whats the age you started trt and your age now

[steroid.com 1]

Time to jump in: 47/51.

Game changer!

[bass]

What, you think you don't look good? Your too damn tough on yourself buddy!

haha, but i only show the good parts! i am still working on the rest, one day i'll get there, i gave my self 5 years, 2 more to go...

[Drmagic]

I'm also a physician who treats over 300 men with TRT. My oldest in in his 70s and has been treated for over 10 years. I have 10 - 20 who are under 35, many of which are shift workers - fire fighters, ER employees etc who are almost always deficient. Western medicine is so far behind in this field it is sad - a lot of these men see their doctors who refuse to treat them if they are in "normal," range even though they are in the bottom 10% of normal at 35 years of age and have every symptom in the book of low testosterone . Or they are treated with useless gels or shots every 2 - 3 weeks which may be worse than not treating at all becasue of the roller coaster of hormones. I see more and more younger men with lower levels, not sure why but my theory is that we drive ourselves so hard in today's culture, less sleep, poor diet, long work hours, high stress all of which decrease production. I monitor many labs on my patients and almost always see reduction in cholesterol, body fat, blood pressure and CRP levels. I think we will see a huge long term improvement in health and longevity in men who are treated over time. Research is pretty clear that lower levels of testosterone over time contributes to higher levels of diabetes, heart disease, and certain cancers. Just make sure you are keeping estrogen in check.

[zaggahamma]

I'm also a physician who treats over 300 men with TRT. My oldest in in his 70s and has been treated for over 10 years. I have 10 - 20 who are under 35, many of which are shift workers - fire fighters, ER employees etc who are almost always deficient. Western medicine is so far behind in this field it is sad - a lot of these men see their doctors who refuse to treat them if they are in "normal," range even though they are in the bottom 10% of normal at 35 years of age and have every symptom in the book of low testosterone. Or they are treated with useless gels or shots every 2 - 3 weeks which may be worse than not treating at all becasue of the roller coaster of hormones. I see more and more younger men with lower levels, not sure why but my theory is that we drive ourselves so hard in today's culture, less sleep, poor diet, long work hours, high stress all of which decrease production. I monitor many labs on my patients and almost always see reduction in cholesterol, body fat, blood pressure and CRP levels. I think we will see a huge long term improvement in health and longevity in men who are treated over time. Research is pretty clear that lower levels of testosterone over time contributes to higher levels of diabetes, heart disease, and certain cancers. Just make sure you are keeping estrogen in check.

welcome

a few questions

do your patients self inject

any problems with dhea

r you yourself on trt...age/age started

have you read our forum/site

[kelkel]

I'm also a physician who treats over 300 men with TRT. My oldest in in his 70s and has been treated for over 10 years. I have 10 - 20 who are under 35, many of which are shift workers - fire fighters, ER employees etc who are almost always deficient. Western medicine is so far behind in this field it is sad - a lot of these men see their doctors who refuse to treat them if they are in "normal," range even though they are in the bottom 10% of normal at 35 years of age and have every symptom in the book of low testosterone. Or they are treated with useless gels or shots every 2 - 3 weeks which may be worse than not treating at all becasue of the roller coaster of hormones. I see more and more younger men with lower levels, not sure why but my theory is that we drive ourselves so hard in today's culture, less sleep, poor diet, long work hours, high stress all of which decrease production. I monitor many labs on my patients and almost always see reduction in cholesterol, body fat, blood pressure and CRP levels. I think we will see a huge long term improvement in health and longevity in men who are treated over time. Research is pretty clear that lower levels of testosterone over time contributes to higher levels of diabetes, heart disease, and certain cancers. Just make sure you are keeping estrogen in check.

Welcome DOC! Questions: Why do you think the higher incidence of TRT for emergency/shift workers. Curious about that as it relates to me. Second, do you consider all gels useless or just some? Please explain as some of us here are on gels and doing fine.

Once again, great to have you here!

[steroid.com 1]

I'm also a physician who treats over 300 men with TRT. My oldest in in his 70s and has been treated for over 10 years. I have 10 - 20 who are under 35, many of which are shift workers - fire fighters, ER employees etc who are almost always deficient. Western medicine is so far behind in this field it is sad - a lot of these men see their doctors who refuse to treat them if they are in "normal," range even though they are in the bottom 10% of normal at 35 years of age and have every symptom in the book of low testosterone . Or they are treated with useless gels or shots every 2 - 3 weeks which may be worse than not treating at all becasue of the roller coaster of hormones. I see more and more younger men with lower levels, not sure why but my theory is that we drive ourselves so hard in today's culture, less sleep, poor diet, long work hours, high stress all of which decrease production. I monitor many labs on my patients and almost always see reduction in cholesterol, body fat, blood pressure and CRP levels. I think we will see a huge long term improvement in health and longevity in men who are treated over time. Research is pretty clear that lower levels of testosterone over time contributes to higher levels of diabetes, heart disease, and certain cancers. Just make sure you are keeping estrogen in check.

WELCOME Doc!

Amen on the last sentence; you can't believe how many times we hear Doc's not wanting to even check for E2 levels...like they never heard of Aromatization!

I tend to believe in your theory as much as I do aging and genetic make up as for low or imbalanced hormonal levels.

Restorative medicine in the US is slowly becoming main stream but it's a slow migration as you well known.

Please do us all a huge favor and visit us from time to time! We value the input and counsel from a trained Physician like yourself. You can really be a big help to many men here.


BTW, are you an A4M?

gd

[bass]

I'm also a physician who treats over 300 men with TRT. My oldest in in his 70s and has been treated for over 10 years. I have 10 - 20 who are under 35, many of which are shift workers - fire fighters, ER employees etc who are almost always deficient. Western medicine is so far behind in this field it is sad - a lot of these men see their doctors who refuse to treat them if they are in "normal," range even though they are in the bottom 10% of normal at 35 years of age and have every symptom in the book of low testosterone. Or they are treated with useless gels or shots every 2 - 3 weeks which may be worse than not treating at all becasue of the roller coaster of hormones. I see more and more younger men with lower levels, not sure why but my theory is that we drive ourselves so hard in today's culture, less sleep, poor diet, long work hours, high stress all of which decrease production. I monitor many labs on my patients and almost always see reduction in cholesterol, body fat, blood pressure and CRP levels. I think we will see a huge long term improvement in health and longevity in men who are treated over time. Research is pretty clear that lower levels of testosterone over time contributes to higher levels of diabetes, heart disease, and certain cancers. Just make sure you are keeping estrogen in check.

welcome to our village doc! my question is whats your take on SQ injections?

[bigboy67]

welcome to our village doc! my question is whats your take on SQ injections?

Should we start a Dr.Magic thread to bounce ideas/questions off of him?

[lvs]

he may not know what he got himself in to!

[steroid.com 1]

he may not know what he got himself in to!

LOL and we are probably visited by a lot of TRT Docs but don't participate for just that reason lvs

[Bigfoot66]

I monitor many labs on my patients and almost always see reduction in cholesterol, body fat, blood pressure and CRP levels

All true for me. Amazing.

[warchild]

I'm also a physician who treats over 300 men with TRT. My oldest in in his 70s and has been treated for over 10 years. I have 10 - 20 who are under 35, many of which are shift workers - fire fighters, ER employees etc who are almost always deficient. Western medicine is so far behind in this field it is sad - a lot of these men see their doctors who refuse to treat them if they are in "normal," range even though they are in the bottom 10% of normal at 35 years of age and have every symptom in the book of low testosterone. Or they are treated with useless gels or shots every 2 - 3 weeks which may be worse than not treating at all becasue of the roller coaster of hormones. I see more and more younger men with lower levels, not sure why but my theory is that we drive ourselves so hard in today's culture, less sleep, poor diet, long work hours, high stress all of which decrease production. I monitor many labs on my patients and almost always see reduction in cholesterol, body fat, blood pressure and CRP levels. I think we will see a huge long term improvement in health and longevity in men who are treated over time. Research is pretty clear that lower levels of testosterone over time contributes to higher levels of diabetes, heart disease, and certain cancers. Just make sure you are keeping estrogen in check.

great to see a trt doc on the forums! i agree with everything you said, i am a fireman and been on trt since 25. I know a few other guys i work with that are also on trt in their 20s and 30s.

[Bigfoot66]

haha, but i only show the good parts! i am still working on the rest, one day i'll get there, i gave my self 5 years, 2 more to go...

I carry this TRT "secret" because of the negativity that comes from it ... only my doctor and wife know...but it would be great if all of us old farts who are on TRT and are working our asses off in the gym were in vicinity of each other for workouts. I feel pretty confident in my assessment of those in the gym who are in a cycle...

You can only hope I guess.

[flatscat]

Uh guys..... this is like a profile pic on a dating site... I hope he is a physician, but he could be a tour guide. Jus sayin ....

But welcome anyway doc!

[mauler]

How many cycles did you guys do before you needed hrt?

[bass]

How many cycles did you guys do before you needed hrt?

good question, but this should be its own thread!

[zaggahamma]

good question, but this should be its own thread!

AND
last i looked its in our profiles?????????????????????????????????????????? ?????????????????????????????????????????????????? ???????
not sure if its just me but i'm seeing quite a bit of merry go round posts these days

[steroid.com 1]

Uh guys..... this is like a profile pic on a dating site... I hope he is a physician, but he could be a tour guide. Jus sayin ....

But welcome anyway doc!

I thought about the same thing later Flats.

Time will tell; you can tell a true TRT Physician from a layman in a New York minute.

[zaggahamma]

twas a nice refresher first post

[funkymonk]

How many cycles did you guys do before you needed hrt?

0

[Drmagic]

Sorry about the delay in response, little password problem. To answer your questions, 90% of my patients self inject, some come in to see me weekly, others use topicals or troches (sublingual). No problems with DHEA but it can muddy the waters because the body can turn it into other hormones including estrogen so like everything else you have to watch dosing. I've seen a few people get palpitations from it and that seems to be common knoweledge in the anti aging world. I take cyp 150 or so per week, cycle on and off HCG , and have recently worked in a couple months of sermorelin/GHRP combo - mostly to see if it would affect healing my knee as I am also getting PRP treatment done on it. I have been browsing the site for the past few days, some of the members here know more than most doctors about HRT/TRT, I get patients who are well versed and there are not a lot of referenced out there for me so I read the studies but forums like this are like a real world biochemistry experiment. Learning a lot. BTW, started at 39, now 42.

[Drmagic]

Thanks for the welcome, SQ injections of what?

[Drmagic]

Thanks gd, I'm in the fellowship program through A4m, went to learn about HRT because of my own profound experience and it has turned into so much more than that, has changed how I practice medicine across the board and caused me to open my own shop so I can practice medicine how it was meant to be practiced. Happy to give my 2 cents, I'm learning along the way although I am 3 years into my practice, I have a lot of antecdotal info to share as I have watched patterns over this time and have altered my treatment protocols because of them.

[Drmagic]

Thanks Kelkel, What I have found with topicals is this: the mass produced stuff is junk, rarely works, messy, smells, and doses are too low. I use compounded creams mostly because they can make higher concentrations like 200mg/gram. What I have found is that some people absorb well and some people don't. There is a bell curve for everything and you see this with topicals. I have men that are able to maintain 900 levels and others that can barely get above 300 taking 150 mg per day. I believe it is related to absorbtion rates but can't be sure. I use it once in a while to take a break from shots and it seems to work well but I don't usually monitor my numbers. As I said in my prior post, shift work just grinds you down, circacian rythms are so important for hormone control so if you aren't sleeping at night you disrupt this cycle, cortisol usually elevates and you run a sleep deficit. Then we dump caffien in the mix to stay away which alters cortisol and insulin so you have a whole other problem there. I try to minimize medication in my practice but when it comes to sleep I am more aggressive, use ambien, melatonin, whatever it takes to get proper sleep, especially the older you get. the peptides seem to help me with this as well.

[Drmagic]

welcome

a few questions

do your patients self inject

any problems with dhea

r you yourself on trt...age/age started

have you read our forum/site

Answered these questions but they are at the end of the thread.

[zaggahamma]

Answered these questions but they are at the end of the thread.

yeh i saw and appreciate and saw your other posts as well

like the reference to the importance of sleep

look forward to your input and also more updates with your recent sermorelin/GHRP combo...couple months already? any benefit thus far?

welcome to 42

[bass]

Thanks for the welcome, SQ injections of what?

testosterone !

[Drmagic]

bass, there seems to be a movement in that direction in the anti-aging world - I've heard it talked about at the last few conferences and people seem to have good results. I'm not sold because most of the research on TRT is on IM injections which are fairly predicable as far as results and it is what the vast majority of patients use so that is what I am sticking with for now.

[Drmagic]

jpkman, I did two months, hands down slept better - took this month off and realized that right away. I probably had improved energy as well. I'm starting back up this month so I'll keep you posted. Really taking it to see if it helps my knee along with PRP injections.

[flatscat]

Hey Drmagic,

I think it would be great if you would go to the new male members area and introduce yourself to the mods of this site. Also if you would start a new thread so we can get out of this one - it will be harder to find questions and reposes to you and from you on these topics in this thread.

[bass]

bass, there seems to be a movement in that direction in the anti-aging world - I've heard it talked about at the last few conferences and people seem to have good results. I'm not sold because most of the research on TRT is on IM injections which are fairly predicable as far as results and it is what the vast majority of patients use so that is what I am sticking with for now.

i agree with Flats!

Doc, i switched from IM to SQ about three weeks ago, and next week i am doing blood work to see how it worked. i will let you know when i post my blood work results! thanks for taking the time to answer our questions.

[kelkel]

Thanks Kelkel, What I have found with topicals is this: the mass produced stuff is junk, rarely works, messy, smells, and doses are too low. I use compounded creams mostly because they can make higher concentrations like 200mg/gram. What I have found is that some people absorb well and some people don't. There is a bell curve for everything and you see this with topicals. I have men that are able to maintain 900 levels and others that can barely get above 300 taking 150 mg per day. I believe it is related to absorbtion rates but can't be sure. I use it once in a while to take a break from shots and it seems to work well but I don't usually monitor my numbers. As I said in my prior post, shift work just grinds you down, circacian rythms are so important for hormone control so if you aren't sleeping at night you disrupt this cycle, cortisol usually elevates and you run a sleep deficit. Then we dump caffien in the mix to stay away which alters cortisol and insulin so you have a whole other problem there. I try to minimize medication in my practice but when it comes to sleep I am more aggressive, use ambien, melatonin, whatever it takes to get proper sleep, especially the older you get. the peptides seem to help me with this as well.

Thanks Doc! You just described the first half of my career. Shift work can be very hard on your body. I'm still on agel and respond well but I'm sure I'll make the jump in the future. Question: Why cycle on and off HCG ? Pretty sure I know your answer but I'd still like to hear it!

Thanks again and welcome (again)

[Drmagic]

Kelkel, One reason is that there has been some anectodel evidence that we may develop antibodies to HCG when taken exongenously and although I don't have any research to back this up, it seems to me that it is a good idea to take a break from contant stimulus of the endocrine system regardless of what you are using. I generally have my patients use it every other month or two months on one month off.

[warchild]

Kelkel, One reason is that there has been some anectodel evidence that we may develop antibodies to HCG when taken exongenously and although I don't have any research to back this up, it seems to me that it is a good idea to take a break from contant stimulus of the endocrine system regardless of what you are using. I generally have my patients use it every other month or two months on one month off.

dr. at what doses do you recommend cycling hcg ?

[kelkel]

Kelkel, One reason is that there has been some anectodel evidence that we may develop antibodies to HCG when taken exongenously and although I don't have any research to back this up, it seems to me that it is a good idea to take a break from contant stimulus of the endocrine system regardless of what you are using. I generally have my patients use it every other month or two months on one month off.

Interesting. Figured you'd answer similar to that! Would a diagnosis of primary or secondary make a difference with cycling in your opinion?

[The Bishop]

What I noticed right away is that I got rid of anxiety, something that had plagued me for years
I also wish that I got on test much sooner.
I am not sure how to put it in english but I was diagnosed with a growth in my brain that my doctor tells me is the culprit regarding most of my troubles, at least the low test.
The growth was spotted on an MRI from 2007 and has not grown since so its not cancer but it also tells us that it has been there for much longer, resulting in a hormone imbalance and discomfort

**************

[steroid.com 1]

Kelkel, One reason is that there has been some anectodel evidence that we may develop antibodies to HCG when taken exongenously and although I don't have any research to back this up, it seems to me that it is a good idea to take a break from contant stimulus of the endocrine system regardless of what you are using. I generally have my patients use it every other month or two months on one month off.

WOW!

I personally never heard of this; but I am not a medical Doctor.

Antibodies to hCG ???

Where the hell is this coming from?

Are there antibodies to naturally produced LH???

hCG is an analog to LH so please explain what mechanisms would cause this to happen???

Taking breaks?

Does a normal healthy male with a normal healthy functioning endocrine system take a break?

The body thrives on regularity.

Please support your position with some amount of evidence as this flies in the face of much of what we all know to be true so far.

Thanks Doc,

gd

[Drmagic]

GD, see referenced below, there are more out there. The human body can develop antibodies to almost anything wether we produce them or ingest/inject them. There are many diseases (Hashimotos thyroiditis is the # 1 cause of hypothyroidism and is caused by auto antibodies to the T3 receptor site) that are caused by autoantibodies, The family of diseases is called autoimmune diseases. And yes, the endocrine system is all about stimulation and supression, we cannot live in a constant state of stimulation which is why we have feedback loops. This is part of the mechanism involved in medications that become less effective over time, the body will reduce the number of receptor sites available to bind when they are overly stimulated over time (down regulation). Another good example is adrenal fatigue which is an epidemic and is caused by constant stimulation of cortisol production by different forms of stress - excess cortisol will eat you up over time. You've asked for references for this and I would ask you to do the same for your positition. I'll tell you what I tell my patients, some of which are professional athletes: Just because something hasn't been proven to be detrimental doesn't mean it is safe. As a physician I am conservative by nature, I don't use or prescribe supraphysiological doses of hormones for many reasone - I want to keep my liscence for one but because I know endocrinology and that the body has a way of always trying to maintain homeostasis - testosterone goes to high it shunts it in another direction (estradiol or worse estrone) among other pathways, just because we can take a medication to stop this pathway doesn't mean there is not another consequence downstream or upstream. I've also seen over time that physiologic doses of TRT seem to become less effective over time in terms of the initial benefits - I've experienced this myself, we all feel great when we go from a level of 300 to 900 but that feeling wanes over the years and we don't know exactly why but there is probably some downregulation going on in to combat the elevated levels of testosterone . Sort of rambling here but you asked for it. I will close with this - HRT/TRT is an ongoing experiment and I am a true believer in it's benefit, there is still much to learn which is one of the reasons I am on this site, I attend a brutal amount of continuing education but there is nothing like practical knowledge you can get from sites like this, much like the things I have learned in watching my patients over a 2 - 3 year period on treatment and realizing one size never fits all when it comes to this stuff. I don't know it all, and I read things on this forum from guys that act like they do and that can be scary. I'm not here to scare anybody just adding to the conversation.
1.Sokol RZ, McClure RD, Peterson M, Swerdloff RS 1981 Gonadotropin therapy failure secondary to human chorionic gonadotropin -induced antibodies. J Clin Endocrinol Metab 52:929–933
2.Wass M, McCann K, Bagshawe KD 1978 Isolation of antibodies to HCG /LH from human sera. Nature 274:368–37
3.Pala A, Coghi I, Spampinato G, Di Gregorio R, Strom R, Carenza L 1988 Immunochemical and biological characteristics of a human autoantibody to human chorionic gonadotropin and luteinizing hormone. J Clin Endocrinol Metab 67:1317–1321

[Drmagic]

Kelkel, If you have primary hypogonadism you usually have elevate LH to begin with so HCG is a waste of money. If the testes aren't responding to endogenous LH they will likely not respond to HCG so the answer is I wouldn't use it at all in those patients.

[steroid.com 1]

GD, see referenced below, there are more out there. The human body can develop antibodies to almost anything wether we produce them or ingest/inject them. There are many diseases (Hashimotos thyroiditis is the # 1 cause of hypothyroidism and is caused by auto antibodies to the T3 receptor site) that are caused by autoantibodies, The family of diseases is called autoimmune diseases. And yes, the endocrine system is all about stimulation and supression, we cannot live in a constant state of stimulation which is why we have feedback loops. This is part of the mechanism involved in medications that become less effective over time, the body will reduce the number of receptor sites available to bind when they are overly stimulated over time (down regulation). Another good example is adrenal fatigue which is an epidemic and is caused by constant stimulation of cortisol production by different forms of stress - excess cortisol will eat you up over time. You've asked for references for this and I would ask you to do the same for your positition. I'll tell you what I tell my patients, some of which are professional athletes: Just because something hasn't been proven to be detrimental doesn't mean it is safe. As a physician I am conservative by nature, I don't use or prescribe supraphysiological doses of hormones for many reasone - I want to keep my liscence for one but because I know endocrinology and that the body has a way of always trying to maintain homeostasis - testosterone goes to high it shunts it in another direction (estradiol or worse estrone) among other pathways, just because we can take a medication to stop this pathway doesn't mean there is not another consequence downstream or upstream. I've also seen over time that physiologic doses of TRT seem to become less effective over time in terms of the initial benefits - I've experienced this myself, we all feel great when we go from a level of 300 to 900 but that feeling wanes over the years and we don't know exactly why but there is probably some downregulation going on in to combat the elevated levels of testosterone . Sort of rambling here but you asked for it. I will close with this - HRT/TRT is an ongoing experiment and I am a true believer in it's benefit, there is still much to learn which is one of the reasons I am on this site, I attend a brutal amount of continuing education but there is nothing like practical knowledge you can get from sites like this, much like the things I have learned in watching my patients over a 2 - 3 year period on treatment and realizing one size never fits all when it comes to this stuff. I don't know it all, and I read things on this forum from guys that act like they do and that can be scary. I'm not here to scare anybody just adding to the conversation.
1.Sokol RZ, McClure RD, Peterson M, Swerdloff RS 1981 Gonadotropin therapy failure secondary to human chorionic gonadotropin -induced antibodies. J Clin Endocrinol Metab 52:929–9332.Wass M, McCann K, Bagshawe KD 1978 Isolation of antibodies to HCG /LH from human sera. Nature 274:368–37
3.Pala A, Coghi I, Spampinato G, Di Gregorio R, Strom R, Carenza L 1988 Immunochemical and biological characteristics of a human autoantibody to human chorionic gonadotropin and luteinizing hormone. J Clin Endocrinol Metab 67:1317–1321

Thank you so much for the response Doc; I do appreciate it given you busy schedule I can only imagine.

Let me be perfectly clear here: I AM NO DOCTOR, so I respect with the highest level your position and I thank you for that.

Testosterone Repla***ent is an art and I don't see it any other way. I have studied with great interest the varying protocols by many well known TRT Doctors and am always amazed at how they vary.

The one message I hear over and over again from restorative medicine practitioners is that restoring levels at or near optimal should minimize many of the potential complications that you listed above. If men inject low doses of testosterone to get them near, but not over, optimal levels then all we are doing is restoring the body to youtful levels...nothing more.

You would think if this is the case, then, many of the conditions you listed above would be present in normal healthy young males presenting with the same serum levels...it's here where I get lost Doc.

The reasoning from here, in my opinion, would be if that's the case then why periodic cycle times on hCG? The body thrives on regularity and all I see by doing this is causing unwanted let downs in serum levels and putting a man on roller coster.

I have always been under the belief that prolonged elevated levels of E2 can cause androgen receptor downgrade. I have heard Crisler speak to this in Orlando a couple of years ago but I can not find supporting research...especailly focused on men. Any thoughts?

And thanks again Doc; I sincerely appreciate the time you spend in your response.

gd