***NEED ADVICE/OPINIONS ON DR CRISLER'S TREATMENT PLAN***

[JoshNyce]

Its been a while since I have posted, but I thought I would get input from the Anabolic Minds community prior to my next Dr.'s visit. Its been a long 2 years since I started TRT with little to no results from my primary care physician. I decided to bite the monetary bullet and bring in Dr. Crisler, who is very well known on this forum as the "go-to" Dr. for testosterone/hormone related male issues. Basically, here is my background info and my question/concerns for you all:

2 years ago, my initial bloodwork showed that I my total testosterone was in the 640's (not bad/not great) and my free testosterone was a hair under the normal range. Dhea was within range and all other hormone panels were in range as well. I was experiencing some libido issues and all of the other symptoms you would see from someone experiencing low test including major stress from work and other outside factors. My primary Dr. decided to put me on androgel for 2 months after my total free was a hair out of range. I felt a little better on the gel towards the end of the treatment, but after just a few weeks I began to feel even worse. A few months later I drew a lab with an endocrinologist and my total testosterone dropped to 520, everything else was in range according to him. The endocrinologist said that these values were not bad for someone who was placed on TRT and advised that actually being administered Androgel could have suppressed my own natural testosterone. He didn't agree on my primary physician putting me on the androgel in the first place. He did little to help me and said that I was "normal". Since then I have seen a steady decline in total testosterone since then. During this 2 year period, my primary Dr. has had me on and off Androgel a total of 3 times. Its sad to say, but now my total test has consistently seen a slide since then. My Dhea is also out of range as well.

I decided to bring in Dr. Crisler as many of the board members trust in his opinions/knowledge. Dr. Crisler was able to identify severe adrenal fatigue to be a one of the many issues, something that my primary care physician failed to see. He has since decided to put me on hydrocortisone so my adrenals could heal.

My questions to you all is if I was indeed in the mid 600 range and was stressed out all the time, could it have been identified earlier as just severe adrenal fatigue? I have read that experiencing adrenal fatigue can lead to some of the symptoms I was experiencing before; mainly a decreased libido/feeling tired all the time/foul mood, etc. From what I have read Dhea is also related to the adrenals as well. Maybe putting me on androgel and not actually addressing the adrenals was the incorrect thing to do?

Dr. Crisler has now decided to start me on a weekly test cyp injection to get my testosterone in range along with the hydrocortisone to heal my adrenals. My main concern is that we may be suppressing my natural production of testosterone and not actually aiding it with the new regimen. I know my testosterone is already low, but the absolute last thing I want to do is to rely on testosterone shots my entire life. Since I was producing ‘ok’ but not great levels of testosterone prior to all the androgel treatments my primary put me on, maybe the androgel treatments she suggested actually suppressed me more than they actually helped me?

I know you guys are not Dr's, but what other treatments would you guys suggest? Do you think Dr. Crisler is correct for putting me on the test cyp shots? Wouldn't this also kill my own natural production? What is his thinking behind this treatment? I would appreciate the advice. Thanks to all.

-J-

[Philec48]

I'm shocked that your first doc put you on Androgel when your total T was 640! Did you have your E2 (estradiol) tested at that time? Ever tested? How about your LH and FSH?

Dr. Crisler would be the best person to answer the questions in your last paragraph. If you like, post all your lab results to see what comments may be offered.

Phil

[3djedi]

How did he determine you have adrenal fatigue? Just curious. I would be thrilled to have a 600 t count! Mine was 188…

[mqsymth]

You need to check your E2, prolactin, SHBG and bio-available T.

In addition you should check your thyroid hormones, TSH, T4 Free, T3 Free, Reverse T3.

Once you start TRT it's for life so don't start if you can get your pituitary HPTA axis going though other means.

[The Matrix]

You need to check your E2, prolactin, SHBG and bio-available T.

In addition you should check your thyroid hormones, TSH, T4 Free, T3 Free, Reverse T3.

Once you start TRT it's for life so don't start if you can get your pituitary HPTA axis going though other means.

This is not rocket science
1) identify probably cause -DR's need to ask right question not focuing so much on hormones. Hormone imbalances are majority a symptoms of the cause.

One patient 24 years old had bad hormone and adrenal profile and wanted TRT. Found out that he was toxic from diet soda. Taper the soda, supported hormone systems with adapotgens ,detoxed him correcting the enzymatic pathway associate with aspartame poisoning. His
brain cleared, libido got better, and hormones rebalanced in 4-5 months . NO HRT. I have had numerous cases of these. Look for the cause not the symptoms.

2) clean the cell matrix get the crap out support enzyatic pathways.
3) exmine adrenals going to thyroid then sex hormones.

There are some time where there has to be HRT but people under 30 by going deeper then most dr body can be rebalanced on its own.

food is thy medicine and medicine is thyr food.

[jinxie]

Its been a while since I have posted, but I thought I would get input from the Anabolic Minds community prior to my next Dr.'s visit. Its been a long 2 years since I started TRT with little to no results from my primary care physician. I decided to bite the monetary bullet and bring in Dr. Crisler, who is very well known on this forum as the "go-to" Dr. for testosterone/hormone related male issues. Basically, here is my background info and my question/concerns for you all:

2 years ago, my initial bloodwork showed that I my total testosterone was in the 640's (not bad/not great) and my free testosterone was a hair under the normal range. Dhea was within range and all other hormone panels were in range as well. I was experiencing some libido issues and all of the other symptoms you would see from someone experiencing low test including major stress from work and other outside factors. My primary Dr. decided to put me on androgel for 2 months after my total free was a hair out of range. I felt a little better on the gel towards the end of the treatment, but after just a few weeks I began to feel even worse. A few months later I drew a lab with an endocrinologist and my total testosterone dropped to 520, everything else was in range according to him. The endocrinologist said that these values were not bad for someone who was placed on TRT and advised that actually being administered Androgel could have suppressed my own natural testosterone. He didn't agree on my primary physician putting me on the androgel in the first place. He did little to help me and said that I was "normal". Since then I have seen a steady decline in total testosterone since then. During this 2 year period, my primary Dr. has had me on and off Androgel a total of 3 times. Its sad to say, but now my total test has consistently seen a slide since then. My Dhea is also out of range as well.

I decided to bring in Dr. Crisler as many of the board members trust in his opinions/knowledge. Dr. Crisler was able to identify severe adrenal fatigue to be a one of the many issues, something that my primary care physician failed to see. He has since decided to put me on hydrocortisone so my adrenals could heal.

My questions to you all is if I was indeed in the mid 600 range and was stressed out all the time, could it have been identified earlier as just severe adrenal fatigue? I have read that experiencing adrenal fatigue can lead to some of the symptoms I was experiencing before; mainly a decreased libido/feeling tired all the time/foul mood, etc. From what I have read Dhea is also related to the adrenals as well. Maybe putting me on androgel and not actually addressing the adrenals was the incorrect thing to do?

Dr. Crisler has now decided to start me on a weekly test cyp injection to get my testosterone in range along with the hydrocortisone to heal my adrenals. My main concern is that we may be suppressing my natural production of testosterone and not actually aiding it with the new regimen. I know my testosterone is already low, but the absolute last thing I want to do is to rely on testosterone shots my entire life. Since I was producing ‘ok’ but not great levels of testosterone prior to all the androgel treatments my primary put me on, maybe the androgel treatments she suggested actually suppressed me more than they actually helped me?

I know you guys are not Dr's, but what other treatments would you guys suggest? Do you think Dr. Crisler is correct for putting me on the test cyp shots? Wouldn't this also kill my own natural production? What is his thinking behind this treatment? I would appreciate the advice. Thanks to all.

-J-

First off, your testerone is not low. Not at all. It's one of the higher values I've seen on this board. I don't know how old you are, but mine was half that at 37, and many on this board are much lower than me.

Your issue seems to be free testosterone, and possibly high E2. I dont think you should be supplementing with test at this point. And even if you were to want to increase total T, hCG and/or arimidex would be the way to go. Your balls work well.

Others will disagree with me, but I think "adrenal fatigue" is way overdiagnosed, and HC WAY overprescribed. Same goes for hypothyroid and Armor. Often times these meds will make us feel better in the short term, but that doesn't mean that's the problem. Most of us would feel good taking methampetamine in small doses for a short while. Get it?

I would encourage you do a lot of research before proceeding down your current path, as I don't think it's the right one. Remove the stress, eat well, sleep well, and make sure E2 and SHBG are optimal, and then go from there.

Good luck.

[luclyluciano]

How do you remove Stress. Jump in a casket and wait, my guess?

[The Matrix]

How do you remove Stress. Jump in a casket and wait, my guess?

Identify the cause and addess it accordingly what ever it may be (emotional , phyiscal, biological, environmental, dietary)

Since you are being unde Dr J care he would be the one to ask for this information. We can only give imput but our suggestions are not to be substiuted for your treating dr's medical advice.

[JoshNyce]

I guess I needed to be a little more clear about my values. At one point they were in the 640 range. From my most current lab (approx 2 months ago) they were in the low 300 range. According to Jinxie, I should propose HCG. Ever since these symptoms one thing that has never changed is the lack of testicular sensitivity to that area. Testes hang high and tight and libido is in the tanker. Would that be something I should propose? I have read of a test cyp coinciding with a HCG protocol. Thoughts? I will have to post my latest bloodwork for you guys to see. But from what I know Dhea is below range and total test and free test are low. E2 has been mentioned by everyone on this blog thus far. What can I expect if E2 is set back in line? In addition, I am really curious to see whether or not my thyroid is functioning correctly as I was told previously that it was fine. Others were curious of my age. I am 27 years old. Appreciate all your feedback thus far. This has been a life wrecker. Especially since my wife and I would like to have kids one day. Many thanks.

[JanSz]

dr John is the best there is.
but
even the best doctor can't help you if you are going to be inconsistent in your demands.
First you want doctor to help you
second
you worry that you will have to be on T-shots for life,
make up your mind.

You have to sit down and discuss with dr John your priorities.
You may not realise but you are making contradictory demands.

I think dr John is already making shortcuts just to please you.
He have a patient compliance in mind.

If that was me, I would tell you do do testosterone shots every other day.
-----------------------------------------

When you want to know if you have enough testosterone, you have to look at BAT-BioAvailableTestosterone.

Very often TotalT~600 is nothing to brag about.
If your SHBG is on a high side, you may need TT~1200, twice of what you have now.

...

[Philec48]

Yes, ask your doc about T and hcg protocol combo. It may help keep some testicle function/fertility for you, or at least maybe make it not too difficult to become fertile again.

[JoshNyce]

dr John is the best there is.
but
even the best doctor can't help you if you are going to be inconsistent in your demands.
First you want doctor to help you
second
you worry that you will have to be on T-shots for life,
make up your mind.

You have to sit down and discuss with dr John your priorities.
You may not realise but you are making contradictory demands.

I think dr John is already making shortcuts just to please you.
He have a patient compliance in mind.

If that was me, I would tell you do do testosterone shots every other day.
-----------------------------------------

When you want to know if you have enough testosterone, you have to look at BAT-BioAvailableTestosterone.

Very often TotalT~600 is nothing to brag about.
If your SHBG is on a high side, you may need TT~1200, twice of what you have now.

...

Jansz,

I respect your feedback and you have given some of your time to a lot of members on this board. I understand that it may come off as if I am contradicting myself, but this is my thought process. If my bioavailable test was slightly below range prior to all the androgel protocols made by my primary Dr. (off and on for 1 plus years) and now we see even lower values in basically every testosterone category...It leads me to believe that she misdiagnosed me and possibly even hindered my own natural production. What could have been done differently to raise those levels? Everything else was in range before, how could it all go to crap 1 plus years later?

If I am in worse shape then when I first started, what is Dr. Crisler's theory behind putting me on T shots? Wouldn't that just mess up my natural production even further? What other protocols could I bring up to him as possible solutions? What other questions should I pose to him? Maybe I am in denial, but I refuse to give up hope and rely on a synthetic product for the rest of my life. Hope in reversing this trend is all I have right now. Thanks again.

-J

[JanSz]

Jansz,

I respect your feedback and you have given some of your time to a lot of members on this board. I understand that it may come off as if I am contradicting myself, but this is my thought process. If my bioavailable test was slightly below range prior to all the androgel protocols made by my primary Dr. (off and on for 1 plus years) and now we see even lower values in basically every testosterone category...It leads me to believe that she misdiagnosed me and possibly even hindered my own natural production. What could have been done differently to raise those levels? Everything else was in range before, how could it all go to crap 1 plus years later?

If I am in worse shape then when I first started, what is Dr. Crisler's theory behind putting me on T shots? Wouldn't that just mess up my natural production even further? What other protocols could I bring up to him as possible solutions? What other questions should I pose to him? Maybe I am in denial, but I refuse to give up hope and rely on a synthetic product for the rest of my life. Hope in reversing this trend is all I have right now. Thanks again.

-J

I am not sitting in dr John's head,
I assume that dr John looked at you, like on any other guy who comes to him,
and is making effort to help you.

He is a very good doctor but he is not miracle maker.

If you listen to dr John advice you will get better.
But to stay in that improved state you will have to do something continously for as long as you want to stay in that improved state.

Once you stop, you will revert to your initial condition or worse.
Most likely it will be worse than initial condition.

Time passes, you are older.
Testicless are stressed (lack of HCG), now will produce less, etc.

Your best chance to get back to the best natural state is;
stop everything, wait 2-3 years for the body to get back to its natural balance, and you have to accept whatever that is .
============================== =============

TRT is not like curing broken leg.

Once the bones grows back you are ok, no more attention need.
With TRT you have to tend to it all the time.

============================== ============

You could try to improve your situation by tending to adrenals and thyroid,
but it is also something that you would have to tend to indefinitely.
So better give up on that too,

Usually all that mean that, at this time, you not ready to make required effort,
possibly you will give it another try latter.


...

[JoshNyce]

I am not sitting in dr John's head,
I assume that dr John looked at you, like on any other guy who comes to him,
and is making effort to help you.

He is a very good doctor but he is not miracle maker.

If you listen to dr John advice you will get better.
But to stay in that improved state you will have to do something continously for as long as you want to stay in that improved state.

Once you stop, you will revert to your initial condition or worse.
Most likely it will be worse than initial condition.

Time passes, you are older.
Testicless are stressed (lack of HCG), now will produce less, etc.

Your best chance to get back to the best natural state is;
stop everything, wait 2-3 years for the body to get back to its natural balance, and you have to accept whatever that is .
============================== =============

TRT is not like curing broken leg.

Once the bones grows back you are ok, no more attention need.
With TRT you have to tend to it all the time.

============================== ============

You could try to improve your situation by tending to adrenals and thyroid,
but it is also something that you would have to tend to indefinitely.
So better give up on that too,

Usually all that mean that, at this time, you not ready to make required effort,
possibly you will give it another try latter.


...

Hey Jansz,

Dr. Crisler actually hasn't seen me in person. I have just brought him in as a consultant. Unfortunately, thus far I do not feel like he is doing a good enough job for me. Do you know of any good endo's in the Dallas area?

[CROWLER]

2) clean the cell matrix get the crap out support enzyatic pathways.

How do you do this?

[pmgamer18]

Here is my take on this first your Dr. should not have put you on Androgel with the Total T levels you had. I say this because Androgel if your lucky will only get you up to about 400 on 5 grams some men only see a TT level of 500 on 10 grams of gel. Here is what happens your brain sees the added T in your blood and stops sending the LH and FSH message from your Pituitary to your testis so they slow down making T and all your left with is what the gel is doing so in your case you end up lower.

Now I hate to tell you this but most men that go on TRT and did not need it are on it for life it shuts down your HPTA much like men going on Steroids but they cycle it on and off to keep there Testis working. Your Dr. put you on this Gel and you were shut down to long.

Now for why Dr. John put you on shots he is trying to get your levels up into the upper 1/3 of your labs range doing this will get you tuned up to were you were before you felt sick and went on the gel.

We can talk about what was done wrong all day but this is not going to get you feeling 100% again. You have Adrenal Fatigue and until you fix this if it can be fixed I help a lot of people with this problem and even did a FAQ's about it full of info and dosing evern stress dosing. You can find it in this link.
http://livingnetwork.co.za/hormones/adrenal-fatigue/

I have found a lot of people have been down with AF so long they end up on HC for life. I am Hypopituitary and I am on HC for life my Pituitary does not tell my Adrenals to make enough Cortisol. You can read my story here at this link and my Heart update.
http://forums.realthyroidhelp.com/vi...php?f=5&t=9239

Dr. John saved my life I would not be here posting to you if it were not for him and I never seen him he helped me on the Forums at MESO when he ran the men's health forum there.

Now your libido is not up because your on TRT and have AF your Estradiol levels will go up on this and you need to test this on your next set of labs Dr. John will do this anyway.

If your high he will give you arimidex to get it down and your libido will come back in time. I had some bad ED problems do to High Estradiol levels and getting them down fixed this problem.

As you get your adrenals supported talk to Dr. John about try to jump start your body to make your own T he is the best at this and it is worth a try. I know a few men that were on TRT that did not need it and he got them started again.

First you need to look deep into why your stressing your adrenals fix your life style so they get bettter then try a jump start.

[JoshNyce]

Thanks PMGamer,

The last thing I want to do is to rely on testosterone shots for the rest of my life. Especially since I am in my mid twenties. Do you think he should have suggested a restart protocol first prior to supplementing with a these test shots? I know he's the 'expert', but why try external testosterone again prior to starting up my own T first?

[ItsHectic]

Here is what happens your brain sees the added T in your blood and stops sending the LH and FSH message from your Pituitary to your testis so they slow down making T and all your left with is what the gel is doing so in your case you end up lower.

I just want to point out that this is not definite.

After 3 years on testogel my FSH and LH are a little lower than before treatment and my TT level is just a little bit higher, about a year ago my TT level was much higher and my FSH and LH were much lower.

[The Matrix]

Thanks PMGamer,

The last thing I want to do is to rely on testosterone shots for the rest of my life. Especially since I am in my mid twenties. Do you think he should have suggested a restart protocol first prior to supplementing with a these test shots? I know he's the 'expert', but why try external testosterone again prior to starting up my own T first?

If i were you this is what I would do.
Since i consult with Dr O in your case as many other's one should not questions the good dr's judgements.

Here is what I would have done
1) rule out primary secondary (clomid challenge)
2) look at lifestyle, nutritoin, hidden stressors, food allergies, gut dysbiosis (finding alot more candida in males), sleep patterns, heavy metals
3) Look at your thyroid and adrenals indeptly -20 mgs of cortef is not going to hurt any one ...Studys done with given 10 mgs before giving a speech made a person more energetic and confident.

Being in texas your vitamin D levels is in the crapper as every texan that has came up to see us has been ..Chalk up florida too.

Go slow and see if you respond to clomid then treat thyroid/adrenals and back fill with all the necessary building blocks to make hormones so when you stop the clomid you have a strong foundation to come off so you have a greater chance of success.

i just have a different approach which has worked great in the past.

[JoshNyce]

If i were you this is what I would do.
Since i consult with Dr O in your case as many other's one should not questions the good dr's judgements.

Here is what I would have done
1) rule out primary secondary (clomid challenge)
2) look at lifestyle, nutritoin, hidden stressors, food allergies, gut dysbiosis (finding alot more candida in males), sleep patterns, heavy metals
3) Look at your thyroid and adrenals indeptly -20 mgs of cortef is not going to hurt any one ...Studys done with given 10 mgs before giving a speech made a person more energetic and confident.

Being in texas your vitamin D levels is in the crapper as every texan that has came up to see us has been ..Chalk up florida too.

Go slow and see if you respond to clomid then treat thyroid/adrenals and back fill with all the necessary building blocks to make hormones so when you stop the clomid you have a strong foundation to come off so you have a greater chance of success.

i just have a different approach which has worked great in the past.

Thanks Matrix, I will suggest the clomid approach to him. Would I continue to use hcg as well since I still want to try to get the "boys" back to proper size and function? How much clomid/what would the dosage be from your experience? Would clomid be the only substance used? Currently, I am using Hydrocortisone, would Cortef work the same way or be better than the HC? Thanks for the help. I appreciate it.