I like Crisler's Protocol.
The problem these days is obtaining HCG. It is in generally short supply from misuse in certain diet programs.
Aside from the hassle of more injections, dividing testosterone doses can generally be safely done. This reduces the peak testosterone levels which predispose a few men to high estradiol production.
The main question I would ask is why do this without first testing for Estradiol to see if it is high?
It doesn't often happen in my experience. Very very few of the men I am currently treating - including those on HCG only protocols - have needed Arimidex. Ron Rothenburg, M.D., who Crisler regards as the best anti-aging physician in the U.S, hardly uses Arimidex in
TRT, either. Rothenburg avoids using it unless there are clear signs of estradiol excess such as gynecomastia.
I would look at the original labs prior to
TRT to see if a guy coverts a lot of testosterone to estradiol (e.g. low testosterone, normal or high estradiol) to help predict what would happen. Testing allows one to determine if high estradiol production is going to be a problem. This can be done soon after the first injection.
One reason estradiol may not increase excessively with
TRT in many men is that
TRT reduces LH production further. This reduces aromatase enzyme production and the conversion of testosterone to estradiol. Since Crisler uses HCG in very small amounts to primarily maintain testicular size, this small amount, which acts like LH , is not enough to significantly increase estradiol production in many men.
Where more frequent injections are useful is if the half-life of testosterone is short. For some men, testosterone cypionate has a half-life of 3-4 days, not 7-8 days. They absolutely need more frequent injections to avoid being hypogonadal between injections.
What do you mean by "diminishing results" on Androgel?
Does this mean the testosterone level has been decreasing?
External testosterone, when used in
TRT, reduces thyroid hormone production in some men. This results in thickening of the skin and reduced absorption of transdermal testosterone, such as Androgel. The resultant lowered testosterone and lowered thyroid hormone may then reduce the expected results of
TRT.
Injectable testosterone does the same thing - lowering thyroid hormone - but bypasses the skin, thus can maintain a more consistent testosterone level. However, the lower thyroid hormone may diminish the results of
TRT.
If thyroid hormone is also optimized, while on
TRT, then absorption of Androgel can be maintained.
External testosterone, by lowering thyroid hormone and suppressing adrenal response to stress, may result in increased stress. This, eventually, in some men, result also in adrenal fatigue. This may additional diminish the results of
TRT. Adrenal fatigue is more difficult to recover from, even if shifting from Androgel to Injected Testosterone.
Having learned from experience, where I would be ready to add Arimidex is in the case of a patient with serious psychological issues, such as a personality disorder, trauma, or childhood sexual abuse, whose mood tends to be very unstable. Being IMPATIENT and DEMANDING are clues to underlying serious psychological issues.
Since
TRT can reduce thyroid hormone and suppress adrenal response to stress - which already can destabilize mood, any extra estradiol - which also reduces thyroid hormone activity - can additionally destabilize mood. In such seriously mentally ill patients, I may do
TRT last to minimize mood problems. Some of these patients can't tolerate
TRT even if needed because they already have ongoing thyroid and adrenal problems. I would consider first treating the nervous system, thyroids, adrenals, and nutritional issues first.
In more seriously mentally ill patients - such as those with schizophrenia, I may skip
TRT all together if judgment is seriously impaired - even if it would prolong the person's life - since the risk to others would have to be considered.
Note that Androgel should be started at 10 grams a day. At 5 grams a day, there are too many men who get a lower testosterone level on Androgel than before treatment since external testosterone shuts down testicular testosterone production but at low doses, does not totally replace what is lost.
To reduce the hassle of transdermal testosterone, compounded higher potency testosterone gels or creams may be used instead. Generally a 5% gel is the highest useful concentration without causing the testosterone to precipitate. In this case, a much smaller area of application is needed. This increases the ease of use of transdermal testosterone.
Best wishes.
Quote:
Originally Posted by friendlymachine  On Thursday I'm going to go to my doc and ask that he put me on Dr. Crisler's protocol. I've been on TRT for about 1 and 1/2 years with diminishing results. I'm going to ask him to run Dr. Crisler's blood tests. I'm also switching from Androgel 10g daily to IM injections because of rash and hassle. I'm also on Arimidex - E2 was recently 30 on a range of 10 - 50 being normal at my lab, hence the Arimidex script. The Arimidex is VERY hard to properly dose in my experience. So, my question:
Could I safely divide the T dose to 2x per week with the HCG the day before each T injection to keep e2 down - a sort of modified Crisler to avoid the E2 problems and maybe skip the Arimidex?
So, I'd be going with 60mg of Test cyp. 2x per week and 250 i.u. of HCG per week given the day prior to T to start and then adjust as needed based on labs.
Also, when getting my blood tests, what are the rules for that? When should I get the blood drawn?
After I get my initial blood tests, which I suspect will have some weird numbers on them on the variables not previously tested, I was considering bringing in Dr. Crisler as a consulting. Any thoughts?
Thanks in advance! |
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