[dano]

@DrMariano 3311 wrote:

Pellet hormone delivery does not necessarily give “balanced” hormone delivery. Nor does it “flow straight into the blood stream whenever your body needs it” as if the body can decide whether or not to turn off the flow from the pellet. However, it does give a person pretty stable blood levels of the hormone. This helps avoid peaks of testosterone to estrogen conversion, which may give some men problems. And it bypasses the skin, so that DHT production is minimized. My primary objection is that pellets make the patient very dependent on the physician. The patient has to schedule their implantations (which occur about once every 3 months) around their physician’s schedule. They have to schedule their vacations so they don’t conflict with the days of implantation. The physician also can’t just take a vacation at any time since he/she has to schedule around the patients schedules for implants.

Other than high DHT levels, transdermal testosterone also provides very very stable blood levels of testosterone. One can minimize estrogen by avoiding placement on the abdomen. Some men prefer to not give themselves injections. However, many men feel transdermal testosterone is less convenient than once a week injections of depot testosterone. Thyroid function needs to be optimized since low thyroid hormone signaling will impair absorption of transdermal testosterone.

Injection of depot testosterone can cause a person to have significant peaks and valleys in testosterone levels, with the peaks becoming a problem since estrogen production is also increased during the peak. However, nearly flat levels can be obtained by doing more frequent injections. For example, if the half-life of testosterone cypionate in a man is about 7 days, then dosing every 3 days gives a much flatter testosterone curve than with once a week or less frequent injections. The flatness of the testosterone curve is very acceptable to many men, however, even when dosing once a week to even once a month (as one practitioner I know does her injections for her patients). The reduced frequency of injections compared to daily use of transdermal testosterone makes injections attractive to many men compared to transdermal testosterone.

Either one of these delivery systems has specific benefits and is completely acceptable.

In general, nearly all men tend to gravitate toward testosterone injections. Dosing is convenient. And it allows them, as with transdermal testosterone, to be fairly independent of the physician (unless the physician insists on giving the injections him or herself.).

Thank you for your detailed response. I actually was asking because I have tried both transdermal and injections. With injections, I felt very good, however, my libido was very poor, which was a major reason I sought out TRT. Injections did not increase my estogen. It stayed between 20-30 range (Quest Labs). In fact that was what my baseline estrogen was when I started TRT, just my testosterone levels were very low. With transdermal, initially, I felt great, and libido was excellent, then within a couple of weeks, my estrogen shot up to 70-100, and my libido disappeared, along with proper erectile function. When the doctor reduced the level of transdermal that brought my estogen levels into proper range, but then my testosterone levels were too low and I felt weak and tired with no libido. Very frustrating. BTW, my thyroid and adrenal was optimal during this period.

The doctor I was seeing at that point kept me on transdermal, and added a very low dose of arimidex and 25mg of danazol/day to control SHBG. At this point, I was perfect, great sense of well-being, excellent libido, all numbers in a optimal range, including SHBG dropping from about 53 to 28. Unfortuneately, I relocated, and my doctor only treats local patients. Therefore, I am now with a new provider who prescribed transdermal cream, but does not believe in arimidex for men and, like many doctors I have talked to, is not familair with low dose danazol treatment and its success as well documented by Dr. Malcolm Carruthers in his book.

He suggested pellet implants becuase he believes it is the best method of testosterone therapy for men and he feels it will give me the steady levels of testosterone, with positive libido effects and no spike in estrogen.

[dano]

@wondering 2473 wrote:

Sensitive is the real deal.

Define your symptoms and post any/all other lab results.

Symptoms:

Sore nipples, lose of erections ( especially morning wood), anxiety.

Thank you

[dano]

@Figuring 2461 wrote:

@dano 2455 wrote:

Yes, the sensitive will more accurately reflect low levels.

I just meant that the regular test is inaccurate for men and really won’t alert you to anything unless you’re showing at the bottom of the range or way above range. If your twice the top of the range on the normal E2 test I’d still say you have a problem!

Range was 7.6-42.6 pg/ml, I came in at 81.2. Absolutely no sex drive, no erections. What do you think?

Thank you.

[dano]

@Figuring 2453 wrote:

The other one won’t tell you anything of value unless your levels are very very high or very very low.

Just wondering about this because Labcorps website states that actually the sensitive is to detect low levels in males as follows?:

The analytic range of the assay is appropriate for the assessment of the low levels of estradiol typically observed in men

[dano]

Thank you. Also, many people speak of the ultrasensitive from Quest. Is Labcorps sensitive equal to the Quest Ultrasensative? My reasonm for asking is that I always get bad readings from the Quest Ultra, comes back alot at less than (<) 2. I know in talking to other people on other forums they say this is a bad reading when Quest comes back at < 2?

Any thoughts.

[dano]

@hardasnails1973 1798 wrote:

Clymer center also known as The Woodlands in quakertown. PA

Thank you very much, sir.

[dano]

@hardasnails1973 1787 wrote:

If you are in PA I know of a place that does it dirt cheap with glutathione pushes as well. .

Actually, I am in the Pocono area, and would be willing to travel some in PA. Could you give me the name of the place you refer to please. Thank you.

[dano]

@hardasnails1973 1780 wrote:

I had chelation therapy done. It cost 115 – 150 bucks depending on the cocktail can last up to 2-3 months. It helps to remove toxins from your system, but in mean while pulls out minerals mainly copper, zinc, calcium, magnesium, iron. People that are in a diseased state are already nutrient deficient state to begin with. It is highly successful in treating heart disease for removing plaque. There are better ways to remove toxins in the body then chelation, but if you are going to use it for heart diseae then it will work wonders.

Thank you for your response. I am 60 years old and recently had a 64 slice CT scan of the heart and they found about 50% blockage in the coronary artieries. The cartiologist says they don’t normally use invasive techniques until one is about 90% blocked. They want to treat with statins, which I don’t like. I heard about chelation.

So do you agree that I would possibly be helped by having chelation? I talked to someone who had the treatment and they stated that the way to combat the mineral loss is by also getting IV mineral treatments(Myers Cocktais for examplel). Would you agree with this to stop mineral loss.

Thank you

[dano]

Thank you for your response. I am 60 years old and recently had a 64 slice CT scan of the heart and they found about 50% blockage in the coronary artieries. The cartiologist says they don’t normally use invasive techniques until one is about 90% blocked. They want to treat with statins, which I don’t like. I heard about chelation.

So do you agree that I would possibly be helped by having chelation? I talked to someone who had the treatment and they stated that the way to combat the mineral loss is by also getting IV mineral treatments(Myers Cocktais for examplel). Would you agree with this to stop mineral loss.

Thank you

[dano]

@hardasnails1973 1781 wrote:

Here is in a nutshell

If you want NT goto lef.pharmacy it will be back there in about 2 weeks.

Sorry for my ignorance, however, you mention NT at lefpaharmacy. What is NT?

[dano]

@hardasnails1973 1534 wrote:

Think the Big pharma are trying to push to synthetics which IMO may not be that bad if proper combination of t4 and t3 are used correctly. I also notice that people that are on armour and glandulars tend to have a lower ft4 and after a long time start to have some symptoms start to return and never get ft4 to match ft3 levels. I see so may people that are on armour and have a good ft3, total t4 and total t3 but ft4 is at bottom range. As DR. M pointed out that this can cause problems with peoples conversion in the brain since t4 is a resevoir of t4. I am actually looking into thyrolar which since it is not a glandular may prove to be a better because the body may not convert t4 to t3 at such a rapid rate altering some peoples emotional status. This may be the number one reason why armour gives good numbers and people still feel not right, but do feel better.

Won’t work. Heres a recent statement from Forrest Labs on their website about Thyrolar:Statement from Forest Laboratories Re: Availability of Thyrolar:

U.S. Pharmacopeia, an official public standards–setting authority for all prescription and over–the–counter medicines and other health care products manufactured or sold in the United States, has mandated new specifications for the manufacturing of Thyrolar. As a result, all strengths of Thyrolar are currently on long-term back order while Forest makes the modifications necessary to meet these new specifications.

Forest is working diligently to complete these modifications. In the meantime, patients should speak with their physician regarding appropriate treatment for their condition, and check for future updates on the availability of Thyrolar through the Forest product availability toll-free hotline at (866) 927-3260.

I’m also told Westhyroid and Nature-Throid are also on long-term backorder. Anyone have any suggestions for those of us who want a natural thyroid product?

[dano]

@DrMariano 1085 wrote:

@dano 1074 wrote:

Some people have difficulty absorbing medications such as testosterone via the transdermal route. For them, alternative routes for dispensing the medication are necessary.

But what lets the physician know the patient is not properly absorbing; is it mainly poor testosterone numbers after using the transdermal? Thank you.

[dano]

@DrMariano 1052 wrote:

@dano 1049 wrote:

Transdermal testosterone – if it can be absorbed – is the favored treatment by many hormone replacement specialists. The limitation is : if it can be absorbed.

Thank you. When you say if it can be absorbed, do you mean that the person maintains adequate testosterone levels from its use, or do you mean something else?

[dano]

@DrMariano 1042 wrote:

The extreme flat dosing is achieved via testosterone pellet placement.

Dr. M, would transdermal testosterone be a alternative to the pellets for flat dosing? Thank you.

[dano]

Dr Mariano:

HOW does one combat this reversal you mention below and thereby maintain a successful replacement program?

@DrMariano 954 wrote:

If a male is hypogonadal for an extended period of time, then the first exposure to testosterone replacement can be exhilarating. Then it eventually goes away.

Here is a simplification of what may be happening:

Testosterone increases dopamine signaling in the brain. Dopamine signaling promotes sex drive, attention, interest in activities, elevates mood, and is calming in effect since it also reduces norepinephrine signaling. Without testosterone, there may be an increase in dopamine receptor concentration due to the loss of dopamine signaling.

Testosterone, itself, has a calming effect on the brain. It helps reduce norepinephrine signaling. Losing testosterone loses another of the control signals on norepinephrine production.

The loss of testosterone production is also accompanied by a loss of testicular thyroid releasing hormone production. This results in a reduction in thyroid hormone production. This results in a reduction in metabolism and energy. The brain compensates by increasing norepinephrine production to increase energy. This increase in norepinephrine signaling can promote insomnia, irritability, anxiety. It also does not usually improve energy well.

Over time, with aging, thyroid hormone production is reduced. This compounds the problem of thyroid loss accompanying testosterone production loss, including a further increase in norepinephrine signaling to compensate for the loss.

Testosterone, overall, is an anti-inflammatory signal and helps govern adrenal function, preventing excessive production of cortisol. Without testosterone, under increased norepinephrine signaling levels, high cortisol production may occur – which may or may not cause problems.

The elevated norepinephrine signaling may then be accompanied by pro-inflammatory cytokine signaling as the brain becomes chronically elevated by stress signaling/norepinephrine. Over time, this may then cause hypothalamic-pituitary-adrenal dysregulation with low cortisol production.

Estradiol, functioning as an MAO, increases serotonin greater than norepinephrine. It promotes competitiveness, drive, sex drive, aggressiveness. Without testosterone, however, and the dopamine increase it promotes, Estradiol would tend to flatten sex drive and promote irritability and aggression, anger, instead. Unless testosterone production is very low, Estradiol can be maintained since so little in relationship to testosterone, is needed in men. The relative change in signaling strengths of each poses problems of excessive estrogen. This includes increased thyroid binding globulin and reduction of free thyroid hormone signals. Excess estrogen, by increasing serotonin excessively, may reduce sex drive.

Norepinephrine is important for sexual function. It promotes the high and excitement that accompanies sex drive / libido. But in excess, it does not. It causes tension, stress, distress, anxiety, irritability, which lowers sex drive. To increase norepinephrine, the brain may reduce serotonin, GABA, then dopamine production – causing problems with deficiencies in serotonin, GABA and dopamine.

Excessive norepinephrine production also causes insulin resistance. The increase in insulin production that results is pro-inflammatory. It also further reduces testosterone production. Insulin also promotes fat storage. The resulting increase in fat results in an increase in Leptin and other pro-inflammatory signals from fat cells.

And so on and so on. These are some of the changes that permeate the system from the loss of testicular testosterone production. Some are added to by changes in the metabolism of the other cells which produce other signals such as thyroid hormone, through the process of aging or with nutritional problems or with genetic predisposition to other signaling or metabolic problems or through structural changes such as the loss of cells in the hippocampus and other brain structures.

---

So what happens when testosterone is replaced?

There is a reversal of some of the initial signaling problems.

Because there is a larger number of dopamine receptors from the dopamine signaling deficit caused by the loss of testosterone, there is dopamine supersensitivity to the surge of dopamine signaling that accompanies the increase in testosterone with replacement. This can cause a high – with heightened sex drive, alertness. and an elevated mood.

Testosterone would also free up thyroid hormone by reducing thyroid binding globulin, reversing estrogen’s effects, improving function from this angle. This would improve energy

Testosterone would then reduce excessive norepinephrine signaling, which as it comes more in normal physiologic strength, helps dopamine in providing a higher level of libido, sex drive, and an emotional high.

The testosterone to estrogen ratio would improve, reducing effects of excess estrogen. Insulin signaling is reduced. The body becomes less in an inflammatory state.

The person feels better, if not feels a high from the initial treatment with testosterone.

—-

Over time, however, with increased dopamine signaling, dopamine receptor production is reduced back to a normal amount. Dopamine, as the reward signal, the feel good signal, can’t be elevated for a prolonged period of time excessively, without problems occurring. It no longer becomes a reward signal if it is elevated for a prolonged period of time. Tolerance, through receptor reduction, occurs.

After the initial high, other problems also occur.

Exogenous testosterone suppresses testicular thyroid releasing hormone production. This reduces thyroid hormone production, undoing the initial increase in free thyroid hormone that testosterone caused. If there is hypothyroidism in the first place, this exacerbates that problem.

If there are other neurotransmitter, hormone, cytokine signaling problems or metabolic-nutritional problems outside of hypogonadism, these may complicate or undo what testosterone initially did.

If the man aromatizes testosterone to estrogen excessively, problems with excessive estrogen occur. If aromatization is not enough, then problems with too little estrogen occur. In either case, sex drive is impaired.

Thus, the hypogonadal man returns to Earth. And the initial high is lost.

[Author]

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