Describe your process of evaluating a new patient for trt and if appropriate how you layout a beginning protocol. What are you looking for with symptom resolution. Is there a point where you come to the conclusion that remaining symptoms are not related to lack of testosterone?
Thank you
Sweet I have a question Iāll post when I get back to Aus. On plane now
So, @dbossaā¦ what gave you the idea to contact/get ahold of Dr Sir? His wealth of knowledge is impeccable
@unreal24278 he contacted me. He said he enjoyed the content I was providing here as well as on the YouTube channel and would enjoy being interviewed by me. Needless to say, it took me by surprise. Weāve been texting regularly ever since. Nice guy!
Yea, heās a cool guyā¦ very busy though (as is to be expected from a man with 4 kids and a full time job as an endocrinologist whilst managing a clinic of his own!!!
I havenāt spoken to him in a while, but when I did he always gave me solid advice regarding questions I couldnāt ask anyone else. His presence will forever be missed by myself and many others.
Heās a grown ass man. If he wants to answer them heās got them. Not asking a question is a great way to not get an answer. Post your question
@wolf359 - he created a thread a while back related to your question -
Yes, I know, but the interview is not necessarily a continuation of a forum thread. People watching/listening may be unaware of any postings here and would be interested in his processes and treating philosophy.
Very true @wolf359, I was just taking this into consideration when responding with that link.
@bcostigan41
That link is great. I had totally forgot about it
Iām going to try and get to as many questions as I can during the interview.
Hopefully this will be the most viewed video yet, there sure seems to be a ton of interest
A couple of questions:
Thanks!
Hey guysā¦ the interview is confirmed for Saturday, January 11th at 1pm Eastern Standard Time on the TRT and Hormone Optimization YouTube channel.
We will do our absolute best to try to answer as many questions as possible. T-Nation guys will get priority over the chatbox guys.
which timezone is that @dbossa?
Sorry about thatā¦ I just edited the postā¦ Eastern Standard Time
What FT/TT level do you recommend someone hit for a ācycleā? When people talk of cycles they always talk in mg/g which seems odd considering the subjectivity of it.
What do you look at when your TRT patients complain of fatigue? If its DHEA or pregnenalone where do you like to see their levels?
My questions
20: regarding the whole andropause movement. Do you believe testosterone levels within the male population legitimately and consistently decline by 1-2% per year say after age 35ā¦ or is the new, alarmingly high prevalence of hypogonadism within older populations (and younger populations now) a result of poor lifestyle/dietary habits, extensive exposure to environmental toxins/chemicals (preservatives from processed foods, phytoestrogens etc) and overuse of various prescription meds (SSRIās, Statins etc)ā¦ also, why are reference ranges getting lower and lower, I keep seeing ref ranges now that are teetering on 75-600ng/dlā¦ no normal adult male will have a TT of 75ng/dl
21: PFSā¦ what do you do about the men unfortunate enough to have acquired hypogonadism and/or neurological abnormalities stemming from use of 5a reductase inhibitorsā¦ itās not merely the test levels, but the potent effects blocking DHT can have on downstream hormonal patterns (of which many DHT metabolites are vitally important regarding neurological regulation as they function as potent neurosteroids)ā¦ if these pathways are perhaps irreparably damaged, are these people simply doomed to live out a life of erectile dysfunction, depression and overall inadequacy?
22: With TRT becoming more and more mainstream, yet still not entirely understood by many MDās, it appears quite a few men with very unhealthy lifestyle habits are being put on. An extreme example would say beā¦ a morbidly obese man (BMI of 40, bf% 40%)ā¦ Iām tempted to say bmi of 50 but at this point itās just a joke lolā¦ he also has type 2 diabeties and is a smoker. A practitioner puts him on TRT (innapropriately, he clearly needs to clean up his habits)ā¦ what impact would a mere replacement dose have on this mans long term cardiovascular risk factors. Many say āTRT doesnāt increase overall cardiovascular mortality rates etcāā¦ but for someone in this state, what would the long term implication be? Thereās a reason his T is low, aside from insulin resistance/leptin resistance, a super shitty lipid profile (I assume), perhaps hypertension, his adrenals are probably jacked up from the smoking and the obesity etcā¦ his T is low in part due to many mechanisms within his body being thrown off due toā¦ well his terrible state
My questions are very long, Iāll shorten them up when I get home
My next question would be āwhat do you think he future of TRT/ART holdsāā¦ but Iām pretty sure I know the answer. I hypothesise itāll be some kind of SARM/uniquely modified AAS that legitimately entails minimal long term risk/effect on numerous haematological, endocrine, neurological, cardiovascular parameters to accost for the variables detailed in question 22ā¦ and whoever creates this drug will be rich as FUCKā¦ because he/she may single handedly dramatically reduce rates of obesity/Ill health, be able to improve survival rates within individuals in severely chachetic states (say people on chemotherapy etc) and whatnotā¦ I hope itās meā¦ However I donāt need think Iād be cold hearted enough to put a patent on such a compound if it were that successful, generics are more affordable
So glad I didnt have students like you when I was a TA. 
Most 18 year olds would ask āwhatās a good stack for me to gain 50 pounds and make my dick huge at the same time?ā
Whatās TA?
Andā¦ what stack can I use to gain fifty FIVE pounds and get my dick huge?
I was thinking
1500mg tren
100mg test
50mg sdrol daily
10ius of GH daily
40mcg clen 2x daily
#suddencardiacdeathatage22