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Krk

TRT advice.

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On 06/01/2019 at 12:02 PM, Lukeg said:

Email gendergp (mike webberley) 20£ a month plus 4£ a vial for sust

Their website seems to be gender reassignment only?

Thats a great price though. 

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5 hours ago, charlysays said:

Quoted from BSSM guidelines 2010:

Page 5: "Whilst there are no generally accepted lower limits of the normal range for testosterone, there is general agreement that a testosterone level above 12nmol/l do not require replacement"

page 7 "The aim of therapy should be a total testosterone level of atleast 15nmol to ensure symptomatic improvement" and "normal concentrations" (page 10)

page 7 "in the presence of a clinical picture of testosterone deficiency and borderline serum testosterone levels, a short therapeutic trial (e.g up to 6 months) of testosterone may still be justified"

Page 3 of the ISSM guidelines:

" The prevalence of hypogonadal symptoms increases with
TT levels below 12.1 nmol/L (350 ng/dL) [26] (Level 2b,
Grade A). However, Zitzmann et al. have shown that
testosterone deficiency symptoms may also be seen with TT
levels as high as 15 nmol/L. This study showed that the
prevalence of loss of libido or vigor increased at testosterone
concentrations below 15 nmol/L (
p50.001), whereas depression and T2DM (also in non-obese men) were significantly
more prevalent in men with TT concentrations below
10 nmol/L (
p50.001). ED has been identified as a composite
pathology of metabolic risk factors, smoking and depression,
whereas only TT concentrations below 8 nmol/L contributed
to that symptom (
p ¼ 0.003). Behre et al. [14] demonstrated
that 6 months of TRT improved body composition and quality
of life in men aged 50–80 years with TT
515 nmol/L and
hypogonadal symptoms; these men showed further improvements in body composition and quality of life over the
following 12 months of TRT. Lower TT levels have also been
shown to be associated with sub-threshold symptoms of
anxiety and depression [67]. There is also a recent study
reporting increased hypogonadal symptoms in younger
men
40 years with TT below 400 ng/dL (13.9 nmol/L) [68]"

From the above it looks as though there is no general agreement that levels as high as 12nmol don't require TRT in the presence of symptoms. In addition levels as high as 15nmol must be a risk factor for low T symptoms or the guidelines would not say to maintain a TT level of atleast 15nmol to "ensure symptomatic improvement" and "normal concentrations" (page 10).

Research published in the ISSAM guidelines also found that men with TT levels below 15nmol had increased symptoms of TD which then resolved once on TRT. In addition another study also published in the ISSAM found that levels below 13.9nmol in younger men were associated with TD symptoms.

With regards you feeling fine with a 10nmol/l trough reading, I'm sure you do. The reason for this is that your peak and average levels are way above this- I would bet your average levels are well over 15nmol/l. A natty who tests at 10nmol/l has a peak reading of 10nmol and a trough level possibly up to half that. They have a trough every single day and as such their average level is much lower than someone on TRT who will have troughs days, weeks or months apart. The only way you can compare symptoms vs levels between someone on TRT and someone not on TRT is to measure their peaks and troughs and work out their average level of testosterone. Any other comparison is not scientific due to not accounting for the variation in levels.

8-12nmol is considered low normal according to BSSM (whos site doesnt even exist anymore) not hypogonadal.

even what you've posted says symptoms are more prevalent at these levels not it is.

my trough level (as most on TRT is) is actually around 8.6nmol and yeah i feel ok. I also have trough weeks not days as per the long Esther being used. 

 

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1 hour ago, Krk said:

I thought a test boost at 40 would benefit every guy as it naturally reduces?

It’s not like I’m self injecting at 21. 

Why would it be stupid?

only benefits you if your test is low.

if you are trying to cure something you don't have, yes it's stupid. by the time your 50 youll regret having to go for those injections all the time when you know you didn't need them.

you taking test at 40 you don't need is no different than taking test at 21 you don't need. if you need it thats a different matter.

you won't notice improved recovery or physique if your test isnt low.

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1 hour ago, Lifesizepenguin said:

8-12nmol is considered low normal according to BSSM (whos site doesnt even exist anymore) not hypogonadal.

even what you've posted says symptoms are more prevalent at these levels not it is.

my trough level (as most on TRT is) is actually around 8.6nmol and yeah i feel ok. I also have trough weeks not days as per the long Esther being used. 

 

Yes, 8-12nmol is low normal with "no general agreement" that those levels don't require trt when symptoms are present, especially if calculated free T comes back below 0.225nmol/l which it often will with even mid range shbg.

If someone who has less than 12nmol TT (or less than 15nmol according to ISSAM research) has symptoms which clear up when the testosterone level is raised, does that not indicate that they were hypogonadal / low on testosterone? If not,  what were they low/hypo with?!

Even some NHS ranges start at 10nmol/l. Someone who is symptomatic and testing at 9 or 10 should not be withheld or advised against a trial of trt, as per bssm guidelines.

It's a poor trt protocol if your trough is borderline clinically low but if you feel fine then alls well that ends well- the guidelines clearly state that the level should never drop below 15nmol/l though to ensure symptomatic improvement.

As i said, a natty guy has a trough every single day which results in a lower average exposure to testosterone even though a snapshot lab result may appear to show the "same" levels as someone on trt. This is why issues with high hct and even hair loss are much more common when on trt compared to being natty.

Let me know what your peak level is and we'll work out your average level and compare it to a hypothetical man who has a peak reading of 10nmol and a reasonable daily trough of say 7nmol. I can guarantee the average readings are in different ball parks. 

 

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On 05/01/2019 at 7:48 PM, lowttt said:

iv had 4 test numbers 7.44nmol 8nmol 10nmol then most recent 6.5nmol all done by doctors and endo from nhs they dnt want to help so booked appointment with dr savage but i also emaiedl all my results to prof hakett he contacted my gp and my gp wants to see me so hopfuly they will listen because ei feel like death lol

The important thing is here is looking at the average - tests are a snapshot in time and are subject to small inaccuracies in the lab for example. By averaging results (assuming they were done at the same time of day) we can get a better picture.

Your average TT is 7.98nmol/l which is clinically low and in the presence of symptoms is enough for a diagnosis of hypogonadism. As your lh is something like 1.7miu/l you certainly have secondary hypogonadism and your doctor should be checking for reversible causes. You might avoid trt for a long while and resolve most of your symptoms with low dose clomid too if no reversible cause is found.

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6 minutes ago, charlysays said:

The important thing is here is looking at the average - tests are a snapshot in time and are subject to small inaccuracies in the lab for example. By averaging results (assuming they were done at the same time of day) we can get a better picture.

Your average TT is 7.98nmol/l which is clinically low and in the presence of symptoms is enough for a diagnosis of hypogonadism. As your lh is something like 1.7miu/l you certainly have secondary hypogonadism and your doctor should be checking for reversible causes. You might avoid trt for a long while and resolve most of your symptoms with low dose clomid too if no reversible cause is found.

i dntno lol my doctor gave me Viagra today 100mg  based off of prof hakket contacting him .... i said i dont feel like having sex at all ... i tryed it 5 hours ago i feel nothing lol

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2 hours ago, charlysays said:

Yes, 8-12nmol is low normal with "no general agreement" that those levels don't require trt when symptoms are present, especially if calculated free T comes back below 0.225nmol/l which it often will with even mid range shbg.

If someone who has less than 12nmol TT (or less than 15nmol according to ISSAM research) has symptoms which clear up when the testosterone level is raised, does that not indicate that they were hypogonadal / low on testosterone? If not,  what were they low/hypo with?!

Even some NHS ranges start at 10nmol/l. Someone who is symptomatic and testing at 9 or 10 should not be withheld or advised against a trial of trt, as per bssm guidelines.

It's a poor trt protocol if your trough is borderline clinically low but if you feel fine then alls well that ends well- the guidelines clearly state that the level should never drop below 15nmol/l though to ensure symptomatic improvement.

As i said, a natty guy has a trough every single day which results in a lower average exposure to testosterone even though a snapshot lab result may appear to show the "same" levels as someone on trt. This is why issues with high hct and even hair loss are much more common when on trt compared to being natty.

Let me know what your peak level is and we'll work out your average level and compare it to a hypothetical man who has a peak reading of 10nmol and a reasonable daily trough of say 7nmol. I can guarantee the average readings are in different ball parks. 

 

I understand the concept of the AUC and total exposure.

It's not really a poor protocol its absolute standard with NHS Nebido.

 

I'm not saying you cant have symptoms at 10nmol, i'm saying a number of things.

1. Going on TRT for life should be a last resort, when the guys only symptoms are similar to that of someone who has anxiety, stress or depression. Considering the guys on medication for one of those conditions its not too far fetched to assume this indicates the possibility.

2. "not optimal" and "Low" are two different things

3. the NHS do not go off average, they go off lowest consistent reading.

 

In this particular case  with the above 28yr old,  they got a few readings, I would expect more blood tests until a consistent reading is achieved.

Viagra is not the answer for 6.5nmol reading.

 

But the OP sounds like he needs explore other avenues and he is on medications which literally cause the symptoms he is having.

 

 

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13 hours ago, Lifesizepenguin said:

I understand the concept of the AUC and total exposure.

It's not really a poor protocol its absolute standard with NHS Nebido.

 

I'm not saying you cant have symptoms at 10nmol, i'm saying a number of things.

1. Going on TRT for life should be a last resort, when the guys only symptoms are similar to that of someone who has anxiety, stress or depression. Considering the guys on medication for one of those conditions its not too far fetched to assume this indicates the possibility.

2. "not optimal" and "Low" are two different things

3. the NHS do not go off average, they go off lowest consistent reading.

 

In this particular case  with the above 28yr old,  they got a few readings, I would expect more blood tests until a consistent reading is achieved.

Viagra is not the answer for 6.5nmol reading.

 

But the OP sounds like he needs explore other avenues and he is on medications which literally cause the symptoms he is having.

 

 

 

No worries. It just makes comparisons of levels between TRT and natty somewhat irrelevant unless the peak and trough is averaged out. Most of the time natty test is only checked at peak so its even rarer that we have all the readings needed to compare levels vs symptoms in natty vs TRT. Also it takes some time for receptors to switch off or become unoccupied which will also be helping carry you over the trough, then you're back to probably 30nmol/l+ a few days after a nebido shot.

If it works for you that is great, if you have any doubt or issues with it though remember that the BSSM and international guidelines advocate a 15nmol trough reading. NHS consultants very often fail miserably to abide by guidelines from reputable professional organisations like the BSSM, ISSAM or even EAU (all these guidelines are broadly similar though EAU are the most comprehensive). If you're a member of TRT in the UK on facebook there are stories every week backed up by lab reports and even letters from consultants showing NHS Endos totally ignoring guidelines. One guy was told by a consultant endo in a letter that there can't be any issues unless he was below 6nmol/l lol.

I agree with all your three points mostly, though the NHS have been known to keep testing someone who's borderline over many months then discharge them when they test a couple of nmol/l within range.

Also I would argue the above 28yr olds readings are consistent, they're within a few nmol/l of eachother (and consistently at a level where TRT would be beneficial in the presence of symptoms) which is pretty normal as the body is not a digital machine and neither is the process of testing the level, the whole process is open to small errors and natural variations. On a three fold range, a few nmol/l is neither here nor there, hence the comment in the guidelines about borderline levels. Someone who tested at 8nmol one day with symptoms (a level where most men will benefit from TRT) isn't going to feel any better the day they test at 11nmol but they will have a much harder time getting any treatment from the NHS.

I agree the OP needs to look at other avenues considering the medication and issues the medication is treating for sure. TRT should always be a last resort.

 

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16 hours ago, lowttt said:

i dntno lol my doctor gave me Viagra today 100mg  based off of prof hakket contacting him .... i said i dont feel like having sex at all ... i tryed it 5 hours ago i feel nothing lol

100mg is a lot. I think my head would go purple if I took that much. At your age 50mg should be plenty, but prof Hackett said himself that Viagra won't work unless there is a healthy T level. See here:

https://www.dailymail.co.uk/health/article-3184279/It-s-not-Viagra-needs-s-testosterone-men-think-little-blue-pills-takes-pep-flagging-love-life-new-research-suggests-wrong.html

 

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2 hours ago, charlysays said:

100mg is a lot. I think my head would go purple if I took that much. At your age 50mg should be plenty, but prof Hackett said himself that Viagra won't work unless there is a healthy T level. See here:

https://www.dailymail.co.uk/health/article-3184279/It-s-not-Viagra-needs-s-testosterone-men-think-little-blue-pills-takes-pep-flagging-love-life-new-research-suggests-wrong.html

 

bro i dont know what to say man iv done everything i can to get help... pro hackett is retiring in 5 weeks i asked if he could help i sent my results and he did contact my gp thats why they gave me Viagra 100mg i took it and felt nothing i was shocked tbh... i did call up today and prof hackett said he will see me for 150 pounds bit i asked her if he would treat me she said she cant answer that ... i need it to be more transparent as i only have around 300 pounds to do this my job is abit crap atm i cant keep paying for more test and more appointments so dr savage is the only one that is saying he will tereat me .... i might just go with optimale they will do it on a skype call and its only 130 but i know the monthly cost is a rip off but im desperate at this point guys this sucks  

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personally, i'd go with either hackett or savage as when you try to get your GP to prescribe off their recommendations it should carry more weight that they are both NHS registered doctors.

no one on the NHS will promise to treat you , infact if anyone does you should run as they dont have your interests in mind.

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47 minutes ago, aqualung said:

personally, i'd go with either hackett or savage as when you try to get your GP to prescribe off their recommendations it should carry more weight that they are both NHS registered doctors.

no one on the NHS will promise to treat you , infact if anyone does you should run as they dont have your interests in mind.

Bad news mate :lol:

Callum Hackett 'stabbed David Savage after having sex with Donna

https://www.express.co.uk/news/uk/733116/teenager-murdered-man-after-partner-sex-at-party-gosforth-court-trial

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52 minutes ago, aqualung said:

personally, i'd go with either hackett or savage as when you try to get your GP to prescribe off their recommendations it should carry more weight that they are both NHS registered doctors.

no one on the NHS will promise to treat you , infact if anyone does you should run as they dont have your interests in mind.

do you hvae any idea on what the protaco will be with hackett? its 150 to see him but will he treat me there and tehn or you think he will just do more test an then ask for another appointment ? 

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17 hours ago, aqualung said:

personally, i'd go with either hackett or savage as when you try to get your GP to prescribe off their recommendations it should carry more weight that they are both NHS registered doctors.

no one on the NHS will promise to treat you , infact if anyone does you should run as they dont have your interests in mind.

Exactly. And both have written TRT guidelines the NHS allegedly follows. Prof Hackett as you probably know mostly wrote the BSSM guidelines and Dr Savage co-wrote the guidelines on TRT in diabetics. Any GP with their head screwed on should prescribe under the guidance of either doctor.

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16 hours ago, lowttt said:

do you hvae any idea on what the protaco will be with hackett? its 150 to see him but will he treat me there and tehn or you think he will just do more test an then ask for another appointment ? 

I've not actually read of anyone who was treated by him, not sure why as he's widely recognised and must know his stuff. He should follow the guidelines he wrote though which say to maintain a level of at least 15nmol (15nmol troughs) and I would imagine a peak level somewhere at the top of the normal range (30-35nmol or so)... so by definition any protocol from Prof Hackett should provide relatively stable levels. As lifesizepenguin has said a typical NHS nebido protocol often won't meet the requirements of the BSSM guidelines so it would be interesting to see what prof Hackett has to say about that. On "TRT In the UK" there are people splitting up nebido shots to enable them to maintain more stable levels with success.

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i was Dx'd by hackett and stayed with him until i was stable (under NHS) ,he had no problem dropping from a 12 to an 8 week interval after i had only 3 shots as my test was really low.

there are some good doctors out there if you genuinely need them  (savage and hackett being 2 (i spoke to savage before i saw hackett , infact it was savage that mentioned i had an NHS specialist quite near me (hackett)).

protocols differ depending on whether you are seeing them via the NHS or private as on the NHS they have to stay within strict guidelines (for instance the NHS wont prescribe HCG or clomid (unless its for fertility problems , the same goes for AI's (reduce dosage not add an AI)

people keep forgetting that the NHS protocols are about functionality not optimisation.

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2 hours ago, charlysays said:

I've not actually read of anyone who was treated by him, not sure why as he's widely recognised and must know his stuff. He should follow the guidelines he wrote though which say to maintain a level of at least 15nmol (15nmol troughs) and I would imagine a peak level somewhere at the top of the normal range (30-35nmol or so)... so by definition any protocol from Prof Hackett should provide relatively stable levels. As lifesizepenguin has said a typical NHS nebido protocol often won't meet the requirements of the BSSM guidelines so it would be interesting to see what prof Hackett has to say about that. On "TRT In the UK" there are people splitting up nebido shots to enable them to maintain more stable levels with success.

yea i tryed to look around to see if anyone can give info on how he is.... i have a appointment book with dr savage in 2 weeks.... so i guess il just have to go there the only other place is optimale and yes i know the monthly fee is a rip off but its alot cheaper in down payment and i wont have to go anywhere ... but its 90% going to be dr savage though but thats just another option im thinking about 

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25 minutes ago, aqualung said:

i was Dx'd by hackett and stayed with him until i was stable (under NHS) ,he had no problem dropping from a 12 to an 8 week interval after i had only 3 shots as my test was really low.

there are some good doctors out there if you genuinely need them  (savage and hackett being 2 (i spoke to savage before i saw hackett , infact it was savage that mentioned i had an NHS specialist quite near me (hackett)).

protocols differ depending on whether you are seeing them via the NHS or private as on the NHS they have to stay within strict guidelines (for instance the NHS wont prescribe HCG or clomid (unless its for fertility problems , the same goes for AI's (reduce dosage not add an AI)

people keep forgetting that the NHS protocols are about functionality not optimisation.

so you think my best bet is dr savage? im in birmingham aswel... 

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On 1/7/2019 at 7:36 PM, lowttt said:

i dntno lol my doctor gave me Viagra today 100mg  based off of prof hakket contacting him .... i said i dont feel like having sex at all ... i tryed it 5 hours ago i feel nothing lol

From what I understand viagra just makes blood flow easier and does not increase libido. I think it was designed to help with high blood pressure originally but ''side effects'' were noticed.

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48 minutes ago, monkeybiker said:

From what I understand viagra just makes blood flow easier and does not increase libido. I think it was designed to help with high blood pressure originally but ''side effects'' were noticed.

^this

Sildenafil was developed as a medication to treat arterial hypertension. Patents reported better erections so it was then marketed as Viagra specifically for erectile dysfunction. It works by causing arterial dilation allowing for more blood flow. It will not increase desire in any way, however 

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3 hours ago, lowttt said:

yea i tryed to look around to see if anyone can give info on how he is.... i have a appointment book with dr savage in 2 weeks.... so i guess il just have to go there the only other place is optimale and yes i know the monthly fee is a rip off but its alot cheaper in down payment and i wont have to go anywhere ... but its 90% going to be dr savage though but thats just another option im thinking about 

What I know for a fact is that Dr Savage will, if you ask him, send documents to your GP saying that you've seen him along with his diagnosis and recommendations. He also sends a sort of CV and the usual result is that the GP is then willing to work under his guidance and prescribe and monitor on the NHS. Follow ups are free via email then. He'll change the prescription to adjust dose etc, add in an AI if really necessary (rare if dosing and frequency have been dialled in). The same should happen with Prof Hackett tbh but I can only be sure of my own experience.... Even though I was prescribed clomid my GP was suddenly willing to monitor on the NHS and said he could quite understand why I went to see dr savage after receiving the paper work from Dr S whereas before he'd been telling me that 10-12nmol was "plumb normal" and not possibly a cause for symptoms.

I do pay for my prescriptions (about £2.50 per month lol) as clomid is off label and you couldn't really expect a GP to prescribe something not approved. It's ridiculous how fearful a lot of NHS doctors are about correcting hormone issues. Unless it's really bad they tell you its too dangerous. Can't say I've noticed any negative sides from clomid in 2 years. I also recently experimented with cabergoline to bring down my persistent mild prolactin elevation- yet another thing my GP said wasn't worth treating due to risks and 0.125mg per week keep prolactin at around 100miu/l with nothing but benefits. I guess we do live in an era of litigation though.

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as above , both NHS doctors will work with your GP  -you want a proper diagnosis and the support that comes with it - TRT is for life.

.... or you can goto places like balance my baws who will usually give out scripts without a thorough examination /diagnosis and just throw other crap in for you to buy when they f**k it up (such as an A.I ) - they make more money the more crap they sell to you  , this just goes round in a circle until you are broke , at which point you go to the NHS who will start from scratch and may say something along the lines of   'why exactly have you been taking this in the first place as your results dont warrant it ' .

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2 hours ago, aqualung said:

as above , both NHS doctors will work with your GP  -you want a proper diagnosis and the support that comes with it - TRT is for life.

.... or you can goto places like balance my baws who will usually give out scripts without a thorough examination /diagnosis and just throw other crap in for you to buy when they f**k it up (such as an A.I ) - they make more money the more crap they sell to you  , this just goes round in a circle until you are broke , at which point you go to the NHS who will start from scratch and may say something along the lines of   'why exactly have you been taking this in the first place as your results dont warrant it ' .

do you gusy know the price of trt? dr savage emailed me back and said this .. 

'you will not find high quality testosterone care I believe for less you would have to pay the £43 a month during your trial period but some patients split the Sustanon so you only use 2 vials a month costing you approx £8'

so i might want test e as i heard its better... but am i reading this right... he said 43 a month during my trial period ? does that mean it will be even less in the future? if so thats amazing 

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