Doogie's Call for Help

Pharma / TRT Testosterone Replacement
1

Edited to add ranges in results below:

I’ve been feeling like crap for awhile, lethargic, no sex drive, no spontaneous wood (not even morning wood), and I’ve packed on about 45 pounds since November (practically all in my stomach area). I’m 38, 5’10", 260lbs.

I’m bipolar and take Abilify 20mg, Lorazepam 2mg, and Cymbalta 60mg. I know what depression feels like, and that isn’t exactly what I’m feeling. For blood pressure and cholesterol I take Caduet 10/20 and Lisinopril 20mg. Up until the end of October I was working outdoors installing cable. I lost about 40 pounds in 4 months during the summer months. I quit working in November to start remodeling my home to sell it and that is when the weight packed on. I haven’t worked out consistently in over a year, but will be starting back next week.

I just moved and had to find a new Internal Med. doctor for my blood pressure/cholesterol issues. I told her how I was feeling and she agreed to lab work. The results were as follow:

Testosterone, Total LCMS-MS 139.4ng/dL 350-1030
Testosterone, Free (Direct) 3.8pg/mL 8.7-25.1
Cholesterol 168mg/dL 50-200
Triglycerides 69mg/dL 30-250
HDL 58mg/dL 40-60
LDL Calculation 96mg/dL
Chol/HDL ratio 2.9

Sodium 143 137-148
Potassium 4.6 3.5-5.1
Chloride 106 98-112
CO2 29 20-32
Glucose 94 70-100
Anion GAP 8 5-14
BUN 18 6-20
Creatinine,blood 0.8 .9-1.2
Calcium 9.9 8.5-10.6
Albumin 5.0 3.4-4.8
Total Protein 7.6 6.4-8.3
ALK PHOSPHA 79 25-100
Bili total 0.7 .3-1.2
AST (SGOT) 36 8-33
ALT (SGPT) 60 10-50
Globulin 2.6 1.6-4.9
A/G 1.9 .7-3.0
Bun/creat 22

The doctor gave me some samples of TESTIM 1% 50mg testosterone per tube. She’s supposed to be calling in a prescription, and didn’t even tell me whether I’m to use one tube or two per day. (I didn’t get to talk to her when I picked up the samples). She wants me to use the TESTIM for two months and then have everything checked again.

I’ve asked for a referral to a endocrinologist, and I’ve checked out 5 books from the library on T and T replacement. I have no science background so I’m struggling to grasp a lot of this stuff.

I read the stickies and know what tests I need to have my endocrinologist run. My questions are these: Should I even start on the TESTIM before I go to the endo, or should I just hold out. How do I convince to endo to prescribe shots. If I’m able to get shots, how often/how much/ect and what else do I need to request from him? Thanks for any help.

2

In your post, in the lower RH corner: use the [edit] and add lab ranges to the lab results.

You need to test for TSH, fT3, fT4, AM cortisol

Test for LH/FSH before starting TRT!!!

Using iodized salt?
Feel cold?
Check body temperature when waking and during the day.

Hypothyroidism and hypogonadism have similar symptoms.

See if you can take Lorazepam only when needed and not all of the time.

This seems to have started suddenly. Any blows to the head or whiplash prior to that.

What do you eat and what supplements? How/when did that change?

What drug changes last fall?

Have your testes changed? Testes ache? Every ache with a fever?

How did “I lost about 40 pounds in 4 months during the summer months” happen, that can damage sex hormones, thryoid and adreanals. Any other stress events other than this starvation?

Ever take any hair loss drugs, internet steroids?

Have you lost any width of peripheral vision?

Health insurance?

3

[quote]KSman wrote:
In your post, in the lower RH corner: use the [edit] and add lab ranges to the lab results.

You need to test for TSH, fT3, fT4, AM cortisol

Test for LH/FSH before starting TRT!!!

Using iodized salt?
Feel cold?
Check body temperature when waking and during the day.
[/quote]

I don’t salt anything. Habit from having high blood pressure since I was 18. I feel cold, but I chalked that up to moving from South Texas to Northeast Indiana at the end of January. I’ll start taking my temp.

[quote]
Hypothyroidism and hypogonadism have similar symptoms.

See if you can take Lorazepam only when needed and not all of the time.[/quote]

I have an appointment with the shrink on 4/7/11. I’ll try to get off of it then.

[quote]

This seems to have started suddenly. Any blows to the head or whiplash prior to that.[/quote]

No blows to the head or whiplash. I was working 14 hour days outside in 100 degree heat and eating only once or twice a day. I went from doing that to sitting at home eating all day.

[quote]
What do you eat and what supplements? How/when did that change?[/quote]

During the last few months with the weight gain, I’ve eaten a typically shitty diet. Last week I went on a low carb diet with a Saturday cheat meal. I was on day 6 of no carbs when I had my labs done. I’m curious if my Glucose was high considering that. Supplements are fish oil, vitamin, and Black Mamba on days that I have to actually accomplish something:

http://www.amazon.com/Innovative-Bio-laboratories-Black-Mamba-90-Count/dp/B003B8V25K

I was beginning to swing up into a manic episode at the end of October. At that time I was taken off of Lamictal 100mg, my Cymbalta intake was cut from 120mg to 60mg, the Abilify was upped from 15mg to 20mg, and the Lorazepam 2mg was added.

[quote]
Have your testes changed? Testes ache? Every ache with a fever?[/quote]

I really don’t know if they’ve changed or not. The do stay up tight against my body 99% of the time. Haven’t had a fever in forever, so not sure if they ache or not.

My daughter caused us a lot of aggravation during this time and was sent to Indiana to live with her grandmother. My wife was a mess after making the decision and decided that we were going to move to Indiana, too. That meant selling our house, uprooting our son, and losing two good paying jobs. I also wasn’t sleeping well with the long hours I was working 6 days a week. That tends to throw me into a manic or hypomanic state.

We up and moved in late January. Leaving Texas for Indiana is a stress in and of itself. We are living with my inlaws while we wait on our house to sell. I’m still unemployed.

[quote]
Ever take any hair loss drugs, internet steroids?[/quote]

I took 4-ad and MAG-10 back years ago. That is it.

[quote]Have you lost any width of peripheral vision?

Health insurance?[/quote]

No loss of vision that I’ve noticed. Have good insurance through my wife’s work as a nurse at a hospital. Thank god, right, with all the meds I’m on.

Thanks again for you input. I’ve got an appointment with on Endocrinologist on April 6. I talked to his nurse yesterday and she said he doesn’t have any issues with prescribing injections if they are needed. I have to go fasted, so I assume he’s doing bloodwork at that time. I have a follow up appointment on April 20 when I assume he’ll go over the results of the bloodwork. Until then I’m reading everything I can get my hands on (and hopefully understand).

Edit to add that I have obstructive sleep apnea and a CPAP machine. Honestly, though I take the mask off during the night in my sleep so I don’t know how much I actually use it.

4

12 hour fast before lab work: do not get dehydrated.

Have you seen this: KSMan? - Testosterone Replacement - Forums - T Nation

You have to be iodine deficient. That needs to be dealt with. You have probably been iodine deficient for most of 20 years.

Any iodine in your vitamins?

Salt does not cause high blood pressure, but can create some issues when there is high blood pressure. What supplements are you taking for the BP.

Ephedra can mess with dopamine systems in the brain. Might be a risk factor for you.

ALT/AST are elevated. Did you have sore or bruised muscles at the time of the labs?

TRT often makes obstructive sleep apnea worse. Reasons are not known. Thought to not be from physical changes to the air ways. Obstructive sleep apnea can lower GH/IGF-1 and other steroid hormones.

Given your descriptions, adrenal fatigue would not be a surprise, almost expected. Sleep disturbances contribute too. Note that one of the things recommended for adrenal fatigue is drinking glasses of water with 1/2 teaspoon of salt - tricky.

What was the diagnostic cause of your high BP when you were young? Sort of expecting that the cause was not determined the the symptoms were treated and the cause ignored.

Right now you can check body temps, read the linked thread for some iodine background, find a source of iodine.

5

[quote]KSman wrote:
12 hour fast before lab work: do not get dehydrated.

Have you seen this: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/ksman_has_a_thryoid_problem

You have to be iodine deficient. That needs to be dealt with. You have probably been iodine deficient for most of 20 years.

Any iodine in your vitamins? [/quote]

I read your thread on iodine yesterday, and I looked up a lot of articles about iodine deficiency. Really seems to be part of my problem. Will starting iodine supplementation help with the low T? Should I wait until I see the endocrinologist before supplementing? If I can feel better fast, I’d like to start on it tomorrow. There is no iodine in my vitamin.

[quote]
Salt does not cause high blood pressure, but can create some issues when there is high blood pressure. What supplements are you taking for the BP.[/quote]

No supplements for the BP, just Lisinopril and the Caduet.

[quote]
Ephedra can mess with dopamine systems in the brain. Might be a risk factor for you.[/quote]

I hope it messes with it in a good way, because I NEED it to accomplish anything right now. I don’t take it daily or anything, but if I’m not going to be laying on the couch all day I take one.

[quote]

ALT/AST are elevated. Did you have sore or bruised muscles at the time of the labs?[/quote]

Neither.

[quote]

TRT often makes obstructive sleep apnea worse. Reasons are not known. Thought to not be from physical changes to the air ways. Obstructive sleep apnea can lower GH/IGF-1 and other steroid hormones.

Given your descriptions, adrenal fatigue would not be a surprise, almost expected. Sleep disturbances contribute too. Note that one of the things recommended for adrenal fatigue is drinking glasses of water with 1/2 teaspoon of salt - tricky.

What was the diagnostic cause of your high BP when you were young? Sort of expecting that the cause was not determined the the symptoms were treated and the cause ignored.[/quote]

The cause of my high BP was chalked up to heredity. Dad and granddad both had it. I was fit as could be when it was first diagnosed. 5’10", 190lbs of lean mean fucking machine. The doctor doing the physical asked me if I was on the roids (that was in 1991). They used 3 different cuffs that day and the best it came out was 160/110. Now it stays around 138/88

Thanks again

6

Ephedra and other stimulates, can ruin your brain. And can really contribute to adrenal fatigue. Same effects as cocaine, crack, amphetamines, just a matter of degree. In your case, you can’t afford to reduce your ability to benefit from your dopamine reward system.

7

Ok. So I bought a thermometer and haven’t had my morning temp get above 96.5 degrees yet. It ranges from 95.2 to 96.5. That is in the ear.

I’ve been reading a lot about hypothyroidism, low T, adrenal fatigue, and depression. They all have the same freaking symptoms.

I know I have low T from the blood work.
I may have adrenal fatigue from taking ephedrine for 20 years.
I may have hypothyroidism from not consuming iodine since I was 18.

Where do I start if I have all of that mess?

8

The high blood pressure was most likely from the ephedrine. Were you taking the ephedrine when you were diagnosed with the high blood pressure? I would recommend not taking the ephedrine any more.

9

I don’t know if the in-the-ear thermometer is a good or bad match. Check temps during the day as well.

10

[quote]dunnwes wrote:
The high blood pressure was most likely from the ephedrine. Were you taking the ephedrine when you were diagnosed with the high blood pressure? I would recommend not taking the ephedrine any more.[/quote]

No his BP was not from his ephedrine use. He had it in HS, he didnt start the ephedrine until he was in his 20’s.

11

[quote]KSman wrote:
I don’t know if the in-the-ear thermometer is a good or bad match. Check temps during the day as well.[/quote]

I do not have faith in the tympanic I would recommend a normal old fashioned mercury oral thermometer.

So you are suspecting also hypothryoidism?

12

[quote]DJHT wrote:

[quote]KSman wrote:
I don’t know if the in-the-ear thermometer is a good or bad match. Check temps during the day as well.[/quote]

I do not have faith in the tympanic I would recommend a normal old fashioned mercury oral thermometer.

So you are suspecting also hypothryoidism?[/quote]

BUT my thermometer cost more. It has to be better.

As for the hypothyroidism, I don’t know. Just wondering if being iodine deficient has fucked it up.

13

[quote]doogie wrote:

[quote]DJHT wrote:

[quote]KSman wrote:
I don’t know if the in-the-ear thermometer is a good or bad match. Check temps during the day as well.[/quote]

I do not have faith in the tympanic I would recommend a normal old fashioned mercury oral thermometer.

So you are suspecting also hypothryoidism?[/quote]

BUT my thermometer cost more. It has to be better.

As for the hypothyroidism, I don’t know. Just wondering if being iodine deficient has fucked it up.

[/quote]

Did they do a TSH, T3 and T4?

14

[quote]DJHT wrote:

Did they do a TSH, T3 and T4?[/quote]

Not at the internist, but i’m going to make sure the endo does.

15

[quote]doogie wrote:

[quote]DJHT wrote:

Did they do a TSH, T3 and T4?[/quote]

Not at the internist, but i’m going to make sure the endo does.[/quote]

I am sure he will.

16

UPDATE:

I say the endo on 4/6/11. Based on the labs from the internest, the endo prescribed a 10% bio-identical testosterone cream to be used once per day. He also drew about 8 vials of blood for labs. I went back today (4/20/11) to follow up on the labs.

Lab results were as follow:

Test, bioavailable 123.00 ng/dL No reference range on report
Test, Free-CAL 5.24 12.00-49.00
Hemoglobin 15.6 13.0-17.0
Albumin 4.9 3.5-5.0
ALK Phosphate 82 35-123
ALT (SGPT) 33 10-40
AST (SGOT) 32 5-32
CO2 22 20-28
CHloride 102 98-107
Bilirubin total 1.0 0.0-1.0
Calcium 9.6 8.5-10.5
Creatinine 0.7 0.7-1.3
Magnesium 1.7 1.6-2.3
Protein Total 7.4 6.0-7.8
BUN 13 7-18
Potassium 4.4 3.5-5.1
Sodium 139 136-145
Glucose 90 70-105
Homocysteine 8.4 5.0-12.0
CRP-High Sens 0.18 0.00-3.00
T3 Free 4.01 1.80-4.20
TSH 1.31 0.40-4.00
Free T4 1.06 0.89-1.76
Folic Acid 22.30H 3.00-17.00
Vitamin B12 759 193-982.0
ACTH 11.5 0.0-46.0
Cortisol 7.2 5.0-25.0
C-peptide 3.25 0.90-7.10
Insulin 15.10 0.00-29.00
FSH 3.98 0.70-11.10
LH 2.96 0.80-7.60
SHBG 21.3 10.0-57.0
PTH, INTACT 49.6 12-65
Test-TOTAL 217 160-726
PSA 1.0 0.00-4.00
Prolactin 1.22L 2.50-17.00
DHEA-Sulfate 235 80.0-560.0
25 OH VIT D 74.7 23.0-113
Test Free 8.14L 12.00-49.00

During the 10 days I’ve been using the cream, I’ve noticed 0% difference in libido, motivation, or anything else. It sucks. The endo said that it takes longer than ten days to notice any improvement. I told him I wanted injections because my insurance doesn’t work with the place he ordered the cream from, I don’t want to get the cream on my wife or kids, and the injections are cheaper. He suggested that I use the cream 2x day instead of once a day. I insisted on the shots. He finally caved in. I asked about arimidex and he said he couldn’t prescribe it because he hadn’t tested my E levels. I asked why, and he said it was because my insurance didn’t cover E labs.

He prescribed me Testosterone Cypionate 200mg/mL injected once IM per week.
No arimidex. No HcG. Come back in two months and he’ll do more labs and I can pay for the E test out of pocket. Fine. He also prescribed 10,000 IU of Vitamin D.

Questions:
Are there other ways to get arimidex and HcG?
Should I break up the shots into twice a week instead of weekly?
Should I inject SQ instead of IM?
Does my doctor sound like a prick?

Thanks for your help.

17

your vitamin D is just fine. One of the few I have seen at that level actually. why take more D3?

How much are you injecting? 1ml a week? Most do 100mg (.5ml) a week in divided doses (i.e. 30mg(.15ml) EOD)

when was the blood for cortisol drawn? You should retest cortisol next time, but insist on an 8am blood draw.

insist on Estradiol, Sensitive test from Quest.

TSH and FreeT3 look pretty good.

moderate SHBG may indicate that your Estradiol may not be out of control (yet).

18

I’m taking 1ml devided into 2 doses weekly of test. My insurance won’t cover Estradiol test. I plan to self-medicate an anti-E, but don’t know which way to go. I have access to liquid Anastrozole 1mg/ml and 60 ml/bottle, Letrozole 2.5mg/ml 60ml, and Exemestane 25mg/ml 60ml.

Which of these is the way to go? Any help is appreciated.

19

[quote]doogie wrote:
I’m taking 1ml devided into 2 doses weekly of test. My insurance won’t cover Estradiol test. I plan to self-medicate an anti-E, but don’t know which way to go. I have access to liquid Anastrozole 1mg/ml and 60 ml/bottle, Letrozole 2.5mg/ml 60ml, and Exemestane 25mg/ml 60ml.

Which of these is the way to go? Any help is appreciated.
[/quote]

If I was in your shoes I would just pay out of pocket for E2 tests. If high will doctor then prescribe you with arimidex or alike?

If you need fine doses of an AI do the liquid route. Or do as VT suggests get a pill and dissolve it in Vodka and dose that way.