Should I do TRT?

[calmcalmcalm]

Hematocrit will increase within 1-3 months and can take on average 9-12 months to stabilize
.
Trust me when I tell you that donating blood too frequently to control elevated hemoglobin/hematocrit is a bad move as you will surely just end up crashing your ferritin/iron which can lead to a host of other issues.

Even then weekly dose of T used and what overall TT/FT levels will have the biggest impact on increased RBCs/hemoglobin/hematocrit.

What should you do if your hematocrit is high while having low ferritin/iron?

 

[calmcalmcalm]

Are you sure about that?

Defy does offer it.

So jumping on trt is not the same as in both cases we are replacing hormones through exogenous T and the kicker is Natesto will not shutdown the hpta!.....This seems more like a temporary fix instead of fixing the main root of the problem.

Im curious, if thats the case then why aren't Natesto more widely prescribed or recommended by Dr Saya? If it can be used for long term fix, why not just prescribe Natesto instead of prescribing his patient with TRT? I believe he is more knowledgeable than anyone on the forum.

 

[fifty]

That’s a great question.

 

[calmcalmcalm]

Did Dr Saya offer you Natesto or did he offer the testosterone injections or both?

He immediately asked me if I was comfortable with TRT and I said yes. No mention of Natesto whatsoever, and I believe if Natesto can work for my situation Dr Saya would mention it to me instead of telling me to do the TRT route.

 

[fifty]

The cynic in me would ask: Is Empower nasal gel just their normal testosterone cream (100mg/ml) in a different dispenser with a skyrocketed price?

 

[Cataceous]

Natesto and Empower's imitation thereof are relatively new products. There may be some hesitation in prescribing such treatments when there's not much clinical experience. I can understand why they might wait for volunteers to ask for it.

The cynic in me would ask: Is Empower nasal gel just their normal testosterone cream (100mg/ml) in a different dispenser with a skyrocketed price?

The price is $65 for 3 mL @ 5 mg T/0.05 mL. That could get pricey if you really need six pumps a day.

 

[madman]

Im curious, if thats the case then why aren't Natesto more widely prescribed or recommended by Dr Saya? If it can be used for long term fix, why not just prescribe Natesto instead of prescribing his patient with TRT? I believe he is more knowledgeable than anyone on the forum.

Natesto is still fairly new to the market.

Injectable esterified testosterone has been used for decades.

Injections, pellets, patches, transdermal (gels/creams) have a long history of use.

The major downfall of Natesto is that it would not allow one to attain very high TT/FT levels and when it comes to trt some men will do well with TT in the 600-800 ng/dL range and others tend to need higher levels 800-1200ng/dL to feel optimal.

You mean Dr. Saya.....who knew lol!

 

[madman]

If one could truly feel optimal long-term using Natesto than it would be a no brainer!

Unfortunately when using all other trt methods although we are replacing physiological levels of hormones through the use of exogenous T unfortunately we are shutting down the hpta which may very well end up have long-term detrimental effects.











Findings from the study demonstrated that 95% of men treated with NATESTO® for hypogonadism for three and six months, maintained their semen parameters within the normal range while increasing serum testosterone levels to normal and improving hypogonadal symptoms. This is the first such study to demonstrate conclusively that a testosterone replacement therapy (TRT) can maintain key fertility parameters in hypogonadal men. Researchers attributed these findings to NATESTO®’s fast absorption and unique dosing schedule designed to produce fluctuations of testosterone levels in the bloodstream.




“For the first time, a testosterone replacement therapy has been proven to increase serum testosterone while actually maintaining sperm concentration, motility, and total motile sperm count,”


In between NATESTO® doses, all patients in the phase 3 study maintained their natural testosterone at the same levels they had prior to entry into the study, indicating that NATESTO® does not suppress natural testosterone production




*Based on the data, Acerus believes that the mechanism of action of NATESTO® is unique whereby the peaks in testosterone generated by NATESTO® dosing provide efficacy and improvement of symptoms, while the time between doses (4-8 hours) allows for the maintenance of testicular testosterone production and sperm production.


*The release of testosterone with NATESTO® is pulsatile - closely matching the body's "natural" testosterone release. Consequently, NATESTO® does not suppress a man's natural testosterone level, but simply adds to it to achieve a normal, safe level of testosterone.

 

[madman]

 

[fifty]

My questions are:

1) How is Natesto different from testosterone cream?

2) Why would I pay $65 for a 300mg testosterone bottle of Empower nasal gel (or $280-$840 for Natesto) when I could pay $75 for a 6000mg testosterone bottle of testosterone cream and rub it inside my nose?

 

[madman]

My million dollar questions are:

1) How is Natesto different from testosterone cream?

2) Why would I pay $65 for a 300mg testosterone bottle of Empower nasal gel (or $280-$840 for Natesto) when I could pay $75 for a 6000mg testosterone bottle of testosterone cream?

Would you really want to slap cream in your nasal cavity?

Prop vs Cypionate for E.O.D Injections..

If someone was swapping to more frequent injections (E.O.D) to help keep e2 from spiking as much, would it be better to swap to propionate? From my understanding most of the e2 conversion is from the part of the oil that helps give testosterone prop/eth is longer half life. I mean if you’re...

www.excelmale.com

Natesto is a thixotropic gel that is applied using an applicator that releases the gel through the dispenser pump and is not sprayed.

Natesto uses an ultra-thin layer of bio-adhesive gel which has a thickness comparable to the natural mucus layer in the nose.

*The surge in high physiological levels of testosterone will peak within 45 minutes post-application (half-life 10-100 min).


Purchase the cream and try dosing it out 3X daily.....get back to me on that one!

 

[fifty]

Would you really want to slap cream in your nasal cavity?

Purchase the cream and try dosing it out 3X daily.....get back to me on that one!

Working on it.

 

[madman]

What should you do if your hematocrit is high while having low ferritin/iron?

In most cases, if you are battling elevated RBCs/hemoglobin/hematocrit than your dose of T is too high which would result in too high TT/FT levels.

A dose reduction would be key.

Could even look into injecting more frequently using lower doses of T but even than it is not a given that this will lower hematocrit.

Some men are more sensitive to testosterone than others and may still struggle with elevated hematocrit even on a lower dose of T.

 

[madman]

Working on it.

Can I put that on layaway?

 

[sammmy]

Sammy, how much dhea are you supplementing with? What do you keep your levels at? How was your sexuality before DHEA? What do you mean by endurance, sex or physically?

I do not use DHEA on regular basis because it interacts with my HIV meds and HIV itself and crashes my immunity, like most androgens I've tried. When I used it, it worked at 10-20mg/day, micronized, oral. The lower dose will need several days to accumulate to feel an effect. For me it increases libido, improves anorgasmia/delayed ejaculation, and increases endurance at the gym. I never measured blood level of DHEA and go solely by its effect on symptoms.

Also, I am not on TRT. Testosterone total is normal, free testosterone is 'low normal' due to high SHBG.

 

[Gman86]

I think we are more alike than we think, I was the "health nut" in my social circle as well. Initially, I only tested for my total testosterone and I was a little disappointed thinking that I would get a higher number than I expected since I follow everything in order to optimize my T. As I get to understand this topic further I was surprised my low free T and the high SHBG.

For the high libido before sleep, I am exactly the same as you as well. In my early to mid-teen years, I got mild sleeping issues but thinking about the sex part help me get to sleep real quick. It was not a problem and very manageable but now the anxiety and racing thoughts are getting more frequent.

Can I ask did it help you with your anxiety issues or making you calmer?
Did Dr Saya immediately suggest you start the TRT? What is your dose for EOD injection?
Dr Saya suggested that I start with MWF injection schedule but I think I am doing EOD injection. Have you tried using MWF injection in comparison to EOD injection? Is it the extra injection? Also, where is your injection site? With EoD injections, I assume we have to find a spot convenient enough since we will be injecting it more frequently. I am considering the deltoid muscle or love handle area, but is it okay to rotate only between 2 sites? so let's say only left and right love handles or only right deltoid and left deltoid?

Again thank you for your input man! This is the only helpful input so far

I honestly didn't really have much anxiety before going on HRT, and I've always been a very calm and zen and laid back person. But when my levels dropped, I just couldn't deal with anything. Everything seemed so much harder than it really was, and I would get stressed out very easily, and was very irritable. HRT allowed me to get back to my baseline, and I think had increased my confidence a bit above baseline, and one thing it has definitely done is make me an eternal optimist. Prior to HRT, I didn't really have depression really, but I would get pessimistic about things going on in my life. There's positives and negatives in every single situation in life, it's just a matter of what you focus on. Prior to HRT, even before my levels dropped, my brain would sometimes get the best of me and focus on the negatives, and it would really bum me out and kind of give me a sense of doom and gloom for a bit. I don't think I would call it depression, but just feelings that definitely didn't feel good, and it would happen every so often. On HRT, I have zero depression, zero anxiety, and zero pessimism. I never ever get those feelings anymore, and 100% of the time my brain focuses on the positives. Even when crappy things happen now, my brain just brushes them off and focuses on the positives and just tells me everything's gonna be alright, and to not even worry about it. It's definitely my favorite benefit that I've received from going on HRT. The negative things in my life are obviously still there, but my brain just totally ignores them, and I never get bummed out anymore. Just always in a good positive mood.

So I would say HRT has made me slightly calmer. Everything just rolls off my back now. I was pretty much like this my whole life though. I would say HRT just increased my level of calmness and ability to not let anything get to me, and has definitely made my mood and how i deal with life and people much more consistent, which has been awesome. HRT is going to mix with each person's physiology and personality, and therefore probably give every person slightly different results. These are just some of the things that I've personally experienced. Obv results will differ person to person.

I've never done M, W, F injections. I've only ever done EOD or ED injections. EOD is my sweet spot. Ya it would basically be one extra injection per week I guess. The injections don't bother me at all though. I use a 1/2" 27 gauge insulin syringe. I've only ever injected into my thighs. Been injecting into my thigh muscles for years now, never had an issue. I try to keep it to like the outer part of my thighs I guess u would call it. The top of the thigh has more fat that the outer part. So I just try to inject where there's less fat, and can get deeper into the muscle. I use both thighs, and inject all up and down them, as to not inject in the same spots all the time. I just sit down, inject my testosterone in on thigh, and the nandrolone in the other thigh.

I had been through so many protocols prior to signing up with Defy. Tried HCG mono therapy, Clomid mono therapy, Clomid and Nolvadex together, basically everything but testosterone, and just couldn't get dialed in. So by the time I got to Defy, Dr. saya knew that the only thing left to try was testosterone. So he recommended I start with a test and HCG protocol. I was around 30 years old by the time I got to Defy.

 

[Gman86]

What should you do if your hematocrit is high while having low ferritin/iron?

Lower your dose a bit, or wait it out and see if HCT stabilizes. As long as ur platelets aren't too high, ur HCT can go up to around 55 without causing any issues. You don't want to keep it there longterm, but having HCT up to 54-55 won't be an issue while u see if it will stabilize overtime. Again, as long as ur platelets aren't also elevated. You definitely don't want to donate blood too often. Tanking ferritin is no fun. Ferritin is easy to tank, and takes forever to raise back up. Donating every few months will 100% tank ur ferritin levels. I would say the average guy on TRT shouldn't donate more than 2-3x/ year.

 

[TucsonJJ]

I do not use DHEA on regular basis because it interacts with my HIV meds and HIV itself and crashes my immunity, like most androgens I've tried. When I used it, it worked at 10-20mg/day, micronized, oral. The lower dose will need several days to accumulate to feel an effect. For me it increases libido, improves anorgasmia/delayed ejaculation, and increases endurance at the gym. I never measured blood level of DHEA and go solely by its effect on symptoms.

Also, I am not on TRT. Testosterone total is normal, free testosterone is 'low normal' due to high SHBG.

What is low normal, if you don't mind? Mine has been 5.2ng/dl for years... SHBG is at high end of range. I started TRT, 100mg/wk, 4 weeks ago and feel like crap after 4 weeks, so will probably stop. No major symptoms, low libido/motivation, minor ED... I'm 64, so maybe no biggie... my bad side effects are scaring me.

 

[sammmy]

My test levels actually depend on the HIV drug I am on. On HIV drugs that do not boost LDL, typical free testosterone is 62 pg/mL (Quest Diagnostis by Dialisys range 35-155 pg/mL). This is equal to 6.2 ng/dL but free testosterone values are comparable only by the same lab. If not by Quest Diagnostics, the best you can do is look where in their normal range you stand.

On HIV drugs that boost LDL (Intelence), my free testosterone gets in the middle of the normal range, around 85 pg/mL (same test by Dialisys). That small boost in free testosterone correlates with improvement of sexuality and orgasmic ability (I have delayed ejaculation problem in general). No improvement in energy levels, depression, confidence, sleep, or working out. So getting optimal levels of free testosterone acts mainly on sexuality. To get any other effect, you will have to jack it up probably.

 

[TucsonJJ]

I am no expert... but Free T levels are what they are... what differs... are the ranges that different labs present as "normal"... Lab Corp normal is much higher than Sonora Quest... the two I have used... IMHO, your Free T is LOW. Most pros online claim that the desired "sweet spot" for Free T is 15-20ng/dl... yours is 6.2 or 8.5ng/dl... to me, that is low.
BTW: I had high LDL... didn't want to go on statins, so I tried red palm oil concentrate 100:1 from Swanson vitamins and my LDL dropped like a rock.
2nd BTW: I wonder if your HIV anti-virals make you bulletproof against COVID?