Cotton-wool spots occur in approximately 50-60% of patients with advanced HIV disease and are the earliest and most consistent finding in HIV retinopathy ( Figure 1 ).( 21-24 ) They represent infarcts of the nerve fiber layer and are no different from cotton-wool spots seen with other systemic disorders such as diabetes mellitus and systemic hypertension. They are not vision threatening, although we have seen several patients with advanced HIV disease who presented with small visual field defects corresponding to the cotton-wool spots. Although they can be confused with early cytomegalovirus (CMV) retinitis lesions, cotton-wool spots usually can be distinguished by their smaller size, superficial location, lack of progression, and tendency to resolve over weeks to months.
I think this approach is fine. I must say having been doing this for years, treating hundreds and thousands of men I have been underwhelmed with the results with topicals. Injections can cause peaks and valley and I have many younger men inject twice a week that smooths out the peaks and valleys. I think it is appropriate to follow the advice of your primary doctor and endocrinologist. I have just seen too many men spend months or years with gels with sub optimal results. Many men are diagnosed with depression and are not really depressed (I have no idea if this applies to you), but the presumed depression is base dupon low T.
My recommendation would be to pursue this but if a few months pass and results are modest consider another approach. Pellets are one approach to have smooth levels of T and are placed every 4 months.
An impaired liver produces less steroid binding protein, or sex hormone binding globulin (SHBG). SHBG is decreased in pattern baldness, which explains higher ratio between “free” testosterone and testosterone. A lack of SHBG also increases estrogen, as SHBG binds and neutralizes estrogen in the blood. In addition to less SHBG, an impaired liver produces inadequate albumin. In 1976 Jordan et al. found that "serum albumin showed significant correlation with the protein content of the growing hair root bulbs" , and that "there was significant correlation between the percentage of growing hairs, their bulb diameters, and protein content, which in turn, correlated with the protein intake of the subject."