Is my urologist crazy?
- 06-28-2007, 07:51 AM
Is my urologist crazy?
So in April switched over to a local urologist for my TRT so that I could get this paid for by my insurance.
I had been on 5g Androgel daily, hcg 200iu every other day. Feeling decent in the head but still not much libido or energy.
He does a big blood test panel. Apparently he has his own "RIA" (radio immuno assay) equipment in his clinic. Insulin was a bit high, homocysteine was really good, and other things to him indicated that the 5g Androgel daily was not enough. He commented that he usually starts men out at 10g Androgel per day.
Based on those results and how I was feeling, he recommended going to weekly IM Test Cyp shots, starting at 200mg per week. I told him that seemed high. He said after 6 weeks we'd see, and that I could continue the QOD hCG if I wanted to. He said Total T is not as important as Free T, which he likes to see around 300. His philosophy is that instead of aromatase inhibition, you need to add so much T that it always "out races" the estrogen at the receptors. Hmm.
Six weeks later, he tested only 4 things. Here are the results:
Total T: 1502 (his range goes up to 1700 or so)
Free T: 532 (way over 300 I'd say)
Estradiol: 48 (0-58)
SHBG: 13 (bottom of his scale)
I asked him if he thought my estradiol should be lower, he said as long as it's below 58, it's fine.
During the first couple weeks of 200mg per week, I felt like the horny teen I never was, but after that, I was back to how I started, great mental clarity, but not much libido or energy.
At our most recent discussion, he told me to go up to 240mg per week and come back in 3 months. He also told me that if for any reason I felt it was too high, I could lower it at my discretion.
I also found out he's a sex-change doctor, and that's where he gets a lot of his clinical experience with the effects of T. Oh my. He also told me he's been on TRT for 3 years and he still hasn't figured out the perfect dosage for himself.
His solution to the roller coaster is to push up the whole curve, so to speak.
I really don't like my estrogen number, but he would not prescribe Arimidex.
So, is he crazy? Back when I was on 100mg T per week I was told my Total T was a bit high and to lower it. Quite frankly, I feel I would prefer a lower does and some Arimidex right about now.
I know that my body is very estrogeno-philic (did I just make that up?). I am not happy being at 48 on a scale of 0-58, but that's based on reading that middle or slightly below middle of the range seems preferable to others.
I've got plenty of night wood and morning wood. I do think about sex more often, but my body doesn't exactly "keep up". Also sometimes my prostate feels a little "bigger" than normal, including it being a little more difficult to urinate. Not difficult as in painful, but I can't "push it out to make it go faster", if you know what I mean.
Since he said I could lower the dose at my discretion, I'm leaning towards doing just that. He also said I could split my doses, but doing so could mean needing a lower dose over all. Finally he said it could take 9 months to a year to really stabilize and for testosterone and estrogen related metabolic issues to get sorted out once stable.
Any professional or non-professional opinions?
- 06-28-2007, 09:05 AM
Your dr needs to get up to date with information. Free T is worthless reading because half test are not measurede accurately you need to go with biotestosterone whihc yours is WHY TOO HIGH and your e2 to testosterone ration is not that bad. I would lower your range down to 1100 or possible just look for inuslin reistance which high testosterone and dht can cause ..You are wise in going with 100 mgs of testosteorne a week for 6 weeks . It looks like you are not really having any e2 problesms because the scales not calibrate to tradiitonal ranges. If they where then you may have a better understanding where e2 stands, but more so my concern would be DHT and inuslin resistance since elevated DHT can lower shbg.
Start out 100 mgs a week may be split into shots 60 mgs monday and 40 mgs thursday with 250 ius hcg day before
each shot and run this for 6 weeks then retest if still not happybump it up to 115 mgs.
- 06-28-2007, 09:15 AM
How exactly does one "find the range where the e2 and testosteorne cross"?? Does that require frequent testing and graph plotting?
Any other comments, guys?
06-28-2007, 09:26 AM
06-28-2007, 09:52 AM
06-28-2007, 10:02 AM
06-28-2007, 10:15 AM
Despite all of this, I know I have to get my bodyfat percentage (that is, volume of aromatization space) down from about 24% where it is now, to lower, gosh 15% or less. If I get to that point, I may not need as much exogenous T.
06-28-2007, 11:01 AM
Your enemy is low SHBG. When you are taking any supplements, watch out, check first if they do not lower SHBG.
Assuming that it is due to insuline resistance, get as much info as you can from Hardasnails and deal with that.
If you want to go hog high with your testosterone injection,
your goal FreeT=300
using Dr Shippens chart you want
Using my chart you should get there using
using 200mg/mL T-cypionate (Depo-Testosterone)
Your total weekly dose
125/200=0.625ml=62.5units on insuline syringe
You should really do your shots more often
if twice weekly 62.5/2=31.25 units
if E3D 62.5/7*3=26.8 units
if E2D 62.5/7*2=17.9
round up to the nex half unit
I did my first SubQ T shot today using very small needle, it does have 1/2 scale markings. I used
BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b
BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b Price: $25.95
There is another less expensive but same size needle
Easy Touch U-100 Insulin Syringe 31 Gauge 3/10cc 5/16 inch Short Needle 100/Box
Easy Touch U-100 Insulin Syringe 31 Gauge 3/10cc 5/16 inch Short Needle 100/Box Sale Price: $13.99
If your doc do not want to give you script for Arimidex, you can always get LiquiDex. Actually easier to measure small doses.
I would worry about other estrogens,
LEF DualAction, 4 pills, I use 6 pills
LEF TMG, 2 pills.
06-28-2007, 11:19 AM
06-28-2007, 11:50 AM
What supplements lower SHBG? Do you mean bind to SHBG such as Avena Sativa or Nettle Root?
06-28-2007, 04:41 PM
my Hemoglobin A1C=5.4
that coresponds to average glucose level=114
I calculated here:
Jan's BloodTest April13/2007
surprising, my glucose test shows 105
I am taking this supplements
Jan's BloodTest April13/2007
will test latter to see if they actually work.
To lower SHBG
Avena Sativa Extract
Urtica dioica aka Stinging nettle
I think higher levels of T & E also inhibits SHBG
To make SHBG higher
============================== ============================== ================
There is a thread on this board (James something) talking about low SHBG
06-28-2007, 04:50 PM
JansZ is the man, great adivse, echoing every thing I would have said.
06-28-2007, 04:51 PM
you can always get liquid arimidex from the chem one guys, if your dr wont give it to you.
lets go with 1mg per week divided up.
06-28-2007, 06:45 PM
06-28-2007, 07:11 PM
06-28-2007, 07:27 PM
06-28-2007, 07:46 PM
06-29-2007, 12:04 AM
06-29-2007, 04:22 AM
06-29-2007, 10:10 AM
Bow to BCBS, your new master!!
The urologist is crazy and I wish I could find one like that.
"Here Bio, take this gallon of testosterone home and just see what happens." lol
06-29-2007, 10:34 AM
From my experience, doctors that I see and some/many that I do not see, when they charge my insurance, it is often incorrect or incomplete information is provided. I am asked questions 6 months to sometime year and half latter. Mostly I do not have good answers, I am not educated enough in health insurance ways.
When large hospital or doctor's office cannot get it straight, there is a little chance there for regular Joe, other than cough up the cash.
OTOH, I do not blame you one bit for what you are doing, insurance way.
The system is screwed up, but please no social medicine, not in USA.
06-29-2007, 10:51 AM
06-29-2007, 12:43 PM
06-29-2007, 01:31 PM
06-29-2007, 04:09 PM
06-30-2007, 12:00 PM
06-30-2007, 12:31 PM
06-30-2007, 12:42 PM
07-06-2007, 10:34 AM
Back to the topic. I just got my DHT results in (his in-house lab doesn't do it, they sent it to labcorp). It was right at the top of the range. No surprise. What baffles me is that the urologist doesn't seem to care about DHT. I requested the DHT test, and his phlebotomist just submitted it.
I have been tapering down the dose. I've also been taking some Saw Palmetto and now I can pee more freely again. It was getting bad, almost painful.
07-06-2007, 10:52 AM
Your TRT should include PSA lab work and an annual DRE. Not doing that with TRT could be considered substandard medical care. Many Doctor's would want to be checking DHT and taking action if above normal, if only to not be in a sticky legal situation if you happen to get prostate cancer. In many cases, legal risks drive details of therapy.
If you are doing transdermal TRT, switching to injections might reduce your DHT levels.
07-06-2007, 11:27 AM
07-06-2007, 05:17 PM
4 weeks off anti E's due to improper blood testing results my e2 was 73 on 1/3 cc of sustenon every 3 rd day. I know scold me put I had some Test eth left and after being on 50mgs every 3 days for 3 weeks my testosterone came back to 332, e2 19, shbg 37 which told me it was fake . Since my Dr saw my blood tests where low he gave me told me to take 200 mgs shot of PRESCRIBED cyp to get things rolling then go 45 mgs every 3 day and we will restest in 5 weeks.. Knowing my e2 was high before of 73. Would it be advisbable to just run straight cyp without an AI or knowing that previouslty with elevated e2 . Right now I am having troiuble peeing which is telling me my e2 is going up again. I feel bloated and sever constipation
07-07-2007, 02:37 PM
Most are fine with 1/2 inch.
Bloating is always a sign of high E, not low. Its probably one of the very select few signs of E problems that signals high E only(usually, all the other symtoms can be interchanged with to high or to low E).
The only other one off the top of my head that I can think of is very low cholesterol, which is usually low E exclusive. But that can come from other issues as well.
What to do is up to you. Ideally you want to run T injects 4 weeks to get an accurate measure of E levels without an AI. However thats a long time if your already feeling blah, you might wanna take action now.
07-07-2007, 02:56 PM
It is hard to believe that you will not need some AI. I don't know how much you should take. But if you took a reasonable stab at a proper dose, then your next E lab work could be for a dose adjustment instead of a leap into the unknown. Meanwhile, the TRT might go better and some E issues might improve. If taking anastrozole, front load your dosing as the maintenance dose alone can take a week or more to achieve steady state serum levels. Take 1mg/day for the first two days, or the intended weekly amount, then begin the intended maintenance amount.
08-08-2007, 09:27 AM
UPDATE: for the past 5 or 6 weeks, I've been injected QOD hcg and T-cyp "adjusting at my discretion" which my urologist allowed me to do. I've been feeling excellent with the following every other day:
I'm also using Dermacrine daily. I have to take Saw Palmetto otherwise my prostate seems to enlarge a bit (judging by urination issues).
Since getting on that, I've had the libido I want, energy to work out, alertness at work, and mentally feel great!
08-08-2007, 11:11 AM
Research showed that 250iu HCG EOD maintained testicular function in young normal males who were PHTA shudown with 200mg/wk of test cyp. So that dose might be better for you.
If you use a 10,000 iu vial, that would last 80 days... pushing its life span. If a lower dose in that size it would last even longer.
You might profit from a bit more anastrozole, but if breaking up 1mg tablets, that is hard to do.
08-08-2007, 03:07 PM
08-13-2007, 10:25 AM
08-13-2007, 10:33 AM
08-19-2007, 02:43 PM
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