# PCT before TRT?



## Viduus (Feb 16, 2019)

Thought experiment for fun...

Are we wrong to recommend TRT for low testosterone? We jump to an exogenous solution instead of trying to fix the body first.

I heard a british researcher talking about “functional medicine” on an Advices radio podcast. He outlined a systematic way to work backwards from the testes to verify each step in the HPG axis. This has been rattling around my brain.

Would the following protocol be a better way to handle low test? Specifically thinking about people who are overweight or recently were since it tends to go hand in hand with higher estrogen.

Assuming estrogen is high:

1) Take an AI to bring estrogen levels down to low normal. Higher estrogen prevents the pituatary gland from producing LH. (Via gnrh reduction from the hypothalamus) Monitor if lowering estrogen causes the pituatary gland to start producing LH. If so, work on estrogen management and improving natural clearance. (Possibly Nolvedex would be better then an AI... not sure if you want it directly effecting the pituatary gland or not)

2) If that doesn’t work, introduce clomid to kickstart the pituatary gland to produce LH. If that works, might be screwed with your pituatary gland? Not sure there’s anything to do - trt time

3) Once you have your body producing LH, verify your natural test levels. If LH is in range but test is low, you probably have bad tested - trt time

The British researcher had a version working backwards from the testes using HCG to imatate LH but I imagine a fair number of us had low test because we over aramotize and had higher estrogen, therefore blocking the pituatary gland from wanting to produce LH in the first place. Might as well start there.

Then only do TRT if you prove out you have non or poor functioning testes or pituatary gland.

Just a thought....


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## Jin (Feb 16, 2019)

These are steps many doctors would take before prescribing exogenous test. Especially if the patient is young and/or there are fertility concerns. 

Before trt I was prescribed Clomid, hcg monotherapy and AI monotherapy at different points. 

The methods you describe aren’t new. But your point about how we should advise folks is a good one. 

IME nothing worked save for exogenous testosterone. So I am a fan of test injections. 

I think it’s wise for younger patients to try to get the HPTA back running before shutting it down with exogenous test.


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## Megatron28 (Feb 16, 2019)

All this is determining is if said person is primary or secondary for Hypogonadism.  It isn't going to solve the underlying problem causing the Hypogonadism.  We always encourage guys to try to get to the root of the problem before going on TRT for the rest of his life.


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## Viduus (Feb 16, 2019)

Megatron28 said:


> All this is determining is if said person is primary or secondary for Hypogonadism.  It isn't going to solve the underlying problem causing the Hypogonadism.  We always encourage guys to try to get to the root of the problem before going on TRT for the rest of his life.



Good point. 

My experience with a doctor and clinic bypassed it. I guess if I knew it was secondary I’d spend the time to figure it out the way Jin mentioned.

I’ve seen a few people mention it here in passing but it’s definitely not the norm across the Internet.

What are the ways you can tackle secondary hypergonadism?


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