My First Self Injection

kincaiddave

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I'm on my fourth Doc and
it looks like he is going to work out great.

I started with him in August and when I tested at 319 total T, I was
put on AndroGel at 5g. Took a while on emails between me and the
nurse practitioner to get them to go ahead and give me a lab order
for a follow up test. They wanted me to go 8 weeks on the gel
before testing. I did get tested at 5 weeks and my total T was
161. They then put me on 10g. Two weeks later (there's progress -
I didn't have to wait too long) I tested at 331.

I scheduled an appointment to discuss what to do, since the gel was
obviously not doing the trick. I should mention that I have gained
about five pounds since the start of the gel. I am sure it is all
fluids from elevated E2. Please correct me if I am wrong there.
There is no significant change in my diet or activity/exercise.

I met the doctor (an urologist) for the first time yesterday. First
appointment and emails have been with the nurse practitioner. He
discussed different methods of TRT and then said that he would like
to try me on shots. He made some points with me with that
suggestion.

He said we need to see how I react to shots and said we would start
with 200mg every two weeks (he lost some points). I asked about
100mg every week and he immediately said that would be OK (he made
the points back and then some).

He said we can give you the first shot today and then I can come
back. I said I hoped to try self injecting. He said sure - more
points.

I asked about HCG in addition to the shots and he said that the
evidence is not there to support the benefits (lost a bunch of
points) and that he wouldn't feel comfortable monitoring me on HCG
and would need help from an endo. I said that I was glad to hear
that he would want help and presented him with print outs of
the "Recipe" and the HCG update from Dr. Crisler and asked if he
would mind working with Dr. John on my case. He said sure. He
earned major points there. He asked to keep the print outs and said
he would contact Dr. John. I hope he has already contacted you Dr. John.
I asked about E2 management on Arimidex and he said no problem (more
points). He said we need to wait for the follow up in five weeks to
see where my E2 is. I wasn't sure about that part. Should I do
anything about E2 between now and the five week follow up? I don't
like the weight gain to date and expect my E2 to go up worse on the
shots and am dreading the negative aspects of that. Any suggestions?

I mentioned that I was concerned about my AM cortisol level of 9.9
(range 8.7 - 22.4). I said that I had ordered some Isocort and was
he OK with that. He said no problem, but didn't offer any other
help on the cortisol. Maybe I should expect that cortisol and
thyroid are a little out of the area of an urologists' expertise. Phil said I
should wait on Dr. Johns' advice on the cortisol and hold off on the Isocort.
I'm going to take his advice.

The nurse went over self injection and handed me a 20g 1 1/2"
needle. That's what was on the script too. I asked about 27g and
she made a face. I said that others were successful by warming the
test up and being patient for the test to flow. She changed the
script - more points. She did not mention aspirating - lost some
points.

When I got my prescription today, they actually gave me 25g, 1 1/2" needles.
I stuck it in about 1". I found that my being nervous about the self injection was unfounded.
Next time won't be so bad psychologically.

When should I feel the first effects?

Should I do anything about E2 for the next five weeks other than 50mg of Zinc twice daily?

Thanks for anyones suggestions/observations and I am really hoping to hear from you Dr. John.
 

pmgamer18

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I'm on my fourth Doc and
it looks like he is going to work out great.

I started with him in August and when I tested at 319 total T, I was
put on AndroGel at 5g. Took a while on emails between me and the
nurse practitioner to get them to go ahead and give me a lab order
for a follow up test. They wanted me to go 8 weeks on the gel
before testing. I did get tested at 5 weeks and my total T was
161. They then put me on 10g. Two weeks later (there's progress -
I didn't have to wait too long) I tested at 331.

I scheduled an appointment to discuss what to do, since the gel was
obviously not doing the trick. I should mention that I have gained
about five pounds since the start of the gel. I am sure it is all
fluids from elevated E2. Please correct me if I am wrong there.
There is no significant change in my diet or activity/exercise.

I met the doctor (an urologist) for the first time yesterday. First
appointment and emails have been with the nurse practitioner. He
discussed different methods of TRT and then said that he would like
to try me on shots. He made some points with me with that
suggestion.

He said we need to see how I react to shots and said we would start
with 200mg every two weeks (he lost some points). I asked about
100mg every week and he immediately said that would be OK (he made
the points back and then some).

He said we can give you the first shot today and then I can come
back. I said I hoped to try self injecting. He said sure - more
points.

I asked about HCG in addition to the shots and he said that the
evidence is not there to support the benefits (lost a bunch of
points) and that he wouldn't feel comfortable monitoring me on HCG
and would need help from an endo. I said that I was glad to hear
that he would want help and presented him with print outs of
the "Recipe" and the HCG update from Dr. Crisler and asked if he
would mind working with Dr. John on my case. He said sure. He
earned major points there. He asked to keep the print outs and said
he would contact Dr. John. I hope he has already contacted you Dr. John.
I asked about E2 management on Arimidex and he said no problem (more
points). He said we need to wait for the follow up in five weeks to
see where my E2 is. I wasn't sure about that part. Should I do
anything about E2 between now and the five week follow up? I don't
like the weight gain to date and expect my E2 to go up worse on the
shots and am dreading the negative aspects of that. Any suggestions?

I mentioned that I was concerned about my AM cortisol level of 9.9
(range 8.7 - 22.4). I said that I had ordered some Isocort and was
he OK with that. He said no problem, but didn't offer any other
help on the cortisol. Maybe I should expect that cortisol and
thyroid are a little out of the area of an urologists' expertise. Phil said I
should wait on Dr. Johns' advice on the cortisol and hold off on the Isocort.
I'm going to take his advice.

The nurse went over self injection and handed me a 20g 1 1/2"
needle. That's what was on the script too. I asked about 27g and
she made a face. I said that others were successful by warming the
test up and being patient for the test to flow. She changed the
script - more points. She did not mention aspirating - lost some
points.

When I got my prescription today, they actually gave me 25g, 1 1/2" needles.
I stuck it in about 1". I found that my being nervous about the self injection was unfounded.
Next time won't be so bad psychologically.

When should I feel the first effects?

Should I do anything about E2 for the next five weeks other than 50mg of Zinc twice daily?

Thanks for anyones suggestions/observations and I am really hoping to hear from you Dr. John.
Don't do this much Zinc for more then 4 weeks when you first started on it and be sure to add 2mgs. of Copper to each 50 mgs of Zinc. Zinc lowers your Copper.
Solaray Zinc & Copper 100 capsules, Solaray - Solaray Multiple Minerals 50% Off
Phil
 

1cc

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All my scheduling goes through Kim, my Executive Secretary. I never know who I am supposed to talk to until she puts the phone in my hand. LOL.
Do you do consults by phone or by e-mail?
 

Sendo

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I don't have much to add here except that I'm glad that you found a doctor who is trying to work with you.

It took me a while to even find a GP who I felt actually cared about my input on things. Now I hope to find some specialists like him as well.

Good luck on your progress.
 

1cc

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We remotely serve through local physicians in any way the local physician prefers.

Other than that, I have to personally see each patient. It is illegal--and unethical--AND bad medicine to not establish appropriate Dr./Pt relationship. Thta means personally seen by the physician, his/her PA or NP.

BTW, merely sending a nurse to your home to take vitals and Medical History in no way qualifies, and is illegal.
Are your follow-up consults with your patients that you have physically personally seen for an initial consult, done by e-mail or by phone?
 

kincaiddave

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We have not heard from him yet.
I emailed the nurse practitioner and asked if Dr. Dixon had tried to contact you yet. She replied that she couldn't find anything in my chart indicating that he had tried to contact you yet and that Dr. Dixon would be out of town until next Wednesday.

Should I be taking any supplements (DHEA, pregnenolone....) I took Phil's advice and backed off to 50mg of Zinc once a day. Although Phil said wait on the Isocort for your advice, I went ahead and started it last week (sorry Phil).

I have been feeling a bit better and the weight gain (about five pounds) from the AndroGel treatment has gone. Back down to 213 (6' - no clothes). Energy level has been a little better, but libido about the same. Makes me think that 100mg/week is inadequate for me.

I have been surprised that I don't feel much different throughout the week. I expected to feel the peak and valley.

If Dr. Dixon doesn't contact you in a week or so, I will give him a call. I guess there's no rush since this is just the start of week two of the injections.

Thanks Dr. John and the others that have posted!
 

kincaiddave

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Well right or wrong, I quit cold turkey on some medications three days ago. I quit taking the Welbutrin XL (150mg ED), Lisinop for blood pressure with a mild diuretic (10-12.5 WAT whatever that means), and Zetia for cholesterol (10mg ED). I haven't noticed any feelings of depression, my blood pressure was 129/69 with a pulse of 59 this morning, but naturally I don't know what is happening with my cholesterol levels. My weight has shot up to 219. I assume that is fluids from discontinuing the Lisinop.

The thing that I feel least comfortable about quiting is the Zetia. My thoughts are to stop it for now and wait for my next bloodwork in about three weeks. I will see if the increased testosterone from the injections and other lifestyle changes will be enough to control the cholesterol without the expensive Zetia.

I have been back on the weights and my alcohol consumption has been greatly reduced for almost a year.

Any comments on stopping the meds?

Thanks as always!
 
ECTOmorph

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wat were all your symptoms that lead you to think you needed hormones tested?

just the basic ones?
 

kincaiddave

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wat were all your symptoms that lead you to think you needed hormones tested?

just the basic ones?
Libido like most everyone else I guess. My energy levels aren't what they used to be and they never were the best. My drive and confidence in myself aren't at all what they used to be. My wife and I don't have kids after years of unprotected sex. I was 147 pounds at six feet tall when I graduated high school. Started body building (no steroids) somewhat fanatically my senior year of high school and made very slow gains over the years while others around me grew muscle much faster.

I'm an electrical engineer, a licensed pilot, I built my own two seat 200 MPH airplane, I designed and built my own pedal powered hydrofoil craft, I started my own wireless internet service provider business, etc.

Now I do better than just get through the day for sure, but I've lost a lot. When I think of starting a project like building an airplane from plans (no kit) again or starting my own company - forget it.

My job now pays about 40% what my previous job paid and I don't have the confidence or drive to go out and get a higher stress, higher paying job now.

I am feeling a bit better these days and have hopes of getting back in the groove when my hormones are what they should be.

I was the one that came up with the idea of testing my testosterone level, not my doc. I am a firm believer that you have to take responsibility for your health and not just leave it in your docs hands. Even if they mean well they too often come up short.
 
glg

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I think stopping all your meds was not a great decision. you can definitely have some rebound effects when stopping meds abruptly. The anti-deppresant, BP and Chol meds usually are tapered off to some extent and done under supervision.

At the very least call your doc and say what/why you are doing it and get some professional feedback.
 

Jeff

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I was taking anitdepressant, Zoloft, for about a two years, I quit that stuff cold turkey. It really wrecked my libido and I put on about 25 pounds. I wonder how much that stuff affects testosterone levels and thyroid levels.

I don't really feel like I need the zoloft for depression anymore, having my thyroid functioning properly seems to help a great deal. My doc said something about t3 or t4 sparing your natural seretonin levels, or something blah blah blah - I didn't catch all of what he said, the nurse had such a huge rack I could hardly tell he was in the room :)
 

kincaiddave

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glg - I appreciate your comments and have consulted with another doc - my brother. He said that he didn't see any problems with abrupt cessation of the meds, but would check into it further. My blood pressure just now is 135/76 and pulse of 58. I have felt no worse mentally, so I don't miss the Welbutrin XL so far. I wish there was a quick, cheap cholesterol tester similar to that for blood sugar. The Zetia cessation is still the only thing that bothers me at all, since I don't know my cholesterol level changes.

Jeff - The more I read about others with low testosterone, the more I hear about those that have been put on anti-depressants. It's just an easy thing for docs to write the script and say see you next time, pay on your way out. Makes me wonder how often it is ignorance and how often it is apathy that causes the doc to do so without finding that hormones need fixing first.
 

kincaiddave

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I mentioned above on my 10-26-06 post that I wished there was an at home test for cholesterol. I just found out that there is. Under twenty bucks for a two test kit.

I quit the Zetia on 10-22-06 and don't know if its effects are gone or if they are keeping my cholesterol down. Anyone know if my level would still be lower now after quitting the Zetia less than two weeks ago?

My test this morning came out at 194 - WHOOHOO! That contrasts with my pre-Zetia and pre-TRT level of over 300 about a year ago.
 

kincaiddave

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How do you do the test?
The test kit is by AccuTech out of Vista, CA. The name of the kit is CholesTrak - Acctech, Manufacturer Of Cholestrak Total Cholesterol Home Test..

You use the supplied finger pricking device and put a couple drops of blood in the designated area. Pull out a tab that activates the test and when the white dot turns green, take the reading. There is a strip that turns from white to blue. At the end of where it turns blue, you read the number and look that number up on the supplied chart.

What will they think of next?
 

kincaiddave

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I went for my appointment yesterday which was five weeks from the first 100mg/week injection. My doc had talked with Dr. John about my treatment. I asked about his impression of Dr. John and he said that he certainly knows his stuff. The only reservations he had about what Dr. John had recommended was the cost of the treatment. He didn't specify what was so costly about what they discussed. He said that we will just use most of what Dr. John recommended and not all. I said to please give me the option on everything, because I am willing to spend some money on feeling better and he agreed.

At my first appointment I brought up HCG and he was not up to speed on it. At this visit he brought it up and asked if I was ready. I said sure.

At the first visit, he wanted me to inject every two weeks and agreed when I said how about every week. This time I asked about going to every three days and he agreed.

That's two things that are definately changed after speaking with Dr. John - frequency of injection and HCG acceptance.

Blood was drawn and I asked to be sure that E2 would be checked and add cortisol (my one and only cortisol test was an am draw - 9.9 (8.7-22.4)), FT3, and FT4. He agreed to these. He is to call me Monday with the results.

I went ahead and injected 100mg test cyp Friday as usual. I am not sure of how to properly transition to T cyp every three days with HCG in between. I am guessing that the dosage change will be discussed Monday when I am given the blood test results and that my first every three day injection will start on Friday. Does that sound right?
 

pmgamer18

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Here is how we did it 100mg div. by 7 = 14.29 x 3 = 43mgs every 3 days. I do my HCG the 2 days in between doing 400 IU's. As for the HCG start low and test like 250 on the day before your next T shot. If usiing 200mgs./ml of T then the dose will be .22 mls.
Phil
I went for my appointment yesterday which was five weeks from the first 100mg/week injection. My doc had talked with Dr. John about my treatment. I asked about his impression of Dr. John and he said that he certainly knows his stuff. The only reservations he had about what Dr. John had recommended was the cost of the treatment. He didn't specify what was so costly about what they discussed. He said that we will just use most of what Dr. John recommended and not all. I said to please give me the option on everything, because I am willing to spend some money on feeling better and he agreed.

At my first appointment I brought up HCG and he was not up to speed on it. At this visit he brought it up and asked if I was ready. I said sure.

At the first visit, he wanted me to inject every two weeks and agreed when I said how about every week. This time I asked about going to every three days and he agreed.

That's two things that are definately changed after speaking with Dr. John - frequency of injection and HCG acceptance.

Blood was drawn and I asked to be sure that E2 would be checked and add cortisol (my one and only cortisol test was an am draw - 9.9 (8.7-22.4)), FT3, and FT4. He agreed to these. He is to call me Monday with the results.

I went ahead and injected 100mg test cyp Friday as usual. I am not sure of how to properly transition to T cyp every three days with HCG in between. I am guessing that the dosage change will be discussed Monday when I am given the blood test results and that my first every three day injection will start on Friday. Does that sound right?
 

kincaiddave

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I'd first like to say that I wish that I would not have mentioned my docs' reservation about Dr. John's protocol being a bit expensive. Especially since he didn't specify what he thought was expensive.

I got my test results back from last Friday's blood draw -

Total T 569 (241-827)
T3 Uptake 37 (22-35) I asked and he said this is the same as free T3.
T4 5.4 (4.5-12.5)
FT4 2.0 (1.4-3.8)
TSH 1.02 (0.4-5.5)

Cortisol and Estradiol were denied by the insurance company.:frustrate I said that I would have been happy to pay that out of pocket. He said OK next time which is in four weeks.

I said that I was hoping that the tests would show a "smoking gun" or two and that E2 was the one that I was most suspect of. He said that E2 is probably most likely significant in my current symptoms and agreed to a script for Arimidex.

I confessed that it would be weeks before I received it, but I had ordered some Cortef for my cortisol. He agreed to a script for it.

I am hoping that switching from the Isocort to Cortef will allow some of the over range FT3 to be utilized and help me to feel better. The only time I have been tested for cortisol was an AM draw that came back 9.9 (8.7-22.4). He agreed that low cortisol is likely why my FT3 is high.

I really have a lot to learn in the adrenal/thyroid area. Any suggestions or comments are welcome as always!
 

pmgamer18

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I am sitting here looking at my blood work and my Dr. ordered T3 uptake I added Free T3 and both are on my sheet and T3 Uptake is not Free T3.

When you make the switch to HC drop the Isocort and start at 15mgs. of HC 5 mgs. 3x's a day. Your test was low in the morning like mine so start in the morning.

As for Arimidex state a 1/4 of a one mg. pill every 3 days this stuff is dam strong and you don't even know if your low. To not go to low keep an eye on morning wood or if in the morning before you get up try to get it up if you can't after having morning wood your going to low stop taking it untill things come back then go back on it but do every 5 days.
Phil
I'd first like to say that I wish that I would not have mentioned my docs' reservation about Dr. John's protocol being a bit expensive. Especially since he didn't specify what he thought was expensive.

I got my test results back from last Friday's blood draw -

Total T 569 (241-827)
T3 Uptake 37 (22-35) I asked and he said this is the same as free T3.
T4 5.4 (4.5-12.5)
FT4 2.0 (1.4-3.8)
TSH 1.02 (0.4-5.5)

Cortisol and Estradiol were denied by the insurance company.:frustrate I said that I would have been happy to pay that out of pocket. He said OK next time which is in four weeks.

I said that I was hoping that the tests would show a "smoking gun" or two and that E2 was the one that I was most suspect of. He said that E2 is probably most likely significant in my current symptoms and agreed to a script for Arimidex.

I confessed that it would be weeks before I received it, but I had ordered some Cortef for my cortisol. He agreed to a script for it.

I am hoping that switching from the Isocort to Cortef will allow some of the over range FT3 to be utilized and help me to feel better. The only time I have been tested for cortisol was an AM draw that came back 9.9 (8.7-22.4). He agreed that low cortisol is likely why my FT3 is high.

I really have a lot to learn in the adrenal/thyroid area. Any suggestions or comments are welcome as always!
 

kincaiddave

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I posted at Stop The Thyroid Madness » Index Page and Val agrees with you Phil. I should have known from the 37. That's way over range for all the FT3 ranges that I have ever seen.

It's frustrating and as my wife is reminding me my doc is being open and going with most that I request and I just need to be patient - not one of my strong points.

I'll get in touch with the doc and request the E2, cortisol, and FT3 be tested again.

What does the Total T of 569 look like? Should I just ratio it for the change to every three days like Phil did above or should I change the dose? I'm thinking that I should stay with the same dose and use 43mg every three days with 250IU HCG the two days in between. Does that sound right?
 

pmgamer18

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Yes leave the dose at 43mgs every 3 days and if your E2 is high and you get it down this number will go up with Free T. I feel one needs there Thyroid and Estradiol leveled before messing with T does. I just went through this with my Dr. I wanted to up my Armour higher and he told me going up to fast can make T levels go down. I never heard of this but he is the Dr. If you do the shots every 3 days for 4 weeks then do the tests you want. The change to every 3 days can bring down your Estradiol levels.
Phil
I posted at Stop The Thyroid Madness » Index Page and Val agrees with you Phil. I should have known from the 37. That's way over range for all the FT3 ranges that I have ever seen.

It's frustrating and as my wife is reminding me my doc is being open and going with most that I request and I just need to be patient - not one of my strong points.

I'll get in touch with the doc and request the E2, cortisol, and FT3 be tested again.

What does the Total T of 569 look like? Should I just ratio it for the change to every three days like Phil did above or should I change the dose? I'm thinking that I should stay with the same dose and use 43mg every three days with 250IU HCG the two days in between. Does that sound right?
 

kincaiddave

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Thanks Phil. I think you are right about leaving it alone. I was also forgetting that if I get my E2 down my T should be better.

I sent an email to my doc last night asking about the dose - no reply yet.

I noticed that the needles they gave me are only 1/2" (27g). Is this long enough? I don't have that much fat on my thighs, but I am wondering if they aren't a bit short.
 

pmgamer18

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Thanks Phil. I think you are right about leaving it alone. I was also forgetting that if I get my E2 down my T should be better.

I sent an email to my doc last night asking about the dose - no reply yet.

I noticed that the needles they gave me are only 1/2" (27g). Is this long enough? I don't have that much fat on my thighs, but I am wondering if they aren't a bit short.
I use this size and my legs have very little fat I do the shot just off the top on the side and I stick it in all the way. If Dr. Shippen can do this subQ and have good levels we can do short needles and get the same.
Phil
 

kincaiddave

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I got my Arimidex today. I wasn't ready for the price. $98 for 10mg - is that normal? Is there a way to reduce/beat the price? Insurance didn't cover it naturally.

I started at .25mg today.

I requested Cortef to take the place of the Isocort and doc said OK, but he couldn't find it in the book he was looking in. He said he would investigate and call a script in for me today. The nurse called today and said that the doc said that I should just get Phosphatidylserine over the counter.

I posted on Stop The Thyroid Madness » Index Page and Val was shocked and responded that that is for lowering cortisol.

I beleive that my doc is trying to help and I appreciate him going along with most of what I request, but I think he is totally out of his area on adrenal/thyroid issues. This is evident from the wrong test for FT3 (lab did T3 uptake) and the change from cortef to wanting me to get the Phosphatidylserine.

Gonna try working in blood draw for tests on cortisol, FT3, and estradiol tomorrow.
 

smitty4

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I got my Arimidex today. I wasn't ready for the price. $98 for 10mg - is that normal? Is there a way to reduce/beat the price? Insurance didn't cover it naturally.

I started at .25mg today.

I requested Cortef to take the place of the Isocort and doc said OK, but he couldn't find it in the book he was looking in. He said he would investigate and call a script in for me today. The nurse called today and said that the doc said that I should just get Phosphatidylserine over the counter.

I posted on Stop The Thyroid Madness » Index Page and Val was shocked and responded that that is for lowering cortisol.

I beleive that my doc is trying to help and I appreciate him going along with most of what I request, but I think he is totally out of his area on adrenal/thyroid issues. This is evident from the wrong test for FT3 (lab did T3 uptake) and the change from cortef to wanting me to get the Phosphatidylserine.

Gonna try working in blood draw for tests on cortisol, FT3, and estradiol tomorrow.
Val is correct. Phosphatidylserine will lower your cortisol levels.
 

kincaiddave

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Could anyone recommend a compounder that might carry the Arimidex? I looked up Signature and they didn't have it listed on their site. I sent them an email this weekend and no reply yet.

I got a reply on my email to my doc about the Phosphatidylserine. He apologized for his brain fart (his words) and said that he would look into the proper dosing for the Cortef.
 

pmgamer18

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Could anyone recommend a compounder that might carry the Arimidex? I looked up Signature and they didn't have it listed on their site. I sent them an email this weekend and no reply yet.

I got a reply on my email to my doc about the Phosphatidylserine. He apologized for his brain fart (his words) and said that he would look into the proper dosing for the Cortef.
I have a post to a guy the just got some so when he gets back to me I will give you the info.
Phil
 

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