[quote]VTBalla34 wrote:
HCG should not be used with a SERM, as hcg is suppressive so it would at least partially negate the benefits of the SERM. You could try hcg monotherapy for a bit to see if your testes respond (confirmed by bloodwork) and by that point, your testes would be working you could discontinue the hcg and try the SERM restart. This intermediate step would probably make it easier for your recovery so as to not try to turn too many things back on at once.
[/quote]
Sorry, I hadn’t been entirely clear; the hCG wouldn’t be taken in conjunction with the SERM, but instead I would begin the PCT with the hCG (about 12 weeks), follow that up with a period on the SERM, and then follow that with a period taking the AI (my previous use of the term ‘combination’ wasn’t meant to imply that they would be taken alongside one another, but instead as a combination in an overall treatment cycle.)
The intention is that the hCG will stimulate the LH mechanism initially, and the SERM will pick up where it leaves off, to increase the amount of LH. Basically, it was meant to imply what you have just mentioned, lol.
Sounds liek a decent plan to me. I would take the AI with the HCG though as the extra T may cause araomtization issues for you. Discontinue both when you begin the SERM. No need to run an AI after the SERM unless you are still having (confirmed) E2 issues.
[quote]VTBalla34 wrote:
Sounds liek a decent plan to me. I would take the AI with the HCG though as the extra T may cause araomtization issues for you. Discontinue both when you begin the SERM. No need to run an AI after the SERM unless you are still having (confirmed) E2 issues.[/quote]
Based on my recent bloodwork, my E2 numbers came back reading “< 50 pmol/L” yet didn’t give any specific number as a result (nor a reference range) so I’m unsure whether I could say even now that aromitization is an issue. However, should I be able to follow such a protocol, I will bear your advice on the matter in mind! In terms of getting hold of such treatment, do I just enquire with my endo? At the minute I’m not sure when I’ll next see him; he doesn’t schedule frequent appointments, so I’m not actually due to see him until September…
Very grateful for your advice thus far VT- there’s quite a lot of information I’m trying to take in and get knowledgable with, so I appreciate the guidance.
[quote]PureChance wrote:
< 50 means the wrong test was used.
you want to test with the range of 5 to 55 (or something close to that).[/quote]
But surely < 50 puts me within that range?[/quote]
I suspect one of you is speaking metric (watermelon) and the other is speaking conventional (purechance). Units are important in this discussion. Let’s not shoot our Mars orbiter towards venus shall we?
If your E2 is < 50 pmol/L, you divide that by the molecular weight (3.671 for E2) to get 13.6 pg/mL.
This is probably an ultra-sensitive test, so yes it is likely the wrong test.
[quote]PureChance wrote:
< 50 means the wrong test was used.
you want to test with the range of 5 to 55 (or something close to that).[/quote]
But surely < 50 puts me within that range?[/quote]
I suspect one of you is speaking metric (watermelon) and the other is speaking conventional (purechance). Units are important in this discussion. Let’s not shoot our Mars orbiter towards venus shall we?
If your E2 is < 50 pmol/L, you divide that by the molecular weight (3.671 for E2) to get 13.6 pg/mL.
This is probably an ultra-sensitive test, so yes it is likely the wrong test.[/quote]
You want it to be somewhere around 5-55 pg/mL for the range. So that would be something like 18-200 pmol/L. I think I’m doing the math right. Maybe someone that is more used to working with metric units can chime in here.
But you basically want the sensitive test (not ultra-sensitive).
[quote]VTBalla34 wrote:
You want it to be somewhere around 5-55 pg/mL for the range. So that would be something like 18-200 pmol/L. I think I’m doing the math right. Maybe someone that is more used to working with metric units can chime in here.
But you basically want the sensitive test (not ultra-sensitive).[/quote]
Just looked up the conversion rate of Estradiol, so from the units I used (pmol/L) to the units you’re using (pg/mL), the result is, at most, 13.6 pg/mL. I don’t suppose there’s any possibilty of just using that reference for my E2 levels, rather than having to request the sensitive test, which (based on the fact they don’t test for Bio-available Test) I don’t even know if they will do?
you could, but at least here in america the tests that use that reference range are not accurate…the actual E2 levels are vastly different. You can proceed however you want though.
[quote]VTBalla34 wrote:
you could, but at least here in america the tests that use that reference range are not accurate…the actual E2 levels are vastly different. You can proceed however you want though.[/quote]
I’d suspect that I may have to go with whatever tests the doc is already running- it seems that what they test for here (or are capable of testing for) is possibly limited. I certainly can ask if they run any alternative tests for E2, but may just have to continue the route I’m on. It would be easier if they would at least give me some sort of reference range, mind…
All in all, I will be attempting to contact my doc to arrange an earlier appointment; personally, I believe it’s ridiculous that he would leave it the best part of a year before choosing to see me again. I can understand that he wants to give the Testosterone jabs some time to do their thing, but it also means that I could just be kept waiting to find out they’re doing jack shit.
[quote]VTBalla34 wrote:
Yes in this situation it is very important to let your symptoms guide you[/quote]
I wouldn’t be able to say with certainty that my E2 levels are noticeablely elevated. Going off of a physical analysis, I don’t believe I have any noticeable breast-tissue development, and my fat-distribution pattern (though I’ve mentioned it as a possible indicator before,) may simply be genetically determined? However, as I don’t know what to be taking from the results of my previous bloodwork, I can’t say either way. I’m planning to get an appointment arranged with my endo, so as to discuss the possibility of attempting PCT, so I can try to get some feedback from him about my own E2 numbers and their general ranges. He has already agreed to my request of going on an AI (should I need it,) so seems open to the idea of other treatment options. Have to way and see though.
Going back over the history of my bloodwork, my very first results show my LH/FSH numbers as being next to 0, as was my Testosterone. However, based on the fact that my diagnosis was of secondary hypogonadism, and one NOT caused by a defect of the pituitary, only now am I wondering why a PCT-type course of treatment (to stimulate LH) wsan’t the first course of action, rather than just targeting the Test numbers. More recently too, with realizing that my Test levels don’t stay elevated when off TRT, I don’t know why his answer to that has been to just start injecting Test again…
[quote]PureChance wrote:
< 50 means the wrong test was used.
you want to test with the range of 5 to 55 (or something close to that).[/quote]
But surely < 50 puts me within that range?[/quote]
I do not see the problem being addressed and using HRT is fine in the beginning, but further evaluation needs to be done looking at other factors out side of HRT. There still is not enough empirical data to make the determination if HRT is the proper solution for him long term. This is the common mistake people make because the Dr’s are too lazy to investigate other causes.
[quote]PureChance wrote:
< 50 means the wrong test was used.
you want to test with the range of 5 to 55 (or something close to that).[/quote]
But surely < 50 puts me within that range?[/quote]
I do not see the problem being addressed and using HRT is fine in the beginning, but further evaluation needs to be done looking at other factors out side of HRT. There still is not enough empirical data to make the determination if HRT is the proper solution for him long term. This is the common mistake people make because the Dr’s are too lazy to investigate other causes. [/quote]
This rings true of my previous post. I have been down the path of TRT for around 3 years now, yet cannot bring myself to say that there has been any considerable improvement. The focus seems to be geared towards my Test levels, rather than any other likely contributing factor (LH/FSH.) I myself (and I would like to think that my doc should, too) can see that I am unable to maintain elevated Test levels when I am not receiving TRT, yet he seems to think that staying the that particular course is the right thing to do. Based off some of my other bloodwork, I don’t see why he hasn’t considered the alternatives.
Just managed to get another result back from my latest bloodwork…
DHEA-S: 3.9 umol/L (ref. range 1.2 - 17.3)
First time I’ve had that tested. Seems to be within range, though on the lower side of ‘normal’. Should I still be happy enough with these numbers, or (as they’re on the lower side,) could they be indicating something?
I wouldn’t be happy with that. You could try magnesium trans-dermally or supplementing DHEA directly. If supplementing directly, trans-dermal should be much more effective.
You could also test pregnenolone to see if that’s low.
[quote]dhickey wrote:
I wouldn’t be happy with that. You could try magnesium trans-dermally or supplementing DHEA directly. If supplementing directly, trans-dermal should be much more effective.
You could also test pregnenolone to see if that’s low.[/quote]
It’ll be another thing to bring up when I manage to get another appointment scheduled. When I requested the test, he said he would certainly run it, but added that he didn’t know what he would be able to do if it came back abnormal. I’m worried he might try to brush it off because it has still managed to fall within the reference range…
[quote]dhickey wrote:
I wouldn’t be happy with that. You could try magnesium trans-dermally or supplementing DHEA directly. If supplementing directly, trans-dermal should be much more effective.
You could also test pregnenolone to see if that’s low.[/quote]
[quote]PureChance wrote:
if he doesn’t know enough to know what to do if it came back abnormal, then yes, he will brush you off if it is within the “normal” lab range.[/quote]
In which case, is dhickey’s advice the way to go? With the consideration of requesting to my doc that I attempt the PCT, can I additionally request the supplementation alongside? Or should that be something I request be looked into before going on to the PCT?