Got Questions After Reading Stickys

Pharma TRT
1

Went to my GP on 8-19-10 because of no energy, depression, mood swings, weight gain around my middle and loss of interest in sex. He decided to do blood work and check T and TSH. He prescibed me Wellbrutrin XL 150mg one a day (Helped alot with my mood). I waited to hear back from my GP and I finaly called 10 days later. He was busy and his nurse called me back and told me my T was low and he wanted me to come by that day and get a shot.

So I went down and got a shot of T from the nurse and she said she would see me in two weeks for my next shot. I ask her how many shot i had to get, imagine my surpise when she told me from now on. I was not happy with that and hit the WWW, which brought me to you fine folks.

A little about me, I’m 37yearold 6’2" weight now is 300lbs I carry it pretty well(no one believes weigh that much). Did have a very active life style up till 8years ago, started having BP problems(Vaso Vagel Syncope) got put on a beta blocker and put on 20lbs in two weeks and could not workout with any intensity, 4years ago had my gallbladder removed, had a vasectomy last year and have been going down hill and gaining weight and loosing muscle every since. I have not been on any meds for at least 3years. Here are my labs before the shot.

Quest Diagnostics

KS-T4 FREE 1.2 0.8-1.8ng/dl
AMD-T 193 250-1100ng/dl
AMD-T FREE% 1.85 1.50-2.20%
AMD-FREE T 35.7 35.0-155.0

TSH 1.97uIU/ml M/F 20 years 0.40-5.50

glucose 93 70-110mg/dl
bun 19 9-21mg/dl
creatinine 1.1 .7-1.2mg/dl
bun/creatinine 16.8
sodium 144 137-149mmol/L
potassium 4.1 3.6-5.2mmol/L
chloride 104 98-108mmol/L
co2 28 22-30mmol/L
calcium 9.8 8.4-10.5mg/dl
phosphorus 3.4 2.5-4.5mg/dl
uric acid 8.9 3.5-8.5mg/dl HI
total protein 8.1 6.3-8.5g/dl
albumin 4.5 3.9-5.2g/dl
globulin 3.6 2.4-3.5g/dl HI
a/g ratio 1.2 1.1-2.2
ast 40 5-40U/L HI
alt 49 7-56U/L
ldh 410 313-618U/L
alkp 79 38-126U/L
total bili .7 .2-1.3mg/dL
triglycerides 243 40-160mg/dL HI
cholesterol 206 0-200mg/dL HI
direct hdl 39 35-100mg/dL
ldl 118 0-130mg/dL
vldl 49mg/dL
chol/dhdl 5.24

After researching here and other sites I got a copy of my labs but no one could tell me what my shot was other than 2ml of testosterone(which was heaven, got more done in a week than I had in the last month). So at this point I decided to go to a Urologist. He then did a physical and ordered more blood work and put me on a compounded T/Chrysin 10/5% cream ED(not a big fan of this after having the shot and having two small daughters).

I didn’t see the order but heard him say to do T, FSH, LH and I think Estrogen but hoping Estradiol. I have not got those results due to him being on vacation and the nurses will not give me copy till he gets back on the 8-24-10. He said he I had Primary Hypogonadism.

So my questions are can he get that diagnosis with just the TSH? Can I still get any useful LH, and FSH labs after one shot? I’ve also been wanting to take so Zinc, vitamin d, b12, fish oil and maybe some sodium or should I wait to get on more regular treatment plan before adding any additional things? I also have a very stressful job and have read about cortisol in searches and wondering if that is something to consider now or later?

Any info you can aford me would be greatly appreciated. I got alot of information in the stickys and www, it’s alot to digest so I hope I’m not asking to many stupid questions but am aiming for the TRT protocol set in sticky, it’s a pretty important step in my life and just needed a little direction.
Thanks again

2

welcome onboard. You found the right place.

Good luck with the fun wonderful HRT journey you have just started (sarcasm).

LH and FSH are worthless after you start shots, as the shots will shut down your production of LH and FSH.

I am worried about your Urologist since there is no way to know if you are primary or not without a baseline LH/FSH results (BEFORE you started HRT which you don’t have).

TSH is basically useless, but the 1.97 does show that you have a problem, and you need a complete Thyroid workup per the blood test sticky to see what is going on (including RT3, antibodies, etc.)

you know that biweekly or weekly T shots are terrible due to the hormone rollercoaster.
you know that T shots without aromatase control are a bad idea.
you know that HCG is needed to maintain testicular function (not just sperm, but pregnenolone, etc.)
you know that finding a good qualified doctor to work with you is extremely hard to do.

zinc, D3 (not just D), B12, fish oil, etc. are all good for most people. No reason not to start them.

yes, you should test cortisol, ferritin, Vitamin D 25OH, etc. - check out the blood test sticky.

High Cholestorol is your system trying to feed more raw material to your hormone production line.

3

PureChance, thanks for the reply. You confirmed what I had thought, a month wasted. I sorry I didn’t say it earlier but after reading about the biweekly shots rollercoaster is why I switched to the Urologist. I had a physical at work on the 16th and had my list of the test to take after starting TRT, they said they would try to test what they could, not sure what tests I’ll get back, if any.

I’ll ask the Urologist questions about the LH, FSH tests and thyroid workup and what he’s willing to try in the way of self injections, AI, Hcg if thyroid is ok and go from there. Lay all my cards on the table and see if I need to go else where.
Thanks for the help, it’s greatly appreciated!

4

iodine in vitamins?
using iodized salt?

How long between injection and the other lab work?
You were doing the T cream for the other lab work?

If on the cream and T levels are low, that mal-absorption is a symptom of hypothyroidism.

Check waking body temp, before you get out of bed. Temps near 97F are an indication of low thyroid levels, 97.8 is considered ideal. Start recording temps if low. fT4 does not indicate hypothyroidism.

If you have thyroid problems, you may not be able to absorb transdermal cream.

“So my questions are can he get that diagnosis with just the TSH?”
-TSH has nothing to do with diagnosing hypogonadism, did he say hypothyroidism? Most docs would not think so.

“He said he I had Primary Hypogonadism.” That cannot be diagnosed without LH/FSH test results.
-Your urologist may be an idiot.

5

Hey, thanks again for the help. Went to the UR today got some test results back.

Boston Labortories
Estrogens Total 187 40-115pg/mL
LH 1.7 1.5-9.3mIU/mL
FSH 1.4 1.4-18.1mIU/mL
Prolactin 8.5 2.1-17.7ng/mL

This is all he tested for. These results were taken after one week of a two week shot. After looking at these results he said it was definitely Primary Hypogonadism. I ask him how he could tell that with these result after having had a shot. He replied that if I was not producing LH or FSH that the numbers would be a lot lower than they are and if they were to high they would still be high showing a problem.

iodine in vitamins? Yes, 150mcg ED.
using iodized salt? Not very often, the salt we use is iodized.

How long between injection and the other lab work? Got one two week shot on 8-20-10, then been on the cream ED. Thats all they gave me as far as lab work.
You were doing the T cream for the other lab work? I have had labs done for a physical at work but have not got the results yet, since I’ve been on the cream.

I think he said that the TSH showed him my Thyroid was working? But I’m still sure on that diagnosis.

I did talk to him about the TRT Protocol for injections listed in the stickys. He said is that what you want to try? I said hell ya! So he made RX for Cypionate but wants me to take it weekly, said that he might have to give me a HRT shot later on, and that I didn’t need an AI I just needed to loose some weight(which is one of the reasons this whole roller coaster got started).lol
But it’s a start at least I can inject E3D now, and try to find something OTC for my E2.

Went to get my RX and ask for #29 0.5ml 0.5" insulin syringes and my Pharmacist said those weren’t what I would need for a IM shot, so I told him what I planned on doing and said that an excellent idea and wonder why he hasn’t heard of that before. He only had 1.0ml syringes thought.haha One step forward two steps back. At least we’ve converted a Pharmacist to the darkside.lol
Once again Guys thanks for the help

6

Drop total E and go with E2 labs if you can.

TSH=2 is a concern, but remember that docs are into treating diseases, not optimizing health.

I don’t like what the doc seems to be saying, but if he writes the scripts, you can manage the rest.

7

please check out stopthethyroidmadness for more info on Thyroid issues.

TSH > 1 means there is a possible problem
TSH > 2 means that there is a problem

most docs won’t treat until you are TSH > 5 (which is stupid).

8

[quote]PureChance wrote:
most docs won’t treat until you are TSH > 5 (which is stupid).[/quote]

And some won’t even treat until you are above 15 (per the “stupid doctor quotes” thread on STTM.com) facepalm

9

[quote]VTBalla34 wrote:

[quote]PureChance wrote:
most docs won’t treat until you are TSH > 5 (which is stupid).[/quote]

And some won’t even treat until you are above 15 (per the “stupid doctor quotes” thread on STTM.com) facepalm[/quote]

Oops, that should have been another ‘0’ as in one hundred fifty (150)

#70 per below:

10

and some will tell you that anything other than TSH is unnecessary unless 5 or more and that asking for t3/t4 is something that OHIP shouldn’t have to pay for and make you feel like some kind of criminal for asking for it

OHIP - ontario’s free health care system

11

not that i’m bitter

12

You can use the [edit] function to correct a post. + [edit]

[quote]VTBalla34 wrote:

[quote]VTBalla34 wrote:

[quote]PureChance wrote:
most docs won’t treat until you are TSH > 5 (which is stupid).[/quote]

And some won’t even treat until you are above 15 (per the “stupid doctor quotes” thread on STTM.com) facepalm[/quote]

Oops, that should have been another ‘0’ as in one hundred fifty (150)

#70 per below:

http://www.stopthethyroidmadness.com/give-me-a-break/[/quote]

13

[quote]KSman wrote:
You can use the [edit] function to correct a post.
[/quote]

That depends on what kind of mood the mods are in. Sometimes the edits hold up, sometimes they don’t!

14

So, I had a physical for work and gave them a the list of labs from the lab work sticky. They told me they would see what they could do for me. Well they did the usual, but also did E2, T, Estrogen total and a PSA, TSH. Here are some of my labs after a two weeks of T cypionate(1 injection of 2ml of ?mg) and three weeks of coumpounded T/chrysin 10/5%.

Quest Diagnostics
PSA .48 0.00-4.00ng/mL
Estrogen 326 130 or less
Estradiol 120 13-54pg/mL
Test Total 696 250-1200ng/dL
Test Free % 2.2 1.50-2.20%
Free Test 140.6 35.0-155.0pg/mL
TSH 1.20 0.34-4.82uI/ml

I’m worried about my E2 but my UR said not worry about it that it would go down as I loose weight. My GP is clueless about it all. Can you get an AI OTC? Since these labs I’ve start taking T cyp. times a week along with 50mg of zinc, 2000ui D3 and wanting to try some resveratrol if it works. I’m trying to loose the weight but when you feel like shit its hard to workout(which I have been). I think if I could get an AI I would be in good shape, I would hate to start all over out of town Dr that might not do anything different but I might have to. Once again thanks for any suggestions.

15

if your doctor doesn’t see a problem with Estradiol at 600% of the ideal male level, then I am not sure what to say - have you called a compounding pharmacy? very few people have had any luck with urologists, endocronologists, etc.

yes losing weight will help (but it is hard to see a scenario where that alone would drop your E2 by 82% or 98 points). Why not give you AI now, and then wean you off once your weight is down to see how you do?

DIM is suppose to help with estrogen conversion (I believe), and if you are on 50mg Zinc, you really need to take 2-4mg Copper (as extra zinc is known to cause a drop in your copper levels).

I would also bump your Vit D to 6,000iu as that seems to be the minimum for most people per countless sites/forums I have read.

how many times a week are you injecting? and how many mg (not ml) of Test?

16

PureChance,
I’m injecting 0.33mg of T cyp. m/w/f. Ur wants 100mg a week. Thanks, I’ll take more D3 and I’m going to get some copper just haven’t had a chance yet. Man, I’m just frustrated and might need to just go somewhere else and start all over. Thanks again

17

50mg zinc is too much, you need anastrozole, the other items will not solve this problem. Get forceful with your doc, you are way out of normal and are at a high risk for gyno and BPH, as well as the mental effects that you have.

What was lab timing relative to injections?

Total estrogen is a waste, just do E2.

You can’t loose effectively when your E2 is high. Your doc does not understand.

If insurance will not cover anastrozole, then you would not want the script, too expensive.

18

Arimidex is now generic. $4 per 1mg pill or something like that I think. I will find out when I go in for a refill - I plan on getting mine compounded into .125mg capsules to take daily.

.33mg is not right.

your bottle says something like 100mg/ml - 10ml or 200mg/ml - 10ml

If you have 100mg per ml bottle and are injecting .33ml = 33mg EOD = 99mg weekly

19

Sorry about that I meant, 1ml every week, so I’m injecting .33ml m/w/f which is 99ml. Close to my 1ml a week Rx. My bottle reads 200mg/ml 10ml. Thats good to know about the generic, every little bit helps. I bet the compounded capsule would make it alot easier, good luck.

20

side note - talking in “ml” is useless. Only use “mg” amounts.

you are injecting 1ml a week and 1ml = 200mg of Testosterone.

so you are injecting 200mg a week.

Just an FYI - 200mg/week is a pretty major dose. Most men only need 100mg a week (500mg a week is a starting cycle levels - I think??). If you need more than 100mg a week, then there is a very good chance that there is something else that is wrong with your system - like cortisol, thyroid, vitamin D, ferritin, etc.

you have a MAJOR problem with your estradiol. I would advise asking your doctor about reducing your Test dose to 100mg a week and starting on Arimidex. You also need a more detailed Thyroid workup as noted earlier.