all right so last one we got tonight

says hi I am 34 years old and have been

on TRT for about ten years now on about

350 milligrams of tests per week take

two point five milligrams of letrozole a

day holy moly I have noticed about three

years ago I started to experience Edie

you know I'll bet we're gonna help this

person I can tell all right

I have tried natural sups and other

remedies but nothing worked

I take ten milligrams of cialis and that

works but what to fix the root cause my

blood pressure is 140 over 86 and

estradiol is 43 at last Bloods is there

something I'm not doing right and what

exactly causes edy red a lot it seems

there is no clear answer thank you sir

okay this sorry it just doesn't make any

sense I can't imagine a doctor

prescribing two point five milligrams of

letrozole per day so I have to assume

that this is no black-market obtained or

certainly not obtained through a doctor

but my implication being that this is

not pharmaceutical grade letrozole

because that would just absolutely bury

your estrogen period letrozole is

typically reserved for really

recalcitrant calcitriol cases of

aromatization and it's very very rare I

mean I can't think of but a few times

I've ever had to call on it and it's

been for a short term because it really

works strongly letrozole was invented

before and nash's always what we now

know as Ledger's always goes by tomorrow

and then an Ashes all goes by Arimidex

so a remedy X was actually second

because we found liver enzyme elevations

using letrozole and they were mild but

still a it's enough to make it an issue

and and rightfully so so so we came up

with a natural who didn't see the same

problems but latch is also strong that

in them itself baring you're after

and we touched on this earlier

minimizing it or I should say over

suppressing it a little bit can cause

issues it's rare but with letrozole

because you're bearing it it happens a

lot and it might be because of letrozole

itself i haven't been able to tease that

out but whenever I've used letrozole or

more often heard about people using

letrozole in other words we talk about

what's going on what they're using on

their own I think oh and I'm using left

result oh that's the problem we get them

off letrozole Edie resolves mmm so I'm

I'm I don't understand why despite

taking two point five milligrams of

letrozole per day and I would say you're

gonna be using that dose once a week and

still hammering your estrin pretty good

twice a week you've got to be just

destroying it but once a week you're

probably still destroying it so every

day makes me wonder is this is this real

such as well how can you still have an

estradiol of forty-three and by the way

you know I've said this before estradiol

is not going to be valuable for guys

because it's not precise enough to be

accurate that makes sense so for guys

because you're trying to get some

precise to measure those much smaller

levels lower levels I should say of

estradiol we need an estradiol sensitive

but even still I mean it should register

zero no matter how you're you know how

imprecise you you're measuring it or

close to it

forty-three just doesn't make sense so

it's over your counter and fake I mean

it's we got it we got a look into it

well but then okay so then you go okay

well which is it then ran you just said

using letrozole is gonna get a barrier

estrin and that's what causes it or

maybe selectra saw itself well if it's

fake letrozole then why or thunder

doesn't have a need either you know

which so I don't know the answers but it

doesn't add up but you know for the

benefit of everybody else if you've got

Edie and you're using letrozole stop

using letrozole for sure simple and if

you're burying your estrogen ditto you

know ease up on the aroma taste neighbor

and see if the e did Edie doesn't

resolve in a week or two you know

there's a lot to this and again I can't

practice medicine here but I would say

he says beyond trt since he's 24 like

because he's 34 now so the phone rings

er Z well and on a hefty dose obviously

of testosterone sipping it compared to

the norm but one other thing you might

try is is adding some ACG to the regimen

because what we found is again this is

rare because usually get people on

testosterone replacement therapy who

have hypomanic oh thank you thank you

Jesus thank you Lord you saved my life

you know I got my libido back everything

comes back and they're happy it's very

rare that they they get all the benefits

except for the increased libido or the

return of libido right every one small

though you had a little bit of HCG to

those people again that's a rare person

that happens to and they go that was it

you cured me I can't imagine what the

the mechanism of action is because I'll

see yes you do know we're regulating the

estrogen I mean have very few people

that are on testosterone replacement

therapy males that don't use some sort

of estrogen control we'll call it

whether it's through a blocker or more a

SERM or usually through an aromatase

inhibitor so is it the fact that you

just they just need a little bit of a

Dodgers production that makes the

difference I don't know what the answer

is but I know it often is what solves

the problem yeah so you might want to

try adding that the the fact that the

cialis works is interesting too isn't it

because that's just gonna that's a pde5

inhibitor although it works on other

pd's you know whatever it is 893

but it's mainly a pde5 inhibitor and

it's it's working on nitric oxide

reabsorption right so if that solved the

problem go back to okay well what's the

issue is it maybe just that you're not

getting enough of the precursors for

example I mean he's a tricky one so is

it you're not getting enough arginine

l-citrulline and enough meaning you know

if you're gonna supplement with a try

two to four grams at a minimum of either

one of those and see if that doesn't

help but are you doing your cardio

because we have I mean 34 you're way too

young to worry about nitric oxide

synthase cells you know not doing their

job and the endothelial walls mean that

you know but-but-but what stimulates

them to do their work is is is moving

the walls around with you know exercise

particularly cardiovascular activity

right so I mean you know 34 we've seen

bodybuilders don't do a lot of cardio

right yeah still you would think that

that wouldn't be the issue again that

was something that something might throw

in the program I think the main problem

is the letrozole even though the

estradiol levels don't make sense now

the other thing you mentioned is 140

over 86 if that's truly your blood

pressure then that's too high meaning

that's your blood pressure all the time

now there's another tricky one though

with with blood pressure dr. Eric Topol

came up with a great idea long time ago

this is a guy who works south of us here

down in San Diego and he's got a foot in

clinical and a foot in academia perfect

right he said you know we're doing

measurements of blood pressure in the

office at least half the people come

into the office have what we call white

Co syndrome

hey man who likes to go to doctors

offices you know it usually implies are

something wrong right why do you go to

dark hey just want to say hi today red

no I got a complaint here or you know

they you know it's a pain in the rear

because they don't want to but we're

dealing with your whole subs so we got

to see at least you know what's here so

no there's no really fun reason and so

the blood pressure goes up for those

reasons let's measure it at home smart

right so I think a lot of people are

catching on with with dr. Cocles idea by

the way because it's gonna be

artificially inflated at the doctor's

office if you find that your say 120

over 70 at home you're done yeah I joke

with guys if you're going to gym and you

take your blood pressure and 180 over

130 turn around and go home man you

ain't ready yet you're not fired up the

brain can fire up your blood pressure in

other words yeah and you know if you're

a morning lark and you get up and you

know cortisol levels are high if it's

not 140 over 80 it might be unusual for

you because you're going but then by

nighttime you know it drops down to 120

over 70 you're okay it doesn't mean you

have hypertension you don't have a

pathology right no you're just wound up

yeah you know so you get my point and

and this is not just me I mean you might

argue as I did I think once in front of

my cardiologist I said well but then if

it's not a pathology by the standard

definition is still a pathology by you

know new standards of you know just

being stressed all the time well no

don't forget you still go to sleep so it

you know it may be high all day long

because of stress and the way you deal

with stress but then you go to sleep and

it comes back down to 120 over 70 that's

enough of a break yeah just like well

yeah but in working out would be

terrible for you because it's 180 over

130 while you're doing deep squats right

oh yeah yeah and so you don't know you

know it's kinda like the concept of

training versus overtraining yeah

there's enough for you're not you know

putting too much pressure on the

arterial walls and then the kidney don't

help them at all the time yeah yeah so

but that's something that if it is truly

high blood pressure you know we want to

get that down too and that you know

blood pressure issues can affect edie

for sure you can that be very mild

hypertension you know stage one also

something just don't on the subject of

VD thinking of the blood so there's no

reference here to the H and H hemoglobin

hematocrit red blood cell counts always

nice to have with that and sleep apnea

which is a typical cause that I see in


of that HNH elevation because that blood

thickness we loosely determine yeah can

effectuate Edie - I've seen there you go

cool thanks doctor