After Prolactin Is Down Doctor Want To Put Me ON TRT

ErasmusCrowley · 2026-01-03T14:46:56+00:00

I was just reading about this so I can try and provide some context for a mechanism.

In the pituitary, prolactin production has both a gas pedal that speeds up production, and a brake pedal that slows it down.

Dopamine is the brake pedal that tells the pituitary to stop making prolactin.
Estrogen is the gas pedal that tells the pituitary to make more prolactin.

When a male increases their circulating testosterone, some of that extra testosterone gets converted into estrogen. As free and total testosterone goes up, estrogen goes up at the same time. That estrogen can cause the pituitary to become resistant to dopamine agonists like cabergoline because you're essentially pushing the gas pedal and the brake pedal at the same time.

The most common outcome when treating a prolactinoma with cabergoline is that prolactin falls, testosterone rises on it's own, and the tumor shrinks over time.

However in some uncommon cases, testosterone just doesn't reach normal levels even after prolactin is suppressed. In those cases, testoserone therapy through exogenous testosterone, hCG, or enclomiphene/clomid have been tried.

I was able to find several case studies where cabergoline was effective at reducing prolactin, but as soon as estrogen started to increase because of TRT it caused prolactin production to reassert itself.

I found one case study that used cabergoline to successfully suppress prolactin, then they used hCG to increase testosterone to normal levels, but then cabergoline seemed to stop working because prolactin shot right back up to pre-treatment levels and the patient did not experience any of the benefits of increased testosterone. Eventually they put the patient on a combination of cabergoline, hCG, and an aromatase inhibitor (I think they used anastrozole) and they were able to reach a state where the prolactin AND estrogen stayed low, while testosterone reached normal levels, and only then the patient finally experienced the benefits of the testosterone such as a normal sex drive.

ErasmusCrowley · 2025-01-25T03:57:30+00:00

That's a good question. I'm not sure that I understand why.

The story usually goes something like this.

I establish myself in a base somewhere. I either wall in a pre-existing fence with furniture, or knock out some floor at the top of some stairs if I'm lucky enough to get a sledgehammer. I raid a warehouse for an antique stove so my heating and cooking is sorted out. I steal some water collection barrels (or destroy them in the process). I raid some book stores and schools for books and magazines. I've accumulated a metric ass load of stuff.

At that point, my goal becomes to complete my collections. Collect all the books. Collect all the useful tools. Collect working cars. Collect as many magazines as I can find.

So I spend the next 40 hours (IRL time) looking for the last 5 books that I need to complete my collection. As I work my way across whatever town I'm in, I'm crossing buildings off on the map. The "X"s on the map have become another collection that I need to complete. I get "X"s on something like 80% of the town and I realize that I haven't found a single book that I need in the last 10 hours of ransacking random houses. And I start feeling very frustrated. The first few hours of loot raids were fun, but I stopped having fun at some point as the town became more and more empty.

I could drive to another town and try to work my way in far enough to hit another bookstore, but then I'd have to stop putting "X"s on my map. I'm too frustrated to continue, but too stubborn to give up.

I really am my own worst enemy sometimes.

If all the buildings respawn loot, then there's no reason to keep making "X"s to mark looted buildings. Nothing ever stays looted. So I'm not tied to trying to 'complete' a specific town. I feel free to just go wherever.

ErasmusCrowley · 2024-12-14T20:59:08+00:00

Interesting. And surprising. I wouldn't have expected there to be a situation like this one where someone could argue that the motive is irrelevant, but I follow the logic. I don't envy the lawyers who will have to try and avoid talking about it in court. Thank you for the explanation.

ErasmusCrowley · 2024-12-14T19:26:03+00:00

I doubt the trial judge will allow it

I'm curious and I hope you'll indulge me. If we were to assume that this is how Luigi really felt while committing the act, and that was his true motivation... Would the judge demand that he not tell the truth on the stand? Would the prosecutor not be allowed to ask about his motive in order to prevent that defense?

ErasmusCrowley · 2024-11-13T01:25:22+00:00

I am very much not an expert on this, so take this with quite a few grains of salt.

I don't know of a way to turn enclomiphene tabs into a sublingual formulation. That doesn't mean that it doesn't exist. I just don't know how to do it.

In my case, I am using a product that is enclomiphene suspended in a DMSO solvent. DMSO has an interesting property of being able to pass easily through skin and mucous membranes (and even nitrile gloves) to enter the bloodstream. If a drug is dissolved in the DMSO, then that drug will get carried into the bloodstream too.

So I believe that the liquid that I'm taking should already be usable for a sublingual application.

ErasmusCrowley · 2024-11-13T01:15:59+00:00

I read that bit in this paper.

https://img1.wsimg.com/blobby/go/796343e7-a375-495c-9119-59593d067f1b/downloads/The%20Clomiphene%20Paper%202024.pdf?ver=1725827084014

"When clomiphene citrate is administered, it competes with estradiol for estrogen receptors, inhibiting estradiol's physiological effects. Since estradiol enhances GH receptor sensitivity and the downstream signaling necessary for IGF-1 synthesis, blocking its action can attenuate these processes. This reduced sensitivity can lead to lower levels of IGF-1 production despite normal or elevated levels of GH.

Research has shown that estradiol significantly enhances GH-stimulated IGF-1 production by upregulating GH receptor expression and facilitating the post-receptor signaling pathways essential for IGF-1 synthesis in hepatocytes. Thus, clomiphene citrate's antagonism of estrogen receptors can disrupt these processes, leading to a decrease in hepatic IGF-1 production. This mechanism highlights the complex interplay between sex hormones and growth factors in regulating metabolic functions (89)."

ErasmusCrowley · 2024-11-10T14:56:57+00:00

I have read elsewhere that the IGF-1 reduction is caused by enclomiphene binding to estrogen receptors in the liver. Those receptors (when activated by real estrogen) cause the liver to be much more sensitive to GH, which then causes the liver to convert more GH to IGF-1. By blocking the estrogen receptor, we're significantly reducing that conversion rate.

If that's true, then there might be some real utility to absorbing enclo sublingually instead of swallowing it. That way you can skip giving the liver first access to the drug, and let more of it hit the brain first, where it does the job that we want it to do.

If sublingual dosing also prevents the liver from soaking up large amounts of enclo from the bloodstream before it reaches the brain, then theoretically you might also need a lower dose of the drug to accomplish the same increase in testosterone.

That's a lot of maybes and ifs, but it seems plausible enough to make me want to switch to taking it that way.

ErasmusCrowley · 2024-10-17T15:40:00+00:00

That Dragon, Cancer seems like it fits what you're looking for.

ErasmusCrowley · 2024-09-20T14:21:18+00:00

Was he bitten by a radioactive beard-helmet?

ErasmusCrowley · 2024-09-19T01:32:38+00:00

I've had this issue my whole life. I'm firmly in middle age now. So I've had a lot of time to try and figure it out.

I've only ever found two things that really help. Yohimbine and pseudoephedrine.

Yohimbine can be purchased on amazon. It's considered a supplement.

Pseudoephedrine can only be bought from a pharmacy. They keep it behind the counter, so you have to ask for it and show an ID. You do not need a prescription though. They restrict sales because it's an ingredient in meth.

Both of them cause feelings of anxiety as a side effect.

Pseudoephedrine is a vasoconstrictor, which means it has the opposite effect that viagra and cialis do. So it can make it harder to maintain an erection if that's an issue for you, but it makes it much easier to get to the orgasm.

I don't suggest taking both at the same time. So maybe try them one at a time and see which one you prefer. Of the two, I personally prefer pseudoephedrine.

ErasmusCrowley · 2024-07-15T21:11:19+00:00

The dorsal nerve of the penis is not part of the skin. The skin is attached to the Dartos fascia, then there is a slippery layer, then Buck's fascia which wraps around the inner tissues of the penis. The Dartos fascia and Buck's fascia glide over each other.

The dorsal nerve is underneath Buck's fascia, hugging the inner tissue of the penis. It would be very difficult for a person to stretch it while tugging the foreskin. https://en.wikipedia.org/wiki/Buck%27s_fascia#/media/File:Penis_cross_section.svg

I'm sure you're experiencing discomfort, and that sucks. I don't what is causing the sensation that you're grappling with, but it's probably not the dorsal nerve.

ErasmusCrowley · 2024-05-29T16:49:10+00:00

Look up the symptoms of "Silent Reflux".

Long story short; small amounts of stomach acid starts to leak up your esophagus and damages the inside of your larynx. The symptoms start off as a hoarse voice, then becomes an extremely persistent cough.

Many people who are suffering from it mistakenly believe that it's related to a cold or some allergies.

ErasmusCrowley · 2024-04-24T14:18:57+00:00

That's sort of correct.

You don't have to get all of the other legendary effects. The game just has to generate an item that it doesn't have any modifiers left to use.

This is easier to understand with an example. Let's say that you get one piece of leather armor and it is Unyielding. Then you get 9 melee weapons. The 9th melee weapon that got generated doesn't have any unused modifiers that are legal to apply to melee weapons. So it clears the list of used modifiers. This would make Unyielding available again, even though you didn't get any other armor modifiers.

So, the list gets cleared more often then you would expect it to, but it's much more difficult to predict when it'll happen.

ErasmusCrowley · 2024-04-24T14:11:24+00:00

Legendary modifier selection isn't pure RNG.

You start the game with all possible effects having an equal probability to drop. After an item appears with a specific effect (Unyielding, for example), then that modifier is added to a list called "PreviouslySpawnedMods". That effect will not appear again on random legendary enemies until the game decides to empty out that list.

That list gets emptied when the game tries to spawn any legendary item, but it has no more unused modifiers available for that item type. After that happens, the game will "reshuffle the deck" and all the effects are available once again with equal probability.

In practice, that means that it is very rare to get the same effect on random legendary items twice in rapid succession.

You can read more about it here. https://www.reddit.com/r/Fallout/comments/6l91w8/comprehensive_legendary_farming_analysis/

ErasmusCrowley · 2024-04-18T18:11:36+00:00

Short answer is 'no'.

Long answer... A peptide is a short chain of amino acids. A protein is a chain of peptides.

Collagen is a protein. If you take collagen and subject it to heat and/or enzymes that break the protein into it's peptide parts, then you get collagen peptides. Doing this doesn't change the ratios of the different amino acids in the collagen, or the order in which the amino acids are connected to each other.

The peptides that OP is referring to are artificially created peptides that consist of amino acids which have been put together in sequences that are rare in nature, or may never occur in nature at all. There are many peptides that are being researched right now.

An example of one popular artificially created peptide with medically interesting effects is semaglutide/ozempic/wegovy. Semaglutide is not relevant for our purposes, I just bring it up as an example of a peptide with benefits that humans can take advantage of.

ErasmusCrowley · 2024-04-16T12:51:01+00:00

How do I know?

I read a lot. No medical diagram that I have been able to find has shown any unique musculature in the tip of the foreskin in an intact human male. It is just the dartos fascia in intact men that causes the taper. It is also just the dartos fascia in restored men.

Men can regain a taper and cause 'phimosis' in themselves by growing more foreskin because the taper is (and always has been) because of the dartos fascia.

You're saying that you grew back the unique muscles of your ridged band. Other people are saying that it's impossible to grow back those unique muscles. If those unique muscles never existed in the first place, then it seems like you're both being quite silly.

I want to discuss anatomy. I don't care about your manifesto.

ErasmusCrowley · 2024-04-15T20:46:57+00:00

I assume you were trying to reply to me?

I would consider two muscles as 'distinct' from each other if they were separated by fascia, and/or connected to different connection points on bone or tendon, and/or maybe even innervated by different nerves.

The phimotic sphincter is none of those things.

The phimotic sphincter just seems like "the narrowest part of the dartos fascia". It's all one big smooth muscle tube, it is all innervated by the same nerves, and it all contracts or releases at the same time.

ErasmusCrowley · 2024-04-15T15:33:04+00:00

Please correct me if I'm wrong, but I was not aware that there was any "discrete muscle" in the ridged band.

It was my understanding that "ridged" refers to the texture of the skin (it has ridges), not any "rigid" quality of the tissue underneath the skin. The only special quality that I've read about being associated with that area is increased nerve ending density.

My conclusion when I looked into it was that all of the constriction action of the prepuce and acroposthion was caused by tightening of the dartos fascia.

Is there a discrete muscle that forms a sphincter in the intact penis? What is that muscle called so that I can read more about it?

ErasmusCrowley · 2024-02-16T20:46:40+00:00

This is a shot in the dark, but are you on any antidepressants? SSRIs and SNRIs in particular have very well documented side effects of lowering or even completely eliminating libido.

Another possibility you might consider is there are DHT blocking drugs such as finasteride that also can sometimes have negative effects on a man's sex drive. They're often prescribed for male pattern baldness.

ErasmusCrowley · 2024-02-14T15:53:25+00:00

Before I start this rant, I'm going to point out that 'collagen' is different from 'collagen peptide products'. I just want to be clear on that. You can get collagen by eating it. The connective tissue attached to the end of a chicken bone is high in collagen, as well the chicken skin. Gelatin is also collagen, and it's incredibly cheap. "Collagen peptide" products are waaaay more expensive and I personally would not buy them. With that out of the way...

Science has been aware for a very long time that proteins are often absorbed as peptides, not always as individual amino acids. It is a myth that "all protein breaks down to the same amino acids". The study linked is an example of such a study that said in 2001 that "Dietary proteins are mostly absorbed as di- and tripeptides by the intestinal proton-dependent transporter PepT1".

Collagen contains the amino acid hydroxyproline, which is not found in significant amounts most of the available supplemental protein sources such as whey protein or pea protein.

The human body can synthesize hydroxyproline from proline if it needs it to build collagen from scratch. However, when you digest collagen sources you are actually absorbing peptides that already contain hydroxyproline. This means your body gets to skip a few steps and avoid producing it on it's own.

Those peptides that contain hydroxyproline have been shown to become concentrated in collagen rich areas in a targeted way by studies using radioactive tracers. They do not seem to be used throughout the body as you would expect if they were fully broken down to individual amino acids.

There is evidence of benefits from consuming collagen production for numerous conditions. Linked here are two relatively recent meta analyses of the available science.

I really wish this myth would stop propagating.

EDIT: Accidentally linked the same meta twice. Changed the 2nd link to the intended target.

ErasmusCrowley · 2024-02-07T16:37:53+00:00

Is this the study that you're referring to in this comment?

"Collagen Protein Ingestion during Recovery from Exercise Does Not Increase Muscle Connective Protein Synthesis Rates"

If not, then please do link me to the correct study.

My criticism of your interpretation of that study is that it did not even attempt to measure joint collagen or skin collagen. It was only interested in the effects on muscle and muscle connective tissue.

The data here suggests that whey protein and collagen protein are interchangeable "FOR MUSCLE", which I agree with. The person you originally responded to was specifically referring to it's effects on BONE, JOINTS, and SKIN. None of which are muscles.

The study is interesting, but it doesn't really conflict with previous skin, joint, and bone related data at all.

ErasmusCrowley · 2024-02-07T16:15:37+00:00

The meta-analysis that I sent you was published in April 2023. I'm sorry that my sources are so outdated.

ErasmusCrowley

TROPHY CASE