HRT Q&A with Dr. Nathan

[joedemarco]

The masters forum has the good fortune of having Joel Nathan, M.D. available for an HRT Q&A thread.

Joel Nathan, M.D. is an Internal Medicine physician. He directs his own hormone replacement practice, Evolve Medical Services, in New York City. He taught on the faculty of the Medical Colleges of Stanford University and the University of California-San Francisco. He is certified in Age Management Medicine through Cenegenics®.

His focus is on the endocrine system. Medical research and literature continue to mount, favoring a balanced endocrine system for healthy aging—which means maintaining levels at the upper 25% to 30% of the normal range, adjusted for age.

Dr. Nathan can answer your questions on the safe and effective use and monitoring of testosterone, growth hormone and other supplements that can help add quality to your life.

Please welcome Dr. Nathan to our great forum and fire away with your questions. Thank you Dr. Nathan!

[DA]

question for dr. nathan, i am 38 years old and looking to get off HRT so i can get my wife pregnant. went off HRT last year for 4 months, took hcg, clomid went to a urologist and my sperm count was only 300k. was told normal level is 20 million. any advice? thank you.

[caribeman]

Dr. Nathan what negative side effect have you seen with long term Test users? Of course besides the shrinking testicles and estrogen high/low? Prostate issues, blood pressure, choleterol, etc.

Would like to know your experiences on this topic.

[Dr. Joel Nathan]

question for dr. nathan, i am 38 years old and looking to get off HRT so i can get my wife pregnant. went off HRT last year for 4 months, took hcg, clomid went to a urologist and my sperm count was only 300k. was told normal level is 20 million. any advice? thank you.

Yes, AAS will lower sperm count. However, you're still producing sperm that can reach the ova and get her pregnant. If you have not succeeded after trying to become a dad in 6 months from now, see a urologist.

In the future, the use of Human Chorionic gonadotropin will help your testes stay closer to baseline functioning. It is the anabolic that has the least effect on fertililty. Since I am not your doc, I cannot recommend dosing. For that, see your medical provider.

[Dr. Joel Nathan]

Dr. Nathan what negative side effect have you seen with long term Test users? Of course besides the shrinking testicles and estrogen high/low? Prostate issues, blood pressure, choleterol, etc.

Would like to know your experiences on this topic.

If you're done making babies, as long as you're monitored with blood work every 3 months and get yearly physical exams, men can be on this indefinitely. (see exceptions below)

If your PSA is greater than 3.0, Cholesterol rises, DHT or Estradiol rises, CBC or Liver Function tests rise, then your health care provider can help with interventions to keep you healthy.

[Dr. Joel Nathan]

Joe,
Thanks for adding me to your forum. If the members have questions for me on hormone replacement therapy in Masters Bodybuilding, please have them put them under this "sticky." They can also PM me for privacy if need be.

Regards,
Joel

[caribeman]

If you're done making babies, as long as you're monitored with blood work every 3 months and get yearly physical exams, men can be on this indefinitely. (see exceptions below)

If your PSA is greater than 3.0, Cholesterol rises, DHT or Estradiol rises, CBC or Liver Function tests rise, then your health care provider can help with interventions to keep you healthy.

Dr. Nathan;
Thank you for your input. Hang around I am sure we can all benefit from your comments.

[KevinCouch]

Dr. Nathan, my creatinine levels are consistently high and my primary care physician is worried. I get blood work done 2 times per year and they are usually between 1.4 and 1.7 at its highest. I am five foot five and weigh around 190 pounds and am a national level competitive BB and am a regular on this Masters Thread. Wouldn't the increased muscle mass on my frame as well as heavy resistance training raise creatinine levels to higher levels. Should I be as worried as my PCP? I don't have any symptoms of kidney disease at all. Of course, my pcp doesn't know the "supplements" I'm taking either.

[Dr. Joel Nathan]

Dr. Nathan, my creatinine levels are consistently high and my primary care physician is worried. I get blood work done 2 times per year and they are usually between 1.4 and 1.7 at its highest. I am five foot five and weigh around 190 pounds and am a national level competitive BB and am a regular on this Masters Thread. Wouldn't the increased muscle mass on my frame as well as heavy resistance training raise creatinine levels to higher levels. Should I be as worried as my PCP? I don't have any symptoms of kidney disease at all. Of course, my pcp doesn't know the "supplements" I'm taking either.

Your muscle mass elevates your creatinine. There is a calculation called the BUN/CR ratio. The ratio between a person’s BUN and creatinine to help them determine what is causing these concentrations to be higher than normal. The ratio of BUN to creatinine is usually between 10:1 and 20:1.
If you're between those numbers, your kidneys are filtering well, so just continued to be monitored as your health care provider requests.

If you'd like to privately discuss the supplements you're taking to see if any may effect your creatinine, please PM me.

Joel Nathan, MD

[Bryan Hildebrand]

Great question. Doc, maybe you can explain variations of HDL& LDL while on TRT or even in supraphysiological dosing. What to be concerned with and when intervention needs to take place.

[KevinCouch]

Your muscle mass elevates your creatinine. There is a calculation called the BUN/CR ratio. The ratio between a person’s BUN and creatinine to help them determine what is causing these concentrations to be higher than normal. The ratio of BUN to creatinine is usually between 10:1 and 20:1.
If you're between those numbers, your kidneys are filtering well, so just continued to be monitored as your health care provider requests.

If you'd like to privately discuss the supplements you're taking to see if any may effect your creatinine, please PM me.

Joel Nathan, MD

Thanks Doc! I'll check my blood work results (done every 6 months) and see if shows the ratio. Hopefully, it will be in the normal range.

[Dr. Joel Nathan]

Great question. Doc, maybe you can explain variations of HDL& LDL while on TRT or even in supraphysiological dosing. What to be concerned with and when intervention needs to take place.

Testosterone elevates cholesterol and LDL cholesterol and LOWERS the good HDL cholesterol. I monitor my patients every 12 weeks with fasting blood work to see how their lipid levels are trending.

Having a "clean diet" with less red meat and more chicken, fish, or turkey is also important in controlling cholesterol levels.

If need be, statins can be used to lower cholesterol. Statins are not benign medications. Even though the FDA has approved this class of drug.

Some use Niacin or Red Yeast Rice to lower cholesterol. By the way, a lot of people like the non-flushing niacin; however, it's the niacin that causes flushing that works better.

Regards,
Joel Nathan, MD

[joedemarco]

Testosterone elevates cholesterol and LDL cholesterol and LOWERS the good HDL cholesterol. I monitor my patients every 12 weeks with fasting blood work to see how their lipid levels are trending.

Having a "clean diet" with less red meat and more chicken, fish, or turkey is also important in controlling cholesterol levels.

If need be, statins can be used to lower cholesterol. Statins are not benign medications. Even though the FDA has approved this class of drug.

Some use Niacin or Red Yeast Rice to lower cholesterol. By the way, a lot of people like the non-flushing niacin; however, it's the niacin that causes flushing that works better.

Regards,
Joel Nathan, MD

What would be your recommended dosage of Niacin per day?

[Dr. Joel Nathan]

What would be your recommended dosage of Niacin per day?

Joe,


Therapeutic doses of crystalline niacin (typically 2.0 to 6.0 g/day) lower both total and LDL cholesterol by 15% to 30%, lower triglyceride levels by 30% to 40%, and raise HDL-C levels by 15% to 25%.


The preparation must be niacin and not niacinamide, which has does not work effectively.


If you doctor advises that it is safe for you, taking an aspirin about 1 hour before the niacin can diminish the flushing, possibly by inhibiting prostaglandin-mediated side effects.

The most serious complication of niacin therapy is hepatotoxicity, and therapy should be accompanied by monitoring of serum liver function tests. When on AAS, it is particularly important to monitor liver function tests about every 3 months.


Regards,
Joel Nathan, MD

[joedemarco]

Joe,


Therapeutic doses of crystalline niacin (typically 2.0 to 6.0 g/day) lower both total and LDL cholesterol by 15% to 30%, lower triglyceride levels by 30% to 40%, and raise HDL-C levels by 15% to 25%.


The preparation must be niacin and not niacinamide, which has does not work effectively.


If you doctor advises that it is safe for you, taking an aspirin about 1 hour before the niacin can diminish the flushing, possibly by inhibiting prostaglandin-mediated side effects.

The most serious complication of niacin therapy is hepatotoxicity, and therapy should be accompanied by monitoring of serum liver function tests. When on AAS, it is particularly important to monitor liver function tests about every 3 months.


Regards,
Joel Nathan, MD

Great info! Thank you.