few questions - seeing urologist this week, starting trt
- 05-18-2008, 09:25 PM
few questions - seeing urologist this week, starting trt
I was about to start TRT with my endo, but she didn't want to treat with HCG at all, she refered me to an urologist.
So now I am seeing my urologist this Wednesday and have a couple questions before going in.
My last bloodwork was as follows:
LH 5.6 (1.2 - 11)
FSH 7.1 (1.6 - 9.7)
Total Test: 372 (400-1080)
SHBG: 12 (11-80)
Bioavailable Test: 280 (131-682)
Free Test: 105 (47-244)
DHEAS: 281 (120-520)
Prolactin: 11.3 (5.0-18)
Estradiol: 30 (<66)
Looking at those numbers above, should I try for an HCG stimulus test to see if I can use HCG as sole treatment?
My endo says that with that level of LH, my test should be much higher. However, my primary care practitioner tells me that with test that low, my pituitary should be sending a MUCH higher signal to raise my test, and that my LH should be much higher. One dr thinks it's a primary issue, the other thinks it's secondary. I also have a pituitary micro adenoma...seems to be non-secreting, but who knows.
I want to start treatment asap, so I don't want to waste anymore time, should I just got for test + hcg, or try out hcg on it's own at first based on my bloodwork?
- 05-19-2008, 09:48 AM
HCG is always the first option to stimulate the testes with sometimes the use of clomid. If that doesn't work the only treatment you should be on is TRT + AI (Aromatase Inhibitor like Armidex) + HCG) These are the only treatments you should accept if the doctor doesn't agree you have to find a new one. Note: younger doctors are ALOT better than older doctors.
Armidex is a must to prevent high E2 (estrogen) and keep it under control since the test you inject could possibly convert itself to estrogen via the aromatase enzyme. Trust me high estrogen is hell i've experienced it.
05-19-2008, 10:38 AM
05-19-2008, 01:08 PM
If he is not comfortable prescribing arimidex, I am fine with sourcing my own. The main thing I am concerned with is having the HCG there as well as Tshots. I do not want androgel. I already am prone to bad skin and TRT will already cause problems with this for a bit, but I know high DHT will cause a lot of problems over the longterm and I just don't want to deal with that or with the need for accutane.
I'm worried about HCG not doing much for me, I mean it looks like I should have much more test for the amount of LH I am producing, yet it also seems that my pituitary should be sending out a MUCH higher signal if my test is that low! It is possible that there is a combination problem going on, due to the micro adenoma, and also what seems to be primary hypogonadism. If that's the case, I could be a rare person who has a combination of primary & secondary issues.
I dunno, I'm really leaning to just go for t-cyp + hcg + arimidex, oral dhea and maybe some progesterone to help the hcg work better (as well as PP's toco-8 product, which should help with testicular sensitivity to LH/HCG). But the thought of only having to use HCG is so nice, I just want to get on a working protocol asap, I've been at this since last fall with constant bloodwork and going through different dr's.
What is a good dose of HCG for the sole purpose of raising test to natural levels (without tshots)?
Should I try it for a week, get new bloodwork, and then decide what to do?
I have to admit, I've tried HCG in the past on it's own, 380-500iu 2-3 times a week, and felt nothing, I did it properly and stored/reconstituted properly as well. No libido boost, no sense of well being, no feeling of increased test. I did not do bloodwork then though.
05-19-2008, 01:19 PM
Another issue. My low DHEA.
As far as I know, low DHEA is due to adrenal imbalance, not hypogonadism.
I've had cortisol tested, it's fine and seems normal. But my DHEA is low. Is it also possible for long term adrenal fatigue to cause low T? I know my vegetarianism/vegan diet that I had for years is another likely cause of my metabolic/hormonal issues I have now, even though my diet is fine...but I'm confused about the low DHEA. Could be adrenals, could be metabolic issue.
All I know is that I'm tired of waiting for my diet + enzymes, betaine, oxbile, etc to potentially increase / fix my hormonal issues. Just doesn't seem to be working at all if the numbers aren't budging one bit....so I've completely decided on therapy now.
05-19-2008, 01:52 PM
How is your diet now? You should be getting things like red meat, chicken, seafood, oatmeal, rice, fruits and vegetables and Essential fatty acids from flaxseed oil, flaxseed meal and fish oil capsules. A vegeterian diet will destroy your hormonal balance.
Emphasising the the meats and healthy fats will certainly help Testosterone and adrenal function better. Too much sugars or carbohydrates in general are bad for adrenal function.
Things like Vitamin C in high doses (for adrenals), Vitamin E, DHEA, ZMA, Omega 3's and essential fatty acids are all needed for better hormone production.
We are on the same boat i have low T, poor adrenal function (low DHEA's), hashimoto's thyroiditis (a type of hypothyroidism where antibodies are attacking the thyroid), low IGF-1 and very high estradiol and and high liver enzymes.
The only thing im on now is thyroid medication its making me feel worse because my adrenal function is poor. im waiting for my blood work then seeing an endo to fix all this. And my symptoms.... where do i begin lol and im only 19!!!!!!
Anyway... a good dose of HCG with TRT is 250iu's EOD though im not sure how much you need if you run it on its own and you definitly need to use an AI with it.
Yes low DHEA is a sign of poor adrenal function. You dont have to have very high or very low cortisol to have adrenal fatigue. what was your cortisol reading? im guessing it was a one off reading from blood work. This doesnt tell you anything about your overall adrenal function it could be normal when you did the blood test then get too high or low at other times of the day. The only way to do a cortisol/dhea check is through saliva (the best way) or a 24 hour urinary cortisol/dhea which is also good.
Do you have any symptoms of adrenal fatigue? cravings for salt, not being able to wake up in the morning, getting startled easily, avoiding stressful situations, easily fatigued?
Your DHEA doesn't look low to me mine was 4.5 (7.5-14.5) thats low. LH and FSH are higher and SHBG as is expected as your body is attempting to boost its T production. I wouldnt use TRT right now i would just go the HCG route everything else looks fairly normal. Using an AI with it and making sure to do blood work.
This will help: David Z’s Primer on TRT, HCG and E2 Management - Part 1 of 2 - MESO-Rx
David Zís Primer on TRT, HCG and E2 Management - Part 2 of 2 - MESO-Rx
05-19-2008, 02:16 PM
I'm eating and supplementing just like that. Getting all of that.
Yes I have those symptoms you mentioned of adrenal imbalances. They are also symptoms of low T as well I thought. I have almost every one of those so there's no doubt something also going on with my adrenals. I had a poor lifestyle for years, was a workaholic, hardly slept and was taking caffeine pills daily washing them down with redbull and coffee and more redbull (or Monster drinks..yumm).
If 250iu's of HCG eod is used for trt, then it's no good for me. It did very little for me at twice that dose (was on a low dose of exemestane at the time as well).
I'm determined to start proper TRT now and address other issues later. I don't have time/space to f^ck around right now where it comes to my life, so no more experimenting to see if I can fix my imbalances. Pretty sure I'm pushing to frontload with 200mg of T-cyp, then 100mg+ weekly, alongside hcg + ai. I'll test my adrenals later and do other nutritional testing later. I know my diet/supplementation/lifestyle is pretty good and has been good. I was vegetarian years ago..but I did have that diet for several yrs as well...but my body should have had it's time to recover since I started eating right again ages ago and changed my lifestyle years ago.
My testosterone is normal...for an 80 yr old's. I don't want to wait till it's in the 200's to start TRT. My life's too important to live substandardly.
05-19-2008, 03:02 PM
Go for it man. Im going the TRT + AI + HCG route as well. Low T flat out sucks! and trying to get a decent physique with Low T sucks even more. I've had a number of doctors tell me my T levels are fine mine were:
Testosterone 9.5 (12-32) Sure looks very normal for a 19 year old :P
Btw im 6"3 and 240lbs we are quite similar how old are you?
05-19-2008, 03:40 PM
My DHEA is also very low. Have you tried DHEA supps? I just started a few weeks ago, and have not had labs done since. Am hoping 50 mg/day will boost levels, but honestly, I don't feel like it's made a difference...yet. Am curious to see if the supps have increased my levels. Will let you know, man.
05-19-2008, 03:44 PM
Here is my blood work results. Does anybody think my adrenals weak? Do i need to go for another test for adrenals?
I have tough time waking up in the morning. I dont feel energy at all to get up and go to work. Fatigue whole day.Constant Head ache. Lost muscles allover body except stomach (fat accumulation). No thgihs now, only bones.I have tingling on left side of face and neck.I feel difference in my mouth.Painful erections.I still need to go for TRT.Not yet started. I used testim for 10 days , but did not feel any diff.So stopped it. Is there any other problem other than low testosterone. Brain MRI came back negative.C-spine MRI came back negative.EMG negative.
Everything normal except for LH and Testosterone
CBC with differential/Platelet
Neutrophis (Absolute) 4.7
Lymphs (Absolute) 1.9
Monocytes (Absolute) 0.3
EOS (Absolute) 0.1
Base (Absolute) 0.0
Comp. Metabolic Panel
Glucose. Serum 97
Creatinine, Serum 0.8
BUN/Creatinine ratio 10
Sodium Serum 143
Potassium Serum 4.4
Chloride Serum 103
Carbon Dioxide Total 26
Calcium Serum 10.3
Protein total Serum 8.2
Albumin Serum 4.9
Globulin Total 3.3
A/G Ratio 1.5
Bilirubin Total 1.0
Alkaline Phosphates S 69
AST (SGOT) 22
ALT (SGPT) 19
Cholestrol Total 155
HDL Cholesterol 41
VLDL cholesterol calc 26
LDL Cholesterol Calc 88
LDL/HDL Ratio 2.1
Testosterone Free 7.73
Last edited by darkblue1; 05-19-2008 at 03:45 PM. Reason: changed
05-19-2008, 04:49 PM
Yeah I'm 30 yrs old.. 6'2 about 230 now...15-16% bf, last time I weighed in I was 226 or 224 at about 14% bf...maybe 13% since I had striations between my pecs and my abs were starting to pop through...this was just about a month ago.
If I had the choice and the knowledge, I would have started TRT in my 20s. I don't care about the hassle of it, nor do I feel like an inferior person for doing it, I just want to function at the best of my ability and be on top of my game. My job/career requires it, and I just don't want to settle for less.
05-19-2008, 04:51 PM
Read my post #79 so you know were I am comming from.
Look at the red lined part of chart.
I you want to try the HCG route;
Assign 2 to 4 months to this project, six if your testis are currenly shrunken.
Secure good supply of (always fresh) HCG.
You can get it in 1000iu, 1500iu, 2000iu doses.
Nothing larger than that or you will have lots of wasted HCG on your hands and/or uncertainty if you use old one.
Have a stash of HCG about 100000iu plus ability to get same amount on a short notice.
Secure supply of Arimidex or (better) Liquidex.
Secure supply of (BD 31ga 5/16" 3/10cc insuline syringes)
Get 2 scripts for testing at Quest
Estradiol, Ultrasensitive, LC/MS/MS (30289X)
Testosterone, Free, Bio/Total (LC/MS/MS)
Dihydrotestosterone, Free, Serum (36168X)
First two months
Drop any testosterone and AI that you may be using.
use 1500iu E3D every third day
On end of two months raw blood, do not stop your scheduled HCG shots waiting for test results.
When you get test results, evaluate where you stand.
You may go down with the dose if you are lucky and things work for you.
You may go up, probably no more than 3000iu E3D
3000iu E3D --> 365/3*1500=182500iu/year
1500iu E3D --> 1500*7/3=3500iu/week
If your testis are shrunk at this time, add another month or even two, waiting for them to get back on line.
05-19-2008, 04:52 PM
I have tried TD DHEA + Preg (Dermacrine) alongside HCG + aromasin. Wasn't enough for me. I was doing a full dose of the Dermacrine.
I've also tried oral dhea alongside an AI. 50mg-200mg for sustained periods. Immediately had LOTS of acne, slight libido boost, that's all. If I start DHEA again, I'm going to be very careful, or load up on b5...either that or I will have to resort to accutane which I don't want to, but am thinking I will have to when I start TRT at first.
05-19-2008, 04:58 PM
Thank you I may try this as a means of TRT and discuss this with the doctor. Because of my pituitary adenoma, it may work out for me, but it may also be that I am primary and the adenoma is not causing troubles at all.
My testis are not shrunken, but they do not appear to be working right. Over the past 10 yrs my 'volume' has reduced drastically. On occasion I get a nice good load size but not often. I am definately not shutdown from anything I have done in the past. My test baseline has always been the same..between 340-370 in the last yr. I only remember feeling slightly better more than 10 yrs ago, which was the reason I never got checked out...I never had a drastic change one day which made me want to go to the DR. I figured it was just me and how I was! I had no clue about hormones until last year, which is pretty funny in itself. I didn't care much for DR's, physicals, etc in my past and only started taking my health seriously in the past year or two.
05-19-2008, 05:06 PM
On second thought.... I do have some of these but not all.
I'll try to explain it.
Cravings for salt? BIG TIME, not so much in recent months as in previous years. I used to crave and eat a LOT of salt. From time to time I still do.
Not being able to wake up in the morning. Yes, definately have major troubles here, and major troubles motivating myself especially in the morning.
Getting startled easily? NO...I am not very edgy or jumpy normally, I would say the opposite most of the time. I feel groggy, foggy, clouded a lot of the time, difficulty concentrating to the point where I thought I have A.D.D. I feel pretty lazy a lot of the time, which is not acceptible for me, and I have no reason to feel this way since I sleep enough. While not being edgy though, I have to say I can be very irritable and get anxious at times. It's for the reasons in this paragraph that I can no longer go without any sort of treatment. Anti-depressants don't work, ativan hardly works...they only cover up symptoms ever so slightly.
Avoiding stressful situations? Yes, but this in turn creates more stressful situations for myself and that's no longer acceptible either, another reason for wanting to start TRT.
Easily fatigued? How about always fatigued. I yawn in the gym mid-workout.
I am also on 450mg of wellbutrin which can also worsen any sort of adrenal fatigue....planning on lowering this to 150mg once I get going with the TRT.
05-20-2008, 05:28 AM
Note: Too much HCG can result in downregulation of the LH receptors in the testes, and is therefore counterproductive. Overdosing of HCG can also result in gynecomastia.
Are you on wellbutrin for depression symptoms? SSRI's are horrible they can also mess up your metabolism. I was on fluvoxamine for a week and it made me into a zombie, never touching that again. Its typical of doctors who treat symptoms not the cause to prescribe something like that. Yu say your jawning during workouts and cant get up in the morning a SSRI will ADD to that ten fold.
05-20-2008, 09:35 AM
05-20-2008, 10:42 AM
Nono I'm purposely not on an SSRI, wellbutrin is different, it works only on Dopamine and Norepinephrin. It is stimulating and I am on the highest allowable dose. This is why I need to watch out for adrenal fatigue on it, but I mean my symptoms existed far before going on wellbutrin. Funny thing is that dopamine is supposed to increase libido, but it hasn't changed mine at all. I thought it would skyrocket somewhat...so I'm also going to try adding in around 10grams of l-tyrosine a day to further push my dopamine levels (while wellbutrin is a dopamine and norepinephrin reuptake inhibitor). But yes, I am on it for my depressive symptoms. It is the mildest anti-depression med you can get. I refuse to take SSRI's again, unless TRT proves to not help my own depressive symptoms and something is actually wrong with my seratonin levels. I'm also going to talk to my urologist about starting me on deprenyl / selegaline.
05-20-2008, 10:45 AM
05-20-2008, 12:20 PM
If you are (pure) primary, only testosterone supplementation counts, small dose of HCG is for cosmetic purpose only
The procedure commonly used around here assumes (without spelling it out) that all men are primary. It is convenience tool.
Because it helps men to get their desired T levels, but it is not the only way to get there.
I am assuming that most men are secondary,
and they can get better results (more natural state) if treated as such.
T h e E n d o c r i n e S o c i e t y ’ s
Testosterone Therapy in
Adult Men with
Androgen Deficiency Syndromes:
An Endocrine Society Clinical Practice Guideline
1.0.2 Classification of Hypogonadism. Abnormalities
of the HPG axis at the testicular level cause primary
testicular failure, whereas central defects of the
hypothalamus or pituitary cause secondary testicular
• Primary testicular failure results in low testosterone
levels, impairment of spermatogenesis, and elevated
• Secondary testicular failure is associated with low
or low-normal gonadotropin levels and low
This classification has therapeutic implications because
fertility can be restored with appropriate hormonal
stimulation in patients with secondary hypogonadism,
but not primary hypogonadism. Fertility options for
men with primary testicular failure are limited to the
use of donor sperm, adoption, or, in some patients,
intracytoplasmic sperm injection. Also, further
evaluation of secondary hypogonadism may uncover a
pituitary tumor or systemic illness.
05-20-2008, 01:47 PM
05-21-2008, 02:25 PM
Wow that was a worthless meeting.
I could have stuck with the endo and had better treatment. She at least was going to give me androgel, although no hcg.
The urologist thought I'm fine since my levels are 'low normal' and does not want to give me test even though I told him my endo was about to start treatment!
He practicly ignored all my symptoms, telling they were inconclusive! He said because I am having sex 4 times a week, and also masterbate, that my libido must be completely normal! I told him uhhh yeah I take cialis twice a week! So he writes a script for cialis and sends me off on my way. He also asked me if I work out....no idea why that would make a difference to any of this...He ignored the fact I have a micro adenoma and that with good LH/FSH levels I am not producing much test...He didn't seem to want to address the adenoma or any of my symtoms, just telling me that depression could be lowering my test levels somewhat..
I'm going to book my trip to see DR John and quite wasting my time now with these other dr's.
05-21-2008, 03:41 PM
05-21-2008, 04:08 PM
Yes I agree, and I told him this too.
I think he's one of those DR's who is used to only treating patients who are severly suffering....waits till they are in the 100s or 200s before treating. I mean sh!t, it should be my choice at the quality of life I want to have...not his.
05-21-2008, 06:22 PM
05-21-2008, 06:38 PM
I can't vote here, I'm Canadian. Is it really going to be illegal for people to not buy health care here? Wow.
Right now I'm covered by Oxford w/ my job. Hopefully my job is changing soon though or I am heading back to Canada in a few months.
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