To Whom It May Concern

[James Howlett]

It's ringing a bell, but cannot keep track of everyone.

It's me BATMAN! :icon_lol: I am crushed, you know Troy don't you?

 

[James Howlett]

I thought taking DHEA & Pregnenolone is a bad idea & what about it's catabolic & feminine tendencies.

I also thought the water & anxiety was E2 related, is it not?

Does my post above have merit, or simply paranoia? I am concerned about gains in the gym (which may or may not happen) :bb2: :yawn: might be hindered as well.

All right, sorry for highjacking your thread Chip, that was my last.

Listen to Dr. John & company.

 

[James Howlett]

He mentioned a connection between Epstein-Barr Virus and Mycoplasma infections, and told me to keep an eye out for those, as they're currently thesubject of many research involving cancers and other human disease processes.

I had Epstein-Barr at a very young age as well (13?) & before TRT, my TT was 382, FT 11 I think. Labcorp ranges.

 

[Chip Douglas]

Depression increases pro-inflammatory cytokines, which inhibits both testosterone and GH production.

Thanks for letting me know--this indicates my T and IGF-1 *could* be low because of Dysthymia.

He also said I had ADHD--that is Dr. Braverman.

Is there any relationship between T/GH and ADHD ? I think there's one, but I don't know what is the mechanism.

Thanks !

 

[Chip Douglas]

I have been on T plus HCG for a while now & it defiantly help’s with my OCD/anxiety plus depression, although I have had some difficulties lately & have retained some water & pee a lot. If I had to choose, I would choose TRT over OTC solutions any day.

OTC's definately more of a hit or miss means, and then it's probably more miss than hit at that ! lol

 

[Chip Douglas]

Does my post above have merit, or simply paranoia? I am concerned about gains in the gym (which may or may not happen) :bb2: :yawn: might be hindered as well.

All right, sorry for highjacking your thread Chip, that was my last.

Listen to Dr. John & company.

No worries about the hichjacing thing, I'm far from being touchy

 

[Chip Douglas]

I had Epstein-Barr at a very young age as well (13?) & before TRT, my TT was 382, FT 11 I think. Labcorp ranges.

Dr. John, would you be so kind as to expound on any possible link between Epstein-Barr Virus and low T if any (through mycoplasma infection) ? Through what mechanism could this occur ?

While I was at Pathmedical, on the second morning, I recall that Jacky (Dr. Braverman's medical assistant) told me that my labs were in showing elevated :

Albumin : 5.6 (elevated)
Total Bilirubin : 2.7 (elevated)
Total protein : 8.5 (elevated)

Then I asked Jacky why those were elevated, and she said that often this happens because of the way blood was carried to the lab. Then they drew some more blood to see if they could find validation in the first set of labs.

So days later, she emailed me the latest results of the above parameters :

Albumin : 5.2 (normal)
Total Bilirubin :1.9 (elevated)
Total Protein : 7.9 (normal)
Direct Bilirubin : 0.3 (normal)
Indirect Bilirubin : 1.6 (slight elevation)


In all honesty I don't know what to make of the above test results--Dr. Braverman didn't seem to think they meant much, at least he never mentioned them to me ever.

What do they mean ?

Thanks

 

[Chip Douglas]

406 is not that bad, but what was estradiol reading. I assume it went up too.

I got my 406 Total T reading from the below labs done on November 2005, 2 week after I returned from NYC--those labs were done locally, but ordered by Dr. Braverman.

DHEA-S 11.6 ( 4.0 - 16.3 ) umol/L

SHBG 17 ( 10 - 73 )

FSH 2 ( men : 2 - 12 ) U/L

LH 2 ( men : 2 - 9 ) U/L

Testosterone 14.1 ( 8.4 - 28.7 ) nmol/L

Bioavail. Testosterone 6.0 ( 2.0 - 14.0 ) nmol/L
==============================================
Now the following blood test results were done locally, this last July, so they're very recent :


Estradiol-17B : 93 men : 42-151 pmol/L
Follicular phase : 69-905
Luteal phase : 130-2095
menopause : < 163



Bioavailable Testosterone 7.0 ( 2.0-14.0) nmol/L


TSH : 2.27 Euthyr. 0.27-5.00 mUi/L
Hypothyr. > 5.00
Hyperthyr. < 0.01



FT4: 20.3 ( 12.0-22.0) pmol/L


Prolactin: H 16.6 ( 4.0-15.2) ug/L
(take account the new reference range which has been modified 06-07-12)

 

[Chip Douglas]

To the last posted blood test results, I forgot to add these :


AST 17 ( 0-37) U/L
ALT 20 ( 0-41) U/L

 

[Chip Douglas]

That's good to know from a Dr. What do you think such a reaction could indicate ?

Come to think of it Dr. Braverman prescribed Paxil and Klonopin to me--I think I mentioned it above.

Al of the supplements he prescribed have to do with increasing GABA, and Serotonin mostly--only one has to do with catecholamines. So he definately found me to need more relaxation than stimulation--he found me already overstimulated.

All I hear most of the time is that in those with low libido, they need Dopaminergics, and I hear GABAergics and serotoninergics kill ones libido-I've found the total opposite in me, that is, dopaminergics kill whatever sex drive is there, and gabaergics restore sex drive. It seems im one of those unusual cases. Say I felt like having sex, I would then take 2.5 mg Deprenyl, and 20 minutes later, sex drive was totally gone, and each and every time it was that way--even at 5 mg it killed it.

 

[Chip Douglas]

that's what I keep hearing these days about DHA and EPA--thanks for the pointer--I'm only using fish oils now--pharmaceutical grade at that.


I still wonder whether Dr. Braverman is right or wrong--You said depression increases pro inflammatory cytokines which inhibits both T and GH, but then why are so many males treated via TRT ? Can't a moderate amount of those men be treated via anti-depressants and then find their T levels improved as a result of this ? I think there's something I don't undertand here.

What Im trying to figure out is : which comes first ? Is it depression which brings about low T, or low T that causes depression ? Likely both answers are correct.


Dr. John, if you could shed some light on this, I'd appreciate it a lot.

In the end who knows, I may end up making an appointment with your clinic.

Thankfully
Marc

 

[Chip Douglas]

One thing is for sure, I'm not going to see Dr. Braverman again--he's a very good doctor no doubt, but too expensive for me !

 

[Chip Douglas]

high DHT

I've just come home from my PCP's office, and he handed me my DHT test results I'd been waiting for for 2 1/2 months. Here goes :


DHT : 1 599 pmol/L reference range (male 20-49) 217 to 1650 pmol/L

Remember that my main concern is low or non-existent libido/sex drive. This blood test results makes something clear to me : low DHT isn't my problem. My bioavailable Testosterone is at midrange which my PCP says is healthy.

I mentioned to him that my TSH has been consistently above 2.0, but then he says my FT4 is way fine, and that there's no need to check for FT3--I think he's not correct in not checking for FT3. He told me that FT4 is converted into FT3, which I agreed, but pursued by saying that some doctors claim the conversion from FT4 to FT3 is not efficient in some individuals.

In the end he said that medically speaking, there's nothing wrong with me, and that I should consult with a sex therapist or psychologist.

I'm more and more inclined to think Dr. Eric Braverman's diagnosis of : Dysthymia and ADHD was correct.

Dr. Crisler, I'd appreciate your commenting on this.

The anxiety diagnosis would provide an explanation as to why : selenium, zinc, magnesium, B6, theanine, st-John's wort, and valerian work so well in restoring my libido.

Cheers

 

[Chip Douglas]

Thanks all the same John, I know you'd provide advice if you could. Each specialty is enough work as it is, so it's impossible to know it all.

Yep, he did see me in real life, so this can make a noticeable difference--I'm at least happy to know my low sex drive cannot be attributed to low DHT--far from it in actually.

Cheers

 

[Chip Douglas]

John : It was assessed through blood analysis--although you perhaps mean what method of analysis did the lab used ?

If it is the latter, let me know and I'll inquire as the analysis was performed out of town in Toronto.

Thanks

 

[Chip Douglas]

It's looking more and more as if serum DHT is not a good biomarker of actual tissue 5-AR activity (the enzyme which converts T into DHT). My friend and colleague Dr. Mark Gordon says sometimes it can actually have an inverse relationship with same!

The best way to ascertain DHT activity, at this time, seems to be ratios of various metabolites of DHT activity, found in urine samples.

That's good to know John, as I wasn't aware of this info.

 

[Chip Douglas]

Did I remember Phil recomenidng you to my friend Dr. Larry Komer in Burlington (near Toronto)?

Invalid Link Removed

I've contacted Dr. Larry Komer yesterday. It'd indeed be a decent give and take for me, even though it would still be a 12 hours drive for me to go there. I'll see about this, however I know in a not so distant future I'll have to make a decision about this.

Thanks for pointing this out again John.

 

[Chip Douglas]

Hi Dr. John,

Do you still maintain that a TSH of 3.02 isn't troublesome ? Here's the post I found it in over at MESO : Invalid Link Removed

Thankfully
Marc

 

[Chip Douglas]

Just a head's up, I am not used to being addressed by my first name while serving as a medical professional.

I'm usually quite familiar with people--please take no offence Dr. john, it's just my outgoing and sympathetic nature at play here. Anyway I sure didn't mean any offence, and can assure you to be a highly respectful type of individual, but on the web, of course it doesn't show as it would in real life situations.

Best regards
Marc

 

[Chip Douglas]

A TSH at that level is well within healthy range. We are getting far, far too picky when we think same may be a sign of difficulty.

Besides, TSH is an "acute phase reactant", meaning it responds quickly to stressors. In fact, it may shoot up to 10 quite quickly.

That is very imortant info for me--it tells me my last 2.2 TSH is like 4 M.D.'s at the clinic I'm patient of, healthy. My PCP think alike you on the TSH issue. Further, my TSH while at Pathmedical last year was 2.0, so now I understand why Dr. Braverman never brought it up.

Thank you very much Dr. John.

 

[Chip Douglas]

A TSH at that level is well within healthy range. We are getting far, far too picky when we think same may be a sign of difficulty.

Besides, TSH is an "acute phase reactant", meaning it responds quickly to stressors. In fact, it may shoot up to 10 quite quickly.

My Basal Metabolic Temperature during the last week was as follows :

November 10 : 96.6 F
November 11 : 97.4 F
November 12 : 96.3 F
November 13 : 96.5 F
November 14 : 96.5 F

The above was taken orally first thing in the morning before I get out of bed.

Is BMT a reliable tool to look at how well the thyroid is doing ?

Thanks

 

[smitty4]

My Basal Metabolic Temperature during the last week was as follows :

November 10 : 96.6 F
November 11 : 97.4 F
November 12 : 96.3 F
November 13 : 96.5 F
November 14 : 96.5 F

The above was taken orally first thing in the morning before I get out of bed.

Is BMT a reliable tool to look at how well the thyroid is doing ?

Thanks

Umm...basal temps are not taken orally. They are taken under the arm.

 

[Chip Douglas]

Initially that is what I read too, but over time I was told (were those people correct, I don't know) orally taken temp would provide the info one is after, but you're definately correct that BMT is known to be taken underarm.

What will clarify this issue is when Dr. John comments on it--hopefully he will. He's such an invaluable resource to this forum and others he has contributed to as well.

Cheers

 

[Chip Douglas]

You are entirely welcome.

Let me elaborate. Free T3 is what counts. TSH can shoot up and down. Generally we are coming to appreciate that we like to see it at or below 2.0. But if it gets to 3 or so, it certainly is not indicative of a problem, for the reason already stated.

Do you find BMT to be a reliable indicator of thyroid functions (FT3) ?

 

[pmgamer18]

Do you find BMT to be a reliable indicator of thyroid functions (FT3) ?

I have read a lot on this and read back in the day before good blood testing taking ones temp before getting out of bed under the arm was used to dose and treat low thyroid. It stated if your temp was under 97.8 doing this your thyroid was still to low. But they also went by how your were feeling.
Phil

 

[Chip Douglas]

I have read a lot on this and read back in the day before good blood testing taking ones temp before getting out of bed under the arm was used to dose and treat low thyroid. It stated if your temp was under 97.8 doing this your thyroid was still to low. But they also went by how your were feeling.
Phil

Thanks Phil, this is very good information to me. I like to know both side of the coin so to speak.

 

[Chip Douglas]

A lot of weight is being placed on this daily temp thing. Here are some problems with that:

1). There are those who will not reach 98.6F no matter how much thyroid you give them.

2). 98.6 was never supposed to be the be-all, end-all for thyroid function. It is an average. Some are meant to be a bit lower--that is normal for them. Many are making a mistake not recognizing this, IMPO.

3). It can be difficult to get a true oral temp.

I also see some gauging their thyroid dosing on heart rate. The problem with that is same can be profoundly influenced--in our own particular population--by how much we have recovered physically from that week's training. Decreased recovery increases heart rate (and ironically, hypothyroidism inhibits recovery). If I remember right, the Russions pioneered this idea, as they applied intensity of that day's training to morning HR.

I'm delighted to learn about this, as this is something I didn't know about at all. I'll make sure to remember this. It explains many things to me to know this now.

Thanks heaps Dr. John
Marc

 

[Chip Douglas]

Dr. John,

The reason I'm happy about your telling about those facts above, is it helps me understand why Dr. Braverman, whom you know well didn't bring up my 2.27 TSH. I've read a lot, and asked a lot from you and others on those great forums (message boards such as this one are such a great resource, it's priceless to me and many others I'm sure), only to find out more and more that Dr. Braverman diagnosed my case with pinpoint accuracy. I'm not yet 100% certain though, but common sense tells me I should really trust Dr. Braverman's assessment and treatment of my case, because he saw me in person, talked with me etc...it cost me a lot of money, but in the end I tend to think that he at least did a very good job.

I know he's a well renowned M.D. and his a great scholar, so again, common sense dictactes that I should trust his expertise. Money is indeed a constraint right now. I've enrolled on a waiting list at an andrology clinic in the neighboring city--should be getting an appointment in about 2 month's time. I'm going to that clinic only to make sure Dr. Braverman's diagnosis is right on.

He found me to be dysthymic with ADHD--ADHD I most definately suffer from since childhood, where teachers would call home to tell my parents I couldn't finish my assignments, was nable to display proper focus and concentration and so on, and even to this day, I' having a real hard time to read a long post or thread completely, because I find I'm constantly sidetracked by something else. I also have much anxiety, which is now somewhat under control, or bearable. I have OCD too, or as I have obsessions about sex and have this obsession of being afraid of harming others--both of these obessions are in my mind great stressors, and what's more it's the kind of stress over which one doesn't feel he has control over, thus it's connected to a sense of failure--I read many times this is a bad kind of stress--that is one that is associated with a sense of failure, over which you don't feel you have any conscious control over.

I've never really been happy until now, because my mind is never at rest. Course, one sort of gets used to feel that way, and after years of feeling this way, we develop some coping mechanism, but deep down, I know live's not meant to be that way. From many of my readings (which took a heck of a long time because of the ADHD), I found out that dysthymia, ADHD, OCD, and generalized anxiety disorder, very often will coexist--it's what Dr. Braverman calls spectrum disorders.

Anyway, it seems I'm slowly regaining some control over my life coupled with more happiness.

Big thanks to all who have landed a hand so far.

Marc

 

[pmgamer18]

Thanks Phil, this is very good information to me. I like to know both side of the coin so to speak.

Here is a cut & paste of just one.

from Medscape Internal Medicine



Continued Low Body Temperature

Question

What screening or other testing should be done for a patient with continued low body temperature (95-97° F)? All thyroid and pituitary tests are within normal limits.





Response from Gerald W. Smetana, MD
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts





No literature exists to offer an evidence-based strategy for the evaluation of patients with persistent low-level hypothermia. I am unaware of any clinical series that detail the ultimate diagnosis of patients with body temperatures in the range you describe. In my own experience, it is rare for a known cause of hypothermia to exist without other clues from the history and physical examination that suggest the diagnosis.

The causes of hypothermia are extensive and include endocrine pathology (as you have considered), environmental exposures, drugs, sepsis, uremia, Parkinson's disease, stroke, exfoliative dermatologic disorders, and malnutrition. Endocrine causes, in addition to hypothyroidism and hypopituitarism, also include adrenal insufficiency, hypothalamic disorders, and hypoglycemia. Drugs known to cause hypothermia include ethanol, phenothiazines, and barbiturates.

It is worthwhile to obtain a rectal temperature to be certain that the patient is not mouth breathing during the measurement of oral temperature, which may give spurious results. Assuming the reduction in body temperature is chronic, one can exclude sepsis and exposures from this list. A careful alcohol and medication history will exclude these as possible causes. It is reasonable to measure BUN and creatinine and, if other clinical evidence suggests adrenal insufficiency, obtain an ACTH stimulation test. If these tests are normal, a patient with persistent low-grade hypothermia can simply be followed without additional evaluation. In most cases, no new diagnosis will emerge over time and this will prove to be a normal variant for the patient.


Posted 01/28/2003


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Suggested Readings
Danzl DF. Hypothermia and frostbite. Harrison's Online. 2002. Available at:
Invalid Link Removed Accessed November 30, 2002.





Medscape Internal Medicine 5(1), 2003. © 2003 Medscape