I just talked to Dr Crisler to discuss my treatment and there are a couple of new things that I’m not sure have made the rounds yet.
He no longer uses blood work for anything. Baseline and follow up labs are only done with the Rhein 24 hour urine. He feels, and I agree after my first experience with it, that it’s way more accurate. My Rhein basically told the tale of how I was feeling. T 45 reference range 45-85. All of my metabolites of T were in proportion with the amount of T I was producing which helps confirm the result. DHEA also low.
New type of gel and new way of applying. Gone is Androgel and the rub all over your body routine. He recommends compounded gel (from a specific pharmacy) now and it’s applied by squirting it on your forearms and then rubbing them together. Apparently absorption is much better in that area and you don’t end up washing half of the gel away on your hands. I had actually read that somewhere else also. Obviously not an option with Androgel because you need such a large surface area. If you insist on Androgel he’ll still prescribe it but why? Also his preference is gel and he’s having success with it. The forearm application cuts down on DHT and E2 conversion. Has anyone tried this application area?
He still sticks to his protocol of adding HCG after the second set of labs. For gel users every three days. I’ll post results and labs as things move along. TRT round 3!! Nice to have a Dr that knows what the hell he’s doing so I don’t have to constantly be the Dr. I’m so sick of arguing with know nothing Drs!
Also if anyone is interested in the test it’s Rhein Consulting Labs. If your doctor will order the test for you they’ll ship it to you. They’ll also send you the paperwork for insurance reimbursement. If you want to see how your bloodwork labs compare to your daily output here you go.
He is my doctor also. I did the Rhein labs and mine told the tale also. He knows what he is doing. Good doctor and a good man. He cut my dose back also. And I got to say I was leary, but I feel great at the new dose. He is well worth the money
Also the blood labs are inaccurate because they can change from minute to minute. The Rhein gives your volume of production over 24 hours and how T is being metabolized as well as E. I believe, from what I read, the T they are measuring is bioavailable.
I would like to hear from someone who was on TRT with serum labs with good numbers who then switched to Rhein which then indicated a need for a significant change to dosing, then felt much better off.
There is always more than one way to do things. That does not mean that other methods are not useful.
The problem is always the confines of lab ranges and variations of individual needs. Accuracy is not really the point if a method is used consistently. A more accurate lab number does not in any way account for individual needs.
KSman I hear you and agree. I think the problem with blood labs is timing. Results can vary widely from time of the day and, if you’re on injections, also time of the week. I think the 24 hour urine is also helpful because they’re monitoring the metabolites of T, E, Cortisol, etc. After reviewing my blood labs and the 24 hour urine labs I can tell you that the urine labs accurately paint my hormonal picture. On the urine labs I came in at the bottom of the reference range for T and E was in proportion to my low T numbers. That wasn’t the case on my blood labs. They were all over the map. Crisler took a look at all of my blood labs and basically told me they were crap. I have a feeling a lot of guys are getting denied treatment on blood labs when they may obtain a more accurate analysis with the 24 hour urine sample. I know this if I felt like crap with symptoms of low T and my blood work came back not in range for treatment I would want the 24 hour urine labs to back it up.
One other interesting thing is as I was looking for treatment I called a few anti aging clinics and they’re using the same procedure as Crisler is using now in regards to the gel. They’re using a potent T gel that is applied to the forearms. The one clinic I talked to said they’re results have been so good with it that they’ll guarantee a T level of 900 or they’ll buy it back. I’m not a huge fan of the online anti aging clinics so I thought it was worth the money to be treated properly by Dr Crisler. My family Dr, who tried to treat me but told me he was in over his head, actually wants to be involved so he can learn something. I wish more Drs were that open minded.
This gel is a compounded and other clinics get the same material? Can you tell me more? PM me with the compounder?
Daily fluctuations of T is greatly diminished with age. And when shut down on TRT, there is probably no pulsatile release of T. But I have never seen any data published on that.
You have an endo willing to use Crisler’s protocols? Wow, that’s shocking. It’s been my experience that endos are the worst for this type of treatment. They like to get your labs in range and tell you to have a nice day. (If they’ll treat you at all)
What is the name of the compounded gel so that I can speak to him about it? Also, does your insurance cover the Rhein test? Lastly, I looked on Crisler’s site and couldn’t find any new data on this protocal - are there any related articles on this?