****huge area of concern!!!!!****

[--->>405<<---]

hey guys.. to the point i sent my doc an email yesterday regarding getting a lab requisition form so i could get what i hoped to be my last frequent blood work due to the fact that i think im pretty dialed into my protocol which is:

test cyp 160mg per week split into 80mg every 3.5 days
HCG 375iU twice per week (day before test shot)
Anastrozole 2mg per week (1mg day after each shot - this is what took me 10 months to dial in.)
E2 (last test - 6weeks after starting 2mg AI per week) 23.4 (baseline was 24.1)

well this is the response i got from my doc's assistant which has me pretty concerned. wanna know what yall think???


"We can check your estradiol level again but I just wanted to let you know Dr. ****** informed me last week that males actually do not need to be on an estrogen blocker simply due to an elevated estradiol according to a recent study just published. In fact estradiol is essential for a healthy heart and the only time a man should be placed on estrogen blockers is with the onset of symptoms such as breast tenderness, nipple soreness or discharge from the nipples. Just FYI. I will send your requisition attached to this email. I have all the tests you requested marked. Let me know if you need anything else."


WTF!!???

[SEOINAGE]

interesting, last i heard from my doc i would be ok with slightly elevated e2 levels in the short term but wouldn't want it long term.

[Texkota]

Total novice here, but what's the point in doing BW if the doc is just going to follow what's been published. Time and time again in this forum you see proof that EVERYone is different and protocols HAVE to be based on the individuals BW and not some published study. What a dumb fvck, might be time for a new doc.

[SEOINAGE]

Well the fact that she called it an estrogen blocker says something.

[steroid.com 1]

So, one potential study on elevated E2 serum levels and he's going to simply overhaul his entire approach to Estradiol management???

God forbid...sometimes I wonder how these people make it through medical school and get licensed to practice...it's scary I got to tell you.

For that one study I can show scores more that present the serious consequences of elevated E2 over the long term NOT discounting the fact that it will lower your Free and Bio-Available Testosterone levels which is EXACTLY what you don't want.

[steroid.com 1]

Well the fact that she called it an estrogen blocker says something.

^^^^Exactly, the first thing I caught as well.

[Brazensol]

Scary as it is if the doc will still continue treating you to your satisfaction it might be better to stick with him. You probably already know how hard it is to find even a half-way decent doc...

[--->>405<<---]

Well the fact that she called it an estrogen blocker says something.

can someone explain to me what the difference between an aromatase inhibitor and an estrogen blocker is?? everything i find online makes them out to be the same thing..

So, one potential study on elevated E2 serum levels and he's going to simply overhaul his entire approach to Estradiol management???

God forbid...sometimes I wonder how these people make it through medical school and get licensed to practice...it's scary I got to tell you.

For that one study I can show scores more that present the serious consequences of elevated E2 over the long term NOT discounting the fact that it will lower your Free and Bio-Available Testosterone levels which is EXACTLY what you don't want.

exactly what i thought..

Scary as it is if the doc will still continue treating you to your satisfaction it might be better to stick with him. You probably already know how hard it is to find even a half-way decent doc...

i have the job freedom and the money to book a flight to michigan tomorrow if necessary and simply cut out the bullcrap!!!

[steroid.com 1]

405 - Read the sticky on Estradiol management at the top of the forum; it will answer your question as to why an AI is not an Estrogen blocker.

[steroid.com 1]

"i have the job freedom and the money to book a flight to michigan tomorrow if necessary and simply cut out the bullcrap!!!"

^^^^This and the route I take for the exact same reasons...no bullcrap and a great Doc I have as a result!

[kelkel]

405 email them this link. Although it may be beyond their limited comprehension:

http://www.lef.org/magazine/mag2012/...ey=june%202012

Next, tan your armpits.

[Texkota]

next, tan your armpits.

doh!!!

[Vettester]

Yeah, I don't like the sound of either 405. As mentioned, checkout the sticky in this forum and the link Kelkel provided. The doctor needs to understand that a healthy level of E2 doesn't mean wait til the patient hits RED LINE with gyno and other sides. Also, if "discharge" were to ever happen, they would probably have a whole other creature on their hands with prolactin problems. Would this doctor know that, and would he know how to treat it? If not, then it might be best to move forward somewhere else ... (Michigan is nice this time of year)

[--->>405<<---]

hey fellas.

first off: kel that was funny i will take tanning my armpits into consideraTION! ur observations never cease to amaze me

secondly below is a copy and pasted/edited (names removed) version of the email i just sent to my TRT doc. i will be interested to get his response. thought id share it with yall.

hey ****.

first off i had my blood taken yesterday (tuesday 9/4/12) so yall should have the results soon.

secondly in reference to ur response regarding elevated Estradiol. to say that i am very, very, very concerned with ur response would be a major understatement. to this point i have been very happy with doctor ****** and our relationship. i have done a lot of research on my own regarding testosterone replacement therapy and have been thru a few doctors in the savannah area to find they didnt know as much as i did in the area of TRT and proper protocol. i also have many, many friends across the United States and around the world via the internet who also have the same problem. it appears finding good doctors in this field who are knowledgeable and conscientious is a task in itself!

from my understanding 3 of the most important factors in proper TRT protocol are:
1. maintaining healthy/optimal free testosterone levels
2. HCG administration for proper testicular function
3. proper Estradiol management

while i do not dispute the fact that Estradiol is an important hormone for men to have, elevated Estradiol can be just as harmful as low Estradiol. as with testosterone it should remain within a certain range. too high is bad. too low is bad.

this is why i had my E2 tested before i started TRT to find out where my body naturally stayed. i believe i was rite at 24pg/mL. since starting TRT the biggest obstacle i have found has been dialing in my aromatase inhibitor so that my levels of estradiol were within the healthy range (from my research 22-30pg/mL) as well as close to my baseline level.

below is one article i have found regarding this very issue:
Doctors Overlook Lethal Impact of Estrogen Imbalance

When Life Extension® started offering comprehensive blood test panels back in 1996, men did not understand why we were checking their estrogen levels. Back in those days, estrogen was considered a hormone of importance only to women.
We tested estrogen based on published data indicating that when estrogen levels are unbalanced, the risk of degenerative disease in aging men skyrockets.38,47-52 Of concern to us 16 years ago were reports showing that excess estrogen contributes to the development of atherosclerosis.74,75 Human clinical studies conducted more than a decade later confirmed our suspicions. Men with even slightly elevated estrogen levels doubled their risk of stroke and had far higher incidences of coronary artery disease.43,76,77 Our early observations also revealed that men presenting with benign prostate enlargement or prostate cancer had higher blood estrogen levels (and often low free testosterone blood levels).78-81 Subsequent clinical studies help confirm our early observations.82-86
Insufficient estrogen, on the other hand, predisposes men to osteoporosis and bone fracture.87,88
The fact that 99% of men today have no idea what their blood estrogen levels are helps explain the epidemic of age-related disease that is bankrupting this nation’s medical system.
A study published in the Journal of the American Medical Association (JAMA) measured blood estradiol (a dominant estrogen) in 501 men with chronic heart failure. Compared to men in the balanced estrogen quintile, men in the lowest estradiol quintile were 217% more likely to die during a 3-year follow-up, while men in the highest estradiol quintile were133% more likely to die.39
The men in the balanced quintile—with the fewest deaths—had serum estradiol levels between 21.80 and 30.11 pg/mL. This is virtually the ideal range that Life Extension has long recommended male members strive for.
The men in the highest quintile who suffered 133% increased death rates had serum estradiol levels of 37.40 pg/mL or above. The lowest estradiol group that suffered a 217% increased death rate had serum estradiol levels under 12.90pg/mL.
The dramatic increase in mortality in men with unbalanced estrogen (i.e., estradiol levels either too high or too low) is nothing short of astounding. It uncovers a gaping hole in conventional cardiology practice that is easily correctable and explains why clinical trials on aging men that fail to measure estradiol have serious shortcomings.
This study revealing the lethal dangers of estrogen imbalance was published in conventional medicine’s Bastille of knowledge—the Journal of the American Medical Association, yet doctors continue to design clinical trials on aging men that measure total and/or free testosterone levels, but fail to account for estradiol, which can sharply increase when large doses of testosterone are administered."

How Aging Men Can Control Their Estrogen Levels

"An epidemic problem we at Life Extension observe in aging male members is insufficient free testosterone, i.e., less than15-20 pg/mL of serum. When accompanied by excess estradiol (over 30 pg/mL of serum), this can signal excess aromatase enzyme activity.
Excess aromatase robs men of their testosterone while exposing them to higher than desirable estradiol.99 Aromatase can be suppressed with absorbable forms of chrysin (a plant flavonoid) and/or lignans such as those extracted from the Norway spruce tree (HMRlignan™).100-104
If these nutrients fail to reduce estradiol adequately, then we suggest that men ask their doctor to prescribe a low-cost generic aromatase-inhibiting drug like anastrolzole in doses as low as 0.5 mg twice a week.
When aromatase is properly suppressed, estradiol levels are reduced to safe ranges, while free testosterone often increases, since less testosterone is being aromatized into estradiol."

from my understanding one of the (if not THE) leading TRT physicians in the U.S. is Dr. John Crisler. he is based out of Michigan and has a website http://www.*****************.html

when i first met Dr. ******* i was going to provide this website and he expressed interest when i mentioned it to him. i believe Dr. Crisler does consultations with other doctors as well as patients. i think in light of our recent communication now is the proper time to present this info.

i cannot stress the importance of getting this matter resolved.

i am hoping there has been some type of miscommunication. like i said i have been happy with doctor ******* and would like to continue our relationship, however, if Estradiol management has gone to the back burner of his TRT protocol i will be looking for another doctor.

sincerely,

[--->>405<<---]

well guys i sent the above email rite before i posted it here and have already gotten a phone call from my TRT doc. he thankd me and said he was proud to have me as a patient and that most of his patients did not take a pro-active approach when it came to their TRT.

he also said there are several schools of thought with regards to TRT protocol. one of which prescribes an AI when symptoms appear and one that prescribes one before symptoms appear. he acknowledged that recent study is leaning more towards the thinking we have here where it is better to maintain E2 levels within the normal range/optimal range we discuss here.

he said he has no prob maintaining my levels of E2 between 22-30pg/mL and said he lookd forward to seeing my lab results from yesterdays blood work.

i feel a little bit better!

[RaginCajun]

good to hear that your doc actually read the article you gave. i think i need to look more into this

[steroid.com 1]

HOT DAMN

Nothing is more rewarding to me than to see a thread like this where a member leveraged the collective knowledge of the members here, asked the right questions and managed his health care to this great outcome!!!

Let this be a lesson to all that it can be done and with success!

Great job 405, you made my day!!!

[HRTstudent]

Well the fact that she called it an estrogen blocker says something.

I wouldn't put too much thought into this because often times people in the medical community try to avoid using jargon which means nothing to a lay person.

Keep in mind, if you know what an aromatase inhibitor... you are unusual

[HRTstudent]

well guys i sent the above email rite before i posted it here and have already gotten a phone call from my TRT doc. he thankd me and said he was proud to have me as a patient and that most of his patients did not take a pro-active approach when it came to their TRT.

he also said there are several schools of thought with regards to TRT protocol. one of which prescribes an AI when symptoms appear and one that prescribes one before symptoms appear. he acknowledged that recent study is leaning more towards the thinking we have here where it is better to maintain E2 levels within the normal range/optimal range we discuss here.

he said he has no prob maintaining my levels of E2 between 22-30pg/mL and said he lookd forward to seeing my lab results from yesterdays blood work.

i feel a little bit better!

A reasonable doc like that seems very re-assuring.

Also, I am curious, you said it took you 10 months to dial in your 2x 1mg anastrozole per week dosing schedule... I am curious did you try more frequent/smaller doses? Also, did you try any more frequent T shots than twice weekly?

I am currently doing to anastrozole dance trying to figure things out as well....

[--->>405<<---]

HOT DAMN

Nothing is more rewarding to me than to see a thread like this where a member leveraged the collective knowledge of the members here, asked the right questions and managed his health care to this great outcome!!!

Let this be a lesson to all that it can be done and with success!

Great job 405, you made my day!!!

well put GD! u guys on here are awesome and i appreciate all the continuous support and valuable, accurate info i get from u all. VICTORY!

[--->>405<<---]

A reasonable doc like that seems very re-assuring.

Also, I am curious, you said it took you 10 months to dial in your 2x 1mg anastrozole per week dosing schedule... I am curious did you try more frequent/smaller doses? Also, did you try any more frequent T shots than twice weekly?

I am currently doing to anastrozole dance trying to figure things out as well....

from the help of this forum and these guys here i started at 2x per week injects rite off the rip. got my own needles off the internet and ignored the dosing frequency prescribed by my original doc.

as far as anastrozole i have basically managed the dosing protocol myself as i think my doc wouldve had me stuck in a rut of going from none per week to 3mg per week for a long time. they just did not get it.

3mg per week bottomed me out down to 7.8pg/ML and none shot me up at high as 60(ish) at one point.

1.5mg helped a bit but i was still in the high 30's so logic has led me to 2mg per week.

it takes time

[fit2bOld]

I realize I'm chiming in on the end of this thread but wanted to acknowledge 405 for being proactive in his treatment. I was reading this forum long before I joined and this is the number one thing I learned here. If i haven't said it, thanks to all the guys that contribute.

[kelkel]

HOT DAMN

Nothing is more rewarding to me than to see a thread like this where a member leveraged the collective knowledge of the members here, asked the right questions and managed his health care to this great outcome!!!

Let this be a lesson to all that it can be done and with success!

Great job 405, you made my day!!!

Times 2! Exactly what this forum is about!

HRT, video that dance please!

405, Well done sir!

[bass]

HOT DAMN

Nothing is more rewarding to me than to see a thread like this where a member leveraged the collective knowledge of the members here, asked the right questions and managed his health care to this great outcome!!!

Let this be a lesson to all that it can be done and with success!

Great job 405, you made my day!!!

i second what GD said! i always say don't ask, demand it! its your money and your health, the doc works for you. if he's hardheaded then move on to another doc. but most of the time you'll get what you want if you know your shit like 405 does. good for you 405!

[--->>405<<---]

I realize I'm chiming in on the end of this thread but wanted to acknowledge 405 for being proactive in his treatment. I was reading this forum long before I joined and this is the number one thing I learned here. If i haven't said it, thanks to all the guys that contribute.

Thx fit i appreciate it man!

Times 2! Exactly what this forum is about!

HRT, video that dance please!

405, Well done sir!

Kel thank u man.. I Appreciate ur concern and ur help!

i second what GD said! i always say don't ask, demand it! its your money and your health, the doc works for you. if he's hardheaded then move on to another doc. but most of the time you'll get what you want if you know your shit like 405 does. good for you 405!

Bass ur exactly right! They do work for us and ill be damned if im gonna sit idle and be dictated to when i am the one ultimately who has to live - or die with the consequences!

Id also like to note ill be posting my next blood work results when i get them. Maybe friday or the beginning of next week. Itll have been at least 10 weeks at 2mg AI per week. Plus id like to get yalls advice as to whether my free test is too high maintaining about 38pg/mL.