Funguy

Finally, someone who understands!

Hi Deadlift1: Several comments - you mention that you are on topical T. That is my favorite method of administration BUT it must be of sufficient strength to raise the T. Preparations such as Androgel (6.25%) don't do it. My patients are put on a 20% cream twice a day (made at compounding pharmacy.) Free T needs to be checked occasionally just to make sure you are in the right range. Daily HCG injections are probably overkill. I recommend to my patients who want to use HCG for exactly the reason you mentioned that using it 3 days in a row is sufficient. It now is available as 500 mg troches (oral gummies) with excellent absorption so those not wanting to inject have that option. As far as placebo effect - it probably is NOT acting as a placebo but really is working and does enhance muscle building. Last - Sermorelin. This is a synthetic Growth Hormone Releasing Factor. If you produce enough HGH it is fine for helping to release it. BUT, if you do not produce enough, no amount of releasing factor will help that. So, to see if it is a good option, have your IGF-1 measured.

Yes - sorry for the delay. Can understand the Hgh as it is mediated by the Pituitary. Not quite certain how the diabetes (DM or DI?) interfered and impacted the size of the testes.

Human chorionic gonadotropin vs. Human growth hormone.

HGH is not a problem. Diabetes should not affect testicular size but will contribute to any ED.

@Rudynate is correct, there are usually solutions for this issue. However, after 24 years (which puts your age at approximately 58?) it is doubtful that slipping in some Hcg will work to stimulate your testes to begin functioning and therefore increase in size. If that is the only negative you can point to at this time, by your description you are blessed with very successful treatment.

You do raise some interesting points but I can only speak for myself and the way I do things. First of all HRT is relatively new. Many years ago Pain Mgmt was in the same place HRT is now. Most present day pain specialists are/were anesthesiologists. HRT is still in relative infancy and therefore often a side specialty of other specialists. I came to the party about 6-8 years ago. I had retired from Pediatrics 20 years ago at age 50 - back issues requiring major surgery and I just burned out in pain. Surgeries and intense rehab for 2 years and it was time to get back to work. Retirement allowed me to pick and choose when I wanted to work and what I wanted to do. First I started back in pediatrics, was asked to manage an anti-aging skin care office and then finally the anti-aging with HRT. Now I do all 3 and it's far more fun than burning out again. Because HRT is coming into it's own there are soooooo many different ways things are done. As I said before, I will only comment on the way I do things. First of all, any visits are doctor-related. No PA's and no non-medical employees. You see me or my partner, period. We have a yearly fee and ALL visits are included, whether you come in weekly, monthly, twice a year or whatever. We don't want patients to feel it will keep costing them visit by visit. Calls, email, etc are included. No extra costs incurred. Right now I am unaware of any other office in my area which runs this way. Every one else is by the visit. We present different methods of replacement for the patient to choose from depending on lifestyle, tho we have our preferences. Examples include for instance in T replacent: topical, injectable. We steer patients away from pellets for various reasons, discuss alternative injection schedules, different types of topical. Monitoring is done with reason, not weekly or even monthly but when needed. Therefore it really is necessary for the patient to be comfortable with the style of the office. The length of time a physician has been doing this specialty is less important than his knowledge and the patient's comfort. There are private offices, clinics, docs which do this on the side as part of their regular practice, etc. Again, it is the knowledge that is important. As to finding the right home for the patient - unfortunately, I think it's still hit or miss. I have many patients who come to me from other docs who do things COMPLETELY differently than I do. I put it to the patient to decide what makes more sense from a practical viewpoint and then plug in the specifics for the patient. We always check blood levels - no labs, no refills! It's that simple. I could go on and on but you get the idea - logical presentation to the patient, use of the most simple methods rather than trying to combine all meds into one pill for everyone, and availability. That's really the key to satisfied patients - can they get ahold of you when they need to. In some metropolitan areas offices are numerous and in some areas nonexistant. I have patients literally from all over the country, Europe, and Asia. A lot of Facetime and Skype is used, we use a compounding pharmacy which can send meds anywhere in this country and nonresidents make arrangements which are workable. I hope this lengthy post answers your questions.

Sorry this reply took so long. Cycling like your friend does is unnecessary and won't prevent the shrinkage. The hcg is necessary in order to stimulate the body's production of T. Shrinkage occurs when the testes stop T production. Taking T only will eventually turn off the natural production.

Hmmmmmmmm

You are indeed old enough - at 30's - 40's we tend to routinely use the combination of Hcg and T; the Hcg helps to avoid testicular shrinkage and maintain sperm production while on T. The problem is that you are on daily T so it's difficult to slip the Hcg into the routine. If you change to twice a week T, then you slip that Hcg in between doses. After about 50 you don't need the Hcg nearly as much tho it is a good adjunct for muscle building. Discuss this again with your doctor.

My pleasure

Age is the important factor here - how old is he?

Upon reflection, @MassageAdam, if you are doing sub-Q daily, please make sure you follow your FREE testosterone. This is one of those situations where a monthly blood test would be VERY helpful. It must be FREE testosterone. If you switch to twice a week at about 50-75 mg each injection, you could add human chorionic gonadotropin (Hcg - NOT human growth hormone) on one of the days between testosterone doses and you will build even nicer muscle and you don't run the risk of testicular shrinkage as you do with daily testosterone.

Because of the issues with Kaiser (yes, Southern California reporting in) we have been able to work out a deal with Quest Diagnostic Labs whereby they bill us and we bill and collect directly from the patient. As far as @MassageAdam 's sub-Q method, it still requires a daily injection. However, studies have shown that you can achieve the same results by giving sub-Q doses twice a week. For example, if the weekly intramuscular dose would be 200 mg, sub-Q doses of 75-100 mg could be given twice a week. In some, if therapeutic range has been realized, sub-Q doses could be given on a weekly schedule. The only way to follow this is by blood tests. @MassageAdam is also correct that insurance does not cover compounded medications and testosterone cypionate is covered by insurance. If you have Kaiser or other "HMO" you can use Goodrx.com and 2 X 10 mL vials is approximately $75 and will also last you several months. Last, anybody who has an interest in "anti-aging" / testosterone replacement should read "How to Achieve Healthy Aging" by Neal Rouzier, M.D. Replacement of Testosterone is NOT the only component to healthy aging. Thyroid, DHEA, diet, exercise are also involved. Good luck to all . . .

Testosterone replacement therapy is not for everyone. First of all you need to have not only your Total testosterone measured but also your FREE testosterone. Total becomes a meaningless number because there are many forms of testosterone included in that number and the FREE testosterone is what we are looking for. "Normal" total testosterone does NOT mean your FREE is "normal." As bio-identical hormone replacement therapy is one of my specialties, I have many men and women patients receiving replacement. As we age we produce less and less of the hormones necessary for optimum condition so we look to put our patients' levels of several hormones back to what they would have been at age 25. This includes not only testosterone, but DHEA and thyroid in men. While your levels may be "normal" I will guarantee they are not "optimum." As far as testosterone goes, it can be injected weekly to every 10 days or so or topical. If you go for topical it must be a cream made at a compounding pharmacy and NOT preparations such as Androgel. Androgel is about 6% in concentration and we use a 20% cream twice a day. There is minimal risk of prostate cancer and if the PSA goes up we discontinue for a month and then restart, the PSA goes right back down. We test PSA prior to staring therapy and we have picked up a few prostate cancers PRIOR to therapy. Those patients will not get Testosterone treatment. Had we not checked the PSA these patients (and their doctors) would have blamed the testosterone. Of note, there is a big difference between libido and ED issues: libido is the desire for sex and ED is trouble getting/maintaining erections. If your libido is low, who cares about ED - you're not looking for sex. If your libido is normal/high, then ED can be treated with cialis or viagra or other ED drugs. Many with low libido and ED find their ED resolves when the libido improves. Yes, there is the occasional patient who develops acne but this is rare. The only other significant side effect that I have found is an increase in red blood cells (opposite of anemia) which occurs slowly and is easy to take care of should it reach too high of a level. I have this issue and simply donate (blood bank tosses it away) several units of blood 1-2 times per year. In general, labs are not necessary more than every 6 months or so once the optimum testosterone level is reached. Those on PREP wind up having their blood work done every 3 months or so anyway and it is simple to ask the doc to just add a Total and FREE (very necessary) testosterone to the list. Blood work is covered by insurance, even Medicare, so there should be minimal cost. Unless you are a Kaiser patient - Kaiser, at least in my area, refuses to do free testosterone just as they refuse to do a FREE T3 (thyroid test) unless the total testosterone is low or other thyroid tests are abnormal. They just can't seem to grasp the difference between "normal" and "optimum" health. A very good book, available on Amazon and free to those with a Kindle is "How to Achieve Healthy Aging" by Neal Rouzier, M.D. I suggest any and all who have questions regarding hormone replacement therapy read this book.

Generally, if you leave within the 1st 20 minutes you can get a refund. That's often because the first plot "twist" or real interest takes place at around 20 minutes.

Of course - only with their permission.

I'll go for it - the hood lends a bit of mystery!

Glad to hear you are doing better with the MG. Having some sort of document, be it Medical POA or, as in California, an Advance Directive, is very important. I have also found, through experience, that sometimes close relatives, i.e. your brother, may need a back up in case emotions get in the way. So think of a number 2.

Marylander: How about uncut, bald, silver fox / DILF, and with cock ring?! Perhaps add a harness and arm bands. Then I can go to heaven a happy man! Perhaps have our very own Lance Navarro pose for us (photoshop that beautiful salt and pepper hair out, tho I do love it!)

This thread has been a wonderful look through a window into your life. Once you finally come out to them, you must print this entire thread (your posts AND replies) and make it into a book. I think, perhaps, you will be surprised at the response.

As it happens, German Shepherds attack more people than pit bulls! Most pit bulls are friendly; those who have been abused and trained to fight are the ones you need to fear. Unfortunately, Avalon, you are caving to peoples' prejudices, innuendos, and anecdotes.

Many, many wonderful wishes for you today!

It's not an issue of teaching the bird to say these phrases. If the bird hears them, he/she will repeat. So, the owner needs to clean his or her mouth. Or at least teach the macaw to say, "Fuck off, please!"

Oh, let me count the ways!!!!!!!