Hoping to address my T issue ...
- 09-05-2008, 07:38 PM
Hoping to address my T issue ...
I'm Eisenhower and I've been watching these boards for some time. Here's my issue - and I think it revolves around Testosterone.
As a little background, I'm 37 and in reasonably good shape though I don't exercise - I'm about 170lbs, 5'10".
When I was in my late 20s, I started using Propecia (Finesteride) for hair loss. After about a year and a half, it was killing my erections. I stopped and started again twice to prove it was the Propecia doing it and it was. I then quit Propecia for good, obviously as it was screwing with my hormones.
Things returned to normal (I thought) but for about the last 5-7 years, I noticed I wasn't ever getting nocturnal or morning erections and I was only getting hard enough for sex with some physical stimulation.
I had a bout of Peyronie's Disease in 2002 (a scarring/bending of the penile tissue). It resolved (thank God) but I was left with a little softness in the head of the penis due to internal scar tissue. It was no big deal though and the Uro gave me Viagra to make me super hard. I loved the V!
However, about a year ago, I got in a serious relationship and was taking V regularly. After about a month I startd to believe the V wasn't working as effectively - I was slower to get hard, requiring more stimulation. That led to some performance anxiety too which is nasty stuff.
So, I started thinking about how I never got nocturnals or morning erections for years and after lots of reading, I started to suspect low T. I asked my Urologist to test my T. Test came back 235, which amazingly, he sluffed off and said, "don't worry about nocturnal erections ... as long as you can perform, your testosterone is high enough." He also sluffed off my complaints that the Viagra didn't seem to work like it had been.
I wasn't satisfied. I went to an Endocrinologist who (looking at the 235 test) seemed ready to do TRT, but wanted me to test again. This time, the test came back 434. She then completely washed her hands of it and said "you're within range." No TRT. I can't believe even 434 is a good number for a 37 year old.
Nine months later, I'm some better but still not satisfied. In January, I started taking supplements many with Peyronie's take (L-Arginine, Acetyl L-Carnitine, Propionyl L-Carnitine as well as Zinc) I'm also taking a drug called Trental which basically gets more blood into the legs (and penis) - it's a promising drug in terms of Peyronie's ... but what I've found is that my nocturnal erections have returned to some degree. Some nights more than others. More importantly, for the last 9months I've been having sex without Viagra or anything other than these supplements. I'm not sure if it's the supplements, the Zinc, or the Trental, but something is giving me better erectile performance.
However, I still feel my Testosterone is probably not right and I can't help thinking I'm addressing symptoms but not the cause. Therefore, I've made an appt with Dr. Romeo Mariano in Monterey, CA, who (as I learned on these boards) is a hormone guru. I'm really hoping he can treat me in a way that helps me long term, shake the anxiety, and get control of my life again.
My only concern at this point is that the 9 months of supplements (which are obviously doing something to me) might skew the T test results that Dr. Mariano orders. I don't want to skew the number high (if in fact that's what's happening in my body because of the Zinc, etc.) but at the same time, I don't want to stop taking the supps, because they're working pretty well.
I asked his nurse if I could send him a letter explaining all this before I tested, but she said no, just explain it when you get here. I wasn't thrilled with that answer, but as he's apparently well respected and closer to me than Michigan or Pennsylvania, I do want to see him.
Any thoughts you T experts might offer me would be appreciated. I'm scared of the prospect of being on TRT for the rest of my life (what if I get Prostate Cancer and have to stop?), but I don't like being strung out on supps not really knowing what's going on in my body either.
I need some advice guys. Thanks.
- 09-05-2008, 09:53 PM
Abe lincolon here and mariano is the best move you could have made hands down provided that he is closer to you is even a bigger bonus.I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
09-06-2008, 12:45 AM
Thanks. I've got to say though, I'm scared by the fact that it seems like everybody I read on here doing TRT seems to be on a roller coaster ... fine for a while, messed up for a while, over and over ... maybe I'm just getting that impression, but I'm hoping that I'm not getting into a lifelong roller coaster.
09-06-2008, 09:44 AM
09-06-2008, 11:54 AM
But I think you will do better then if you took no action at all.
Assuming ground temperature guarantees lack of rollercoaster.
From my observation, rollercoaster is often due to schedule changes made on observations rather than testing.
Other common reasons;
doctor bails out and do not want to continue (succesfull) procedure.
09-06-2008, 01:37 PM
Guys, the first test I had done in Oct of 2007 showed these results:
Total: 235 (250-1100)
%Free: 1.71 (1.5-2.2)
Free T: 40.2 (35-155)
FSH: 5.1 (1.5-12.4)
LH: 3.4 (1.7-8.6)
So, I thought, Low Testosterone - great, maybe that's the problem after all. I went to an Endocrinologist who ordered a second test to be sure, but the results really confused me. I will say, I'd been taking 3g of L-Arginine for a few weeks leading up to this second test so I don't know if that may be what skewed the results:
Free T: 91.2
SHBG: 17 (8-48)
Same lab, same time of day (9AM), same everything.
I assume if I'm Hypoganadal it's secondary, because as a young man, I certainly had plenty of nocturnal/morning erections, etc. It was only in my late 20s (after Propecia) that I started having issues.
Any other specific questions and I'll dig the tests out and see if the info you're asking is on there. I do know that neither test checked for estradiol.
09-06-2008, 03:04 PM
It is strange that your Total T is low, because your Free T % and SHBG are both very favorable. As well - as an aside - nocturnal/morning erections are not always necessarily an indicator of Testosterone function. I stopped having nocturnal erections during my teens, but stand at attention quite readily.
09-06-2008, 04:01 PM
09-06-2008, 04:15 PM
darkblue, that second test may look "normal" by the numbers, but surely you don't think that first test is "normal" for a 37 year old man. 235?
It's not just lack of nocturnals that bothers me, I also have low energy, lack of restful sleep, wake up numerous times at night, etc.
09-06-2008, 04:17 PM
09-06-2008, 04:22 PM
If possible, prevent this test from taking place, it is a source of confussion in hands of uninformed doctor.
Best is to look at BioAvailableTestosterone
using test at Quest Diagnostics
Testosterone, Free, Bio/Total (LC/MS/MS)
Quest Diagnostics: Test Menu
Not everybody is able to do this test.
Second best is to calculate FreeT all by your self.
You have this:
SHBG: 17 (8-48)
you missing Albumin.
It can be assumed that your Albumin=.3
It is easiest to use this chart, post #41
if you are sure that you will not mess up units, calculator can also be used.
Free & Bioavailable Testosterone calculator
Just make sure to not look at Bioavailable Testosterone
over there, it is wrong.
How to look at FreeT value derived this way?
If below 100, unacceptable
100-160 very low
over 160, may be acceptable if obtained natural way, HCG only is considered being natural
best value for FreeT~300, this high is usually possible when one is on testosterone supplementation.
FreeT does not works alone.
usually one have to have
E2 & DHT at good levels.
Tests (at Quest):
Estradiol, Ultrasensitive, LC/MS/MS (30289X)
DHT should be at upper range or slightly higher
Estradiol should be less than 29
but similarly as with FreeT it is a function of SHBG and less of Albumin.
One wants to have as much estradiol as possible.
To low E2 causes bone loss.
We already had reports of bone loss, carefull with AI.
Always draw blood at Quest or LabCorp, do not let the blood to be drawn by doctor's office.
09-06-2008, 04:27 PM
JanSz, there was an Albumin figure on that second test:
Albumin 4.7 (3.3-4.9)
Also, DHEA Sulfate: 409 (120-520)
Does that tell you anything?
09-06-2008, 04:29 PM
09-06-2008, 04:37 PM
So Jan, bearing in mind that all this is pretty much over my head insofar as numbers and the science behind it ... do you think I'm warranted in seeking out hormone therapy with Dr. Mariano?
Thanks for your help,
09-06-2008, 04:53 PM
But you also have to become educated customer.
One reason is, so you can help your doc figure out what is your problem.
Read thru my thread, all 4 pages.
contains compilation of dr Marianco's posts.
09-06-2008, 05:32 PM
09-26-2010, 01:33 PM
I have Peyronie's myself. But I'm not quite sure of what caused it. I made off-label use of a beta-blocker to relieve anxiety a few months ago. However, it was only after I took too much Prunus africana (and I really exaggerated on it) that my Peyronie's manifested. The extract from this plant, also known as Pygeum, has a pharmacological action very similar to that of finasteride, i.e., of 5-alpha-reductase inhibition. No wonder it's prescribed with some success to treat benign prostatic hyperplasia.
I was wondering if you took anything to make the plaque go away. Testosterone replacement? hCG? Peyronie's a tough kind of fibrosis. It's not that common to find anyone who completely recovered from it.
10-04-2010, 08:53 AM
10-04-2010, 01:52 PM
I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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