TRT: A Recipe for Success. CAUTIONARY ADVICE.

[Michael Scally MD]

Did Swale write the TRT recipe ? If so this thread should get VERY interesting, lol

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Bump. (I think that is the correct statement)

Mike

 

[earthdog]

From one doctor (Asih.net) to another (SWALE), I find this post disturbingly unprofessional... Maybe it was not intended that way by Asih.net?

I'm not even certain that's correct. Perhaps it should be "from a former doctor to a practicing one."

Is this the same Michael Scally?

http://www.kbtv4.tv/news/default.asp?mode=shownews&id=7882 (scroll down)

http://www.intense-training.com/forums/showthread.php?t=20295

If this is the same person, is it appropriate for Mike to put "Doctor of Medicine" in his profile?

 

[Michael Scally MD]

Confused about this comment
Patients with congenital androgen insensitivity syndrome (AIS) provide further evidence for the differential regulation of gonadotropin secretion by T in men, with the demonstration of normal or minimally elevated FSH despite markedly elevated LH levels.

Does this mean a male with elevated t levels that also elevates fsh and Lh is actually AIS? or PAIS? or CAH? od CAIS?....may give me some answers from the past

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This statement is further evidence about the differential regulation of FSH & LH. Individuals with AIS have an androgen receptor that is defective. This runs the gamut from partial to complete insensitivity. Therefore, the expected negative inhibitory influence of T would not be expected on LH. Thus the elevated LH levels. However, with FSH there is the factor of Inhibin that is a negative inhibitory factor. This receptor is not affected in AIS and would be expected to have its normal function uninterrupted. Therefore FSH levels are normal or minimally elevated.

A very good point. In years past much of our diagnosis did not include androgen receptor defects. This was really only possible in the research/academic setting. Even then you had to be in an institution where this research was occurring. It is my firm belief that the androgen receptor will be where all the action is in the future. There exists already SARM (selective androgen receptor modulators) that have anabolic effects with little androgenic effects!!! What say this to all of the pundits!!! We have to understand that AAS are no different than other molecules and preconceived notions as to how they interact within the body originate from an unsupported basis. I also think that this has become part of the baggage with AAS.

In the future we will definitely find androgen receptor assays as part of the weapons in diagnosis. Currently, this is not the case. BTW much of this literature research has its origins in ambiguous genitalia!

Mike

 

[cpeil2]

I'm not even certain that's correct. Perhaps it should be "from a former doctor to a practicing one."

Is this the same Michael Scally?

http://www.kbtv4.tv/news/default.asp?mode=shownews&id=7882 (scroll down)

http://www.intense-training.com/forums/showthread.php?t=20295

If this is the same person, is it appropriate for Mike to put "Doctor of Medicine" in his profile?

They didn't take away his degree. He can't hold himself out as a licensed physician, but I don't think he does.

 

[Michael Scally MD]

I'm not even certain that's correct. Perhaps it should be "from a former doctor to a practicing one."

Is this the same Michael Scally?

http://www.kbtv4.tv/news/default.asp?mode=shownews&id=7882(scroll down)

http://www.intense-training.com/forums/showthread.php?t=20295

If this is the same person, is it appropriate for Mike to put "Doctor of Medicine" in his profile?

============================================

This is one and the same. A degree is not granted or taken away by a state licensing agency. I still have the degree. I challenge you, however, to read the post for the factual content. In either case if you read the post and respond to the facts that would be sufficient. If you look up my info you will find that I am open in who I am. Because I took up the challenge of treating AAS appropriately I have had to pay dearly. The war is not over just a battle!

Mike

 

[DLMCBBB]

A very good point. In years past much of our diagnosis did not include androgen receptor defects. This was really only possible in the research/academic setting. Even then you had to be in an institution where this research was occurring. It is my firm belief that the androgen receptor will be where all the action is in the future. There exists already SARM (selective androgen receptor modulators) that have anabolic effects with little androgenic effects!!! What say this to all of the pundits!!! We have to understand that AAS are no different than other molecules and preconceived notions as to how they interact within the body originate from an unsupported basis. I also think that this has become part of the baggage with AAS. [/COLOR]

In the future we will definitely find androgen receptor assays as part of the weapons in diagnosis. Currently, this is not the case. BTW much of this literature research has its origins in ambiguous genitalia!

Mike

Agreed very much that the androgen receptor will be where all the action is in the future. Also further studies to examine relationships between AR polymorphism and responses to androgens, as well as to whether they will predict androgen responsiveness in long-term, longitudinal, epidemiological studies.

Dustin

 

[DLMCBBB]

ASIH.net's critique of the use of FSH alone is notable and useful.

I would give SWALE leeway, despite the inaccuracies.

SWALE comes from the point of view of anti-aging medicine - where hormone replacement therapy involving all endocrine organs are central to the practice. As a D.O., his focus is on a more holistic point of view of health.

His TRT protocol was not designed for those with ASIH. .

I know SWALE comes from the point of view of anti-aging medicine, but still to me if a patient has discontinued AAS, I would wait 30 days and then check free and total Testosterone, E2, FSH, LH, DHT progesterone, prolactin and SHBG.

At the same time you should also re-evaluate the patients symptoms regarding sexual function and moods. As there is such a large degree of intrapatient and interpatient variability in hormone results. It is still my position that measuring LH in secondary hypogonadism is useless. However SHBG levels are critical!

Dustin

Dustin

 

[pmgamer18]

Phil, I commented on Dr. Scally's post. So did Marianco. We both took expection to one or more points that he made. The comments stayed focused on the technical content of the Recipe and Men's Health. All the rest about what's professional or not takes us away from the content. This is an open forum and from time to time the request for refocus is necessary. This is different from a moderated forum where all posts are forwarded to a moderator before posts are permitted. Please believe me that anyone who has been banned has been requested many times thru PM to change the course of posting without relief.

I am staying out it this from now on after all we all should be here to help each other not drag each other down.

 

[Axl]

Another inaccuracy noted. This will result in unnecessary lab work only.


INITIAL LAB WORK: CORTISOL
Nowhere within the literature is there a correlation or association of hypercortisolemia and hypogonadotropic hypogonadism. Literature exists for the association between the critically ill and HH.

Mike

I have been IHH (ideopathic hypogonadotropic hypogonadism) all my life. I have seen more university hospitals than I have ever wanted to see. But every one of them did the cortisol test at least once. There is a clear and proven interaction between cortisol and hypogonadism. Every doc needs to check it out in his routine... so I don't think it is "unnecesary lab work"... Please correct me if you think I'm wrong: it would be a nice document to hand over to ALL the university professors in endocrinology here in Europe. ;-). Maybe the focus is too much on ASIH (anabolic steroid induced hypogonadism), because in all other cases testing for cortisol is a must.

 

[hackskii]

I can honestly say that without Dr Scally, I would not be on the road to recovery today.

As some know I was put on TRT due to my use of AAS.
I was on TRT for almost a year before I noticed I did not feel as good, low libido, low energy, I hated putting on the creams.

Mike entered the picture and I am on day 17 of a protocol to restart the HPTA.
Trying it myself I felt very unsuccessful results.

Today after the direction of information Mike gave me I am doing awesome. This is the best I have felt in over a year.
I am so excited about my recovery and am totally optimistic that I will fully recover and lead a completely normal life.

I appreciate him taking the time with me, words can not describe how happy with the results and how much I am grateful for his help.

So when guys come on here and toss stones at him it irritates me.
If he helps just one person that is one person that is better.

Funny thing is I keep getting guys that PM me and ask me what I did.
Indirectly how many others will Mike help?

Thanks Mike.

 

[Axl]

I can honestly say that without Dr Scally, I would not be on the road to recovery today.

As some know I was put on TRT due to my use of AAS.
I was on TRT for almost a year before I noticed I did not feel as good, low libido, low energy, I hated putting on the creams.

Mike entered the picture and I am on day 17 of a protocol to restart the HPTA.
Trying it myself I felt very unsuccessful results.

Today after the direction of information Mike gave me I am doing awesome. This is the best I have felt in over a year.
I am so excited about my recovery and am totally optimistic that I will fully recover and lead a completely normal life.

I appreciate him taking the time with me, words can not describe how happy with the results and how much I am grateful for his help.

So when guys come on here and toss stones at him it irritates me.
If he helps just one person that is one person that is better.

Funny thing is I keep getting guys that PM me and ask me what I did.
Indirectly how many others will Mike help?

Thanks Mike.

Great post. This puts things in perspective. He is a good doc. I don't have any issues with Mike. I always appreciate the fact that some docs are willing to spend time on a forum...

Let's all try t be as objective as possible, let's all try to respect other opinions. I don't have any problem if an insight is challenged, as long as the discussion here is respectfull for everybody............ Please don't put CAUTIONARY ADVICE in capitols, unless were are all about to DIE because we have followed the Recipe for Succes...........Honoustly, there are some good points in the post by Mike, but none of them deserve the label "CAUTIONARY ADVISE!!!!!!!"

 

[earthdog]

Today after the direction of information Mike gave me I am doing awesome. This is the best I have felt in over a year.
I am so excited about my recovery and am totally optimistic that I will fully recover and lead a completely normal life.

I appreciate him taking the time with me, words can not describe how happy with the results and how much I am grateful for his help.

So when guys come on here and toss stones at him it irritates me.
If he helps just one person that is one person that is better.

Understood. But consider this: Mike (due to his short time on the board, and not because he lacks skill) has helped relatively few people here on this board, while SWALE, due to his years on the boards, has helped hundreds or even thousands. And yet, it seems to be fashionable these days to do a lot more than toss a few stones at him. SWALE's character has been ripped from one end to another by people of questionable character, and this is permitted, if not encouraged. To hear the cretins that have come out of the woodwork accusing him of this or that, you'd think the guy was the devil himself. But to those of us hundreds or thousands that he's helped, whose conditions were not brought about by AAS abuse, he's been a Godsend, and nothing short of a professional and a gentleman. So when another doctor comes on and begins to nitpick his work, seemingly taking it out of context, you can probably appreciate how those of us who are currently his patients may get a little bit upset, too.

So, is Dr. Scally still treating patients? It wasn't clear from the short research I did whether or not he was still permitted to do so. I'm glad that he is.

 

[hackskii]

Understood. But consider this: Mike (due to his short time on the board, and not because he lacks skill) has helped relatively few people here on this board, while SWALE, due to his years on the boards, has helped hundreds or even thousands. And yet, it seems to be fashionable these days to do a lot more than toss a few stones at him. SWALE's character has been ripped from one end to another by people of questionable character, and this is permitted, if not encouraged. To hear the cretins that have come out of the woodwork accusing him of this or that, you'd think the guy was the devil himself. But to those of us hundreds or thousands that he's helped, whose conditions were not brought about by AAS abuse, he's been a Godsend, and nothing short of a professional and a gentleman. So when another doctor comes on and begins to nitpick his work, seemingly taking it out of context, you can probably appreciate how those of us who are currently his patients may get a little bit upset, too.

So, is Dr. Scally still treating patients? It wasn't clear from the short research I did whether or not he was still permitted to do so. I'm glad that he is.

I myself never bashed Swale. I know you didnt make refrence to me in perticular, but for the record I was very supportive.
I like Swale.

I do think that Mike did a good job using knowledge and information and not any personal attack on Swale from what I read.
There was good knowledge and I liked the information.

I think Mike is a good dude myself.
He is concerned about the Bro's, and if you read some of his posts he does in fact help others.
Give it some time, you will see and so will everyone.

I like both of the docs and many Docs have conflicting information. But to not write something that may be true for the sake of not wanting to correct someone is wrong.
I am not taking sides here as both men are super helpfull.

I think Mike's article was professional in his writing myself.
I never read the original article so I cant comment on that.

For the record, I have been getting a PM every day from diffrent guys on this board asking me what I am doing to recover.
I am more than happy to tell them.

I feel awesome.

 

[earthdog]

I don't disagree with anything you just said. And maybe "nitpick" and "upset" were too strong. I guess what set me off was, like others have pointed out, the CAUTIONARY ADVICE title. That kind of thing is more appropriate when warning people that a particular treatment may cause them harm. Anyway, nuff said. I don't want to give the impression that I'm bashing Mike, because I'm not, or, at least, I don't mean to.

So, to change the subject... I haven't read your history. Are you allowed to say what you are doing? If you don't mind, could you post it? I'm just curious. Send me a PM if you prefer. Thanks.

P.S. - Glad to hear you're feeling good. Dr. Mike's treatment is giving you good results, and that's what's important.

 

[HeadDoc]

It took me a few days to digest all the content intellectually and emotionally from this thread. I am still adjusting to Mike's style of posting. It reminds me of my days back in my internship doing grand rounds. Swale's style was more conversational. Both serve their purpose and valid in themselves. Both have heuristic value. So cautionary advice may mean one thing to a physican among physicans and another to the rest of us. If you'd like to see this illustrated, pick up the Physicans Desk Reference some time. Many of us would never take any medication anytime if you hadn't learned to cut thru the limitations, restrictions, cautions, side-effects,etc. that are listed.

Swale is an acknowledged expert in testosterone replacement. The Recipe deals with replacement. It should not be faulted for not addressing restoration. That is or was not its purpose. It exists in the world of antiaging medicine and hormone replacement. As such, its content and the inclusion of hcg to augment exogenous testosterone is now refered to as " the Crisler method". When I attended A4M intensive hrt seminars, three different teaching physicans, which included Ron Rothenberg and Mark Gordon, referenced the "Crisler method".

I had to do some homework on this one. I searched around my personal library to see how often FSH, LH, and cortisol are used as a part of an initial workup for HRT. Karlis Ullis, MD does all three. Ron Rothenberg does FSH and LH. Both do the FSH and LH on initial and follow up. Mark Gordon did not included these measures in the data base of his presentations. The LEF articles and labs do not include any of the three. While the endocrinological literature may not justify taking a cortisol assay when assessing hypogonadism. Evidently antiaging medicine practicioners would. Endocrinologists seem best at recognizing and evaluating full blown syndromes related to the adrenal hormones. However, border states such as andropause and adrenal fatique are not within their purview. So persistence of above average levels of cortisol which can affect libido and sexual energy and mimic hypogonadism even though these levels may not reach or maintain levels for diagnosable Addison's on the up side or consistently low enough to diagnose Cushings.

Now I am not prepared nor do I want to argue the differences in the core physiology of the various HRT stategies. As a non-physican, I rely on the experts and I'm willing, at least for now, to accept that methods and protocols change with advancing research. I am also cognizant of the fact that we are the guinea pigs. I do try to stay current on the various protocols and how they are applied to the various types and origins of hormone replacement. I look forward to having Mike proposed methods of restoration. Granted so far, we have seen most of this applied to post- AAS. Many of us may be erroneously assuming this only applies to bodybuilders. However, there are probably also applications of the the concepts and methods for those using AAS for medical indications of sarcopenia, muscle wasting, burn victims, etc. This raises the issues of restoration which we haven't devoted much attention to. For you guys younger than me, methods and trials for restoration should be of unique interest.

 

[pmgamer18]

I found this today and felt it only fair to post this link.
http://www.mindandmuscle.net/forum/index.php?showtopic=24059

It will not load up unless your loged in at the site it is Dr. John's reply to this thread.

 

[marianco]

I found this today and felt it only fair to post this link.
http://www.mindandmuscle.net/forum/index.php?showtopic=24059

It will not load up unless your loged in at the site it is Dr. John's reply to this thread.

Thanks for the link, Pmgamer18. That is also a nice forum to join.

 

[masterpp]

just out of interest. with pituitary tumours, would they continue to release lh and fsh once the hpta is supressed. (ie if the patient was on exogenouse trt which under normal circumstances would cause hpta shut down) would a pituitary tumour still lead to elevated lh and fsh.