if if differs from what you have been told

Can you show me this medical literature?
 
Different opinions are welcome. Personal antipathy is not. Please,lower the temperature of the discussion while maintaining an exchange of opinions.
 
Different opinions are welcome. Personal antipathy is not. Please,lower the temperature of the discussion while maintaining an exchange of opinions.

I am open to different opinions, but not in spite of all known evidence, while stating my claims aren't evidence supported.

Plus straw man arguments are used by those who cannot refute the original point. My intentions aren't to create a fight, rather they are asking for evidence.
 
The cream maintains a constant level around 1500 without the rolller coaster effect seen with injections and without the high spikes in E2.

My own N=1 trial with 20% compounded cream resulted in supraphysiological levels 2 hours after application dropping down to about half that 8 hours after application.

I guess everyone in different.

Since switching to every other day injections I've seen much less variability.
 
I think I remember correctly Nelson saying once that teen males can have estradiol in the 70-80s. If he could post a link to that article it would be interesting to read.
 
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 administering IM T to men which significantly raises E2 levels , there is not a study which showed the harm of raising E2. Also, what study has showed benefit to lowering E2 levels? None. The harm is when E2 is blocked. NEJM 2013 Sep 12:369(11): 1011-1022 "Gonadal steroids and body composition, strength, and sexual function in men". There are 2 ways to lower estrogen 1. Aromatase inhibitors 2. Androgen deprivation therapy. I could fill several pages on the negative effects of ADT which totally wipes out both T and E2 (google it). It is used in the treatment of prostate cancer. These men then develop osteoporosis, sexual dysfunction, obesity, insulin resistance, diabetes, metabolic syndrome, cognitive dysfunction, dyslipidemia, and a significantly increased risk of cardiovascular mortality. If they don't die of prostate cancer we kill them in another way and believe me these men want to die because their quality of life is zero. When these men are treated with E2 it dramatically improves their quality of life. They don't become osteoporotic, their lipid profiles remain good, the have imporoved cognition, and they maintain the cardioprotective effects of estradiol. Also, E2 is apoptotic and anti angiogenic to prostate cancer cells. E2 has just as many important functions in men as it does women...we just don't need as much.
Next issue, method of delivery. I have no problems with the differing methods of delivery. I have used pellets, injections, gels, and compounded creams in myself and my patients. There are some studies that show no effect and some that show a negative effect on HDLS with injections: Clinical journal of sports medicine 1996 jul; Vol 6 "Changes in lipoprotein-lipid levels in normal men following administration of increasing doses of testosterone cypionate". I am not anti injections but just like with so many other treatments there is sometimes a better way. I treat numerous men each week who are on injections. They are all skeptical at first but most are referred in from their male friends. Once they make a switch to our method of delivery I have not had a single patient go back to injections. Let be say again I am not anti injectable T. I will give it if they want. I use a 200mg/gm compounded cream in a HRT base (or lipoderm) and it is applied BID to the testicles (yes I said testicles as there is 4-5x greater absorption). I treat symptoms and adjust dose until symptom improvement. I aim for optimal...not normal. Normal is basically the average for a population of sick people that a pathologist at a lab randomly assigns. Do you think with these lab values they go out and test only the most healthy in shape people? All of my male patients have a free T from 30-50 some even higher depending on their optimal. This usually correlates with a total of 1500-2000 .I use LabCorp but not too long ago they changed their reagent where you could not get a accurate free T level. We specifically order a T free/total equilibrium ultra filtration test so I get a actual number. Labcorps normal range" is basically 5-21. Everyone gets caught up in a number and I am treating patients and optimizing their T levels. Not one single patient has had to take a AI. Their levels are consistent day to day and the only way that could be reproduced with injections is with daily low dose injections. So get T the way you can, but also be open to alternative methods. Find a MD that is not caught up in a number on a piece of paper but instead is focused on your symptoms and optimizing your levels to what works best for you. I'll ask anyone on this board would you rather be normal or optimal?
There is another subject that I will address in the near future and that is the issue of polycythemia. T DOES NOT cause polycythemia. It causes a physiologic erythrocytosis just like what occurs at high altitude. That is why our Olympic training center is at high altitude...to take advantage of the erythrocytosis. Polycythemia Vera is a blood disorder where there is a increase in all blood components...most importantly is the increase in platelets which clot. TRT does not cause a increase in platelets. There is absolutely no need to donate blood due to your erythrocytosis. It is not PV. Measure anyone's blood that lives at high altitude and they will have a high H/H. Patients with COPD have high H/H and we are not bleeding them. This is just another one of the falsehoods that gets propagated like blocking estradiol.
 
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I am glad you joined us, Dr. Nichols. I agree with your comments on estradiol. You have probably seen my videos and articles in which I say that most men should not be taking an AI on TRT. It is a myth that has been hard to stop even after 5 years of my trying to educate men!

I have coached men using creams as you described and they are doing great.

We can start a new thread to discuss your comment on erythrocytosis. We started a thread here a few months ago:

Dr Crisler Now Says No Blood Donation is Needed When Hematocrit is High

By the way, guys, here is some info on Dr Nichols (maybe he can expand a little for us to get to know more details about his work)
http://www.t1institute.com/physicians-Nichols.php
 
Thanks so much. The only reason I joined your website is that you are one of the few that seems to get the big picture. We all should continue to learn and grow and be willing wo change our way of thinking if the medical evidence supports a change in what we have been previously taught. Once we learn something one way it is just human nature to resist any change . It's the world is flat mentality. I am glad you understand the importance of estradiol in men (and women) and that is why I am here. Your last video with the urologist was unfortunately not good in promoting maintaining estradiol levels in men. Not from you but from the urologist. He mistakenly extrapolated the adverse effects with Premarin and provera to estradiol. No RCT to date has shown harm with E2. The problem is that physicians and others use the word estrogen loosely without ever distinguishing between "which" estrogen. They are not the same but they get used interchangeably which is wrong. Premarin is Conjugated equine estrogen (only 15% estradiol) and estradiol is 100%17beta estradiol. The same issue occurs with polycythemia Vera and erythrocytosis. They are not the same but erythrocytosis gets propagated as being the same as PV. I will put the evidence together to support what I am saying and post it on the forum. Google the H/H of a Sherpa. Are they being told to donate blood or dying of blood clots while climbing Mt. Everest? Look at the Tour de France athletes that abused T and epogen. Not one died of a heart attack, stroke, or DVT. The reason is that increasing ones H/H is not polycythemia Vera.
 
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