Gyno questions

[pman42]

also, I am trying my damndest to ensure that this blood draw represents my real baseline. i'm training but not overtraining, sleeping well but not oversleeping, eating well but not drastically altering any 1 macronutrient, and reducing caffeine to near zero. at the time of draw it will be almost 2 months after ralox, and over 2 months since I took .625mg of letro. so hopefully it will give an accurate picture.

this endo seems willing to work with me, the only drawback is a 1.5hr travel time to another city but I have friends and business there anyway, so good excuse to go there once in a while.

[Jelisej]

Pman, once I watched this episode of Dr House where he finally found treatment that works well for him mentally and he became very pleasant to work with, nice to other people etc... but eventually he realised that his sudden compassion and caring attitude has negative effect on his work- and thats how it is in reality.
Wishful thinking and sympathy does not solve problems, and it does interfere.....so I hope you and others will forgive me if I'm sometimes too cold hearted or critical or blatant....
Anyway, back to the point- SERM restart protocol does not work for a lot of people for number of reasons- If their testosterone was always low (congenital) usually it does not work, when people get to around 40 the success rate is much much lower... So in your case what have you recently done is more-less some kind of SERM restart and it does not seems to be working, so trying another one like clomid restart is a good idea but chance that is going to be successful is low.
What do I think about M. Scally and his protocols? I think there are better endocrinologist out there, and better and more proven methods as well.
Some of endo's that I found interesting'knowledgable
Dr Sergey Dzugan
Dr Thierry Hertoghe
Dr Romeo Mariano
Dr Jeffrey Dach
I understand your "I really don't want to do TRT. It seems like, long-term"- and this is truth, but mind you there are different types of TRT/HRT including HCG mono or permanently using SERMS etc.... And they are all long term, sometimes person changes its own protocol, but bottom line is- it is for a life.
Lot of people boost their hormones (one way or another) and then they drop, then they boost it again only to be back to the square one- I personaly dont see point in all that, its actually very inconvenient and usually more expensive than just using routine that works.

Personally, I'm fan of "hormonal optimisation" which is basically tunning up whole endocrine system, its bit complicated but it makes people happy, healthy and even when it comes to physique it works fine.

When it comes to hormones, especially testosterone- "denial" is a big problem. It is actually hard to accept that there is a problem, and it takes time. It really does, but eventually all people that went to TRT and done things right way say that they never look back- they enjoy their life- and that is whole point.

[pman42]

Just to be clear, I haven't yet checked bloods after 5 months on raloxifene, so I don't know if that affected them at all. ralox is supposed to have minimal effect on test anyway.

I wouldn't object to the idea of long-term SERM or HCG therapy, I just don't want to do long term TRT since it is expensive and causes further suppression. are there any books by the other endos you mentioned that you would recommend?

and i don't find you to be too harsh, i post on here to get opinions and the like.

[burlyman30]

HCG and or SERM therapy may or may not work to provide the results you want... if it does, then great. If not, then the choice is to feel bad or to go on TRT. I waited for years before I finally went that route, so I understand you wanting to go another route.

[weekend]

the thing is, serms have some level of toxicity, and HCG monotherapy can cause excessive aromatisation, while also suppressing your pituitary gland heavily.

ultimately, if you have already tried getting lean and healthy and the levels still don't go up... give up and go on TRT asap. you will most likely still be able to have kids, and it will probably be easy with the short term use of hCG and hMG when trying to get her pregnant...

[Jelisej]

Just to be clear, I haven't yet checked bloods after 5 months on raloxifene, so I don't know if that affected them at all. ralox is supposed to have minimal effect on test anyway.

1 I wouldn't object to the idea of long-term SERM or HCG therapy, 2.I just don't want to do long term TRT since it is expensive and causes further suppression. are there any books by the other endos you mentioned that you would recommend?

and i don't find you to be too harsh, i post on here to get opinions and the like.

1. When it comes to test boosting properties or restart protocols SERMS (mainly clomid) come handy but thing is with SERMS you almost never get the "feel" that you get when you tune yourself up and bring test. levels up- they dont raise free test a lot and they bring SHBG up as well, then you add aromasin for couple of other reasons as well as for reducing SHBG a bit and bringing free test up, but this is not a big deal so people then add some test boosters which are usually pricey and then they add DAA to raise free test bit more and because DAA raise prolactin they add some dopamine agonist.... etc... etc... so in the end it becomes complicated and very expensive as well
Neverthless it is good to try SERM restart which will also give you an idea, tough in your case I suspect that restart protocol will not work

HCG mono works fine for some folks, but if one is primary it will not work. Apart of primary hypogonadal folks HCG is standard protocol as it has a lot of benefits- along raising test levels (people using both HCG and test shots get around 10% of their tt levels from HCG) it also stimulates adrenals and thyroid plus it raises lot of other hormones which has lot of benefits including improved libido- as Weekend pointed out HCG does aromatise

2. TRTis actually not so expensive really, and is definitely cheaper than using 101 supplement from which most of dont do much
As for supression- once your levels are 300 ng/dl, is nothing there to get supressed and if you use HCG you can always get of TRT and you still will have most of it back- tough you must understand that having low level of hormones has negative effect on your whole body


Again, I understand your reluctance, I agree that TRT/HRT is last resort but sometimes it cant be avoided and at the end of the day all of us at some point will be on some kind of medications for life, TRT is an option- dwelling in the dark is not

[burlyman30]

Very well written post, J.

[pman42]

I have been reading Michael Colgan's book on the subject (old, I know) and I think I would like the idea of gels or patches more, to mimic the natural rhythm. anyway I think I will try the SERM restart anyway, since I have nothing to lose, then talk to the endo again if it doesn't work.

do any of the endos you mentioned have books?

thanks again for the help guys.

[Jelisej]

I have been reading Michael Colgan's book on the subject (old, I know) and I think I would like the idea of gels or patches more, to mimic the natural rhythm. anyway I think I will try the SERM restart anyway, since I have nothing to lose, then talk to the endo again if it doesn't work.
do any of the endos you mentioned have books?
thanks again for the help guys.

Definitely try SERM restart, thats first thing to do, and if it does not work than just go for "classic TRT"

Errrrr... I'm breaking the party again- but altough gels/patches have some interesting properites, they are not really practical and its very difficult to get stable numbers and some people have very poor absorption worst case being hypothyroid sufferers as their absorption is often almost non-existent, on top of that there is lot of testosterone-DHT conversion there, and sometimes people end up with DHT 5-6 X of the ref range, which sounds great but its not really in long term. Shots are your best bet, most simply 3X a week (before or after HCG shots) and thats it. Its done in no time, and is actually more convenient than gels/patches.

Books? I've scrolled trough some in library- I remeber Thierry Hertoghe's book was selling at some silly price like 400$ and it was all theory,
I've scrolled trough S. Dzugans book, it was very interesting- he is big on pregnenolone, I think he exaggerate a bit- I remeber he describes patient using 1300 mg of pregnenolone...

I dont think Romeo Mariano has written any books but he has lot of posts and articles in his site "definitive mind", I dont think he is active on there but there are plenty of interesting articles and posts- mind you he is neurosurgeon and he combines that with classical endocrinology, so in a way he is pioneer and definitely interesting to read


I did not mentioned Michael Lam earlier, but he has some interesting stuff- from him I've learned how to control E2 by adrenal gland function, brilliant stuff- he has website but has some books as well
Adrenal Fatigue and Hormone Therapy - DrLam

Jeffrey Dach seems clever, he has his website and has published some books, did not read any books- he is a lot in bioidentical hormones and "natural way" medication.
Clomid For Men With Low Testosterone by Jeffrey Dach MD

[pman42]

this has been a very informative discussion, and thank you all very much for participating.

Jeli, when you stated early on that TRT would take care of gyno, I assume this is by correcting the androgen:estrogen ratio. actually when reading in Morgentaler's "Testosterone for Life" about the testosterone patches (esp. the scrotal ones) I thought that the "side effect" you mentioned-- DHT 5x the normal range-- sounded great!! increased DHT would be awesome right about now, and as my prostate and hair health are rocksolid, bring it on!

I will discuss these issues with the endo. right now I feel that eliminating gyno is priority number 1. even though not visible it bothers me very much. after the gyno is taken care of then I can think about more complicated issues of the whole hormonal system. Or perhaps it is better to address them concurrently. there's a lot to think about here wrt what direction it takes me in.