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@tylerbond5024: You are correct. Typically, optimizing your testosterone levels will help balance your estradiol levels as well. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@lawrencemunroe6798: I understand the sentiment, but if more strict estradiol control is needed, DIM is often not potent enough. Diindolylmethane only helps to metabolize estradiol produced but does not reduce production. Now, AIs are far overused (my understanding of and the medication itself has changed since this video was made), but that doesn't mean they don't have their place in testosterone optimization. Also, I recommend DIM+CDG to promote metabolism to more favorable pathways. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed Re thinking about an AI ,looking at my lab results my estradiol was 126pg/ml and going the natural route seems to be a challenge .Can they be taken periodically to manage high E2 ?

@@lawrencemunroe6798 Most definitely, I typically use the lowest effective dose to control side effects. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@hectorcrissien163: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. More common symptoms get mentioned more often, which is why you see a lot of attention paid to gynecomastia and "roid rage." I have not seen headaches reported with a high level of consistency in relation to estradiol issues. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Uberdriver9: I applaud your success! Diet and activity definitely do impact testosterone production, and if you're lucky, that's all you need to fix. However, that's not the case for millions of patients. Always remember that one person's experience can never characterize all people's genetic, environmental, biological, and personal circumstances. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@elca2475: Hello! I am a PA, but yes, I am the same guy! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@mancheapterunited5125: Thank you for the kind feedback! Unfortunately, some cases can get complicated. The best way to figure it out is to apply diligence to specific monitoring of symptoms, side effects, and dosing simultaneously. You may also need to have other potential issues investigated further. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Itspep1: Yes, I do my best to respond to all comments! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@petkovalevski2502: This is a daunting question. The best minds in the field point primarily to endocrine system disruptors. Some of these are natural environmental factors, but most are manmade. Unfortunately, even when people do "everything right," Low T is becoming more prevalent. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@ FaithFilled1111: It should be a medical provider who discusses lab results with patients. There is too much to unpack, and the responsibility for that level of care belongs to the treating provider. Two things to consider, though: 1. Not all reference ranges are the same, so the lower limit of normal for some labs/analyzers can be in the 100s 2. If you still hit a wall of indifference, it's usually best to try to find a like-minded provider than to try to "convince" a naysayer of the benefits of TRT Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed Thanks for the feedback.

@@FaithFilled1111: You're welcome!

@martinmagaard325: Thank you for your feedback! The editing chopped up the answer a bit, but if you go to 7:31 in the video, I talk about hot flashes and dry joint aches. In addition to these, you can sometimes see a decrease in libido or the presentation of erectile dysfunction, even despite having an optimized free testosterone level. So, hot flashes, diffuse and unexplained joint pain, decreased libido, and erectile dysfunction are symptoms commonly seen when estradiol levels are too low. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@JohnRayez-md7dq: I recommend looking at your estradiol levels to guide you. I can't give treatment recommendations, per se, but there is much more to optimizing TRT than just starting someone at 1 mL. If your provider isn't looking deeper, it may be time to find a different provider. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@amirahmadi1981: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

In the presence of significant hepatic pathology or the genetic condition of hemochromatosis, the minuscule influences testosterone has on hepcidin and erythropoietin could potentially exacerbate liver injury, but I would not consider it substantial or likely. Hematocrit and iron/ferritin levels are influenced much more profoundly by common conditions such as sleep apnea which are often concomitantly identified alongside hypogonadism. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@l.robertvandyke4398: Thank you for the feedback! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@bm2618: Unfortunately, volatile changes in estradiol can have profoundly adverse effects on some people. This is why balance in dosing and monitoring is so critical. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@mkultra9361: You are most welcome! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@palakkadan1062: Using hCG typically promotes healthy sperm production and is use by fertility specialists for this specific purpose. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@roblincoln10: Unfortunately, the role of SHBG in androgen regulation is much more complex than once thought. Take a look at this excerpt: "In this study we have demonstrated that in the absence of SHBG large amounts of Te rapidly enter the cell where they are inactivated by conjugation to glucuronic acid and effluxed." When symptoms and lab results disagree, it is important to remember that labs only give us insight into serum levels when it's the intracellular environment that we should be most concerned with. You may need to rely on the "tincture of time" to allow things to balance and resolve. I estimate your calculated free testosterone to be ~26 ng/dL. Alone, that number looks pretty good, but chronically low SHBG levels could leave you open to rapid metabolism of free T and thereby actually exacerbate Low T symptoms. Li H, Pham T, McWhinney BC, Ungerer JP, Pretorius CJ, Richard DJ, Mortimer RH, d'Emden MC, Richard K. Sex Hormone Binding Globulin Modifies Testosterone Action and Metabolism in Prostate Cancer Cells. Int J Endocrinol. 2016;2016:6437585. doi: 10.1155/2016/6437585. Epub 2016 Nov 20. PMID: 27990161; PMCID: PMC5136390. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thank you a Augie!! Would that rapid metabolism of T also be applied to my e2? This has been a massive rollercoaster ride. I messed up with the anavar and wished I would've kept that out of the picture for a while. It could have been another story, one more positive.

@@roblincoln10 It certainly could. Free estradiol doesn't get as much press as free testosterone, but the free hormone theory remains pertinent.

@@TCTmed so those massive swings in the e2 could be suspect as well. I'm 4 days post injection on the 200mg and I feel exponentially better each day. Still unusual anxiety and restlessness but absolutely nothing like the first couple right after shot. Even the DHEA and progesterone is affected by this theory, so it could be multifactorial

@@roblincoln10 Yep, it's ALWAYS multifactorial. Even with our best testing, we are still left to make educated guesses about intra/extracellular dynamics and receptor modulation.

sorry to commemt agwin i dont know any oerson or doctor to speak about it

@siuuuuuuuuuu813: The effects of AIs are typically limited to their term of use, and the effects will vary in relation to the half-life of the particular medication. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thanks a lot1😍😍

@siuuuuuuuuuu813: This method can work for some individuals who aren't predisposed to a high degree of aromatization, but for "high converters," the increased potency of pharmaceutical intervention may be necessary. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed god bless you❤️❤️❤️

@GREATTECH1: We have a wealth of material on our website, but be on the lookout for some updates coming this year! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

f@GREATTECH1: Thank you for the feedback! I am glad you found ithelpfull! Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@kaszapnagypeter: You can take hCG concurrently with testosterone. We have many patients that we manage in this way. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thank you

@@kaszapnagypeter You are most welcome!

@@TCTmed I have another question if you don't mind it. Do you think is it a good idea to take 250 ui of hcg 3 times a week and come off testosterone during the summer? I didn't have low testosterone before I was put on the sport trt. I don't really want to use it for the rest of my life. I am 35 years old, 182cm 82 kg. So the plan is to continue to take testosterone along with HCG until May and do a PCT with clomid. The reason for taking it is I am a student at University and self-employed besides the university. I have stopped taking it in the past 3 weeks and I have a brain fog but nothing else.

@@kaszapnagypeter I am sorry, I cannot provide dosing recommendations.

@jlingo8977: It may require imaging to know for sure, but generally, fibrous changes occur after about a year of tissue development. Worsening disruption of chest contouring, increases in excess skin or tissue, and many other changes can accompany worsening gynecomastia. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@pressf4896: Based on the number (and assuming the unit of measure), it looks like they have reported a "direct" or "analog" free testosterone assay. Before you adjust your regimen, I would recommend you look at your calculated free testosterone. Check out www.issam.ch/freetesto.htm. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@kyleboyer1074: This is the thought process behind using hCG (human chorionic gonadotropin). It is an LH analog. While it can increase testosterone production, its half-life demands frequent injections (several times per week), it is considerably expensive, rarely leads to optimal testosterone levels, and induces more estradiol conversion than using testosterone directly. The upside is that using hCG monotherapy does not negatively affect fertility or cause testicular atrophy. Still, it is not a preferred therapy for most patients. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed Thank you.

@@kyleboyer1074 You're welcome!

@neilwattoo: Thank you for bringing this up. I am sure you are one of many people dealing with this. If fertility is ever going to be on the table in the future, I typically recommend sperm banking before TRT and the concurrent use of hCG while on it. It creates a much better environment for transitioning to a fertile state. Once on TRT alone and attempting to regain fertility, there are more aggressive protocols (with regard to hCG dosing) that you can utilize. Additionally, I would say it's best to stay on that type of intervention for at least 3 months before determining what your maximum benefit will be from it. I do not have experience with HMG, but you should be able to achieve favorable results with hCG or clomiphene/enclomiphene. I have definitely seen fertility restored after long stints on TRT. Semen analysis is a crucial metric. With other interventional modalities available, you don't have to be able to produce 20 million sperm, just "enough" healthy ones. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@TCTmed thank you! I truly appreciate your response. I wish my Doc or anyone told me exogenous Test is male birth control back then. I would have dropped tons of kids off at the sperm bank. Wife also has endometriosis, which makes it more difficult. Wish I was in Texas to see you, but i will continue with HCG and some enclomiphene and hope for the best. Thanks again for taking time to respond!

@@neilwattoo You're welcome! Best of luck on your journey!!

@gavbrown85: A few things could be at play. The phrase "good test levels" always gives me pause. If you are judging based on your total testosterone levels only, it's easy to be misled. Typically, low estrogen levels are most often seen with an overuse of aromatase inhibitors (if you are taking them), an aromatase deficiency (reasonably rare, could be related to an extremely low body fat percentage), or a relative deficiency in free testosterone. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed I’ve not taken any inibitators I’m all natural I do hav low body fat as I fast and eat clean my normal test levels are at 18.8 but I’ve not had my free testosterone checked

@@TCTmed I tell a lie tho I did think my east was high as to my moods and off balance I was feeling so I took half a tablet easttogen blocker 2 weeks ago may be that could be the cause so I am booked back in.In 4 weeks time for my free test to be checked and my estrogen again so fingers crossed they will all be ok and estrogen back in good range

@@gavbrown164 I recommend taking a look at your calculated free testosterone level.

@@TCTmed hi mate yes I’m going to as I don’t think half a estrogen tablet blocker would make it drop that’s much so I’m in for full hormone bloods in 4 weeks

@clydebethatway7485: I too had a profoundly better response to Armour Thyroid compared to Synthroid! Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@gust9464: Thank you for the feedback! Whether a level is too high has more to do with the severity or presence vs. absence of associated symptoms. An estradiol level of 68 is "high" per most reference ranges. Still, such a level might be acceptable if you are tolerating it well and not experiencing related irritability, fluid retention, or breast tenderness/tissue growth. I don't recommend doses publicly, but I will tell you that not everyone on TRT needs anastrozole. As with most medical interventions, I prefer the lowest dose possible to achieve optimal results. I hope that helps! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@B88_f: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

Agree

@adamtownsend5045: Your trepidation is common. I have seen cases where testosterone reduction was necessary to achieve optimal semen analysis (SA) results. Frequent, and relatively higher doses of hCG are also often needed. Be sure to keep up with serial SAs to assess the success or failure of changes in your regimen, and best of luck to you two!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@DarkVeghetta: Thank you for your reply and feedback! Fertility can be fickle. It could be that with robust sperm production and motility, you may be somewhat protected from severe TRT-related infertility. Still, you could potentially find yourself exquisitely sensitive to exogenous testosterone, too. Make sure to explore the options of sperm banking and the use of supplemental medication like hCG to preserve fertility should you start TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@mikeyoung1002: It is critically important to the development of secondary sexual characteristics during development but does play a vital role throughout life concerning overall hormonal balance. One can live without testosterone, so for a developed adult, there isn't necessarily an amount essential for life. However, the influence, or lack thereof, would definitely be felt. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Thank you, @sam187st! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Luis-gn7li: Unfortunately, I have never encountered that type of reaction with any of our patients taking testosterone. You could have a drug sensitivity or an allergy to some component of your injection, but based on my almost 12 years in this space, I would have to say that the symptoms you experienced are rare with TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

¡Hola @joetorres9420! No hablo con fluidez, pero ciertamente puedo utilizar un traductor para asegurarme de que respondamos sus preguntas. ¿En qué puedo ayudarte? Atentamente, Augie Galindo, PA-C Centros de Testosterona de Texas | Socio Director

@@TCTmed quiero saber los presios del tratamiento ya que no tengo aseguransa medica .?

@@joetorres9420: Los costos varían mucho de un consultorio a otro, pero aquí hay un desglose de nuestras tarifas por los servicios de telemedicina. La consulta es gratuita. Confirmar el diagnóstico de niveles bajos de testosterona requiere dos pruebas separadas, realizadas en dos días distintos, antes de las 11 a. m. y en ayunas. La tarifa por las dos pruebas de referencia separadas requeridas es de $200 combinadas. Estas dos pruebas, junto con su evaluación virtual por videoconferencia, sirven para determinar si hay niveles bajos de testosterona y evaluar la candidatura a tratamiento. El primer panel, más detallado, analiza su hemograma completo (CBC), panel metabólico integral (CMP), estradiol (E2, estrógeno primario), antígeno prostático específico (PSA), hormona luteinizante (LH), estimulante folicular. hormona (FSH) y prolactina (PRL). En la segunda prueba, repetimos la testosterona sérica total y la globulina transportadora de hormonas sexuales (SHBG) para confirmar los hallazgos iniciales. Después de eso, el costo de la atención es de $200 mensuales más $100 adicionales por cualquier laboratorio programado. Su testosterona, bloqueadores de estrógeno (si son necesarios), suministros para inyecciones, entrega a domicilio y visitas por video mensuales obligatorias están incluidos en ese precio.

@raziqcheck: Hello, and thank you for the question! The short answer is no, but let me clarify. Taking exogenous testosterone will definitively affect your fertility negatively by reducing the brain-driven stimulation to produce sperm. This suppression of fertility will continue for as long as you take TRT. However, in my opinion, there is no reliable evidence that TRT alone will make a person with normal fertility (pre-treatment) permanently sterile. Remember to account for undiagnosed fertility issues that may be present before TRT, and the "rebound" to baseline that takes place in the weeks to months following cessation of therapy. The Endocrine Society does endorse avoiding TRT in the near term of attempting to achieve pregnancy. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thank you for your response. Can TRT be taken simultaneously with medication like Clomid and HCG for maintaining fertility while on TRT?

@@raziqcheck: Yes, you can be on hCG or clomiphene (I prefer hCG and enclomiphene to clomiphene) while on TRT. I was personally on TRT+hCG for about one year when my wife and I decided to have our third child. That pregnancy was achieved quickly and normally, like the two before it when I had not yet been on therapy. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@user-jf7kw9cw5v: Costs vary quite a bit, and like with many things, you often get what you pay for. Our Telemedicine Services are $200 monthly plus the cost of labs. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@medicineandbrasilianjiujit8511: Thank you for feedback. I am glad you found our content helpful! I also train in Brazilian Jiu Jitsu, and I love that your channel is talking about this!! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed God bless!

@dennisdavis2103: Hello, Dennis! DIM as a standalone for treating estradiol elevations may not be enough in some cases, but not everyone on TRT needs "estrogen blockers" (aromatase inhibitors). Whether you need a medication to manage your symptoms/levels should be determined by studying your response to TRT, surveillance of your symptoms, and monitoring your levels. For a patient who isn't a "high converter," DIM can help metabolize estradiol efficiently. I prefer DIM with CDG, as it helps to preferentially support E2 metabolism into more desirable metabolites. Remember that there are other AIs, so anastrozole isn't your only choice. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

@augiegalindo Calcium D Glucerate combo is a great suggestion👍 Also happy to know there's other E2 blocker meds out there too. Thanks Augie!

@@dennisdavis2103 You're welcome!

@dennisdavis2103 hope ypur doing well man i just want to ask what is DIM actually is?

@Lovenlife139: Actually, I’m a PA, not a “doc”, but everyone is entitled to their opinion. Thanks for stopping by! Best Regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@michaelwops: Unfortunately, you are right. That was a splicing error in the editing process. However, if you fast forward to the 7:00 mark, the discussion on the symptoms of low estrogen (hot flashes, sexual dysfunction, dry joint ache, and osteoporosis) is listed there. Best regards, Augie Galindo, PA-C Testosterone Centers of Texas | Managing Partner

Thank you!

@@michaelwops you’re welcome!

@bonfido: You're most welcome! While I've heard anecdotal accounts of people saying they have seen a loss of the ability to naturally produce testosterone after prolonged TRT in over ten years focused on treating hypogonadism, I've not seen a case of this occurring. It's important to note, however, that your baseline production declines over time, so it should be expected that if you were on TRT for an extended period, the "baseline" production your body would return to after cessation of therapy would be lower than when you started TRT. The process of re-engaging the hypothalamic-pituitary-gonadal (HPG) axis would also take several weeks to even a few months to restore natural production. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner