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1. Disregarding systemic effects, are there any downsides for your hair specifically to taking oral dutasteride? I'm fortunate to have zero signs of hair loss with my current dose, but I want to use it as a precautionary measure because I know that everyone will lose their hair eventually — whether that be in 10 or 50 years. And I’ve read that it’s much easier to prevent hair loss if you take a proactive approach. So curious what you think about this approach? And then regarding systemic effects, what percentage of your clients have seen negative systemic effects with oral dutasteride? I want to increase my testosterone dose from 150mg to 200mg every 8 days. I’m mostly concerned with gyno. I’m at 12% body fat and I already do every other day dosing — eg. every other day dosing so 4 shots in 8 days. Everything I read says that using an AI to eliminate gyno concerns presents a whole new set of additional problems because of how important estrogen is. Peter Attia shoots for 40 - 60 pg/mL for estrogen. Why don’t more TRT clinics prescribe tamoxifen or raloxifene to maintain decently high estrogen levels instead of crashing it by using an AI? If I don't immediately plan on having kids, will taking HCG for two weeks every 3 months be sufficient? Also, would you recommend I drop my testosterone dose while taking HCG to reduce the chances of gyno because of the elevated estrogen?

AlphaMD's Answer

  1. There are no downsides to using a 5a-reductase inhibitor. You can sometimes get a period of shedding after starting duasteride or finasteride (trlogen effluvium), but this is only temporary. In general, we do not recommend use of a medication as a preventative measure, particularly when it has such a high side effect profile. All medicines carry risk, and long term use of duasteride has been found to increase the risk of high risk prostate cancer, which is why we only recommend it when necessary.

  2. Tamoxifen and raloxifene are SELECTIVE estrogen receptor modifiers. That means that they block some estrogen receptors, but leave others alone. They do not lower estrogen levels, in fact they raise them. The receptors they do block are completely blocked, preventing any benefits. Also, the side effects of these SERMs for DVT (blood clots) and sexual side effects are more than double in men than in women. They can cause osteoporosis and the risk of blood clot is close to 1 in 50. Side effects of aromatase inhibitors are much, much lower. In fact, low doses of AI’s have shown zero side effects so long as estradiol levels remain in the normal range (all reported side effects of AIs have been only in studies done on women with hormone sensitive breast cancer where the goal is to reduce their estrogen levels to zero to increase their survival).

  3. 2 weeks of hCG use every 3 months is not enough to keep your testicular function at baseline. It takes 78-90 days for sperm to mature, so use of hCG shorter than this amount of time will always result in azospermia.
    Usually TRT dose is lowered to accommodate for natural production of testosterone on hCG.

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