52 Y/O Chronic Pain Medication Usage

Pharma / TRT Testosterone Replacement
1

52 Years old (53 in June)
5’6"
33/34 Waist (slimmer in summer)
180 Pounds (170 summer)
BMI 29.87

Grows beard easily, hairy chest, but not a chimpanzee
Excess weight is carried in the mid-section. (beer belly, but I don’t drink)

RX drugs currently daily 100mg Oxycodone since 2010 (for a spine that looks like a fish hook) and 8mg Doxazosin since 2012. Previous to 2012, some other hypertension med, but they messed with my sexual function. So I researched others and decided because of other positive sides, I’d try Doxazosin. I’ve learned (here) that narcotics can mess with our hormones, more on that later.

No hair loss drugs or what’s called here “gear”.

I mostly cook my own meals, never eat fast food, a few times a month we eat out. I eat fruits and/or vegetables with every meal. Exercise is sporadic at best, increasing 10 fold in the warmer months.

Morning temps are around 97.7, I’ve had a few 97.5, but mostly over that. My mid-afternoon temps are 98.6 (ish).

Morning and nocturnal wood are sporadic at best. Erection strength is not one of the low T-symptoms.

I did have some testicular pain a few years ago, I’m guessing in 2011. No direct blows, just a dull ache. I had an ultrasound on my testes, they said there were not any abnormalities. My GP did comment on the fact that they hung up close to my body, but they always have. I almost forgot about writing about it, the pain is gone and have no idea what caused it.

Medical history:

On June 11th 2013, I was hospitalized and treated for life threatening low sodium levels. I had 2 seizures and they put me into a medical coma to bring my sodium levels up very slowly for two days. I was released 2 days after that without a concrete diagnosis of how my sodium levels tanked. A month and two endocrinologists later, this episode was labeled “water intoxication”. At this point I realized I was on my own with my healthcare, and ordered the following blood work to be done and the results are/were below. I’m really hoping that this is not too much information.

Component Standard Range Your Value

GLUCOSE 74-100 MG/DL 111
UREA NITROGEN 8-20 MG/DL 15
CREATININE 0.66-1.25 MG/DL 0.63
GFR NON AFRICAN AMER >59 ML/MIN/1.73sqm >59
GFR AFRICAN AMERICAN >59 ML/MIN/1.73sqm >59
GFR INTERPRETATION
� 
ESTIMATED GFR BASED ON IDMS TRACEABLE MDRD STUDY EQUATION
VALUE OF >59 ML/MIN/1.73 sqm MAY INDICATE NORMAL TO MILDLY
REDUCED KIDNEY FUNCTION DEPENDING ON PATIENT’S AGE.
INTERPRETATION MUST BE MADE IN CONJUNCTION WITH CLINICAL
ASSESSMENT. (NORMAL, STAGE I, OR STAGE II)

CALCIUM 8.4-10.2 MG/DL 8.8
SODIUM 136-144 MMOL/L 142
POTASSIUM 3.5-5.0 MMOL/L 4.2
CHLORIDE 98-106 MMOL/L 104
TOTAL CO2 21-30 MMOL/L 28

Component Standard Range Your Value

TESTOSTERONE,FREE 8.0 Reference range: 9 to 30
(NOTE)Testing performed by Equilibrium Dialysis.

TESTOSTERONE,TOTAL 471 Reference range: 240 to 950
(NOTE)Testing performed by Liquid Chromatography-Tandem Mass
Spectrometry (LC-MS/MS).

Component Standard Range Your Value

25-HYDROXY D3 (51-80) 34

I started taking 5000 IU D-3 twice daily and was tested again on 9-19, results were 78, so that’s corrected.

Component Standard Range Your Value
WBC COUNT 4.0-11.0 K/UL 5.6
RBC COUNT 4.30-5.80 M/UL 4.49
HEMOGLOBIN 13.5-17.5 G/DL 13.7
HEMATOCRIT 40.0-52.0 % 39.7
MCV 80-100 FL 88.4
MCH 26.0-34.0 PG 30.5
MCHC 31-36 G/DL 34.5
RDW 11.5-14.5 % 13.8
PLATELET CT 130-400 K/UL 177
MPV 9.3-12.5 FL 9.0
DIFF TYPE AUTO
LYMPHOCYTES 13-44 % 30.6
MIXED WBCS 1.3-18.5 % 7.4
GRANULOCYTES 42-75 % 62.0
ABS LYMPHOCYTES 0.9-4.2 K/UL 1.7
ABS MIXED WBCS 0.1-1.6 K/UL 0.4
ABS GRANULOCYTES 2.0-8.6 K/UL 3.5

CORTISOL RANDOM 1.3

  • NORMAL RANGES -
    AM CORTISOL 4.5-22.7 UG/DL
    PM CORTISOL 1.7-14.1 UG/DL

General Information
Collected: 07/02/2013 11:16 AM
Resulted: 07/02/2013 8:51 PM

TSH Ranges 0.4-4.7 UIU/ML Your value 1.58

Component Your Value
ESTRADIOL 27
NORMALS
MALE 5.4-65.9 PG/ML
CHILDREN <10

Component Standard Range Your Value
PROLACTIN 3.7-17.9 NG/ML 12.4

Component Standard Range Your Value
CHOLESTEROL <200 MG/DL 166
LDL <100 MG/DL 115
HDL CHOLESTEROL >39 MG/DL 35
TRIGLYCERIDE <150 MG/DL 78
VLDL 0-100 MG/DL 16
CHOL/HDL RATIO <4.5 4.7
NON HDL CHOLESTEROL <130 MG/DL 131

In October, I tested testosterone again because my Vit D-3 was much better and expected my T Levels would be better as well. My lab results were:

T.T 421 (240-950)
F.T 7.6 (9-30)
SHBG 48 (10-57)

I did not get E2 tested at this time. It was 27 (5.4-65.9) in July.

I tried to talk my GP into trying Clomid, she was uncomfortable with that but offered me a script for Adrogel but I really wanted to try Clomid. I was guessing that my Low FT and high SBHG might be due to extended pain killer usage. And I wanted to exhaust all options before going on lifetime injections.

She referred me to the Urologist that didn’t have any problems with trying Clomid. After about 3 months of 25MG per day my results from (apparently a different lab) are:

T.T. 426 (185-540)
F.T. 4.9 (4.4-16.5)
SHBG 75 (10-61)
E2 < 20 (<20-47)

I know that the Estradiol result is not very useful, and I’m unsure why they changed labs.

I met with the Urologist, who (I think) is very antiquated in his thinking/research and explained to him that I would like to wait till 4-1-14 when my new insurance kicks in. (long story). I also told him I am going to 25MG EOD.

On Clomid, I feel better, but nothing like I did in 2010, when things started to go downhill. Before Clomid my QOL was a 2 (1-10), now it’s a 4. In 2010 it was a 9. Before Clomid, my libido was a 9, now it’s a 2. It’s not something that I plan on living with.

Basically on 4-1-14, I can start over with blood work and a treatment plan. I’d obviously welcome any suggestions/advice.

Thanks

BTW, what a wealth of information that this website contains. I’ve read all of the stickies, I’ll have to read them several more times to digest all the information. And a special thanks to Ksman for the 1000’s of hours of dedication to this forum that likely (mostly) goes unappreciated. The knowledge that you convey is unexplainable. Good Lord.

2

A couple of things that I didn’t report on my initial post…

I also take 2-4 grams of EPA Omega 3’s daily, 50 mgs of Zinc, 400 Mgs of magnesium, and when I remember, 1000mgs of Vitamin C.

I am tapering off of Clomid presently with 25mg EOD for a week, then E3D for a week, then E4D, etc until 4-1-14 when I start with a different treatment. If this is not an appropriate taper, please advise.

My symptoms include the normal Low T stuff, always tired, lethargic, not sleeping well, (I’m gonna try 1mg of melatonin at night), lack of motivation and a general lack of zest for life. Until Clomid, my libido had not suffered, nor has erection strength even with Clomid.

Question, would anyone think that HCG monotherapy might be an option for me?

And would anyone agree that the pain medication that I have been taking be a likely culprit to my test levels?

I know, the easy thing to say, is just stop the pain meds. If I had to chose for the rest of my life, living with the pain levels that I experience or having the low T symptoms, I’d rather live without the constant pain.

I’ve been doing as much reading as I can, admittedly, between having the Flu for the 5 days, and everyday normal activities, I haven’t read as much as I’d like to. If anyone knows of a case thread with that’s similar to mine, I’d appreciate a point in the right direction.
I did do some searching, but likely not well enough.

TIA for any advise that someone can offer me.

3

I know exactly what you mean with the pain meds I’ve been on a high dose for years, what’s bad is when Drs prescribe it they don’t tell you it will make your T levels drop but it for sure dose. One thing that I would question is your high shbg it will bind with your T so that part can’t be used. Your E2 is a little on the low side and that could be effecting your libido. Hopefully someone with more experience will see something else in your labs, good luck man.

4

[quote]ironman4850 wrote:
I know exactly what you mean with the pain meds I’ve been on a high dose for years, what’s bad is when Drs prescribe it they don’t tell you it will make your T levels drop but it for sure dose. One thing that I would question is your high shbg it will bind with your T so that part can’t be used. Your E2 is a little on the low side and that could be effecting your libido. Hopefully someone with more experience will see something else in your labs, good luck man.[/quote]

Thanks for the comments, it’s good to know that I’m not alone on these issues. I read your thread before I even joined here, I’ll read it again to see if I can pick up any tips.

Would you, or anyone agree that I should getting all of the labs for the “Before you start TRT” as per in the stickies when I go in for a blood draw on 4-1?

These?
Labs to be done before you start TRT
-LH and FSH [LH/FSH]
-TT
-FT or bio-T
-E2
-Prolactin [optional in most cases]
-DHT [sort of a waist of time and blood if your testosterone levels are low]
-PSA
-DRE: the dreaded digital rectal exam, doc gives you the finger.

5

I would so that I knew where I was at and how your treatment will be effecting things, that’s been one of my biggest problems is trying to get Drs to run all the tests that you want. I don’t know if you tried the Androgel or not but anything along those lines or even the Clomid will probably have your LH and FSH numbers down some but I would still want to know where I was at. Good luck

6

So I went to see the vampire on 4-1, to get blood drawn and see where my levels are. I had presently been taking 12.5MG of clomid EOD, still feeling like crap, not sleeping well, but could take three 2 hour naps every day. My libido was a little better after I dropped from 25MG EOD to 12.5, but still not even close to what I think is normal (for me).

Last year, I didn’t take any SAD (seasonal affective disorder) meds and should have, this year I called my GP and told her I needed some Wellbutrin to get me over the hump, until springtime. This medication was recommended here by folks, so her and I decided on 75MG twice daily. This has been the only change in medication.

Blood results are:

TT 880 (240-950)
FT 18 (9-30)
E2 34 (5.4-65.9)
LH 5.5 (1.3-10.5)
FSH 18.1 (1.6-9.7) ***

*** Are these levels out of whack because of Clomid, or is this something else I need to be looking into?

Looking at these numbers would make a person believe that I felt like a million buck, but not so much. I was really hoping that the “Clomid Trial” would give me a better QOL, I disappointed that I am in the majority of men that it doesn’t help. Sure helped my numbers though…

Before my meeting with my urologist I messaged him and planted seeds as to what I thought our next step with my treatment. I explained ultimately, I would like to end up with bi-weekly injections, with a AI and HcG. But if he was uncomfortable with me self injecting, then I would like to go with an Androgel trial. (I am trying to do baby steps with him, he has not dug his feet in and said no yet, I don’t want to throw too much at him and leave him overwhelmed.

At my appointment, we talked about the next step, and I suggested Androgel 1.62, he called in a script and off I went.

I started with the recommended starting dose of 2 pumps, 40.5MG daily 4 days ago. I am not feeling any better at all, if anything worse. Others have reported immediate improvements, I am worried that I will not be a good absorber.

I am scheduled for new blood tests on 4-22 to see where I’m at. I will be ordering:
TT
FT
E2
SHBG
?

Question: I should be stopping Clomid now so that I get a true Androgel reading in another 8 days? I think that I read here, that if I went to some form of supplemental test, then tapering clomid wasn’t terribly necessary? Or am I gonna crash because I am not absorbing the gel very well?

Between now, and my next appointment, I am going to drop off some paperwork on “TRT: Protocol for Injections” found here, and some information on HcG as well. Again, baby steps for this man, I have to plant and cultivate seeds.

I’d appreciate any comments on my blood work and any other comments/suggestions that may be helpful with me proceeding forward with TRT.

7

Your blood look pretty good…
E2 is a little higher than most feel best at… Are you talking an AI ?
WIth the same dose if clomid my E2 is 70… I felt better with lower T and NO clomid…
Even small doses make me feel shitty… But I need to get my E2 in check to have an idea.
I am hoping to give my system a restart and am going to taper off soon.

If you stay on clomid there is no point in the andro gel with your blood work…
If I was you… I would drop the gel run take the clomid for another week or 2 then taper off… (You might want an AI for this step)
And see how you feel with no TRT… If that doesn’t work you need a new plan…

8

I have a feeling the clomiphene dose is still too high. I mean, 880 TT is almost double my result on testosterone AND the FSH is through the roof. Once Clomid kicks in maybe it takes less of the drug to maintain effective estrogen blocking? Maybe you could space it out another day as well? The half-life is 5-7 days so EOD is really piggybacking a few of your doses.

9

[quote]C27 H40 O3 wrote:
I have a feeling the clomiphene dose is still too high. I mean, 880 TT is almost double my result on testosterone AND the FSH is through the roof. Once Clomid kicks in maybe it takes less of the drug to maintain effective estrogen blocking? Maybe you could space it out another day as well? The half-life is 5-7 days so EOD is really piggybacking a few of your doses. [/quote]

What do you mean by this ?? how does clomid block estrogen ?

“Once Clomid kicks in maybe it takes less of the drug to maintain effective estrogen blocking”

10

[quote]Macmathews wrote:
Your blood look pretty good…
E2 is a little higher than most feel best at… Are you talking an AI ?
[/quote]

I am not taking an AI. I’m not sure that the doctor even is familiar with it as part of a current TRT treatment. Baby steps…but yes, E2 has increased from 27 to 34. And TT is crazy high, at least compared to what it has been. I am definitely secondary. What I’m mad at myself is not testing SHBG, but everything that I read on here, said that SHBG follows E2, so there’s not much that can be done about it. But if TT is high, and SHBG is higher, along with a elevated E2, that would explain why I’m not feeling much better??

[quote]Macmathews wrote:
If you stay on clomid there is no point in the andro gel with your blood work… If I was you… I would drop the gel run take the clomid for another week or 2 then taper off… (You might want an AI for this step)
And see how you feel with no TRT… If that doesn’t work you need a new plan…
[/quote]

I have been on a Clomid “trial” for 5 months. That should be long enough (?) to make me feel better. The TT numbers tell a story that I should be feeling great, but not so much in my real life. That’s why I wanted to try a more traditional approach to TRT. I’ve read here that trying a SERM monotherapy works for some, but not so much for most. But I wanted to try it, so I did.

Are you suggesting that a restart in my case may be successful? In other words, just taper off the Clomid and hope for the best? And/Or adding an AI because you think my E2 will bounce higher off of Clomid?

[quote]C27 H40 O3 wrote:
I have a feeling the clomiphene dose is still too high. I mean, 880 TT is almost double my result on testosterone AND the FSH is through the roof. Once Clomid kicks in maybe it takes less of the drug to maintain effective estrogen blocking? Maybe you could space it out another day as well? The half-life is 5-7 days so EOD is really piggybacking a few of your doses. [/quote]

Please excuse my brain fog here…but you’re thinking I should divide what I’m taking of clomid now (12.5 MG EOD) in half, to maybe 12.50 E4D along with the Androgel? I know that SERM’s and HcG are different mechanisms, but they (kind of) do the same thing. To repeat myself, I am going to lobby for HcG and some type of testosterone supplement (gel or injection) and a AI if needed as a long term treatment.

Honesty, I thing my urologist will do whatever I want him to do, as long as I present it to him in an intelligent fashion. In small steps, if I don’t come across as a know-it-all, (because I know so very little about this), I think he will entertain any logical prudent approach. But certainly, time will tell.

I can’t thank you guys LOUD ENOUGH, for trying to help me on this. I really appreciate the advice!!!

11

I find it quite unreal that you total T has risen so much yet your E2 stays fairly low.
At least compared to mine… My total T has risen to around 650 from 450 after being on 25mg clomid EOD for 4 months…

But my E2 is up from 20 to 70… My personal feeling in your case… Is that while you may still have good numbers with a lower dosage of clomid… You still won’t feel great… from my research some just don’t feel as good… ME INCLUDED…

I felt better with lower T numbers and taking nothing… I might be worth a try though… I could consider both lowering the dose of clomid and for 2-3 weeks and see you you feel… If NOT good… Taper completely off see how you feel in about 2 months with blood work to back it up…
And go from there.

12

[quote]Macmathews wrote:

I felt better with lower T numbers and taking nothing…
[/quote]

Thanks for the thoughts…

But I don’t…after 7 days of the starting (minimum) dose of Androgel, I am feeling a little better than when I was taking (any) dosage of Clomid. Certainly my libido has returned, and it seems that I have a little more energy. I’m not seeing high E2 sides (yet), blood tests are scheduled for the 22nd.

I have stopped Clomid altogether, the only benefit that I saw from it was it made my nuts hang more like they should. Normally they hang tight up against the body, and when I’m erect, they’re just gone. (They hide out in the inguinal canal) For that matter, when I’m cold, they’re gone most of the time also. But maybe that’s here, nor there.

I’m dropping off information on HcG on Monday for my urologist to review before my appointment to talk about test and E2 levels.

13

[quote]C27 H40 O3 wrote:
I have a feeling the clomiphene dose is still too high. I mean, 880 TT is almost double my result on testosterone[/quote]

I don’t think you can compare properly, since the two lab ranges are very different. The upper limit of the one lab is much lower than the other lab.

14

New labs were done on 4-22.

TT 673 (240-950)
FT 18 (9-30)
E2 30 (5.4-65.9)
SHBG 60 (10-57)

This was after stopping Clomid (after a taper) and starting Andogel (40.5MG per day) on 4-11. So after eleven days of Androgel, should we assume that my normal test production is still supplementing the Androgel? I knew that it was an early blood draw, but I wanted to keep an eye on E2, and not let it get away from me.

BTW, I am applying half the daily amount twice per day to my forearms like Dr Crissler suggests in this video.

I see my urologist on Friday (in 2 days), I am going discuss with him the information I dropped off for him to read about HcG and self injecting. So I’ll be watering the seeds that I planted on my goals for long range TRT. And also see if he agrees with me that my normal test production is likely supplementing the transdermal application presently. And a slight increase in gel may be appropriate to counter effect of losing my natural production likely to happen by the next blood test?

Would anyone here agree with those thoughts? My insurance will pay for the transdermal for up to a year, so I thought I’d ride this out for a while and see if I can get E2 dialed in and start taking HcG. As smalI as the boys are naturally before TRT, I’d still really like to keep them. As well as all the other benefits of HcG.

I am feeling better, I’ve been having more good days than bad ones. I still get insanely tired where I never used to, but that’s improving as well. I know it’s not going to be like flipping a light switch, so I’m glad that it’s going in the right direction. I will say that libido has come on with a vengeance, I am waking up with wood that a cat couldn’t scratch. And I can’t remember the last time that I actually finished (ejaculated) on two concurring nights until a week ago. My G/F jumped off of me and wanted to know what I was taking. (She thought I was taking Viagra, or something to that effect) So that area couldn’t be better.

And finally, any thoughts on my high SHBG? I’ve read that this follows E2, so I’d suppose getting that down a few notches may help? Is this something I should be concerned with?

15

So I met with my urologist 5 days ago to discuss my test levels and talk about dosages. I asked if he agreed with me that my natural production is not completely shut down yet after 2 weeks of applying gel and that my test level of 673 will likely drop when it does, and I stay at the same dosage. He didn’t agree, but was okay with increasing the dosage by 50%. He said we’d have a friendly bet, me thinking that my test levels will not increase much in 30 days and him thinking that they will.

But my insurance company didn’t agree at all. They wanted a second PA (prior approval), and then decided that because my test levels were at 673 after the Andogel, that I was cured. Not only did they deny the increase, they denied the original dosage amount as well.

I can’t explain how happy I am right now that we have a “Affordable Health Care” system in place so that my premiums have increased and things like this are denied. (sarcasm).

So after the doctors nurse and I laughed about their infinite wisdom in diagnosing and treating me, I talked to her about injections, and she didn’t hesitate a bit. I explained that even if the insurance is denied for the shots, the cost (according to KSman) is affordable. I was lucky enough for her to be able to set up an appointment with a nurse practitioner that is trained in instructing/teaching me how to self inject for tomorrow. We didn’t talk about a dosage, I was just happy that they were on board with going forward. So, I’ll bring in the “TRT: Protocol for Injections” writeup with me and see if he/she agrees with the typical 100mg/250IU/1.0mg approach.

I’ll report back with updates.

16

It’s been a few weeks since I posted, I’ll try and catch this thread up to current. This first thing that happened when I talked about injections more frequently than twice a month with the NP that works for urologist, was get referred to another urologist. They wanted nothing to do with even thinking about it, or listening to any explanations why.

After multiple conversations with begging and groveling, I was able to get into seeing this new doctor before the ‘soonest opening’ available, in less than a week.

I spent quite some time with the new Doc, much longer than I had ever spent with a Doc. He asked all the right questions, and gave (most of) the correct answers to my questions. He was good with once a week injections, and wanted to see more information on why SubQ delivery and why E3D (or EOD) would be beneficial. He also wanted to see more information on HcG, but has had patients ask about it. He was very receptive to me sending him that information, absolutely has not slammed the door on this. We haven’t talked about a Al, and I’m not feeling sides, but that’ll get checked when I do blood work around the 16th.

Now some questions, if anyone has made it this far…

The script I got was for Depo Testosterone injecting 100MG per week. They gave me two vials, both under half full. Is there an obvious reason that they didn’t just give me the whole months supply in one vial? It would be less waste, getting to the end of the medication in the vial only once instead of twice per month?

Also prescribed were (4) 3ml 23G X 1 syringes. Before I injected for the first time I went into my local pharmacy (I’ve know the pharmacist for 20 some years) and he gave me some 20G for drawing, so that’s covered. But I gather that most people use shorter/smaller 1ML syringes? It would certainly be easier to get a more precise amount drawn, especially if I would got to E3D with 50mg. And I definitely need the inch needles to do an IM injection on the quads?

BTW, I was nervous as a cat on a metal roof on the first injection. But I read as much as I could, watched some Youtube videos, and talked to my pharmacist about before the first one. I had ZERO pain, and that’s with a 23G needle. I know that some (most?) use 25 or smaller.

17

Blood work scheduled for 6-19.

On another issue, I had my GP test for Pregnenolone, and DHEA, I was hoping to get some baselines before my HPTA shut down.

Preg was low, and DHEA was the wrong test, I knew better and didn’t request the DHEA-S.

Pregnenolone was 36 (33-248)
17-Hydroxypregnenolone was 39 (55-455)

At the time that I had these tested, I had been on 4 weeks of gel and one 100MG shot previous. Is it likely that that I was shut down already? I’m pretty certain that I’ve read (here) that it takes longer than 5 weeks for the HTPA to shut down.

And can I assume that HcG will help restore these to acceptable levels?

18

New labs after injecting 100 MG once per week, no Al or HcG.

TT 1250 (240-950)
FT 35 (9-30)
E2 30 (5.4-65.9)
SBHG 52 (10-60)

Pregnenolone 38 (33-248)
17-HydroxyPregnenolone 57 (55-455)
DHEA-S 52 (35-179)

The Preg and 17-Preg have came up into the acceptable (very low) range, they weren’t on the last test.

My Doc said that my test was too high and blamed that on me injecting once a week. He said that he only has one other patient that doesn’t inject twice a month, E2W. The reason I transferred to him was because he assured that he would listen to my concerns about QOL and frequent injecting. However, he is against me injecting more frequently and that I should reduce my dosage from 100 to 80 MG. I’m okay with that (for now), and we have another lab set up in 3 weeks.

Even though he would entertain discussion on HcG, he hadn’t read any of the literature that I sent him on the subject. And I think that he thought that I wanted to try monotherapy, instead of supplementation. Unfortunately, he rushed me out of there, unlike our first meeting. He did however. send me out with a script for 10ML of 200mg/ml, enough for 6 months of medication with 2 refills.

My concerns are:

1.) According to at least once case study here, that if I start injecting more frequently, my test levels will be even higher, or likely to become so? So I could get the same Test levels (and hopefully QOL) with less medication? My QOL is far better now than it’s been in years, but there is still something missing (HcG?) I don’t have the energy that I had just a few years ago, and I don’t think that the difference between age 48 and 53 should be night and day.

2.)My E2 will likely be lower injecting more often, perhaps closer to the coveted “22” number that makes “most” feel good estrogen wise?

3.) With a E2 presently of 30, and more frequent dosing would likely reduce that, would anyone assume that I can maybe be okay without any sort of an Al? FTR, I am not adverse to taking one if needed. The Doc said that most T–E2 is aromatase from fatty tissues and he said that I was pretty lean compared to his other TRT patients. I don’t agree, but that’s not relevant…

4.) Adding Hcg to the mix would (maybe) bump up my E2 enough to require an Al. Is it that much of a jump? Does it aromatase similar to the test to E2 conversion, or more aggressively?

I haven’t gotten onboard with the protocol that’s followed here, because I was hoping that I could get my Doctor to follow suit. He seems to be dragging his feet, most importantly to me, with HcG. Is there a list of “Pro HcG” information/links that are doctor friendly to help present me (and others) persuade their doctors to be more current on TRT protocols? The links I sent him a month ago are/were:

http://press.endocrine.org/doi/abs/10.1210/jc.2004-0802

http://www.mombu.com/medicine/human-head/t-a-primer-on-hcg-and-dr-shippens-hcg-protocol-2-of-8-hypothalamus-depression-nail-testicular-down-2307457.html

I really want my testicles back, they’ve been hanging (or lack of) close to by body since around 2010, when they started to ache. I had an ultrasound done then, and they said everything was normal. So (of course) the attending doctor said, “it all in your head”, go home and stop whining. And now, with Test injections, they are even worse, spending more time up in my body than in the sack. I think that Hcg will help with that, as well as Pregnenolone, DHEA and other positive benefits.

I came here to educate myself, and have so far. But I’d still like to hear what the experts here are thinking about what’s going on with my case. If anyone is still reading this boring case study, and has time to comment, it would (I’m sure) be helpful.

19

It’s been 3 weeks since I posted some questions, and I have another Doctors appointment in a week. I was hoping that someone could comment on any of the 4 thoughts/comments above. Are these possibly accurate or totally off base?

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Injecting large amounts of T infrequently increases E2 levels.

When injecting once a week or less frequently, serum levels change vastly and lab numbers become meaningless as the biggest determinant in lab values is lab timing.

Your FT was OK, but not high. Your TT level is high, but is mostly T+SHBG that is not bio-available, just waiting for the liver to clear it. Your high SHBG is very telling. Your E2 is elevated, but was probably higher earlier in your week and the effect of that causes your liver to product more SHBG. So your TT levels are a misleading indicator of your T levels.

With infrequent injections, your bio-available T levels are changing greatly. Anastrozole is a competitive drug that needs to match bio-available T levels [T+SHBG does not count as it cannot aromatize]. So you dose an AI properly with that moving target. If you inject twice a week, you can take 0.5mg anastrozole at the time of your injections.

In many men, hCG does not create large increases in E2 levels. Needs to be low dose hCG.

Your doc(s) are not capable of rational analysis, they make things up and then believe that they are factual.