HRT with Testim 1%

[wworkmd]

I agree that pellets are an old delivery system but never taught here in the US. Dr. Ed Lichten taught me (though I do it quite a bit different now than I did originally). I don't use the brandname Testopel since they are expensive. I use the pellets from College Pharmacy in Colorado Springs, CO, and I have had no problems with them. I prefer the 75 mg pellet over any other size pellet and I use normally 10 - 12 pellets at a time lasting about 3 months. I actually do implant the Testopel when a patient of mine gets it covered under a mail-order pharmacy benefit. They get it mailed to them and bring it in and I implant them...simple.

My only question to you...and here is my ignorance...what is HMG? I have used HCG for fertility in men on TRT (75 units SQ/week) but have never heard of HMG.

I have not heard of androstanalone gel and I don't understand why you would use it when T gel/pellets work so well. What specifically would you use it for that would be better than T directly?

I agree with your assessment of endocrinologists and the like and that is for more than just T. I also use cortisol, thyroid (Armour), fludrocortisone and bioidentical HRT for women and most dismiss it out of hand, even when I have demonstrated, using their own tests, that the patients have problems and need treatment. Some of my early patients learned the hardway that these guys were stupid (ignorance can be relieved...stupidity can't) because they were so smart, i.e., a "simple Family Practice MD" could never know more than them or even match them with their "immense knowledge" of endocrinology so obviously they did not have to listen to me.

Sorry...just venting...

Dr. Work

I find this a bit odd. Using hormonal pellets for both women (estrogen replacment) and men(testosterone replacement) has been around for nearly sixty years. So while it may be new to some doctors becuase they did not learn of pellet based HRT, it is by no means new to the medical world. The steady state release of testosterone pellets and the reduced aromitization of T into E are well docuemented, and T pellets are pretty cheap when compared to grossly overpriced (due to patents on the release mechanism) Androgel and Testim.

At this time Bartor Pharmacutical has the only FDA approved commercial product for sale here in the US, and the product Testopel is only available in 75 mg pellets. In Europe you can get 200 mg testosterone pellets, and here in the USA you can get 200 mg pellets from a few of the remaining compounding pharmacies.

Dr. Charles Vincent MD did a great deal of the FDA research on the use of Testopel, and he is a respected authority on the use of pellets for TRT. My MD consults with him from time to time on my TRT program.

I agree that most MD's do not know how to set up and administer a TRT program. Many will not test E2 let alone request the sensitive test so that you can measure under 30. Most have no idea of the importance of the T/E ratio, and they believe the armidex only works on women with breast cancer.

Oddly enough I have found several endocrinologists who were equally clueless about how to administer a male TRT program, and to them the use of HCG - human chorionic gonadotropin - or HMG to rehab a mans testicles was unheard of and almost medical blasphemy as those are "reproductive medications" and they are "very expensive"

Well this is a bunch of uniformed hogwash as both of these preparations are distilled from the urine of women-pregnant women for the former, and post menapausal women for the latter. Also, if it were the doctors testicles or breasts that were shrinking to a shadow of their former size, thier minds would be much more open to the use of HCG and HMG as well as a custom blend of injectible rLH and rFSH for testicle rehab.

As you are an MD, do you have any inside information on why Andractim has not made it to market? The androstanalone gel was going through clinical trials here in the US a few years ago, but there is not much more being said about it.