Dr. John Please Help! AAS Induced Issues...

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    Dr. John Please Help! AAS Induced Issues...


    I know this is somewhat longwinded but here goes….I am 29 years old, 185 lbs, 12%BF. I have done 4 steroid cycles in the past whereby the last one ending in 2004. Since that time my libido has been poor while suffering with ED periodically. I attribute this specifically to my 2nd cycle in 2002 which was a Deca cycle for 10 weeks. A proper HCG/Clomid PCt was done but still 8 weeks after my last shot my Total Test level was 50 ng/dl. Eventually though it returned to 500ng/dl. At this time though my libido was still not back to normal.

    I believe my current issues started with my next bonehead decision. I decided to hop back on a test cycle only 6 weeks later and thus I believe that my HPTA was never able to fully recover. Fast forward to 2004 when all cycles have ceased. From 2004 right up to recently I have had numerous blood tests done trying to pinpoint my issues. Through this time my total test hovered around 480-580 ng/dl. However, my Bio-Available test has been stuck at the bottom of the normal range (ranging from 2.8-6 nmol/l in a range of 6-22. E2 had been tested throughout this time as well and it has always been at healthy levels ranging from 50-140pmol/l (range is<200). SHBG levels have been consistent at around 45nmol/l range is 6-65.

    The one hormone that did stand out was prolactin. Mine tested out consistently high-normal around 19-20ug/l where the range is <21. At this time I believed for some reason the high normal reading of Prolactin was affecting my SHBG and hence affecting my low Bio-T output. I convinced my doc (who is an internist) to put me on Dostinex and interestingly enough, my Bio-T jumped from around 6 to 10 nmol/l in a range of 6-22. Libido improved somewhat but certainly not to where it was pre-Deca. I have been running the dostinex ever since with a “mediocre” libido. I should also mention that throughout 2004-2006 I ran 2 extra HCG/Nolva/Clomid Protocol in an attempt to "shock" system to produce more test. I have also had an MRI ruling out any pituitary issues (which I do not have). Aside from the bump in Bio-T achieved from the dostinex, once I was able to bump it up a few more notches running some Proviron. I was able to get 12.0nmol/l (range 6-22).

    My case seems quite unique as I do not have Primary Hypogonadism (total test is good) nor do I have Secondary (LH levels are also ok ranging from 2.0-4.8, range is <12). So basically my situation can be summed up in that somehow, somewhere, something is causing my body to increase SHBG absorption of my total test, leaving me with a low Bio-T. My albumin has also been tested and came back at 46 g/l (range is 35-50). The only other anomaly has been that my DHEAS has consistently tested low ranging from 1.7-3.1 umol/L (range is 2-16). Just for fun I did supplement with 100mg of DHEA and was able to get the level boosted to the mid range. However, this increase had no affect on my low Bio-Available test readings or on libido. Here in Canada they cannot test DHT. Unfortunately I have no blood testing pre-AAS pertaining to testosterone levels. It is possible that maybe I used to have a higher total test and my current “lower” total test is why my Bio-T is lower. I have been looking into possibly running another PCT this time using HCG in combination of HMG. However, I have yet to find a doc that has any experience and knowledge on this subject.

    At any rate I am at the point where if I cannot rectify my low libido/low Bio-T issue, I’d rather be on a proper HRT instead of taking dostinex for the rest of my life (which as mentioned above has a mediocre effect on libido). However, if there was something I could do to restore my HPTA to what it issued to be, I would certainly give it a try. If Dr. John or anyone else has some possible explanation of my situation and/or has any other useful advice to suggest I would be ever so grateful. Thanks in advance.

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    Neednewballs,

    My situation seems very similar to yours. I have taken several cycles including Deca and Tren. My SHBG is also on the high side and my Bioavail T is low, while having a decent total t level. However my e2 is low. Have you thought about going to see Dr. John. I searched the internet for months- hours on end- trying to find the answer. After finding him on this site and reading recommendations about him on some other sites, I knew it was the right choice. Don't waste your time/money seeing docs who don"t know what to do
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    EDITED BY DR. CRISLER: We're not here to offer free advertising. And I do not recommend ZRT Labs.
    Last edited by Dr. John; 04-15-2007 at 12:38 PM.
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    Quote Originally Posted by mckinnj View Post
    Neednewballs,

    My situation seems very similar to yours. I have taken several cycles including Deca and Tren. My SHBG is also on the high side and my Bioavail T is low, while having a decent total t level. However my e2 is low. Have you thought about going to see Dr. John. I searched the internet for months- hours on end- trying to find the answer. After finding him on this site and reading recommendations about him on some other sites, I knew it was the right choice. Don't waste your time/money seeing docs who don"t know what to do
    Thanks for the reply. So were you ever able to increase your Bio-T somehow? If so How? Or did you go the HRT route? I am fully informed on Dr. John's HRT recommendations and luckily my doc is willing to give me the required compounds and follow Dr. John's recommedend dosages (should I decide to go that route). Like yourself my E2 levels are decent. On one particular test it even came back quite low. However SHBG levels did not change much. It just seems like such a waste for me to go on HRT when I have a healthy total test level.
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    Mod edit: Please no linking to these types of logs/reviews.
    Last edited by Dr. John; 04-15-2007 at 12:39 PM. Reason: Dr. Crisler: Ya, what he said.
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    Perhaps you should continue this discussion in another forum and not on anti aging
    Last edited by Jayhawkk; 04-13-2007 at 08:01 AM.
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    THis forum is for the discussion of Anti-aging and not for directions of using Ph/AAS cycles. There are other sub forums for this purpose. Please help me in keeping Dr.D's forums clear of this. thank you.
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    Quote Originally Posted by Jayhawkk View Post
    THis forum is for the discussion of Anti-aging and not for directions of using Ph/anabolic steroids cycles. There are other sub forums for this purpose. Please help me in keeping Dr.D's forums clear of this. thank you.
    I am not asking for directions of anabolic cycles. I am asking for Dr. John's input whether or not my situation is resolvable or whether HRT is warranted.
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    Quote Originally Posted by Jayhawkk View Post
    THis forum is for the discussion of Anti-aging and not for directions of using Ph/anabolic steroids cycles. There are other sub forums for this purpose. Please help me in keeping Dr.D's forums clear of this. thank you.
    even if what i was saying might help the man jay?

    his situation mirrors the situation i was in perfectly.
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    I have no problem with you offering him help but when that offers help outside of TRT/HRT types of things that the Doc works with it needs to be done outside this forum. That way there's no chance of anyone trying to accuse him of just being a overpaid steroid pusher, so to speak. I hope you all understand.
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    Quote Originally Posted by Neednewballs View Post
    I know this is somewhat longwinded but here goes….I am 29 years old, 185 lbs, 12%BF. I have done 4 steroid cycles in the past whereby the last one ending in 2004. Since that time my libido has been poor while suffering with ED periodically. I attribute this specifically to my 2nd cycle in 2002 which was a Deca cycle for 10 weeks. A proper HCG/Clomid post cycle therapy was done but still 8 weeks after my last shot my Total Test level was 50 ng/dl. Eventually though it returned to 500ng/dl. At this time though my libido was still not back to normal.

    I believe my current issues started with my next bonehead decision. I decided to hop back on a test cycle only 6 weeks later and thus I believe that my HPTA was never able to fully recover. Fast forward to 2004 when all cycles have ceased. From 2004 right up to recently I have had numerous blood tests done trying to pinpoint my issues. Through this time my total test hovered around 480-580 ng/dl. However, my Bio-Available test has been stuck at the bottom of the normal range (ranging from 2.8-6 nmol/l in a range of 6-22. E2 had been tested throughout this time as well and it has always been at healthy levels ranging from 50-140pmol/l (range is<200). SHBG levels have been consistent at around 45nmol/l range is 6-65.

    The one hormone that did stand out was prolactin. Mine tested out consistently high-normal around 19-20ug/l where the range is <21. At this time I believed for some reason the high normal reading of Prolactin was affecting my SHBG and hence affecting my low Bio-T output. I convinced my doc (who is an internist) to put me on Dostinex and interestingly enough, my Bio-T jumped from around 6 to 10 nmol/l in a range of 6-22. Libido improved somewhat but certainly not to where it was pre-Deca. I have been running the dostinex ever since with a “mediocre” libido. I should also mention that throughout 2004-2006 I ran 2 extra HCG/Nolva/Clomid Protocol in an attempt to "shock" system to produce more test. I have also had an MRI ruling out any pituitary issues (which I do not have). Aside from the bump in Bio-T achieved from the dostinex, once I was able to bump it up a few more notches running some Proviron. I was able to get 12.0nmol/l (range 6-22).

    My case seems quite unique as I do not have Primary Hypogonadism (total test is good) nor do I have Secondary (LH levels are also ok ranging from 2.0-4.8, range is <12). So basically my situation can be summed up in that somehow, somewhere, something is causing my body to increase SHBG absorption of my total test, leaving me with a low Bio-T. My albumin has also been tested and came back at 46 g/l (range is 35-50). The only other anomaly has been that my DHEAS has consistently tested low ranging from 1.7-3.1 umol/L (range is 2-16). Just for fun I did supplement with 100mg of DHEA and was able to get the level boosted to the mid range. However, this increase had no affect on my low Bio-Available test readings or on libido. Here in Canada they cannot test DHT. Unfortunately I have no blood testing pre-anabolic steroids pertaining to testosterone levels. It is possible that maybe I used to have a higher total test and my current “lower” total test is why my Bio-T is lower. I have been looking into possibly running another post cycle therapy this time using HCG in combination of HMG. However, I have yet to find a doc that has any experience and knowledge on this subject.

    At any rate I am at the point where if I cannot rectify my low libido/low Bio-T issue, I’d rather be on a proper HRT instead of taking dostinex for the rest of my life (which as mentioned above has a mediocre effect on libido). However, if there was something I could do to restore my HPTA to what it issued to be, I would certainly give it a try. If Dr. John or anyone else has some possible explanation of my situation and/or has any other useful advice to suggest I would be ever so grateful. Thanks in advance.
    Keep Prolactin low, check thyroid, do FreeT3 and FreeT4.
    Print Friendly
    Prolactin
    This test is used to assess inappropriate lactation and is also useful in the detection of prolactin-secreting pituitary tumors. Elevated prolactin is associated with anovulation and amenorrhea. Prolactin can also be elevated in hypothyroidism when TSH is high. Some studies indicate that elevated prolactin may promote breast and prostate cancer growth.

    Reference Ranges:Men:
    2.1–17.7 ng/mL
    LE’s Optimal Range: 2.1–5 ng/mL
    ----------------------------------------------------------
    Last edited by Dr. John; 04-22-2007 at 04:19 PM.
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    Quote Originally Posted by Neednewballs View Post
    Thanks for the reply. So were you ever able to increase your Bio-T somehow? If so How? Or did you go the HRT route? I am fully informed on Dr. John's HRT recommendations and luckily my doc is willing to give me the required compounds and follow Dr. John's recommedend dosages (should I decide to go that route). Like yourself my E2 levels are decent. On one particular test it even came back quite low. However SHBG levels did not change much. It just seems like such a waste for me to go on HRT when I have a healthy total test level.
    I am currently on treatment to lower shbg. I noticed some improvement with the treatment (less fatigue, e.d. is better at times), however I still do not feel nearly close to recovered. I also found out I have LOW E2 which seems strange to me- from what I understand high E2 drives up SHBG. I do not want to go on hrt, but if its the only thing that will correct this, then thats what i'll do. I have read that people with a naturally high SHBG also require a high Total T. Maybe our SHBG levels are normal and our total T is still low for us, and we're not fully recovered (my total t was around 600, my shbg was at the high end). I'm getting more tests next week to see if the shbg has gone down (I'm sure it has since the drug I was prescribed is proven to lower SHBG, but if this is the case then why am I still having problems?). I haven't read any posts where people have had success lowering shbg (or maybe they just stop posting when they're cured). Maybe test levels need to be adjusted to compensate for the higher shbg- maybe our hpta's have not fully recovered?
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    Quote Originally Posted by mckinnj View Post
    I am currently on treatment to lower shbg. I noticed some improvement with the treatment (less fatigue, e.d. is better at times), however I still do not feel nearly close to recovered. I also found out I have LOW E2 which seems strange to me- from what I understand high E2 drives up SHBG. I do not want to go on hrt, but if its the only thing that will correct this, then thats what i'll do. I have read that people with a naturally high SHBG also require a high Total T. Maybe our SHBG levels are normal and our total T is still low for us, and we're not fully recovered (my total t was around 600, my shbg was at the high end). I'm getting more tests next week to see if the shbg has gone down (I'm sure it has since the drug I was prescribed is proven to lower SHBG, but if this is the case then why am I still having problems?). I haven't read any posts where people have had success lowering shbg (or maybe they just stop posting when they're cured). Maybe test levels need to be adjusted to compensate for the higher shbg- maybe our hpta's have not fully recovered?
    You know the more I read, the more I believe what you are suggesting, that possibly our Total test was substantially higher pre-AAS, which would be required for our body's to have a decent amount of Bio-T leftover (given our high SHBG). Just curious as to what drug you are taking to lower SHBG? Also have you ever considered a HMG + HCG PCT run? I know a few people that have successfully restored their total test (after exhausting all common PCT routines). The biggest problem to trying this is to find a doc that has enough knowledge and experience that is willing to presribe the HMG (as it is quite unknown in the physician world). Even the specialist (who is an internist) I go to has very limited amount of experience in this area.
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    Quote Originally Posted by Neednewballs View Post
    You know the more I read, the more I believe what you are suggesting, that possibly our Total test was substantially higher pre-anabolic steroids, which would be required for our body's to have a decent amount of Bio-T leftover (given our high SHBG). Just curious as to what drug you are taking to lower SHBG? Also have you ever considered a HMG + HCG post cycle therapy run? I know a few people that have successfully restored their total test (after exhausting all common PCT routines). The biggest problem to trying this is to find a doc that has enough knowledge and experience that is willing to presribe the HMG (as it is quite unknown in the physician world). Even the specialist (who is an internist) I go to has very limited amount of experience in this area.
    I took hcg, clomid, and arimidex 2 weeks after stopping steroid use (on the recommendation of the dr who provided the steroids). I now know that this was obviously not the correct way to recover, but trusted him at the time. I took 250 iu/day of hcg, 50 mgs/day clomid, and arimidex 1 mg/ eod (very stupid- may be the reason my e2 is low today). I have read about hmg before, but only recently took notice of its uses. From what I understand hcg stimulates LH, and hmg stimulates FSH- could be wrong here. What is the purpose of increasing fsh, while increasing lh? Also, does testicle size reflect testicular function? My testicles didnt shrink much while on steroids- they seem a little larger since I stopped, but not much- they seem the same size they were before. Another thing thats puzzling is that I will go through a few days where I feel better than I usually do- my testicles feel heavier, my penis seems fuller, and I have more energy- then it will go away- almost as if my levels are right on the borderline, or my body is trying to recover but fails. Does this happen with anyone else?

    Sorry about all the question marks.
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    Vitex is very effective at lowring prolactin. Dose with a high potent brand at 300mg once a day.

    SHBG is the problem with taking steroids. Once T is driven up extremely high(steroids) even for a brief, short time, E is driven up as well and that leads to SHBG. All the post cycle therapy in the world can restart T production, but it is useless at stopping SHBG.

    Yes, AI's can probably help prevent E from getting to high and prevent the SHBG problem from becomming a problem in the first place. I do feel that once that pandoras box has been opened though(steroids), things will never quite be exactly right and the same as before. There are just way to many factors at play that need to be in balance, and trying to play chemist with ones body isn't a good idea.
    Last edited by Dr. John; 04-22-2007 at 04:16 PM.
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    Quote Originally Posted by plymouth city View Post
    Vitex is very effective at lowring prolactin. Dose with a high potent brand at 300mg once a day.

    SHBG is the problem with taking steroids. Once T is driven up extremely high(steroids) even for a brief, short time, E is driven up as well and that leads to SHBG. All the post cycle therapy in the world can restart T production, but it is useless at stopping SHBG.

    Yes, AI's can probably help prevent E from getting to high and prevent the SHBG problem from becomming a problem in the first place. I do feel that once that pandoras box has been opened though(steroids), things will never quite be exactly right and the same as before. There are just way to many factors at play that need to be in balance, and trying to play chemist with ones body isn't a good idea.
    The puzzling thing is that steroids reduce SHBG a great deal while taking them- and for many months after cessation. Another strange thing is that neednewballs' e2 and mine are low.
    Last edited by Dr. John; 04-22-2007 at 04:16 PM.
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    Quote Originally Posted by mckinnj View Post
    The puzzling thing is that steroids reduce SHBG a great deal while taking them- and for many months after cessation. Another strange thing is that neednewballs' e2 and mine are low.
    Yep, both E2 and Prolactin are in check. I do think the problem is lack of total test. Gotta get some HMG..it's the only component I have never tried. Might just be the key to solving this complex equation...
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    I have heard of one of Dr Shippen's patients on the propeciahelp forum who was having issues post finasteride use, and he recovered his libido by using Danazol to lower his elevated SHBG and raise his Free T. All of his other numbers appeared to be OK from memory.

    I know nothing about Danazol except that it lowers SHBG, and im not sure if taking it would cause more problems somewhere else, or if you even need it, but it worked for him.

    I read in another section of this forum that DHEA has been known to lower SHBG. Did your SHBG go down at all when you got your DHEA level up?
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    Quote Originally Posted by Dr. John View Post
    Although I have never seen anything published on this topic, I am more and more beginning to think there is a range of affinities in SHBG's affinity for androgens.

    And that anabolic steroids can somehow permanently alter this relationship.

    Who wants to do a little research on this topic?

    Other than that, there is nothing in your labs which I find remarkable.
    Yes, Dr John, from what Ive researched thats exactly what Ive found(and posted above).

    The hormones of the body all work in harmony, a true work of god. From what Ive seen steroid use seems to permanently alter this delicate balance. We still havent perfected(or probably ever will) and found a safe way to use AAS and not cause some sort of permanent change.
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    Quote Originally Posted by Dr. John View Post
    What makes you say that?
    Does this show that fsh stimulates leydig cells? If so wouldn't hmg compliment hcg? This seems to show that fsh affects more than just sperm production.

    Cultured Sertoli cell-mediated FSH stimulatory effect on Leydig cell steroidogenesis -- Benahmed et al. 248 (2): E176 -- AJP - Endocrinology and Metabolism

    Leydig cell and extracellular matrix effects on Sertoli cell function: biochemical and morphologic studies -- Reventos et al. 10 (5): 359 -- Journal of Andrology

    "Sertoli cells produced an increase in the steroidogenic response of Leydig cells to hCG. Pretreatment of the coculture with pFSH enhanced the steroidogenic capacity of Leydig cells and increased the number of hCG receptors."
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    Quote Originally Posted by jaydee View Post
    I have heard of one of Dr Shippen's patients on the propeciahelp forum who was having issues post finasteride use, and he recovered his libido by using Danazol to lower his elevated SHBG and raise his Free T. All of his other numbers appeared to be OK from memory.

    I know nothing about Danazol except that it lowers SHBG, and im not sure if taking it would cause more problems somewhere else, or if you even need it, but it worked for him.

    I read in another section of this forum that DHEA has been known to lower SHBG. Did your SHBG go down at all when you got your DHEA level up?
    danazol shut me down pretty hard. it is a known anti-gonadatropin....its a steroid.

    my doctor gave me this stuff at the age of 16 to knock out nipple soreness from puberty. i gained 5lbs and my nuts shrank. thanks doc
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    Quote Originally Posted by Dr. John View Post
    What makes you say that?
    Well I suppose I have come to this conclusion from a method of elimination. I do know that my libido was great pre-anabolic steroids. I do know that after AAS libido and Bio-T levels are poor. If all my main hormone levels are in check (I should have also mentioned I am on syntroid and my TSH is 1.0) , the only plausible explanaiton (to me anyways) is that as a result of my shutting myself down severely (from the deca cycle) my total test never returned to where it was originally. Let's say my natural total test was 800ng/dl and now after cycle I am now where I am @ ~500ng/dl, the missing 300ng/dl (and it's accompanying androgens) could certianly account for a possible rise in SHBG thus leaving me with a low Bio-T level. Hence, my libido is poor. Now if I could somewhow bump my total test back up (of course assuming it was higher to begin with) possibly with a HCG + HMG combo, SHBG goes down and Bio-T increases. Please correct me me if any of my assumptions are off base. Thanks
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    Quote Originally Posted by jaydee View Post
    Did your SHBG go down at all when you got your DHEA level up?
    The times that I did supplement with DHEA and had that tested, I did not have my SHBG tested. However, my Bio-T was tested and there was no change. Suffice to say one could then assume that SHBG did not change to any significant degree.
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    Quote Originally Posted by Dr. John View Post
    Although I have never seen anything published on this topic, I am more and more beginning to think there is a range of affinities in SHBG's affinity for androgens.

    And that anabolic steroids can somehow permanently alter this relationship.

    Who wants to do a little research on this topic?

    Other than that, there is nothing in your labs which I find remarkable.
    One thing that come to my mind is that there are actually two SHBG's, as found before 1990.

    I just do not know how to test for that or what to do with that test results.
    ----------http://www.atypon-link.com/WDG/doi/pdf/10.1515/JLM.2006.050
    Abstract
    Background: The mass action law-based calculation
    methods for free testosterone (FT) and ‘‘bioavailable’’ testosterone
    (BAT) – routinely used for assessing androgen
    disorders – rely on the supposition that the sex hormone
    binding globulin (SHBG) molecule contains one steroid
    binding domain (SBD). However, recent biochemical
    investigations revealed that this molecule actually comprises
    two SBDs. This necessitates new equations
    (Calc2) for FT and BAT calculation.
    ============================== ============
    CalcV was reported to overestimate BAT by a factor of 1.5–2.2 [12]. Moreover, CalcV was first proposed
    in 1999 w8x and is, naturally, based on the biochemists’ view of the SHBG molecule in the 1990s; but
    the view of this molecule has changed, step by step, in recent years

    -----------
    8. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the
    estimation of free testosterone in serum. J Clin Endocrinol Metab 1999;84:3666–72.
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    Quote Originally Posted by Dr. John View Post
    I wish I knew what is it that causes this phenomenom.

    If you had serial T testing done, you may find it where you started on another assay--but you still feel poorly.

    The same thing can hapen when men take finasteride.

    As you say, you do not know what your baseline was. Assumptions are meaningless in this context.

    Your PRL is not out of range.
    I am the only person I know of across all the internet forums of finasteride users who has got pre and post finasteride Total T levels. Mine dropped by a third compared to pre finasteride levels.

    It makes me wonder how many people out there are actually lower than what they were before and dont even realize it and think they have recovered.
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    Quote Originally Posted by Dr. John View Post
    I wish I knew what is it that causes this phenomenom.

    If you had serial T testing done, you may find it where you started on another assay--but you still feel poorly.

    The same thing can hapen when men take finasteride.

    As you say, you do not know what your baseline was. Assumptions are meaningless in this context.

    Your PRL is not out of range.

    What is PRL?
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    Quote Originally Posted by Neednewballs View Post
    What is PRL?
    My guess, Prolactin.
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    Quote Originally Posted by jaydee View Post
    I am the only person I know of across all the internet forums of finasteride users who has got pre and post finasteride Total T levels. Mine dropped by a third compared to pre finasteride levels.

    It makes me wonder how many people out there are actually lower than what they were before and dont even realize it and think they have recovered.
    Makes sense when you consider that DHT competes with estrogen at the estrogen receptor. I would hypothesize that people taking DHT lowering drugs that have low DHT levels would in turn eventually have an increase in estradoil, which would lead to a decrease in T.

    Let us not forget that ANYTHING that competes with estrogen at the estrogen receptor site will block estrogenic fat deposition, and those areas that are heavy in particular include the breast and love handle area.
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    Quote Originally Posted by plymouth city View Post
    Makes sense when you consider that DHT competes with estrogen at the estrogen receptor. I would hypothesize that people taking DHT lowering drugs that have low DHT levels would in turn eventually have an increase in estradoil, which would lead to a decrease in T.

    Let us not forget that ANYTHING that competes with estrogen at the estrogen receptor site will block estrogenic fat deposition, and those areas that are heavy in particular include the breast and love handle area.
    A little while back I ran some avodart (little more potent then propceica) and went and got tested. My total test was unchanged, but my Bio-T dropped by 30%. Makes sense as their is less DHT to bind to SHBG, thereby SHBG goes up and Bio-T goes down...
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    Quote Originally Posted by Neednewballs View Post
    A little while back I ran some avodart (little more potent then propceica) and went and got tested. My total test was unchanged, but my Bio-T dropped by 30%. Makes sense as their is less DHT to bind to SHBG, thereby SHBG goes up and Bio-T goes down...
    So when supplying external T it pays to watch Bio-T and may be a FreeT rather than being preoccupied with TotalT.
  

  
 

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