36, TT 274, ~400 2 years ago, started TRT 4 weeks ago
- 03-23-2011, 01:08 AM
36, TT 274, ~400 2 years ago, started TRT 4 weeks ago
I know there has probably been numerous threads posted like this... and I just found this forum tonight and have been reading voraciously. However, I figured it couldn't hurt to tell my story and see what people think. I'm not asking for everyone to answer all my questions... but I have just started my trip down the rabbit hole and have much to learn... so I'll learn while I communicate with folks. So much to read, so little time to second guess possibly bad decisions a month ago... *sigh*
My primary care physician says I have hypogonadism. He's probably right, but it is not a satisfying answer in and of itself. I want to know the hows & whys. I want to know if it is primary, secondary, what are my alternatives to TRT, etc.
Some history... I'm 36, no steroid history, been healthy, etc. I've seen mention of low cholesterol levels on here, so I'll throw that out... 2/2011 - HDL 34, LDL 84. 2/2010 HDL 23, LDL 83
Around December of '08 I was in a relationship where I had some very mild symptoms of erectile dysfunction. Basically, with a condom I had no problem getting there, but couldn't really sustain. So, I complained to my doc. He ordered a blood test to check for total testosterone. At that time, my testosterone level was around 370. Erections never really were like they used to be after that.
Fast forward to Oct 2010, and I was yet again in a relationship where there were some issues. Before entering into this relationship I had basically decided I was happy being single after the last train wreck and the amount of stress I was dealing with at work. So... I guess I thought my mind said I was happy being alone, but perhaps it was really my low drive due to below average testosterone for a 36 year old. Anyway, in Dec 2010, I again complained to my doctor about ED issues in this relationship. He scheduled another testosterone blood test in addition to the standard stuff... 2/2011 it came back TT 274. On the followup visit about 6 weeks ago, he informed me he thought I had hypogonadism. He recommended several options.
The options were: Testosterone cipionate (sp?) injections, the usual patches/creams, told me about a local compounding pharmacy, etc.
So, I started doing some reading. For the last two years I was extremely stressed at work, my memory was failing, was lethargic/fatigued all the time, etc. Mild cases of depression, and I think I would call a nervous breakdown around March of 09 due to stress at work. After reading that low testosterone could cause or make worse all of those things, I was eager to get started.... so on 2/18/2011 I went for my first injection. It was weekly for the next four weeks...
I freaking felt great! I felt I was on top of my game again... My memory, concentration, energy, focus, and enthusiasm about life was back again. Now I am 10 days into my last injection, and I can feel it wearing off again. Next injection due in two days. For a week after the injection, erections are like I'm 18 again... which is great. Morning wood, etc.
Now... after the amount of reading I have been doing, I am questioning whether I acted too fast. I am feeling like I am now trapped into this whether I like it or not... I like the return to normalcy, but feel trapped now.
My concerns are:
a) he didn't tell me about the sterility problem... I'm not in a relationship now, but that doesn't mean I won't want kids someday. Convenient not to tell me about the risks... How reversible is this? Is 60 days of TRT difficult to reverse? I think my boys are already shrinking away... which he didn't tell me about either.
b) Should we have done more testing before making a decision?
c) once I'm on this stuff, I hear it is VERY difficult to get off due to the testes/pituitary shutting down, possibly permanently.
If anyone has any insight on my three concerns above, I'd appreciate it. I know the information is here, and I am reading steadily, but it's a bit much to take in all at once...
The worst part is knowing that I need more than just food, water, and oxygen now to survive... I've always been a bit of a loner/survivalist type and it is difficult knowing that I am a vial of testosterone away from a thriving life.
Thanks all for any advice you can offer.
- 03-23-2011, 01:42 AM
First of all welcome :-).
Now onto the fun stuff. Tons of things can affect ur hypogondal axis. But I'm not one who really cares if its primary or secondary. Here is why I say that. Eventually most all of us are going to be candidates for TRT. So I say bring on the test lol.. Some will disagree but again I could care less.
I'm not a fan on injections for trt unless u can do them weekly with HCG alongside it. To me that is the best way to run test cyp for trt..
I personally prefer transdermals like androgel or testim. U apply the gel daily after a shower and keep ur test levels at the top of the normal range forever. Plus androgel is DHT based so it helps greatly with sexual dysfunction.
Low test is not the end of the world and not something I would get excited about if u have options for trt as u do.
Embrace having test levels of an 18-21 yr old for the rest of ur life. If u can't get weekly injections u may wish to look at something like the transdermals unless ur insurance doesn't cover very well. Then injections may be the better route. Strive to get HCG alongside ur test. Ur nutz will stay full and u should have less ups and Downs..
Hope this helps a little. I'm sure many more guys will chime in..
For what its worth. I'm an old school juicer who now is on trt using androgel daily at 10 grams and keeping overall test levels 900-1500. With my bioavailable and free above the top of the normal range. I feel better than ever at 36 hormonally that is.Originally Posted by Arnold Schwarzenegger
- 03-23-2011, 02:00 AM
i will only say if you need trt, which you prolly do so i wont go into life style etc to see if thats the cause, embrace it brother. do you want to go back to feeling like you did 6 weeks ago? you will feel much better doing more frequent injections. i inj 2x weekly others do weekly or every 5-6 days. you and your dr will get it nailed down in time so be patient. some people like the creams/gels as pump does above and others injections. i prefer inj. my t levels are similar to pumps and at 42 i feel freakin awesome
03-23-2011, 02:12 AM
Don't get me wrong... I felt great for the four weeks I was getting weekly injections. I'm not so worried about the lag right now, as I think my doctor would work with me on lower dosage but more frequent injections...
What bothers me is the thinking that I may have rushed into this, and the fact that there is no turning back. I'll talk to my primary and the urologist I am going to see in a couple weeks about the HCG. As many have seem to have mentioned before, I'm not sure they'll go for it, but I'll try.
Also, I failed to mention above, there is a fourth concern. He didn't seem too hot on the idea of me self injecting. If I'm going to be stuck on this forever, I don't want to have to schedule a doctor appointment in a far off town just because I want to take a 2 week road trip... Or drive the 90 minutes roundtrip to the doctor's office every week (I live in the sticks). I'm willing to go in and learn, and demonstrate ability to inject myself... but they didn't seem hot on the idea.
03-23-2011, 02:18 AM
i assume you are referring to your pcp. you may want to look into an endo or uro if they are unwilling to work with you.
if you feel you rushed into this then you probably did because its your mind that has to be made up. look if it makes you feel any better you can always come off with a proper pct especially since you have just started. so if you think you need to step back and do some more research have your dr give you a months worth of clomid and grab some other pct products and run a pct.
03-23-2011, 03:01 AM
Sorry.... not familiar with the abreviation... PCT?
yes, it's my PCP, primary care physician that started me on this path. You're right, I knew something was wrong... and when I correlated my last two years with the list of symptoms, I was eager to get my life back on track. But, I'm worried about things like sterility, etc. I've heard that it is pretty much permanent, and then I've heard about guys on here after years of HRT fathering... so I just don't know what to believe right now. I'm not stopping immediately... I will continue through the next 7 weeks or so, then more blood work. I'm just stressed about learning as much as I can as quick as I can so that I feel comfortable that I am doing the right thing... down the rabbit hole I go!
Anyway, I have an appointment with a urologist in a couple weeks, and then a endo in May. With all the bad reports of experiences with doctors on here though, I think it will be a long search to find the right one.
03-23-2011, 03:05 AM
Nevermind... just googled around for PCT - Post Cycle Therapy.
Thanks for the advice. I may think about it. Wish my primary would have told me about the sterility side of things... I mean, a 36 year old with no kids? Did he not think that may be a consideration?
03-23-2011, 03:24 AM
good luck with whatever you decide to do. but honestly i wouldnt get too stressed about it.
although if you feel that you are likely to come off id get some hcg in the mix. in the mean time relax and enjoy feeling young again
03-23-2011, 06:21 AM
I would try to isolate the cause to as to why your levels are low them seeing if fixing the root cause of the problem would correct your symptoms. Many guys venture into trt will out looking at the simple things first. If imbalances are found and corrected then levels can increase with in a month or so. So many guys are on trt and have either new symptoms or original ones never resolved. As I tell patients some time taking the short path ends up being the longest one. Again there are several variables to deal with and long case history would be needed to even know where to begin. Moral is to many guys jump the gun and end up on trt thinking it's testoerone is the root cauE but in the end they shot them self in the foot
04-13-2011, 10:33 PM
Well, saw a urologist who claims to have ~500 patients in the area on TRT. I wasn't too impressed with him, but I did find some useful information from him and some directions to go... I told him I was simply fact finding now... and would continue to see my primary doc for TRT while I learn.
My primary doc had laid out this plan:
200mg/wk for 4 weeks
200mg every other week for 8 weeks
Then... get this... 200mg/month then on.
The urologist rightly said that was crazy, and he thought too low a dosage. So, I had him send his recommendations to my primary doc. Had an appt with my primary today, and was very pleased on leaving. He is no expert on this, which he readily admitted, and I seem to have information he wasn't aware of... however, he is very open to reading journal papers, etc. that I bring to him and is receptive to getting consults from other docs that I consult. For right now, I think having a primary doc who is intrigued by the information I present to him is half the battle. When you're fighting to get more than a 15 minute meeting with your doc, and he is actually interested and spends 45 minutes while people are waiting, that is to me a good sign even if he is not an expert. I have piqued his interest in this and I think he's onboard with anything relevant I bring him. In the meantime, I need to find someone in the area who is an expert... gonna be tough to get good info though.
So, here is the 8 wk plan...
150/wk test cyp injections, with a semen analysis in the meantime.
When I insisted on lab work last week, I asked them to test testosterone levels and estrodiol. My numbers came in at 204 (at the end of a 200mg 2 week cycle) and estrodiol was around 25. I didn't write down the exact number. With test this low, should estradiol be in that range?
Anyway... it's a short term plan. Also the urologist suggested getting off test cyp after 3-6 months and see what happens. He said he's had some rebound and stay off for up to 4 years. This is the first i've heard of this... and he warned me that I would crash and burn for a while, but especially with the sterility concern he said probably closer to the 3 month mark...
So, my questions are I guess:
1) Is anyone surprised that my test level was 204 after a 2 wk 200 mg shot?
2) Would anyone be concerned about that estradiol level with a test level of 204?
3) Has anyone else heard of this strategy to quit TRT to see if there is a rebound effect? He said there is a possibility of clomid during the withdraw, and also he has people take DHEA during.
4) I think my primary doc will be open to clomid also when test is withdrawn. What do folks think about this? Is my thinking correct that this should be tried when test is withdrawn?
So much to learn...
04-13-2011, 10:45 PM
Also, has anyone here discussed the effect of low zinc on testosterone and sperm production? I have a reference study if it hasn't been discussed here before. Sorry, it's all I can do to read what I have. I'll search in a bit...
Anyone try taking zinc? Did it improve things?
04-13-2011, 10:46 PM
And another question... I read that flax seed can have a lowering effect on estrodiol. Anyone else look into that?
04-14-2011, 05:20 AM
dude you need a new dr.
as for the test levels. when you say 200mg for 2 weeks do you mean 200 each week or 200 on one inj then tested 14 days later. that would make a huge difference. generally speaking a 200mg inj should spike blood levels to ~1800ng the following day and fall from there
04-14-2011, 06:34 AM
04-14-2011, 07:16 AM
04-14-2011, 07:26 AM
100 mg per week dude, can you inject yourself? just split the injects
200 mg and then a measurement at the end of 2 weeks may give a level of 200 yes, that's when it has worn out
estradiol 25 may be what you had at the time of the t level measurement of 200? you need to retest after 4 weeks on 100 mg per week and test on thursday morning if you take shot on monday, and do e2 with it
zinc is good but not strong enough for TRT, but helps with immune system and sperm production
flax seed forget it
indolplex dim is a good option for lowering e2, start with 100 mg a week and take 2 indolplex dim tabs a day and see how you improve
adrenals: cortisol 4x saliva and if possible 24 hours urine test
additional: shbg, free/bio available t, vitamin d, iodine
vitamins: you probably lacking, get dr schulze's superfood plus or energy revitalization system from enzymatic therapy
good luck dude
04-14-2011, 03:33 PM
Originally Posted by ambulldog
I mean 200 injection... then 14 days later blood was drawn. I was getting 200 every two weeks and it wasn't cutting it. I hear a lot of guys are happy with 150/wk which is the current plan.
04-14-2011, 03:37 PM
yes... estradiol was taken at the same time as the results for test which came in at 204.
Thanks for the other suggestions. Anyone have a recommendation on how to find a good doc? Doesn't seem to be any around me... I'm willing to drive/fly and pay.
04-14-2011, 04:04 PM
none would you let you self inject? That would seemingly pretty inconvenient to try and make a bi weekly doctors appt for the rest of your life. Was he responsive in a weekly dosage protocol?
I only ask because I'm talking to my doc atm, and he thinks once a week is the most anyone should inject, never mulitple injects a week. But I don't want to schedule a dr appt every week for the rest of my life, I'd like it to be something I can do on my own.
04-14-2011, 04:26 PM
Im on 200mg every 2 weeks and its hell! Have apointment next month and if he wont change it im gonna quit and tell him thanks for nothing. Week 2 is sleepy, no energy, no libido etc. I would rather feel like sh*t all the time then feel good one week and crap the next.
04-14-2011, 04:50 PM
Just out of curiosity since we are both in MI, which docs have you had no success with? And any that you HAVE had success with?
edit: While I'm at it, I know every good TRT article recommends mutliple injects a week, but does anyone have a good and legit looking article that focuses primarily on the need and benefits of multiple injects a week and why higher doses over longer periods of time does not work nearly as well? I'd love to be able to show it to my doc next time.
04-14-2011, 06:06 PM
I have no articles and I have had no good experiences with any endos but my primary doc was rather helpful. I was on androgel for quite a few months 10g a day and felt awsome but once i suggested injections because of $ issues he set me up with an endo and it was all down hill from there. I just dont see why I should keep dumping $ into something that doesnt work (at the dosage he perscribed me). Its like paying for medicine that doesnt work...why keep taking it? None of my symptoms have subsided in the past year so its pointless in my eyes. Wish you the best of luck man.
04-17-2011, 12:46 AM
I did however leave my doc with a copy of a study on Sub-Q injections. We'll see what he thinks of that. The reason they are worried about self injection is of course that it is IM and there are nerves, etc. that one can hit (sciatic, etc.) that can cause real problems.
The urologist said simply, once you leave my office I don't care what you do... but we have to train someone to do the injections.
04-17-2011, 12:47 AM
04-17-2011, 01:57 PM
04-17-2011, 02:00 PM
08-02-2011, 11:35 PM
Well folks, been a while since I updated this post. This "rabbit hole" sure is a deep one, don't know if I'll find the exit. But anyway, I have an endo appointment coming up end of this month and I have been off of testosterone for ~7 weeks. My primary doc and I decided to do lab work at 2, 4 and 6 weeks off testosterone so we could see what the old H-P-T axis was going to do in response.
So, here's a bunch of numbers, miscellaneous stuff first. I'll get to the rest after. Aything out of range marked red, though nothing looked too far out...
Lyme panel (just a suspicion on my part, so doc tested):
burgdoft Ab: < or = 0.90
burgdorf IgG: Negative
burgdorf IgM: Negative
When endo mentioned hemachromatosis, we tested for that.
TIBC: 326 (ref 255-400)
Ferritin: 160 (24-336)
Transferrin: 233.1 (180-329)
Liver stuff just in case of hemacromatosis:
Bili total: 1.1 (.4-2.0)
Bili direct: 0.1 (0-0.4)
Bili Indirect: 1.0 (0.0-1.1)
Alk Phos: 57 (28-116)
AST/SGOT: 20 (12-40)
ALT/SGPT: 19 (5-56)
Protein tot: 6.5 (6.1-7.9)
Albumin level: 4.2 (3.5-4.8)
Iron: 90 (45.0-182)
WBC 4.5 (4.8-10.8)
RBC 4.64 (4.7-6.1)
Hgb 14.8 (14-18)
Hct 43 (42-52)
MCV 93 (80-94)
MCH 32 (27-31)
MCHC 34 (33-37)
RDW 13 (11.5-14.5)
Platelet 253 (130-400)
MPV 7.9 (7.4-10.4)
Lymphs 41.6 (21-50)
abs Lymphs 1.9 (1.2-3.4)
Segs 41.5 (36-66)
Abs Segs 1.8 (1.4-6.5)
Monocytes 11.5 (2-10)
Abs monocytes .5 (0.1-1.0)
Eosinophils 4.8 (0-10)
Abs Eosinophils .2 (0-0.7)
Basophils 0.6 (0-1)
Abs Basophils 0 (0-0.2)
Way back in Feb....
Sodium 142 (136-144)
Potassium 4.4 (3.6-5.1)
Chloride 105 (101-111)
CO2 31 (22-32)
AGAP 6 (7-16)
Glucose 89 (65-99)
BUN 8 (8-20)
Creatinine 0.82 (0.9-1.3)
Calcium 9.8 (8.9-10.3)
Cholesterol 137 (0-199)
HDL 34 (27-67)
LDL 84 (0-109)
Triglyceride 95 (0-199)
TSH .98 (.34-5.6)
Testosterone total 274 (175-781)
Now... for the numbers during and off treatment...
14 days into a 200 IM inj of test cyp....
Testosterone total: 209
Then... dosing changed after a while to 150/wk as I mentioned earlier in the thread.
5 days into a 150 IM inj of test cyp
Estradiol: 46 (20-47) - getting a little high here
Prolactin: 7.87 (2.64-13.13)
Hgb: 15.6 (14-18)
As we would expect... LH and FSH completely suppressed by exogenous testosterone. Also, a bit of aromatization going on.
Then, we withdrew testosterone completely. At two weeks, crash & burn:
Test total: 192
Then, 4 weeks, no exogenous testosterone:
FSH: 4.26 (1.3-19.3)
LH: 3.1 (1.5-9.3)
Test total: 244
Then, 6 weeks, no exogenous testosterone:
Test total: 214.28
Anyone have any words of wisdom? Does this look like primary or secondary to folks? Or both? Or idiopathic? I know there is some margin of error in these labs, but the decline from 4-6 weeks concerns me. It also concerns me that I am now worse off than when I started down this road in February. Could it be testicular atrophy? Or is it the Hypo/Pituitary not kicking in as much as it should during the withdraw because of whatever reason?
Anyway, I am leaning toward guessing that it is a secondary cause due to the FSH and LH levels being well in the bottom end of the range even with testosterone levels low. I would expect to see the FSH and LH ramp way up if the testicles weren't doing their job... I've seen studies where the FSH/LH levels are well into the teens of mIU/ml when the cause is primary.
What say you folks?
In the meantime, while I'm off, I'm going to have a semen analysis done at the three month mark, and probably start back on *something* after that... whether it be TRT, clomid, HCG, or some combination. I feel like sh*t right now. No energy, losing weight, can't think, low libido, but at least the ED isn't too bad.
Any advice is appreciated. I figure I have Lymes and Hemacromatosis ruled out... and like I say, leaning toward secondary.
08-03-2011, 08:25 AM
I see that there is a deviation in your WBC being low which may be from over training or some type of low grade chronic infections. Why not find out the reason why you are having these issue? Many dr's are just too lazy to look at the potential root cause. I have gotten a lot of guys restart in the past by just taking the time to look deeper into your issues at areas drs never even bothered to look. If you are interested in getting down to the root cause of the issue please feel free to contact me. In order to know where to even start I need much more information. This is about 5%. I need the other 95% of the equation.
09-14-2011, 09:43 AM
Another point of data... I provide this just so that there are more data points in the forum for folks to read & compare to.
Sep 7th, more lab work.
Free testosterone: 79.9
Total Testosterone: 329
Since I've never had my free testosterone checked before, I'm not sure how high/low that number looks. I was given the results over the phone with no units, so I am assuming FT is in pg/mL.
Now time to go and do more research.
11-05-2011, 12:45 AM
Just another point of data for folks who may happen to be reading this, and dealing with their own issues and looking for their own explanations.
Had an MRI Wednesday. Got the call this afternoon... 4x4x3 mm adenoma. Provides a bit of explanation for my symptoms. Hasn't really sunk in yet...
11-05-2011, 06:03 AM
4. Environmental factor
5. Lifestyles patterns
6. Genetics - rare but it does happen since I am now have Dr's do more genetic testing at deeper levels for specific mutations which are starting to pop up more frequently. By identifying and correcting them through modulation of gene expression its reducing the person chances of getting diseases associated with these hidden factors which why had no idea where there.
You will find answer in one of those
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.
01-25-2012, 09:30 AM
Been a while since I posted here. Some new information concerning my case for those that may be interested. Still looking for a decent endocrinologist since mine decided to retire Dec 31st, but between me convincing my primary doc that we should try Clomid and his research, he finally decided to write the script off-label.
So, November 29th, I started taking 25 mg of clomid daily for about a week, then went to 25 mg every other day. I have been taking that dosage since then and have felt significantly better. It's a "different better" than when I was on Test Cypionate, but it's still better. Significantly less fatigue, much better psychological state of mind... it's more "level" than when I was on injections too. Went for my first labs last week since starting the clomid... and the result is:
Testosterone: 770 ng/dl
That's basically what I was at on injections. So, I can say for me it works. I'll get the full lab results tomorrow when I have a followup with my primary doc. We tested LH, FSH, liver, prolactin, testosterone, and I think that's it.
I feel like the fatigue issues should be a bit better, but I can say clomid has helped dramatically with my emotional/psychological state. Things aren't so dreary now.
Your mileage may vary.... not everyone will respond to clomid in my understanding... but so far for me it made some improvement for sure. And another thing... I didn't take it for a few days for a couple of reasons. One, I went out of town and forgot it. Two, I've heard recommendations that folks on clomid skip a 5 day period per month. So, for a few days I wasn't on it... and I crashed hard. Fatigue mostly, but I could tell I was off my dose.
Has anyone here been on clomid long term?
01-25-2012, 11:13 AM
Lower longer the better. When dealing wit Dr's I recommend they down to once every 3 days dosing with smallest amount. I have cases I worked on 12.5 mgs every 3 days pushes people in to 800-1000 TT ranges. I still many avenues which have not been explored. With low cholesterol of 137 that is a huge red flag for depression issues and fatigue as well as major GI and liver issues which need addressing. IMO you are still looking at hormones which in majority of cases I worked on are just an expression of the root cause. I feel HRT this situation will not solve the problem only complicate it at many levels. I see this time and time again Dr's treating the labs not the person.
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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