BNF is only available in the UK NICE

This of course is just a prediction, and individuals will have varying responses due to the aforementioned reasons. However it serves as an invaluable way of demonstrating what protocols and drugs suit a person best. We can plot all of this information onto a graph by computational means with some linear algebra.

Though far from perfect, this generally leads to better outcomes than traditional NHS protocols. We have discussed the evolution of our clinical practice in ‘Gold Standard TRT’. Whist the BSSM guidelines have provided us with a safe platform to work from, we believe that our current patient model is far more progressive and serves in the best interests of the individual. Medicine is a practice; a progressive clinician will continually seek to improve the level of care that they offer to their patient. It is safe to say that times have changed, our understanding of Testosterone Deficiency and TRT has increased exponentially and we have made the necessary adaptations. We have faced numerous challenges along the way, and we are certain that we will face many more.

What should I do if I forget to take Terbinafine cream when I should?

It has been a fascinating, yet challenging journey to date, we look to the future with aspirations of changing practice. With that said, Gold Standard TRT is microdosing daily subcutaneous Testosterone Cypionate (or Enanthate) and HCG injections. The aim should be to both normalise levels, help maintain function and reverse any negative symptoms. It is well-recognised that exogenous Testosterone suppresses both the release of both LH and Follicle Stimulating Hormone (FSH) from the pituitary gland. This means that LH no longer stimulates the Leydig cells of the testes to produce Testosterone, and correspondingly, FSH no longer stimulates the Sertoli cells to produce sperm.

However, it is possible to prescribe medications in an ‘off-label’ fashion. This simply means that the medicine is being used in a way that is different to that described in the product licence, which is agreed by the Medicines Healthcare Regulatory Authority (MHRA). It is even possible to prescribe medications for an intended purpose when there is no product license, such as Transscrotal Testosterone Cream, but this must be done with extreme caution. ‘Primum non nocere.’ In the private medical sector, practices vary widely, from doctor-led clinics to online providers, generally trending towards increased frequency protocols to help achieve more stable pharmacological levels.

We need to listen to the patient but retain a necessary element of objectivity so that we always act in their best interests. Whilst a progressive approach may imply an added level of complexity, in fact the contrary applies. If we apply our current knowledge and understanding of pharmacokinetics to the available medications; smaller, more frequent injections will lead to more stable male androgen levels. Gold standard TRT extends even further than this, the aim is to also optimise function by giving men an appropriate dose of Testosterone and HCG for their genetics, physiological requirements, and subsequent utilisation. This can only be done through careful titration, its certainly a case of “slow and steady wins the race”. Administration of a medication forces a physiological reaction, even if that medication is “body-identical”, a new buzz term in the healthcare sector.

Who Should Not Use Terbinafine Cream and Tablets?

This leads to significantly longer periods of low Testosterone; this will more than likely increase the risk of polycythaemia and cause a roller coaster of emotions. This is FAR from optimal, and in our opinion, this method of prescribing Testosterone enanthate should stop immediately. We have broken this down into the different protocols by sector, including the NHS.

Never share your medicine with anybody else, even if they are experiencing the same symptoms as you. The patient information leaflet contains instructions on how to take it, as well as vital information regarding the safety of the medicine. We are a completely secure site and take many measures to ensure your details are kept safe. We understand that you have a right to extreme privacy when purchasing sensitive health medications. All information that you provide to us is stored on our secure servers.

Using mathematical modelling techniques for predicting the absorption, distribution, metabolism and excretion of synthetic or natural chemical substances in our bodies, we can create pharmacokinetic models. Often the output will be in a graph format, as we are showing what the body is doing to a drug over time. Pharmacokinetics, the name arises from ancient Greek; pharmakon “drug” and kinetikos “moving or putting in motion”. In the case of you and I, we can describe it as the movement of a drug we’ve been prescribed, into, through, and out of our body, and the time course of its absorption, bioavailability, distribution, metabolism and excretion. We perform these steps all at a different rate and manner due to our different genetic profiles and environmental differences. These differences can help explain why you may know of a friend who can drink nonstop booze and be fine, yet you have one glass of wine and you are gone.

It is important to appreciate that all hormones are dependent, whether that be a direct or indirect relationship, they are not independent. An excess of any one hormone has a cascade effect on other physiological parameters. I have often lowered a patients self-perceived “optimal” levels, for them to report that their anxiety has settled and that their libidos have improved.

You should be able to drink alcohol 1 week after taking your last dose of Terbinafine. One of our online doctors will contact you to discuss your liver function test results and provide further information about what they mean. Interestingly, we have also noted improved compliance with small daily dosing into the subcutaneous tissue, as injections are relatively painless compared to the more traditional intramuscular injections. Daily administration also means that injecting simply becomes a part of your morning routine, much like brushing your teeth.

The quantitative level of a particular hormone present in your body at any one time has a direct and indirect effect on numerous physiological processes. To achieve homeostasis, too much is often as bad as too little in what is a very complex mechanism that necessitates fine control for optimum function. With microdosing, we have noted fewer clinical side effects, such as raised haematocrit and elevated Oestradiol which are well recognised with other protocols. Once clinical practice has returned to normal after the COVID-19 pandemic, we plan to engage in a clinical trial to demonstrate the effectiveness of microdosing. As you can see, there is at most a ~30iu difference from the peak and trough, much better than the near 200iu difference seen in private practices elsewhere. This will lead to more stable levels and less E2 spikes, ergo fewer overall issues.

He demonstrated clinical symptoms of hypogonadism, in addition to having concerns about loss of concentration, memory issues and weight gain. Using the most effective injection frequency with the lowest viable dose, to achieve the most optimal patient outcome. This includes looking at patient symptoms, discussion of how the patient feels, biochemical assays/profiles, body composition changes, energy, activity performance and mental wellbeing. We adjust the dose based on these parameters, and include ancillaries such as aromatase inhibitors where necessary and as agreed with the patient.

Leave a Reply

Your email address will not be published. Required fields are marked *