Optimal TRT treatment: Testosterone mono therapy? Or testosterone plus HCG (or any LH receptor agonist)
I’ve read that doing testosterone mono therapy may not be optimal. I’m curious to hear your thoughts on adding HCG (or HMG, or rLH) for added benefit. Specifically what I read was “ If you aren't running hcg you will eventually be deficient in DHEA, Pregnenolone, Allopregnanolone, & Progesterone This means terrible libido, focus, mood, memory, drive & energy” I have listened to your podcast/deep dive on TRT but would love another AMA addressing optimal TRT and if/why you might consider adding an LH receptor agonist. Thank you!
Magnesium
Peter mentioned that serum magnesium is not an accurate test but he did not mention a much more accurate one- RBC magnesium. I wonder why. Also, intravenous magnesium does not have to be administered in the hospital. We give it in the office to hundreds of patients via a 5-minute IV push for both acute migraines as well as monthly, for prevention. Our first trial of IV magnesium for migraines was published in 1995. It also showed that half of migraine patients were deficient as measured by ionized magnesium levels (a research tool). Another comment is that RCTs for oral magnesium supplementation are flawed - they supplement patients regardless of their magnesium status. Those with normal levels are non-responders and dilute the effect seen in those who are deficient. One more comment about magnesium threonate. Most of the trials were sponsored by the manufacturer. As far as penetrating the blood-brain barrier, it is far from clear that threonate is better than other chelated forms of magnesium.
Could n-acetylcysteine be relevant for healthspan extension?
N-acetylcysteine (NAC) seems to be an odd compound. Apparently it supports liver function (it’s a paracetamol ovedose antidote). There’s a pile of research (of various quality) that suggests it might be useful to help to avoid flu, or even COVID, is hypothesised to help with dementia, and counter oxidative stress. On the other hand, it seems to have a good safety profile snd is cheap and widely available. As far as I can tell, NAC does this by being related to glutathione synthesis, and I guess that is pretty central to the immune system? I’d be interested in some sort of clear-headed analysis of whether this could have a possible role on healthy aging.
CtDNA Screening
Dr. Attia. In your podcast episode with Dr. Flaherty you discussed emerging ctDNA screening methods and referred to a couple of companies with tests on the market including Grail and Delfi. At this stage in the science and development of these tests, do you recommend that your patients get one of these tests done irrespective on any risk factors they might have?