This is the TOT Doctors Roundtable Hosted by The Lifting Dermatologist.
Join our Hormone Optimization Doctor's in discussing common issues in the world of Optimization.

Today attending:
Dr. Keith Nichols
Dr. Scott Howell
Dr. Steven Devos (The Lifting Dermatologist)

Topics:
(1) intro
(2) prepared questions:
Do you guys measure Estrogen and DHT? If not for medical reasons, since we won’t be blocking it or doing anything about it anyways, but because of legal reasons, as dr. Rob suggested in previous roundtable?

I am seeing more and more men for hormone optimization nowadays. And in most cases I start by optimizing their testosterone, next thyroid, and in most cases I advise taking vitamin D and Melatonin as well.
2 questions: what supplements should you generally recommend with that? Omega3 fatty acids? Magnesium? Any others?
And in what doses?

Second: when should I add Pregnenolone and DHEA into the mix? Should I wait for certain symptoms before adding these?

If you feel better with TRT than before TRT, when and how to tinker with dosage, timing, and other things to see if you could feel EVEN better?

How can you be so sure that "our" 20%transscrotal testosterone cream will be safe long term? (Any studies on that?)

Is there a big difference in the scrotal application of testosterone vs injections when it comes to elevating HCT?

Thyroid optimization: Are there certain levels of T3, T4 and/or TSH to aim for?
Is the optimal range also higher than the normal laboratory reference range as is the case for testosterone levels?

(3) Q&A from the chatbox, Q that came in while livestreaming:
With TRT, the focus on forums, social media & informative youtube videos (in general) are almost always: testosteron, estrogen, progesterone and DHEA.
However, the hormone chain starts with Pregnenolone, right after Cholesterol. Oddly enough I rarely see it being discussed.
I hope the docs can give a bit of in depth insight in how to tackle low ‘preg’ levels and what optimizing this hormone can achieve in correlation to optimal testosterone levels & what effect it can have on the other main hormones.. mainly.. DHEA

DHEA Vs Keto 7 DHEA please?

Danny Bossa: Can you elaborate on hormone optimization for women who have just given birth. If they take progesterone won't they stop lactating?

Does anyone have any experience or have knowledge of research in the area of TRT helping people that have Multiple Sclerosis?

Is it ok to drink socially (weekends) while taking Metformin, or should I avoid alcohol altogether while on the medication?

Can you touch on the importance of SHBG. Why only 1% of T is free and why you don’t want to lower SHBG.

Question from Deep Freeze: Estrogen symptoms, low bodyfat, daily injections (100mg week), Is it best to lower test. even more or have high testosterone but use an AI?
Symptoms:
low libido, fatigue, ED.. I have been on and off TRT for 3 years. I know for a fact anything e2 over 40ish causes issues
So, lower dose or add AI?

Has a list been compiled of Dr.’s of a similar mind set in different geographic areas? Calling and checking out and eliminating different local clinics because of various “ practices “ is exhausting.

(4) Bro science section:
Each panelist get asked the best (or worst) piece of bro-science he heard or read online, and how he wants to debunk that piece of information.

(5) Option for panelists to explain to viewers/patients how they can be reached, how patients can work with them.


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