I think it's best to use an aromatase inhibitor to keep estrogen levels under control and I wouldn't take a statin drug or any other lipid-lowering drug. Artificially lowering lipids with drugs has not yielded a meaningful decrease in cardiovascular death, while using TRT absolutely does dramatically lower the risk of CVD death and all-cause mortality. High estrogen tends to cause a whole host of negative effects and that should be controlled regardless of lipid profiles. I have only seen a few people (out of well over 1000) have any actual side effects from Anastrozole, and those have been heart palpitations and a feeling of internal anxiety. If someone experiences muscle pain and fatigue from an AI it's most likely because they are overdosing and pushing estrogen levels too low. Low E feels a lot like low T to a man.

I suggest checking Estrone and Estradiol again 2-3 weeks after any substantial adjustment to your TRT dosing or AI dosing. You'll see the new steady state by just two weeks and can make appropriate adjustments. The biggest factor affecting your T and E levels besides the dosing itself is your activity/exercise level because these anabolic hormones get consumed more the more you exert yourself. Mental energy counts too, so when someone is studying and learning something new and complex. puzzling through a problem, or even enduring a lot of emotional stress, those levels will drop some. The reason T levels are highest in the morning is because you've been laying down still all night, not because we produce more through the night and early morning hours. There's no reason your body would do that like it does with Cortisol. Cortisol is what drives your circadian rhythm, not testosterone.

I have recently revised my opinion about testosterone not causing problems at higher levels. It seems that as we age our need for testosterone decreases and maintaining higher levels can be a problem. I think other anabolic hormones/factors drop at certain ages and if you keep pushing the T level up it may cause an imbalance that leads to fatigue, muscle/joint/bone pain and a general ill feeling. I'm 53 this month and had been feeling like that for the past year or more. I started dropping my testosterone dosing this month and have been feeling better. I'll experiment with myself and other older men and try to figure out what range seems ideal for us in this time of life. I suspect a total T in the 1500-2000 range might be ideal, but I'll try to sort that out. Stay tuned!

You can't argue with results. My only suggestion is that if you have never had your level above 2000 you might try getting up there for at least a couple weeks and see if you notice further benefit. There is no way to know if you are truly at an optimal level without surpassing it and finding that your benefits plateau. If it's not any better going up to 2000 you can drop your dosing back down and feel confident that you're on the optimal regimen for you.

We are seeing people have good results like that with the newer GLP-1 peptides, but there has been a strong tendency for people to keep taking them long term because they want to keep that weight off "effortlessly" and I don't know that it's safe or smart to do that. I would suggest using a GLP-1 for maybe 4-6 weeks at a time with breaks of a month or so between and try not to keep using them. We just don't know the long term risks yet and I expect there will be a lot of people harming themselves using these long term. I think using these peptides to achieve initial rapid success and transition to a healthier lifestyle within a few months is the best strategy. There is no substitute for a clean healthy diet and regular exercise, and all of the medications I've seen people use over the past 25 years to help lose and keep weight off have had serious negative consequences with prolonged use. Developing the right relationship with food and healthy lifestyle habits is the best road to success.

One thing I think I've said here somewhere but bears repeating about using GLP-1 peptides: I strongly encourage people to use HCG at the same time as these weight loss peptides. It shifts your metabolic fuel to mostly burn fat for energy rather than carbohydrates, helping you lose more fat than protein and preserving lean body mass to a great degree. We've been using that in combination all along and have gotten great results in people who tried GLP-1 peptides by themselves with no results. We also try to get everyone's metabolic hormones dialed in first too and provide dietary advice that improves outcomes if people follow the directions. This really needs to be a comprehensive metabolic approach rather than just using a peptide and some supplements if you want optimal results without losing a lot of muscle.

If anyone wants a direct consultation for their specific issues they should schedule a Zoom consultation through our office website: www.globalimmunotherapy.com In this forum I'll try to address questions in a hypothetical education sort of way, which might give you the information and direction you need. My suggested target range for 25-OH Vitamin D is 120-150ng/mL and at least above 100. I know that's above almost all reference ranges out there today, but Mayo Clinic and some other labs used to have 150 as their upper cutoff and that makes sense to me based on clinical experience with some specific conditions. Most adults will get there taking 10,000iu per day of a good product. It doesn't need to be expensive, and in the U.S. I recommend the Vitacost brand sold online by that company or the Nutricost brand sold through Amazon because they are very inexpensive and work as well as any other brand out there. I'm sure there are others, and what you want to see is that your blood level rises roughly 1ng/mL for every 100 units you take daily. Most people have baseline levels in the 20-45 range and will go up about 100 more ng/mL taking 10,000iu daily. For kids under 100 lbs of body weight I suggest 100iu per pound per day. If you weigh in Kg just do the math conversion. You cannot adequately understand a person's "thyroid status" from blood tests alone because there are too many chemicals in the world today that block hormone receptors. I see people with clinical hypothyroidism while having all their labs well within the reference range. It is a clinical diagnosis, not purely based on labs, and the definitive answer comes only with trying some thyroid hormone replacement to see if symptoms improve.

Also - I'm not familiar with that antibody test panel for IBS, but none of the similar antibody panels out there seem to correlate with anything meaningful in terms of devising a treatment plan of any kind. I don't advise doing those sorts of tests because they are usually expensive, not covered by insurance, and only seem to lead to success randomly and essentially by accident... Antibodies are nonspecific by nature and cross-react broadly with all sorts of things. An antibody test for EBV, for example, can actually measure antibodies initially made to target gluten, coffee, other viruses and microbes - you just cannot trust most antibody tests at all and shouldn't use them to make medical decisions in most situations. Save your money.

Hi Charles, I think I have a long form video on Thyroid issues that is now on YouTube. Have you seen that? If not, see if you can find it and let me know what questions you still have. I'm not sure I went into a discussion in that video about the tight relationship between adrenal (cortisol specifically) and thyroid hormones, but that is an important discussion too if you think it's relevant or interesting. I can record a video going into more detail about that, because it's relevant to a lot of people today with adrenal burnout who don't seem to be able to get their thyroid optimized. Some of those folks need to reduce their thyroid dose a bit and get on Cortisol to find the right balance. An obvious T3/T4 imbalance is a good clue to that problem, and I think testing TOTAL T3 and T4 is more useful than the "Free" forms, just like with Testosterone. We don't even check Free levels of other hormones (estrogens, DHEA, cortisol, progesterone... I don't think those are even available in the "free" form and the people out there insisting that free hormones are what we need to look at don't seem to notice.