7 Years = No Progress

Pharma TRT
1

I will start off my case by saying that because I have been dealing with Low T for 7 years, my story is somewhat lengthy. I will try my best in keeping it short and simple but still painting an accurate picture.

In approx 2006 after months (and perhaps years) of feeling tired all the time, with no energy and constantly sleeping, low libido. I never really had a problem with ED (I have 3 kids). I decided to see a doctor, immediately they thought it was depression and ran the gammut of prescribing anti-depressants (Zoloft, Lexapro, etc) I wasn’t feeling any better on those medications (I actually felt worse) I decided to see a different GP. He decided to test me for low T. Because of how long ago I cannot remember the numbers. I believe my TT was in the 200 range. He prescribed Angrogel. Initially I felt better but that quickly wained. My numbers never really got up to where he thought they should be even after increasing the dosage. After no success he sent me to a Urologist. The U was no help, all he proceeded to do was increase the dosage to the point where I was taking a bath in Androgel each morning and wanted to prescibe me Viagra. That sucked, so I took it upon myself to see an Endo. The Endo impressed me at first, by running more thorough tests (although not as thorough as indicated on this site), tested my Thyroid, did the MRI (which was clean) and immediately decided that I was not absorbing the Andro and put me on shots. He started me on IM shots 1.0 ml every 14 days. I felt GREAT at first, but after a few months and testing he determined that I was way too high at the beginning of my cycle, so he decided to lower the dosage to .75 ml every 11 days. I have been on that cycle for a few months now and I feel like crap. I don’t even feel better immediately after my shot anymore. My energy is gone, my libido has diminished, I am irritable all the time, easily frustrated. The Endo has even tried to slip the old “your depressed” excuse in there, but I wasn’t having it. ( he has also tried to mask the problem by prescribing once a day Cialis)

Below are my vitals, I have had multiple blood tests with this Doc, but he pretty much tests the same thing every time, so your advice on what is missing from the below list would be very helpful. I have an appt with him next Monday and I would like to go in armed with knowledge. I don’t think I will get much resistance, he seems to be willing to try what I want.

Age: 41
Height: 5’9"
Weight: 185 (was up to 210 before starting TT)
Waste: 33" (was 36" before I started TT)
Body Hair: can grow a mustache but takes about a month. Cannot grow beard. Have pretty hairy legs, not very hairy arms. Basically no chest hair except a little around the nipple. Full head of hair but hair line is thinning.
No major heath conditions. Seasonal Allergies. When I got laid off from my job in 2006 I did suffer panic attacks and was prescribed Wellbutrin for it. (no longer taking) Only surgery ever was having appendix removed when I was 10.
Right now, basically no exercise. Up until about 3 months ago I would do 30 minutes of cardio and pushups, situps and bicep curls 3-4 days a week.
I take a Multi-vitamin, D3 supplement and C supplement every day.
Testes do not ache.
Have some morning wood, but not as firm as it was. Same with general erections, not as firm and recently havent been lasting long.

Labwork: (from LabCorp)

Renal Panel
Glucose, Serum 99 mg Range 65-99
BUN 12 mg Range 6-24
Creatinine,serum 1.14 mg Range 0.76-1.27
eGFR 79 ml Range >59
BUN/Creatinine Ratio 11 Range 9-20
Sodium, serum 140 mmol Range 134-144
Potassium, serum 4.2 mmol Range 3.5-5.2
Chloride, serum 104 mmol Range 97-108
Carbon Dioxide, total 22 mmol Range 20-32
Calcium , serum 9.4 mg Range 8.7-10.2
Phosphorus, serum 3.3 mg Range 2.5-4.5
Albumin, serum 4.6 g Range 3.5-5.5

Free T4 1.3 ng

HDL 42 mg Range >39
LDL 129 mg Range 0-99
TSH 1.940 uiu Range 0.45-4.500
Cystatin C 0.75 mg Range 0.53-0.95
Testosterone, serum 461 Range 348-1197
LH 0.1 Range 1.7-8.6
FSH 0.2 Range 1.5-12.4
Estradiol 33.3 pg Range 7.6-42.6
Cholesterol, total 192 mg Range 100-199
Triglycerides 218 mg Range 0-149

He only tested the Estradiol above because I asked him to. The below tests were about a month prior to the results above in which he did not test Estradiol:

Hepatic Function Panel
Protein, total 7.3 g range 6.0-8.5
Bilirubin, total 0.5 mg range 0.0-1.2
Bilirubin, direct 0.14 range 0.00-0.40
Alkaline Phosphatase 74 IU range 25-150
AST (SGOT) 17 IU range 0-40
ALT (SGPT) 19 IU range 0-44

Free T4 1.0 ng

TSH 1.780 uIu range 0.45-4.500

Reverse T3, serum 12.8 ng range 9.2-24.1

Cystatin C 0.72 mg range 0.53-0.95

Testosterone, serum 494 ng range 348-1197
Free Testosterone 16.7 range 6.8-21.5

Prostate-Specific AG 2.2 ng range 0.0-4.0

Triiodothyronine (T3) 108 ng range 71-180
Thyroxine Binding Globulin 20 ug range 13-39

Any help or guidiance you can provide would be appreciated. I tried not to be too long winded, but hopefully what I have provided painted a big enough picture? I can provide more info as the need arises. Thanks!

2

I plan on getting my blood draw tomorrow so that I can discuss the results with my Doc on Monday. Any advice on which tests I should request and then post results in my case on this board, I would be very appreciative. I have read the stickies above, but along with reading some of other cases, I am very confused on what I should have tested (for a person who has been on TT 7 years)and what I shouldn’t.

3

Your labs are OK. No need to test LH/FSH again.

Please read the thyroid basics sticky

  • provide history of iodine intake from vitamins and iodized salt
  • provide waking and mid afternoon oral body temperatures
  • feel cold easily?
  • dry skin or brittle hair/nails?

What is the range for fT4?

Read the protocol for injections protocol

  • change injection frequency

With injections of one week or longer, labs become quite useless as you are taking a sample of something that is changing greatly.

You would feel better with steadier T levels and lower E2 levels.

4

[quote]KSman wrote:
Your labs are OK. No need to test LH/FSH again.

Please read the thyroid basics sticky

  • provide history of iodine intake from vitamins and iodized salt
  • provide waking and mid afternoon oral body temperatures
  • feel cold easily?
  • dry skin or brittle hair/nails?

What is the range for fT4?

Read the protocol for injections protocol

  • change injection frequency

With injections of one week or longer, labs become quite useless as you are taking a sample of something that is changing greatly.

You would feel better with steadier T levels and lower E2 levels. [/quote]

Thank you for your response!

I started taking my temps last night and here is the results so far:

10:00 pm was 96.0 first reading, I took it again and it was 97.1.

Today

8:00am 97.0
1:00pm 97.7
4:30pm 97.9

I will continue to monitor over the next several days.
I do feel cold ALOT. Constantly cold hands and feet. I do have somewhat dry skin and coarse/dry hair. But nails and hair are not brittle.

My multivitamin has 150mcg Iodine. Which I have taken a few years. My wife cooks with Iodized salt, I use it on some of my food, but not a whole lot. I use it most on potato products (fries, baked, mashed)

The range for T4 was 0.8-1.7 my number was 1.3 (sorry I missed that)

I was thinking my Cholesterol and Triglycerides were high, but then again, I WAS NOT fasting for my blood test.

I go see the Doc on Monday. I will press for the SQ injections a few times a week. What about HCG and AI? Do my numbers warrant them? My testicles have shrunk some and virtually disappear when I get an erection. I figured there was no hope in getting those back because I have been on TRT for so long. I do carry SOME chest fat, but I don’t know if I would necessarily call it gyno. I have always been big in the chest area.

5

In many states, insulin syringes do not need a prescription. You can get those and inject your prescribed amounts in whatever fashion that you feel works best for you.

“You would feel better with steadier T levels and lower E2 levels.”

hCG, testes may be toast…

6

In my state you can’t get the insulin syringes from your local pharmacy without a scrip, but you can buy them at Walmart without one…go figure? So don’t give up just because Walgreen says you can’t get them…much cheaper at Walmart too.

7

Sam’t and Walmart have a house brand. “Relion” which is very affordable.

8

Ugh…went to the Doc. For some reason I let him talk me into switching to Axiron. He agreed that my shots were not frequent enough and that is causing my mood and energy spikes. I asked him about injecting via SubQ more frequently. He did not agree with it. He said that because the injection is not as deep some could ooze back out of the skin. He also said that delivery method is just the same as TD’s because I am absorbing thru the skin/fat. He said I might as well try the Axiron. He said patients have reported absorbing it better than Androgel and Testim.

Results after ONE month (2 pumps) Axerion:

Total Test 493 ng 348-1179
Free Test 11.8 pg 6.8 - 21.5
Estradiol 26.8 pg 7.6 - 42.6
Prolactin 7.7 ng 4.0 - 15.2

Results after TWO months and increasing dosage to 3 pumps:

Total Test 401 ng 348 - 1179
Free Test 11.2 pg 6.8 - 21.5
Estradiol 29.4 pg 7.6 - 42.6
Prolactin 10.9 ng 4.0 - 15.2

Other “alert” levels on my bloodwork:

Glucose 109 mg 65 - 99
HDL Cholest 38 mg >39
Triglycerides 197mg 0 - 149
LDL Cholest 116 mg 0 - 99

I am now convinced I do not do well on TD’s (after an also unsuccessful attempt with Androgel) . Where do I go from here? Obviously I will go back to injections and will do so more frequently, but is he correct with the absorbtion comment? Do I run the risk of not absorbing as well via that delivery method? Or do I just stick with IM injections? Do my Estradiol levels warrant an AI? I have a feeling as my T levels go up so will my E levels.

Thanks!

9

It is possible that E will raise with T, but not in all cases. People who use Ai’s try to get to a level of 22. everyone Is different. Your E is a little bit over 22 but not horrible. I have never tried an AI but for some it works. Realize you do need estrogen if you get to low u are going to know it. U said your built like a cyclist if that is indeed the case and you have low body fat aromatase will be less.

10

Not sure where you got that I stated I was built like a cyclist. I am 5’9" 185. Definately not low body fat. I have some Tamoxifin that the Dr. prescribed a while back. Which I have not taken. From what I can make from the stickies, that is not the way to go to keep E levels down?

I just read another post from today that stated that SQ injections are a slower delivery method. Maybe I will stick with IM for now. Not looking forward to jabbing that huge needle in me every few days.

11

Get HGBA1c and insulin tested, switch to low carb diet, drink cinnamon tea and take alpha lipoic acid. Get a cheap glucose meter and test yourself fasted and two hours after meals anything over 100 fasted and 130 after eating is a red flag.

You need to go back to injections at a higher and more frequent dose, with a little bit of AI and HCG. How many MG’s were you given during injections?

I’d suggested 30 mg of T EOD sub q, 250 IU of HCG EOD, and .25 of arimidex split twice a week for a total of .50 mg.

Aim for Free T right at the top of the range a little bit over is ok. E2 in the low 20’s.

Check hematocrit data.

12

Tamoxifen/Nolvadex Tamoxifen - Wikipedia
This is a SERM and increases estrogen levels while protecting selected tissues from estrogen.

Read the advice for new guys sticky.

To reduce E2, you need an AI, anastrozole is the most widely used effective product.

Doc is making things up as he comes to his opinions. Read the protocol for injections sticky.

Your body temps are low. Have you read that sticky yet?
If you need a 750mg IR, 5000 doses of 150mcg would do that. 150mcg is treading water!
It has been two weeks since those temperature readings… you need to do something.

Was that a 12 fasting glucose lab result?

13

I started my first SQ shot on Friday. Wasn’t too bad. Shot area was pretty sore on Saturday. I did 50mg. I will do 50 twice a week (100mg total) to start out and adjust from there. Felt pretty good all weekend. Energy seemed to be up more than usual.

I will stay away from the Tamoxifen. Bad thing is that I cannot get in to see my Dr. for a month. I don’t think he would have a problem writing a script for anastrozole, but I do not want to wait that long. I tried searching for it as a “research chemical” but nothing looked very legit. How do I know I am getting what I pay for from those sites and not just some vial of water? Can anyone PM me a reputable site to order some?

Regarding my temps. When I took those first readings it was in the middle of winter here in the Midwest (OH), so my body is always cold. As the weather got warmer, so did my body temps. I asked the Doc about it, he said not to go by the 98.6 standard, he said that was bullshit number that was made up. He said in the high 97’s is where I want to be. I started taking Kelp supplements this weekend to be safe.

I never thought much more about the HCG. Per KSman’s earlier comment he said because I’ve been on TRT so long, my nads may be toast already. Again, I asked the Doc about it. He said he’d give it to me if I wanted, but if I am done having kids and all I want it for is the appearance of my nads, it would be up to me to weigh the options of appearance or possible increased health risks by taking HCG. (My wife said she could really care less what size my nads are)

14

One week in on SC injections. I have taken 2 shots at 50mg per shot. Energy level is back to normal, which is good. Although, feeling a little more irritable/aggressive than usual. Find myself getting pissed at things a little easier. Even the wife noticed it. Could I be giving myself too high of a dose? Or should I give it some more time and let things even out?

Have been checking glucose readings. Nothing really out of the ordinary.
Haven’t noticed any differences while taking 550 mcg of Iodine per day. Is that still too low of a dose?
Also have started taking 4 grams of Vascepa (synthetic Omega 3) per day.

Have not received any PM’s regarding a good site to order anastrozole. Should I press the Dr. for HCG when I go back or is it too late for me?

15

don’t think i can PM yet, but google liquidex - the 2nd result on my search is the one i used. seems good - good rep, product seems to work.

[quote]Cat-Man wrote:
One week in on SC injections. I have taken 2 shots at 50mg per shot. Energy level is back to normal, which is good. Although, feeling a little more irritable/aggressive than usual. Find myself getting pissed at things a little easier. Even the wife noticed it. Could I be giving myself too high of a dose? Or should I give it some more time and let things even out?

Have been checking glucose readings. Nothing really out of the ordinary.
Haven’t noticed any differences while taking 550 mcg of Iodine per day. Is that still too low of a dose?
Also have started taking 4 grams of Vascepa (synthetic Omega 3) per day.

Have not received any PM’s regarding a good site to order anastrozole. Should I press the Dr. for HCG when I go back or is it too late for me?[/quote]