Dr here to learn

Hi all, I’m a physician who specializes in TRT. I want to learn from y’all. What frustrates you about TRT doctors, what do you wish we knew or talked about with you?

ETA: For some reason I can’t reply to posters but I agree I think twice a week is optimal but once a week can be ok. If you feel better on three times a week or more I generally recommend oral or nasal options. Agree with FT but there is data to suggest not much difference between equilibrium dialysis vs other. I tend to use calculated free T which is a good and cheap indicator. Also, I personally hate the reference ranges for free T with all major lab companies. I rarely use AI. Estradiol is so important for libido and bone health and only need to reduce if above 50. To be honest we’re not trained on using anavar and deca and most doctors are worried about liability when prescribing these. They are also technically being used off label for the purposes of increasing muscle mass which is not indicated for overall health. I generally think everyone has their own set point for testosterone but typically people tend to fixate too much on the number - goal is to saturate androgen receptors and improve symptoms, more not always better.

ETA: which doctors are prescribing anabolics? I know I’m not. TRT is much safer when dosed and monitored appropriately. I don’t know any doctors who think patients can’t inject themselves but again this is why i’m here trying to learn from your experience.

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It frustrates me that I(and a lot of people in this ste) know more about hormones and how the drugs work/don’t work then the docs prescribing them.
Not sure what you are looking for here. Why don’t you tell us more about yourself, your experience and you practice. How do you determine a course of treatment? How do you feel about ancillary drugs like anavar/deca being prescribed as part of a TRT protocol? Where are you on AI and how it’s misused by many?

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Total test being used as a primary metric for TRT candidacy when FT is a far better tool.

FT being measured by calculation or direct measurement when equilibrium dialysis is the only accurate way of measuring it.

20 year olds having the same reference range as 90 year olds.

Any protocol that has patients pinning less than once a week (twice or more being optimal).

Over-reliance on AI when a better option is to lower TRT dose such that AI is not needed.

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It’s not TRT

Anavar drops HDL by at least 30% and often 60%+

And often doubles LDL… do we naturally produce anavar?

At the very least can we stop calling this “150mg test oer week 100mg deca 40mg anavar per day” trt?

I’ve taken real anavar before and YES… it feels super mild, way milder than test where I feel all amped up whenever my total testosterone goes above like 1100

I tried 20mg, then 30mg then briefly 40mg

Only side effect I noticed was extreme heartburn but the stuff I had was suspended in this solution of ethanol + some godawful solvent

I had to use a PPI if I wanted to take it for longer than a week. I tried it for three weeks before surgery on my shoulder to try gain as much strength around my rotator cuff muscles. It worked super well for what I wanted it to do and actually all of my joints felt much better on it (though doesn’t compare to nandrolone or trestolone which legit gives me like a 70-90% reduction in joint pain)

But I feel toxic on nandrolone… I don’t feel toxic on var outside of heartburn but when I think about the increase in strength on anavar, the quick reduction in BF despite not changing my diet… it’s clearly superior to trt… even if I stopped taking testosterone and just took say 10mg oxandrolone daily it’s superior to 100mgs of test oer week…

Lots of people attribute the lack of gains to the lack of water and glycogen retention you get on anavar… but what you put on with anavar you actually tend to keep most of it

and its impact on lipids… TRT should either hardly budge or even improve cardiometabolic parameters… testosterone replacement therapy replaces deficient hormonal parameters and doesn’t need to be cycled on and off like anavar and deca usually need to be cycled

Replacing T from a deficient baseline doesn’t mediate adverse cardiometabolic outcomes from an epidemiological perspective

Whereas put even a group of healthy, genetically robust men on 100mg test/wk vs 100mg test 100mg deca 20-50mg anavar oer day and have group two undergo two 8 week cycles yearly

Follow both groups over 20 years and the group taking the deca and var will have way more heart attacks, strokes, blood clots of all kinds etc

TRT is almost risk free (or so it seems) for healthy young men. Blasting and cruising comes with risk and I hate it being promoted/pushed as TRT as it makes the guys on real TRT look bad

I remember there was a guy on here (won’t rat him out) who was very pushy about hormone “optimization” e.g. pushing total and free testosterone above and beyond what even the most virile 18 year old male would produce

He wound up publishing photos on Facebook of his amazing trt transformation but as I was talking to him semi regularly at the time I found he was doing “TRT” at 250mg test oer week, then had hopped on an additional 100mgs of deca for like a month or two … then if I recall correctly swapped it out for 100mgs of mast

Then tried dbol for a week or two on top of that

And was claiming his very impressive 4-6 month transformation wss from trt… him starting at 250mg/wk which consistently put him at 1000-1500ng/dl WITH lower SHBG alone isn’t trt…… his “TRT” was the same as the biggest cycle I ever ran!

When I did that at age 18 (was on TRT. I have a rareish genetic disease which fucks up everyrhing from my joints to my endocrine system) I put on like 10 pounds in three months… and had a ton of side effects, my body can’t tolerate testosterone at even remotely supra doses but I could tolerate drugs like primo and anavar really well (well except for lipid destruction)… probably because my doses were super low compared to most

But I took 400mgs of primo on 2-3 consecutive weeks and had essentially zero sides

400mg of test and I’m a bloated sweaty mess with a much higher resting heart rate

So for 99% of the population aside from rapid metabolizers or people with partial androgen insensitivity shndrome 250mg isn’t trt

It’s a cycle… now for the genetically robust they can get away with that long term

But it’s not “safe” from the context of “compared to true replacement, the level of risk associated with taking sports TRT + deca + winny + var” etc is MAGNITUDES higher than say 100mg test/wk (enough to cover like 60% of guys)

Even the 100mg T/wk… not to get into semantics but if you’re on 100mgs of test a week you cannot claim natural

In Australia where I live if you are on TRT you can’t compete in the natural bodybuilding full stop.

Reason being let’s say I take 100mg oer week and I’m at 600ng/dl, my shbg is 25 and my FT is let’s say 800pmol/l

A natty guy at 600 will have far higher shbg and lower FT… maybe a natty guy in the top 0.5% will have a TT of 1200 and a FT of 800pmol/l

So if I’m 600 with FT so high only 1 in 200 exceptionally healthy, lean young men can achieve a similar level under optimal conditions am I still natty?

If you’re hitting 600-1000 TT on trt and your shbg is like below 30… chances are you hit Supra Ft Levels at peak

If I diet down to 4-8% body fat as a natty and get blood work done often testosterone will be super low (100-300ng/dl) or if you’ve gone sub 5% it’s legit often down where a woman’s T would be (like 50ng/dl)

This affects strength, drive in tne gym, mood, it even cosmetically affects how the muscle LOOKS… it won’t pop as much

So a guy on TRT who has been training for five years competes and a fully natty dude does the same… both diet down to 5%

The guy in trt can probably hold an additional 5lbs of lean tissue, and cosmetically he will appear fuller

Not to detract from the effort people put in but TRT isn’t natty (probably more like “half natty” as benefit is only really present when lean)… that and trt allows you to have trash sleep, drink and take a bunch of drugs yet still eek out gains whereas natty guys often need to optimize their routine to make decent gains

And oxandrolone, nandrolone etc certainly ain’t natty

I have a disease called Ehlers Danlos syndrome and I must say however in low dosages these drugs help a looooooooooooooooooooooooooooooooooooooooooooooot. Hardly ever if at all touch them nowadays though… but I credit the AAS for allowing me to live a relatively normal life all the way up through to my early 20s

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Fully agree. Just trying to understand where the OP is coming from.

1000013209

That reminds me, OP.

Add “doctors that are pussies about dosing” to that list.

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I have no issue with doctors actually prescribing steroids to people who want to take them

But it’s risky af for doctors in America to be doing…. It’s a weird grey area and it’s very possible the overzealous doctors and patients will ruin it for everyone and you guys get so strict it’s like Aus and doctors won’t even consider trt for my acquaintance who is at 100ng/dl or slightly lower unless it’s 3 bloods all at least 3-5 months apart and even then they’re difficult

Unless you can find a really good Private andrologist which is like searching for a needle in a haystack

I have a problem with it being lumped in with trt

If someone asked if I was on trt…. I’d lie and say no as the stigma in Australia is MUUUUCH more prevalent (at least I think). Compare Aus to like the UK and the attitudes really are just night and day it’s crazy.

The overwhelming view is “test makes your dick shrink”

So what if it did? Some of us have inches to spare

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Have you ever tried tren?

Or EQ?

If so… how did you feel on them compared to say deca, trestolone, primo, mast etc

No. About to try tren at very low dose.
Ive got Eq on my shortlist of gear to try.

Id rather not keep derailing OPs thread, if it’s all the same to you.

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You should also visit Excel Male TRT Forum. The two sites are different in my opinion on the goal of many users.

What frustrates me is your peddling steroids under the guise of testosterone replacement therapy. Just like all those doctors who were peddling heroin under the guise of pain killing opioids.

In 10 years we’re going to find out what trt really is all about and I don’t think we’re going to like it.

Call me naive, but it is the patients asking the doctors for TRT, but wanting bigger muscles and less fat. To get what the patient is asking, steroids are a reasonable route.

I was prescribed Dianabol by my family doctor during the 1970’s. Was he peddling steroids? At least I knew what I was getting. Then it all went underground. Are anabolic steroids the curse of the world?

TRT is a rather new science. I greatly appreciate a doctor wanting more information from those who put in hours upon hours of research and dialog with others to discover possible nuances to improve TRT. The human reaction to exogenous testosterone is extremely complex.
Please make these doctors feel welcome.

If any of you know me very well, you know that I don’t believe there is any settled science. We only have the current best science. Please aid in helping doctors improve their scientific knowledge of TRT.

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Please, do go on…
:ear:

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Ummm… what?

A tiny portion of doctors were peddling prescription opiates in pill mills and as a result the fda cracked down on opiates so hard people with intractable pain including terminally ill cancer patients have trouble accessing the pain relief they need

Heroin and prescription painkillers are not the same. You buy heroin and it’s in powder form or it’s black tar and now heroin isn’t even heroin but fentanyl and nitazenes… that heroin is clearly not meant for medicinal use, jts designed to be smoked or injected to cross the blood barrier as quickly as possible

I know from experience if you are prescribed an appropriate dose for the condition you have, it’s not nearly as addictive as it’s made out to be and I had no issues getting off even after a solid year of daily use, I just had to wean down over a month or two…

And trt… even prescribing steroid cycles… cannot be compared to nefarious doctors running pill mills who would give you a menu with price tags and write up scripts of OxyContin 160mg, opana, diluadid etc fully well knowing their patients were addicts who were going to shoot up in the adjacent parking lot after the appointment

There is no comparison… night and day

Steroids are a slow burn, they kill you ocer many years and for most decades. Abusing opiates esp today is a one way ticket to deaths door or total destitution.

In ten years… if anything real trt will be far more accessible worldwide than it is today barring some mass recession or apocalyptic scenario eventuating

SUPER common for addicts to swap one addiction for another

I don’t know if you’ve noticed there is like a group of very heavy AAS users (think like Joey Swole) who are former hardened addicts and essentially only got clean a couple years ago and while its great they aren’t acutely on deaths door it’s obvious they’ve swapped one extreme for another

Also seems common for former addicts to become like real heavy weed smokers as weed is somehow not seen as a proper drug by many now

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Why do most doctors trust diabetics (children, teens, adults) to inject themselves with insulin multiple times a day, but don’t trust adult males to inject themselves once or twice a week with testosterone?

Do you have an estimate what percentage of doctors fall in this category? My pharmacy seems to be moving quite a few syringes. I didn’t have any resistance from my doctor about me self-injecting.

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No I don’t. Maybe I should have said “some” instead of most.

Dosing protocols in literature are outdated

Many docs outside of the states have patients self inject 200mg e2w

Because those are the protocols described on the package insert etc

It’s as simple as that

Some newer clinical trials are looking at weekly IM or SQ shots. The super expensive sub Q autojector in the states “xylosted” is designed for patients to self administer every week