I’m 46. After feeling lethargic for some time I suggested to my Dr. I take a blood test for Testosterone. He thought it was depression, but he ordered the labs. I just got the results. 209. Normal is 280-800. I’m starting to think I COULD be a doctor after all!
Okay, so what am I in for? How low is that?? What kind of replacement types and doses can I expect him to prescribe,… or should I just go to an Endocrinologist or urologist?
Also, I’ve been having panic attacks occasionally for 10 years. I’ve been taking antidepresants and Xanax the whole time. This, along with a handfull of visits to Psychiatrists and Psychologists.
I’ve read in this forum that low T can cause this. If my problem all along has been low T and I had to figure it out for myself,… I will be rather displeased with the medical community to say the least.
well start getting displeased.
Xanax: you need to slowly get off of that [crap]. There are real long term problems and changes to the brain that are a harmful trap.
Antidepressants: SSRIs make things a lot worse. Research the negative effects of xanax. If you find that you still need something, get generic wellbutrin. Note that wellbutrin gives you energy, something that might create some issues. If you cannot sleep, start with 100mg of trazodone at night with the expectation that you will need to go to 200mg.
If the wellbutrin gets you too excited, use less and/or get some l-tryptophan, recently now freely available but not yet widely available. This will increase your serotonin and balance the effects of increase dopamine from wellbutrin.
Many guys with low T suffer from doctors giving them drugs that create other problems. They end up on antidepressants and Viagra.
There is a ton of stuff here that you need to read in this forum.
Delivery: to inject or not inject? Read about these issues.
Estrogen: If you do not take an aromatase inhibitor [AI], E2 will increase and the results will not be good!!!
When you do TRT, testosterone replacement therapy, the HPTA [google “HPTA WIKI”] will shut down, LH is near zero. LH is needed to keep the testes working. hCG can be injected to keep them working and alive. Nothing other than hCG is available that works.
Without hCG, the testes shrink, 24x7 ache for a few, the scrotum pulls up tight like a pre-pubescent boy’s. That looks lame and alters your sexual self image and how women will perceive you. When the testes shut down, you loose the largest single source of pregnenolone on the body [do not confuse with [progesterone]. Pregnenolone is vital to brain functioning.
Low pregnenolone then also means lower DHEA levels, again important for many reasons. Just to not have any expectation that you can find a doctor who knows much or anything about these factors.
If the testes are allowed to shrink and stay that way, they can have permanent structural degradation and turn into useless lumps of tissue. Loss of fertility probable over time.
An ideal start to TRT would be:
100mg/wk testosterone cypionate [test cyp], injected IM, into muscle. Most self inject. More frequent injections such as 50mg twice a week can provide better results. Some inject EOD, every other day.
AI: 1mg/wk of Arimidex in divided doses. Arimidex, aka anastrozole, is an oral drug. You need to get your estradiol [E2] levels down into the lower 20s. Find and read issues of anastrozole over responders who need to take much less.
hCG, is a water based peptide [protein type] hormone. 250iu injected SC [under the skin] EOD works very well to maintain baseline testicular function. Baseline for older guy is lower than young, but still something that you need.
TRT will often lower LDL and not reduce HDL. If you are on statin drugs, you might need to reduce the dose of the statin drug. Do not take your total cholesterol lower thann 180. You can also take niacin, folic acid and B-6 to increase HDL if needed.
You may need to change your diet and review all of the drugs that you are taking, OTC and prescription.
If you have low energy after all of this, have your thyroid tested.
LEF.org has a sale on blood work on for April and May [ends June 2nd]. You can get the male panel for $198 if you are a member.
You need the PSA and DHEA-s levels [included in that panel] as well as the other obvious other items. You have to pay out of pocket for this and cannot get your insurance to pay for that. [but you could pay with an HSA debit card] With those test results in hand, you can research things and guide your doctor or use when looking for another doctor.
Always get and retain copies of all of your lab results!!!
I cannot stress enough that you will probably have to learn a huge amount about these things and most find that they need to know more than almost all doctors. Do not think that endocrinologists or urologists are going to be any better at these things than a GP. Anyone, including doctors, can understand these issues and treatment if they are motivated to research and learn.
Wow. Thank you very much KSman for the info and the time it must have taken to put that post together.
Looks like this is going to be interesting to say the least. Still, I’m glad because finally I’m on the right track. Also, I should be able to correct the problem legally. I’m going to email my Dr. right now for the copies of the labs.
way to go KS…
I have a feeling that you helped that guy. He LISTENED to what you said and is taking action. Good for him.
Hey Rkdp: keep us informed of your progress on this thread, ok?
I emailed the doc yesterday asking what was next after the low T blood work. He replied back:
Regarding the testosterone level, we can start some testosterone replacement therapy (intramuscular shots every 3 weeks in the nursing clinic). I would request that you have a baseline PSA blood test before we start. I have then ordered FASTING labs in 3 months: repeat CBC, PSA, cholesterol, testosterone, liver, etc
um,…what’s PSA?
I replied back asking what type of Testosterone and what will the dose be. I told him I thought it would be better to inject at least every week and I asked about alcilaries.
I would goto allthingsmale.com dr crisler’s website and copy “recipe for success” to take with you. Otherwise your doc’s gonna gasp when you say you want HCG shots EOD and arimidex tablets. Trust me… most doctors need to learn HRT protocol themselves, so bring some firepower with you. (or he’s gonna think you are clueless)Also insist on weekly shots (or ask if you can do them yourself) it’s easy, and then you can do it 2 times weekly) just use a lower dose: example 50mg per shot Mon. and Thurs. which makes 100 total per week. Most people start off at 100 from what I’m told, but 200 is also within the normal dosing range. But don’t let him put you on only a shot every 3 weeks because you will feel crappy by week 2. (and you will develop other aromatization issues, etc…)
Oh, and cypionate or enanthate are the preffered forms of test from what I’ve read, because they are both long acting stable esters. They coast slowly and steadily into the blood over a nice long time period and make the ride much smoother. Do NOT get on suspension or propinate. They are not set up for a once weekly HRT shot, and you will crash on those.
KS man, am I right about all of that? LOL
PSA is to make sure you don’t have prostate cancer. Testosterone can be a problem for those with active prostate cancer. Lot’s of controversy about the link between the two, but most recent studies find no correlation.
You also need to insist that he include E2 (estradiol) in your blood work. It is almost guaranteed that your estradiol will go up along with your T levels and many docs are unaware of this or shrug it off as not an issue, but it really is.
If I may… TRT is being promoted by drug companies and lots of patients are asking for it these days and so many doctors are adding this therapy to their practice without doing any real study of it. They will, of course, never admit this and will try to come off like they know what they’re doing. If you let this guy totally run the show like he owns your health and your body, you’re sunk. You need to get assertive and tell him what YOU want and what YOU expect. If you come to him like a beggar asking for a favor, you’re going to have a tough time getting decent treatment. Just my two cents based on my experience and nothing more.
I wish you nothing but the best!
All of the esters have similar half-lives, including propionate.
They all peak within one to two days of injecting and then slowly taper off. This is why injecting EOD is best. Anything less frequent is not going to be optimal as far as maintaining stable test levels is concerned.
Everyone is different and some guys don’t have much of a reaction to small changes in test levels. Some do. You just have to play it by ear and see how it goes. This isn’t to say that you should start at once a month and feel like shit for three months until your doctor decides to do something about it. I’m just saying that there are limits to how much our personal experience is going to translate into someone else’s experience.
That said, the vast majority of guys have poor experiences on anything less frequent than weekly and I’ve never heard of anyone not doing well on EOD. I’d want to start with the protocol that has the best track record, but that may or may not be possible… all things considered.
Some guys do fine on gel for an extended period of time. Some do well on it in the beginning and then start absorbing poorly. Some never do well on gel. You can’t say that your experience is going to be the same for someone else. Just because someone has an experience different from yours doesn’t mean he’s lying or stupid.
This shouldn’t be a pissing contest. Let’s focus on helping each other.
I went though a lot of hell to get where I’m at but in retrospect it was necessary because it forced me to do the research and to get up the gumption to take control of the situation on my own. Yeah, I eventually realized that my doctor wasn’t really on my side, but a few posts in a forum at the start of the ordeal wouldn’t have made any difference.
When I tell guys to get assertive and take control, I’m really just trying to put that bug in their ear so if things get rough they don’t feel like there’s no way out.
By the way, the Xanax is only as needed. So I don’t take it all the time. Only when I start to feel anxious. Several years ago I would take 1 .25mg/day on average. Now I probably take 1 .25mg/4days. Hey, it’s progress, right.
You say they’re bad, but man, they are a God send when you are having a panic attack. Early on, bad ones lasted up to 5 hours. 5 hours of naked fear. Uncontrolled nervousness that just comes over you like a wave. You feel like you’re quite possibly going to die at any moment. And so it feeds on itself. You get symtoms, which makes you scared, which creates more symptoms, etc.
I’ve had tingling in the arms, chest discomfort, pounding rapid heartbeat, trembling, hot flashes, etc. I’ve had hot flashes so bad, I took off all my clothes AND my jewelry!! Several times I drove myself to the hospital thinking I was either having or about to have a heart attack. Xanax has helped me feel better many more times than I can count over the years. I would have gone through hell without it or something else like it.
Thanks a lot for all the input. Great info. It helps me, and I’m sure others, in a similar boat.
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I’ve never heard of anyone not doing well on EOD. I’d want to start with the protocol that has the best track record, but that may or may not be possible… all things considered."
Have you heard of anyone not doing well on EOD?
Maybe young normal men would have a better quality of life if we could figure out how to turn their testes off and on once a well. Level hormones must be dangerous.
Some have a track record of weekly shots not working well.
[quote]Rkdp wrote:
By the way, the Xanax is only as needed. So I don’t take it all the time. Only when I start to feel anxious. Several years ago I would take 1 .25mg/day on average. Now I probably take 1 .25mg/4days. Hey, it’s progress, right.
You say they’re bad, but man, they are a God send when you are having a panic attack. Early on, bad ones lasted up to 5 hours. 5 hours of naked fear. Uncontrolled nervousness that just comes over you like a wave. You feel like you’re quite possibly going to die at any moment. And so it feeds on itself. I’ve had tingling in the arms, chest discomfort, pounding rapid heartbeat, trembling, hot flashes, etc. I’ve had hot flashes so bad, I took off all my clothes AND my jewelry!! Several times I drove myself to the hospital thinking I was either having or about to have a heart attack. Xanax has helped me feel better many more times than I can count over the years. I would have gone through hell without it or something else like it.
Thanks a lot for all the input. Great info. It helps me, and I’m sure others, in a similar boat.[/quote]
I totally agree with how you are using Xanax, only when needed. It will be interesting to see how TRT helps in that regard.
[quote]KSman wrote:
Have you heard of anyone not doing well on EOD?[/quote]
I think you misread my post. As I said, “I’ve NEVER heard of anyone not doing well on EOD.”
Indeed, and yet some do seem to be fine with weekly shots.
There have been a lot of blanket statements being made in this forum lately about “what is best” as if there is one and only one way for people to do well on TRT and that simply isn’t true.
I’m on the “KSman” protocol and I’m doing great and wouldn’t recommend or do anything else, but I’m not going to sit here and proclaim that it is the one and only best deal for everyone and I don’t think you do either. We both know guys who are happy with their transdermals and while they are in the minority, it doesn’t mean they’re “wrong.”
I get PM’s from guys all the time that are doing well on this or that protocol but who are afraid to speak up about it because of the attitudes of some of the more vocal participants here and that’s a shame.
If I was new to this game and I had a doctor that I trusted and he suggested starting with transdermals or weekly injections I would probably go along with his suggestions. I certainly wouldn’t listen to some asshole berating me in a forum.
There’s been far too much chest beating and not enough common sense around here lately for my tastes. Not from you, KSman, but from others and I think they need to back off and think more about how to help people and less about themselves.
I think we owe it to people to tell them about the protocol that has the best chance for success, no question about that. But I don’t think any of us can say with certainty that some other protocol isn’t going to work for them.
Life is always a gamble and TRT is no different.
My motives are to offer an alternative to weekly shots in the gluts with 1.5" needles. This prospect may drive many away from injecting at all.
I offer up the EOD injections as an option that one can consider. This may allow some to go with injections; saving a lot of money over transdermals for some without insurance coverage.
If one thrives on weekly injections… great. If those are also injecting hCG EOD, then they might consider T EOD simply for a routine that they find easier to live with.
The point is that one should be free to choose delivery details and not be a slave to the pronouncements of a doctor. 100mg per week, do that that the way that you want.
The concept of empowerment over such details may be useful for some in dealing with a doctor who things that injections in his office every two or three weeks.
It is all about choice. I can see now how my singing the EOD song can be interpreted a otherwise.
[quote]happydog48 wrote:
KSman wrote:
Have you heard of anyone not doing well on EOD?
I think you misread my post. As I said, “I’ve NEVER heard of anyone not doing well on EOD.”
Some have a track record of weekly shots not working well.
Indeed, and yet some do seem to be fine with weekly shots.
There have been a lot of blanket statements being made in this forum lately about “what is best” as if there is one and only one way for people to do well on TRT and that simply isn’t true.
I’m on the “KSman” protocol and I’m doing great and wouldn’t recommend or do anything else, but I’m not going to sit here and proclaim that it is the one and only best deal for everyone and I don’t think you do either. We both know guys who are happy with their transdermals and while they are in the minority, it doesn’t mean they’re “wrong.”
I get PM’s from guys all the time that are doing well on this or that protocol but who are afraid to speak up about it because of the attitudes of some of the more vocal participants here and that’s a shame.
If I was new to this game and I had a doctor that I trusted and he suggested starting with transdermals or weekly injections I would probably go along with his suggestions. I certainly wouldn’t listen to some asshole berating me in a forum.
There’s been far too much chest beating and not enough common sense around here lately for my tastes. Not from you, KSman, but from others and I think they need to back off and think more about how to help people and less about themselves.
I think we owe it to people to tell them about the protocol that has the best chance for success, no question about that. But I don’t think any of us can say with certainty that some other protocol isn’t going to work for them.
Life is always a gamble and TRT is no different. [/quote]
Regarding esters http://www.muscletalk.co.uk/article-steroid-half-life.aspxand half lives:
http://elitefreakz.com/forums/archive/index.php?t-158.html
A link that connects, about differing ester release times.
Testosterone Cypionate 12 days
Testosterone Enanthate 10.5 days
Testosterone Propionate 4.5 days
Testosterone Suspension 1 day
happydog said:
"All of the esters have similar half-lives, including propionate.
They all peak within one to two days of injecting and then slowly taper off. This is why injecting EOD is best. Anything less frequent is not going to be optimal as far as maintaining stable test levels is concerned."
I see where you’re going with this, but it’s not exactly true. You can maintain a stable level for about 3.5 days on cypionate. That’s why the twice weekly injections are fine. The endo journals have a nice study on 200mg injections of cyp that clearly show the bloodlevel activity after 3.5 days being pretty stable still… a week, well- then you’ve got a pretty visible drop. But 3.5 days shouldn’t cause any noticable difference in the person on HRT. From personal experience I felt no drop. I also had bloodwork done after 24 hrs and also on day 3 to compare for myself last month, and there was no real difference. Here’s the link:
http://jcem.endojournals.org/cgi/reprint/84/10/3469.pdf?ck=nck
Here’s a link that explains half-life in plain terms: