Looking for Guidance

Pharma / TRT Testosterone Replacement
1

Hi T Nation,

I’ve been lurking/reading lots here for awhile. Appreciate the effort everyone has put into putting all this info together.

A bit of background info. I’m a 39 yo male, I have a complete spinal cord injury at the C4/C5 level from a car accident over 20 years ago.

3 years ago I was having many health issues, fatigue, severe blood pressure drops after eating, hot flashes, stomach issues like excessive gas, nausea to the point of dry heaving, no appetite, pain and major weight loss. I spent 8 months in a hospital where I received a full work up of MRI’s, CT scans, full bone scan, multiple X-rays, upper GI, gastric emptying study & lots of blood work. Everything was clear or “within range”.

They did decide I had low B12, potassium & Testosterone. I started B12& Potassium supplements and They also started me on TRT…with one injection of 100mg of test cyp every 4 weeks. My main symptoms didn’t seem to change but I did gain much improved and lasting hardons.

I developed a pressure ulcer that turned into osteomyelitis which required surgery and a massive dose of IV antibiotics. I’ve had a lot of antibiotics over the years. I was discharged from hospital in worse shape than when I went in.

Once home, fed up with the medical system, I started seeing a naturopath doctor. She started me on lots of vitamins & supplements. CoQ10, B12 sublingual, D3 & K2, B-complex, Probiotics, amino acids. and a few others I can’t recall. Very slowly I started to improve. My GP continued my monthly T shot.

Gradually over a year & a half my skin ulcer healed and I was slowly able to eat again and started gaining some weight. During this time however, my T levels dropped & the new found wood all but disappeared. My Dr increased my T shot dose but didn’t increase the frequency. I didn’t feel a difference, & still had infrequent, lacklustre wood.

I also started having new thyroid symptoms of feeling colder than usual, general hair loss, low body temps of 35Ã?°-36Ã?°C, bad muscle & joint aches in my neck & shoulders. My TSH was 3.5. But of course my Dr’s shrugged it all off… “Within range”.
I started an iodine supplement & symptoms improved a lot. TSH dropped to 1.4. A few months later I started feeling similar symptoms again. TSH had climbed back up to 3.2. I finally convinced my Dr to do a thyroid panel. It’s next to impossible to get a full panel here with “in range” TSH.
The only results I received were:
TSH: 3.29
T3Free: pmol/L range (3.5-5.9) result: 4.5
Antithyroid Peroxidase AB: iU/mL range (<=5) result: <3

I discovered that my iodine supplement only had 50mcg of iodine. My naturopath switched me to a kelp capsule with 500mg of iodine & I also started a selenium supplement and I started feeling better again. Ever since my TSH has fluctuated between 2 & 2.3.

I convinced my Dr to go to biweekly shots of 100mg, my T levels didn’t increase in the first month or two, nor did my erections return. I gained more weight but mostly in the gut.

My bio available T has been around 1.3 - 1.4 for past 6 months. The best I had a record of was dec. 2014.

16/12/2014
TT - 15.5 nmol/L Range: 8.4 - 28.7
Bio T - 2.92 nmol/L Range: 2.1 - 8.5
SHBG - 36 nmol/L. Range: 13 - 71

21/04/2015 these were my first levels after starting biweekly injections.
TT - 9.5 nmol/L. Range: 8 - 32
Bio T - 1.4 nmol/L Range: 2.5 - 10
SHBG - 35.2 nmol/L Range: 13.5 - 71

10/06/2015, this is my first E2 level in at least a year. After reading this forum & trying to educate myself.
Estradiol - 64.3 pmol/L. Range 28 -156
TSH - 2.3 mlU/L Range 0.27 - 4.20
PSA - 1.54 ug/L. Range 0 - 2.5

I just received my newest blood work. It was drawn the day before my two week shot. Maybe the biweekly shots are increasing my levels now. It was processed by a lab that never used to do bio T. My E2 is flying pretty high as well.

21/07/2015
Albumin - 34 g/L Range: 35-50
TT - 22 nmol/L Range: 8 - 32
Bio T - 5.63 nmol/L. R: 2.5 - 10
SHBG - 30.7. R: 13.5 - 71
Estradiol - 119.8 R: 28 - 156

DHEAS - 11.73 umol/L. Range: 3.7-13.10
LH - 0.19 (I know there wasn’t much point of this while on trt)
FSH - 0.1 (^^^^^^^^^^^)
Progesterone - 3.13 nmol/L. Range: 0.7-4.3
PSA - 1.42 ug/L. Range: 0-2.52
Cortisol.AM - 471.8 nmol/L. Range: 171-536
Vit D25 - 91 nmol/L Range: 75-250
TSH - 2.18 mlU/L. Range: 0.27-4.2
Ferritin - 25.6 ug/L. Range: 30 - 400
Vit B12 - >1476 pmol/L Range: 156-698
Sodium - 138 mmol/L. Range: 136-145
Potassium - 4.3 mmol/L Range: 3.6-5.2

Cholesterol - 4.04 mmol/L R: 3-5.17
Triglycerides - 2.32 mmol/L R: 0-1.7
LDL - 2.23
HDL - 0.76 mmol/L. R: 1.03-5.1
Ratio - 5.3
Albumin - 42 g/L. R: 35-52

Unfortunately I don’t have my pre trt blood results. I’ve been unsuccessful so far in getting them. My b12 is through the roof. I’ve been on B12 Methylcobalamin 5000mg sublinguals for almost a year. My iron/ Ferritin has been low also. Im on a supplement & it seems to be increasing. It was 11. I have my CBC levels too, I’ll post those tomorrow.

My GP is open to suggestions. He’s considering the SC Tshot protocol. And I plan to discuss Hcg & an AI.

I also have a cortisol 4 point saliva test to do.

My body temps have been fluctuating. they were 36.5-37.2°c range

Yesterday & today am was 37°C", afternoon& evening were in mid to low 36.

Any help/suggestions are greatly appreciated!

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Here’s the cbc results

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Your red blood cells are out of range and your white blood cells are just barely in the listed range. Have you ever inquired as to why your white blood cells are at that level? Do you have any other chronic medical condition?

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I asked a long time ago. My Doctors were never concerned with it. I’m pretty sure he just said it was likely from constant low level bladder infection? I have an indwelling catheter(Suprapubic) so there’s always some irritation & bacteria in there. But no diagnosed chronic illnesses that I’m aware of. I can ask again when I see him next week.

5

I meant to post my list of meds & supplements earlier.

CoQ10 250mg
Potassium 600mg Slow K
B12 Methylcobalamin 5000mg
B Complex
Vit D3 5000iu
Vit K2 100mcg
Selenium 100mcg morning & night
Iodine/kelp 0.05mg x 3, I was taking 500mg of iodine from kelp but recently but just recently stopped in case it was too much. I took it for nearly a year. I also eat salt, but not a large amount.
Ferrous Gluconate 300mg
Zinc 15mg Copper 2mg

Rx drugs

Tecta
Bachlofen
Ditropan XL

6

Where are you located?
Table salt is iodized? What about bread, dairy? Different countries have different systems?

Why did you feel that 0.5mg iodine was too much? [not 500mg, was 500mcg (micrograms).

Have you had an occult blood test to look for blood in your poop? A low level GI bleed would explain some of the issues with your blood count.

Your many antibiotic treatments may have created a problem with the gut flora [bacterial]. You should find a really good probiotic and use for a month. What digestive problems or food sensitivities do you have.

You should be self injecting 50mg T twice a week to get steady levels. With injections every 4 or 2 weeks your levels are peaking and crashing. Then the lab results are more a result of lab timing than anything else.

Your doctor does not know what he is doing and blindly following something he read and is not thinking.

Have you read these stickies?

  • advice for new guys
  • protocol for injections
  • finding a TRT doc
7

quote]KSman wrote:
Where are you located?
Table salt is iodized? What about bread, dairy? Different countries have different systems?

Why did you feel that 0.5mg iodine was too much? [not 500mg, was 500mcg (micrograms).

Have you had an occult blood test to look for blood in your poop? A low level GI bleed would explain some of the issues with your blood count.

Your many antibiotic treatments may have created a problem with the gut flora [bacterial]. You should find a really good probiotic and use for a month. What digestive problems or food sensitivities do you have.

You should be self injecting 50mg T twice a week to get steady levels. With injections every 4 or 2 weeks your levels are peaking and crashing. Then the lab results are more a result of lab timing than anything else.

Your doctor does not know what he is doing and blindly following something he read and is not thinking.

Have you read these stickies?

  • advice for new guys
  • protocol for injections
  • finding a TRT doc
    [/quote]

Hi KSman,
I’m in Nova Scotia, Canada. Salt is iodized, I’m not sure about the bread and dairy.

I initially started with a 0.05mg/50mcg iodine tablet(Thyroid Support by A.Vogel) 3 times a day and wasn’t sure it was enough. I started taking a new one Organika Atlantic Kelp 500mg with 425mcg iodine. I misread the dosage in my earlier post.

Reading so many conflicting opinions, such as the 150mcg per day recommended dose is plenty while others say it’s not enough or much higher doses are bad. I just decided last week to cut back to the 150mcg & see if I felt any different.

I had the poop test done when in the hospital two years ago. Nothing recent. I’m being treated for GERD with a PPI(Tecta). I had acid reflux symptoms years ago so he put me on medication. I get a lot of stomach gas & bloating, no matter what I eat. I have no food sensitivities that I’m aware of. I’m taking a probiotic with 10 strains & 25billion count. I’ve also been looking into some other options.

I’ve read the stickies a couple times and have printed off the injection protocol. It’s basically impossible to get a new Dr around here. I think he’ll listen to these suggestions. We’re going to discuss the twice a week injections next week.

8

My Dr has finally agreed to the SC weekly Test injections! He’s open to the Hcg & AI treatment as well but he’s reluctant to change multiple things at once…baby steps are better than no steps. I assume the AI would take priority over the Hcg? Or would it depend on E2 levels? Should I just start the weekly injections & monitor the levels?

From June 10 until July 21 my estradiol went from 64 to 120pmol/L
Of course It’s still “within range”, 28-156.

9

I just received my saliva test results. Cortisol is off the charts at all 4 points. Greater than 40, which is the highest rating they give.
Recommended Ranges:
AM 0.90 - 9.5 ng/mL
Noon 0.60 - 3.2 ng/mL
PM. 0.40 - 1.5 ng/mL
Night. 0.25 - 1.0 ng/mL
Mine are all above range. >40
DHEAS was within range at 5.5 (2.0 - 11ng/mL)

My naturopath recommended a Cortisol Management supplement. Haven’t started yet.
Any other suggestions or opinions are welcomed.

10

Please become familiar with this territory:

Test ATCH to see if cause is in the pituitary. You need to knpw something about the cause before you do anything.

I am not encouraged that a supplement will manage this. naturopath may be over his head

150mcg iodine is not enough to dig you out of an iodine deficiency hole! Have you read the thyroid basics sticky?

Check oral body temperatures:

  • should be 97.7-97.8 when you first wake up, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon
11

Thanks KSman,

I have been reading up on Cushings & high cortisol since I got my results. I will see my Dr this week & discuss it & the blood test with him. My naturopath is just doing the best she can, with what she has to work with.

I have read the stickies.

I recently switched to another thyroid supplement that includes selenium & iodine & a few other things. I get a total of around 1mg of iodine a day now from supplements plus I eat salt and seaweed. However my temps still run low. Ive ordered some iodoral, so hoping that’ll help.

12

Are there links for official studies on the efficacy & benefits of low dose subcutaneous hcg in males on TRT?

I found one study on SQ testosterone injections. Are there others?

Thanks.

13

The benefits are increased T levels and independent of that, many report that hCG improves mood.

The response to hCG depends on the health and condition of the testes and thus we find that the increased T results decrease with age.

A paper in 2005 showed that 250iu hCG SC EOD was close to a LH replacement dose.

hCG is not going to help with primary hypogonadism, only secondary. But we often see a degree of both.

The active lobe of the hCG peptide molecule is identical to the active lobe of the LH peptide. That is why it works. hCG has a long half-life and LH is very short. So even if LH were commercially available, hCG would be the preferred agent.

Clinical studies show you what happened with a particular sample of males. But as always, when it comes to treatment, the only thing of interest is how you respond and feel.

One needs to avoid having some doctors prescribe high doses of hCG which can lead to unmanageable E2 levels and can desensitize the LH receptors which is a big step in the wrong direction. Similar problems with high doses of SERMs that create high LH levels. So there are obvious reasons why hCG+SERM should not be done.

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Thanks for the info KSman. It makes perfect sense to me. However, The reason I’m looking for actual links to official studies from reputable sources is that I am unable to self inject because of the physical limitations of my disability. The healthcare agency that would do the injections, refuses because subcutaneous is considered off label use for both meds. Right now a family member is assisting me, but if possible I would like to educate the healthcare provider. My doctor is perfectly fine with it and prescribed Hcg & test SC EOD, but the healthcare agency I have to deal with insists on supportive documentation before they will even consider doing it. I clear one hurdle only to get tripped up by another one.

On another note, I finally got some iodoral iodine supplement. I started out slow with just one tablet/day, just to test my body’s reaction to it. No reactions or side effects. I’ve stepped up to 2 tablets (25mg) & for the first few days I had a horrible metal taste in my mouth. All food tasted bad too. It subsided after 3 days. I’m currently on the two tablet (25mg) dose.

Thanks