POSSIBLE ALTERNATIVE TO TRT?

[belixxx]

Agreed!

Both Torem and Nolva are better choices if one prefers the SERM route.

I do prefer the AI route though, as all the above serms increase real E2 (they themselves also show up as E2 on labs so it makes hard to determine the exact amount of increase), increase SHBG (so lowering Free T to Total T ratio) and have vision sides.

But it is harder to get the dose right, especially if you live in Europe or somewhere without access to LC/MS estradiol test. There are formulas for correcting the immunoassay E2 result with your CRP number, but it's still harder than just throwing in a serm and checking your free test results.

 

[Black Beard]

Agreed!

Both Torem and Nolva are better choices if one prefers the SERM route.

I do prefer the AI route though, as all the above serms increase real E2 (they themselves also show up as E2 on labs so it makes hard to determine the exact amount of increase), increase SHBG (so lowering Free T to Total T ratio) and have vision sides.

But it is harder to get the dose right, especially if you live in Europe or somewhere without access to LC/MS estradiol test. There are formulas for correcting the immunoassay E2 result with your CRP number, but it's still harder than just throwing in a serm and checking your free test results.

Problem is that nolvadex


1. Is much less efficacious for stimulating endogenous gonadotropin production than clomiphene.

2. Is linked to neurotoxicity and brain fog. Some people get depressed and lose libido.

 

[belixxx]

Problem is that nolvadex


1. Is much less efficacious for stimulating endogenous gonadotropin production than clomiphene.

It isn't. This is a common misconception.

https://www.ncbi.nlm.nih.gov/pubmed/640052


There are few more studies like this if you look around. (There is also one that compares these two to raloxifene, then another with torem)

2. Is linked to neurotoxicity and brain fog. Some people get depressed and lose libido.

These are also possible sides with clomid too.

Torem has the least sides of the three. I would say best for this purpose. But it still has the eye sides, which I really don't like.

They are all okay for short term, like PCT. But as a long term endogenous test boosting solution, I'd prefer AI only, HCG, or both instead.

There are trt doc's who also add in DHEA with AIs, others microdose a SERM with an AI. There are basically countless variations. I just keep get back to AIs being the base the more I look into this...

 

[Black Beard]

It isn't. This is a common misconception.

https://www.ncbi.nlm.nih.gov/pubmed/640052


There are few more studies like this if you look around. (There is also one that compares these two to raloxifene, then another with torem)



These are also possible sides with clomid too.

Torem has the least sides of the three. I would say best for this purpose. But it still has the eye sides, which I really don't like.

They are all okay for short term, like PCT. But as a long term endogenous test boosting solution, I'd prefer AI only, HCG, or both instead.

There are trt doc's who also add in DHEA with AIs, others microdose a SERM with an AI. There are basically countless variations. I just keep get back to AIs being the base the more I look into this...

That's an awesome link, thank you for sharing.


Agree with you on the short term aspect. The SERMs are super useful compounds. PCT/Gyno reversal. Long-term, i would not bet on their safety.

 

[hoodstark]

Agreed!

Both Torem and Nolva are better choices if one prefers the SERM route.

I do prefer the AI route though, as all the above serms increase real E2 (they themselves also show up as E2 on labs so it makes hard to determine the exact amount of increase), increase SHBG (so lowering Free T to Total T ratio) and have vision sides.

But it is harder to get the dose right, especially if you live in Europe or somewhere without access to LC/MS estradiol test. There are formulas for correcting the immunoassay E2 result with your CRP number, but it's still harder than just throwing in a serm and checking your free test results.

Does the AI route have cause a “permanent” return of HPTA caused by secondary hypogonadism as clomid is expected to? Or do you have to keep taking it forever? Same question with HCG as I understood HCG used for fertility treatment would have your FSH and other levels return to pre levels after discontinued.

 

[Chinese guy]

Does the AI route have cause a “permanent” return of HPTA caused by secondary hypogonadism as clomid is expected to? Or do you have to keep taking it forever? Same question with HCG as I understood HCG used for fertility treatment would have your FSH and other levels return to pre levels after discontinued.

if and when your htpa restarts then you will get as much testosterone as the body is able to produce. will it be enough for you or your need/symptoms? nobody can say. but once its started it wont shutdown on itself again unless you use exo hormones ofcourse. will it return to PRE hormone use? the younger you are the better chance, the older the less chance.

hormones decline by nature, plus suppression = sub optimal hormones and quality of life

 

[nothuman]

Rex Feral made a very detailed post on why nolvadex is really good for anyone who missed it

https://www.professionalmuscle.com/.../162102-rip-big-al-fortney-4.html#post2751352

 

[Black Beard]

Rex Feral made a very detailed post on why nolvadex is really good for anyone who missed it

https://www.professionalmuscle.com/.../162102-rip-big-al-fortney-4.html#post2751352

The issue with nolva is the possible neurotoxicity. Many people notice brain fog and this is well documented in women using it long-term for breast cancer.


Estradiol is a very important neurosteroid in the brain and nolvadex is going to either block and/or activate receptors in different parts of the brain with unknown long term effects.

 

[hoodstark]

Just some further food for thought:

Letrozol at 2.5mg/day which is way overdosed but bare with me:
https://academic.oup.com/jcem/article/90/10/5717/2839298

Resulted in higher free test numbers than 300mg/week of test-e did in this study (in which the men gained more than 11pounds of LBM in 20 weeks without exercise):
https://pdfs.semanticscholar.org/e679/b56e7cd1ab7acb3332d09940629389922705.pdf

Again 2.5mg/day is clearly too much, and did result in oversuppressed E2 levels in the subjects (the purpose of the study was comparing the reaction to AIs in elderly and young men to a fixed dose [1pill/day], not individually getting them to optimal levels).

This is just to show you what's possible by increasing the production in your own testes. Especially if you do it in smart way without oversuppressing E2 and fine tuning according to your own needs (HCG+AI, torem+AI adding in boron or a DHT blocker as needed, etc).

Yo man it seems you think like a doctor. I saw new doc today, Endo who is supposed to be one of the best in NYC. After talking with him for 30m and laying everything out his response, “let’s get blood work back but I think we would do well trying an AI”. He was very hesitant to go to an exogenous T bc family history with prostate C. I gotta say I’m a little bummed at how nonchalant DR treat this issue. These are legit hormones, not opioids. Anyway here is another study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182219/

 

[Black Beard]

Yo man it seems you think like a doctor. I saw new doc today, Endo who is supposed to be one of the best in NYC. After talking with him for 30m and laying everything out his response, “let’s get blood work back but I think we would do well trying an AI”. He was very hesitant to go to an exogenous T bc family history with prostate C. I gotta say I’m a little bummed at how nonchalant DR treat this issue. These are legit hormones, not opioids. Anyway here is another study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182219/

Testosterone replacement does not cause prostate cancer. You are bringing levels up to physiological ranges. There may even be a protective effect in some instances. Most doctors are poorly informed on the subject.


The benefits to health and quality of life from TRT are substantial. Low testosterone is a risk factor for heart disease, depression/anxiety, weaker muscles/bones, and maybe even dementia/alzheimer's. Low testosterone itself is a big problem that can lead to many issues on top of poor quality of life.

 

[belixxx]

Most doctors are a lot better informed on the subject then people you find on the internet. Most doctors also don't communicate all the nuances they make their decisions well. Simply because they don't know/care about how deep they should go into explaining the factors they consider to their patients.

TRT doesn't cause prostate cancer. But TRT can increase E2 which does, and TRT can increase DHT which does. So if a patient has a high risk for prostate cancer then TRT might not be the best route for him.

Most doctors are not retarded. No matter how common it is to make fun of them on the internet. There are exceptions to every rule though...

Testosterone replacement does not cause prostate cancer. You are bringing levels up to physiological ranges. There may even be a protective effect in some instances. Most doctors are poorly informed on the subject.


The benefits to health and quality of life from TRT are substantial. Low testosterone is a risk factor for heart disease, depression/anxiety, weaker muscles/bones, and maybe even dementia/alzheimer's. Low testosterone itself is a big problem that can lead to many issues on top of poor quality of life.

 

[hoodstark]

Testosterone replacement does not cause prostate cancer. You are bringing levels up to physiological ranges. There may even be a protective effect in some instances. Most doctors are poorly informed on the subject.





The benefits to health and quality of life from TRT are substantial. Low testosterone is a risk factor for heart disease, depression/anxiety, weaker muscles/bones, and maybe even dementia/alzheimer's. Low testosterone itself is a big problem that can lead to many issues on top of poor quality of life.

I agree BB, it does feel like many don’t know what they are doing or don’t care enough. So hard to discern without real explanation of their process. That being said it seems every one wants to use exogenous T as a last resort, which is all good with me. But all options should be weighed, and most don’t even want to consider exogenous T if your under 50.


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[hoodstark]

Most doctors are a lot better informed on the subject then people you find on the internet. Most doctors also don't communicate all the nuances they make their decisions well. Simply because they don't know/care about how deep they should go into explaining the factors they consider to their patients.



TRT doesn't cause prostate cancer. But TRT can increase E2 which does, and TRT can increase DHT which does. So if a patient has a high risk for prostate cancer then TRT might not be the best route for him.



Most doctors are not retarded. No matter how common it is to make fun of them on the internet. There are exceptions to every rule though...

It’s hard to tell if they just aren’t knowledgeable or just don’t feel like explaining so myself (and I’m sure others) jump to conclusion they aren’t informed and don’t care.

I am chiding myself for not pushing him for an explanation when he made that statement about exogenous TRT putting you more at risk for prostate cancer. If it’s just E2 he is worried about why wouldn’t he just use an AI in conjunction with exogenous T?


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[belixxx]

It’s hard to tell if they just aren’t knowledgeable or just don’t feel like explaining so myself (and I’m sure others) jump to conclusion they aren’t informed and don’t care.

I am chiding myself for not pushing him for an explanation when he made that statement about exogenous TRT putting you more at risk for prostate cancer. If it’s just E2 he is worried about why wouldn’t he just use an AI in conjunction with exogenous T?


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I obviously don't see in your doctor's head, but my opinion is that if a T problem can be solved by boosting your natural production (and that is a big if), than one should pursue that avenue, instead of putting the patient on trt.

I really think ai only as a very good way with the right patient. I also think it can provide an awesome alternative to a mild T cycle. But careful monitoring and bloodtests are mandatory.

 

[Black Beard]

Most doctors are a lot better informed on the subject then people you find on the internet. Most doctors also don't communicate all the nuances they make their decisions well. Simply because they don't know/care about how deep they should go into explaining the factors they consider to their patients.

TRT doesn't cause prostate cancer. But TRT can increase E2 which does, and TRT can increase DHT which does. So if a patient has a high risk for prostate cancer then TRT might not be the best route for him.

Most doctors are not retarded. No matter how common it is to make fun of them on the internet. There are exceptions to every rule though...

It’s hard to tell if they just aren’t knowledgeable or just don’t feel like explaining so myself (and I’m sure others) jump to conclusion they aren’t informed and don’t care.

I am chiding myself for not pushing him for an explanation when he made that statement about exogenous TRT putting you more at risk for prostate cancer. If it’s just E2 he is worried about why wouldn’t he just use an AI in conjunction with exogenous T?


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From September 12th 2019:


https://www.renalandurologynews.com...5iHb-c8xyxzDN5z3VOvYSC5p4x-w9o7l5OgN79Nmqd8PU

 

[Black Beard]

Most doctors are a lot better informed on the subject then people you find on the internet. Most doctors also don't communicate all the nuances they make their decisions well. Simply because they don't know/care about how deep they should go into explaining the factors they consider to their patients.

TRT doesn't cause prostate cancer. But TRT can increase E2 which does, and TRT can increase DHT which does. So if a patient has a high risk for prostate cancer then TRT might not be the best route for him.

Most doctors are not retarded. No matter how common it is to make fun of them on the internet. There are exceptions to every rule though...

You overestimate the skills and knowledge of your average practicioner. Most are average or mediocre at best. You need ato actively work to find a great practicioner, they are the exception, not the rule.


It is extremely important for doctors to educate patients on how, what and why, the patient is supposed to be directly involved and informed in their health care . This is one of the biggest issues we face today, patient's who don't understand their care are at much higher risk of non-compliance with medical advice.


If you can't explain it to a layman, then you don't truly understand it. I've helped multiple patients start and STICK to insulin therapy for type 2 diabetes after explaining in detail how insulin works, what happens when you don't take it consistently, why and how these problems develop. 85% of the time, these patients will ASK us for the insulin once they understand the disease process and therapeutic effect of the medical intervention and consequences of non-compliance.


It's very difficult o convince someone to poke themselves with a needle x 1-3 times a day for the rest of their life when they don't understand why the hell they are doing it. Most doctors don't take 5 minutes to explain anything, just "here, take this shit and get the fuck out of my office".

 

[Black Beard]

It's not as simple as E2 and DHT "cause" prostate cancer. They are definitely involved in the pathology of prostate CA but TRT does more good than harm in most cases.


The most well-informed and cutting edge urologists know this and its supported by most of the current research on the subject. Even supraphysiological doses of testosterone are being used to KILL prostate cancer cells. Prostate pathology is complicated subject and like male pattern baldness, there's still a lot we don't know about it. (I am in regular communication with these MDs)

 

[belixxx]

Pretty well explained here for example at about 33minutes in why, most Doctors are afraid of TRT (they are discussing transdermal, subq and IM as well) and prostate cancer:

https://www.youtube.com/watch?v=0ZyptAoqnJw

 

[Black Beard]

Pretty well explained here for example at about 33minutes in why, most Doctors are afraid of TRT (they are discussing transdermal, subq and IM as well) and prostate cancer:

https://www.youtube.com/watch?v=0ZyptAoqnJw

Most doctors are not specialists in the field of urology/endocrinology, and most urologists/endocrinologists are not up to date on the latest research.


Science and medicine is constantly evolving. People used to smoke regularly, use lead in everything, asbestos, etc. We are always learning and advancing.


Blood "thinners" like warfarin/coumadin might decrease coagulation risk but can also increase calcification/plaque formation creating a new problem. There are tons of examples.


It does "make sense" at first glance to be wary of TRT for prostate issues since testosterone/E2/DHT are involved in the pathology of BPH/CA of the prostate, but physiology is just not that simple.

 

[hoodstark]

I obviously don't see in your doctor's head, but my opinion is that if a T problem can be solved by boosting your natural production (and that is a big if), than one should pursue that avenue, instead of putting the patient on trt.



I really think ai only as a very good way with the right patient. I also think it can provide an awesome alternative to a mild T cycle. But careful monitoring and bloodtests are mandatory.

This is the exact reason Drs get a bad wrap. This endo, who again is supposed to be top 50 NYC FORGOT to order a blood for testosterone. He tested me for every other thing under the sun but forgot to order the test for the reason I went to see him. This is the second Dr in NYC that has proven they can’t handle the job. I’m leaning toward Black Bear on his assessment of doctors.

Not even sure what to do at this point. I don’t trust him to continue my care if he can’t even remember to test for testosterone.


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