My Story - Questions and Concerns

Howdy. Thanks for reading my story and providing any additional insight or opinion. I’m sorry for the lenght, but I am fairly detail oriented. I have read every sticky front to back and have been lurking for 3 weeks now. Am completely confused and frustrated about my situation so I decided to post my story.

-age: 32
-height: 6’
-waist: 38"
-weight: 275

-describe body and facial hair: Low body and leg hair. Very little under the arms, on legs, or chest. I can not grow a full beard, goat or mustache. There is hair, but it is sporadic and not thick at all. I shave twice per week.

-describe where you carry fat and how changed: mid section and upper torso. I recently lost 60lbs in the last 9 months, but have stalled out the last 2 months and have gained a few lbs with no major change in diet or excercise.

-health conditions, symptoms: no major health concerns. blood pressure has been a little high lately. Symptoms include fatigue, recent weight gain, foggy/cloudy brain, bad memory, low labido, ED, trouble sleeping sometimes (no apnea), low motivation, lack of motivation at work

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Daily multivitamin and some generic fish oil
-lab results with ranges: see message body text

-describe diet [some create substantial damage with starvation diets]: low fat, lower calorie (1800 or so per day), low salt, high protein. NO fast food, no soda’s, some caffeine

-describe training [some ruin there hormones by over training]: Mostly walking and jogging with my dog. Weight train 1-2 times per week when I am not exhausted. Work is sedentary and on a computer most of the day

-testes ache, ever, with a fever?: No
-how have morning wood and nocturnal erections changed: Morning wood 1-2 times per week for as long as I can rememeber.

Tuesday (10/9) I had a physical. Iâ??ve been seeing this doctor for 8 years so he knows me and my history. What prompted the physical (other than it being over 2 years since my last one) was poor performance in the bedroom with my serious girlfriend of 6 months.

The first time with her a while back I had serious problems and then a few times a month since then I would have problems. I chalked it up to first time (with her) jitters but the more it happened the more I realized something was wrong. I went to the doctor to figure out what that something was and to discuss ED drugs (before I knew anything about low T).

The doctor asked me some questions and put Testosterone on the blood work.

On Thursday (10/11) they called me with the results. Everything looked great, but my T level was â??on the low end of the scale" at 341 (348 - 1197). The doctor wanted me to come in to talk and discuss treatment options. I had Friday (10/12) off so I went in.

Blood Test results from first blood test (there are more results, but I picked the ones I thought were most relevant). Fasting at 9:15am

Testosteron, Serum = 341 (348-1197)
LH = 2.5 (1.7-8.6)
FSH = 1.6 (1.5-12.4)
T-3 Uptake = 30 (22-35%)
T-4 = 8.9 (4.5-12.5)
Free T4 2.7 (1.4-3.8)
TSH 1.94 (.4 - 4.5)
Hemoglobin = 15.1 (12.6-17.7)
Hematocrit = 45.5 (37.5-51.0)
Cholestoral, Tota = 174 (100-199)
HDL Cholestoral = 52 (>39)
LDL Cholestoral Calc = 105 (0-99)
AST (SGOT) = 111 (0-40)

**not sure it has anything to do with my symptoms but thought I would post it here. Doc wants to test it again in 2 months…I am not a heavy drinker. 0-4 beers per week…no hard liqour.
Glucose, Serum = 94 (65-99)

I spent 20 minutes with him and before I left they had injected me with 1mL of T. cypionate (200mg) and I had a vial with another 10mL and 10 syringes with directions to inject myself every Friday with .7mL and to get another blood test done in mid December.

It was made clear that this second blood test would cover any and all things related to testosterone. At that point we would discuss continued treatment and at what dosages. Iâ??m pretty pissed at myself that I just let this all happen without fully understanding the scope of what it all meantâ?¦.but he was my doctor and I thought he would know bestâ?¦.maybe he still does.

The more I read about low T and the symptoms, the more I realize I have been suffering from it for a while nowâ?¦.at least since my early 20â??s. This is something I do not want to ignore and want to treat, but I am scared of some of the side effects.

I WANT to have kids some day and am worried about becoming sterile. Is this a guarantee? Anything I can do to avoid it?

10/18 One week after the shot and diagnosis, I went to a “T” clinic in Dallas for a second opinion. I knew what these guys were about but wanted to hear more information and was willing to pay for it. Before even looking at blood, they were trying to seel me on a T + HCG + AI treatment, but it is expensive.

They did take more blood and below are the results. Yes this is 6 days after getting a big shot of Test Cyp, but it came with the consult and I wanted more information.

Total Test = 923 ng/dL (241-827)
Free Test (Direct) = 6.6 pg/mL (8.7-25.1)
LH = <.2 mIU/mL (1.5-9.3)
Estradiol = 63 pg/mL (0 - 39)
PSA = .6 nm/mL (0-4)
AST = 94 (10-40)
They did a full CBC, but it is similar to the above.

So obviously, the big shot of Test Cyp made a huge difference in my Total T numbers. In one week it also completely tanked my LH numbers. Not knowing what Estradiol or Free Test was before the shot…I’m not sure what the difference is. That being said, my E2 number is way too high and my free T number is very low.

10/26 Being an information junky, I decided to go to an endocrinologist. As I expected, this guy was not helpful. He basically told me I worry to much, that my doctor is an idiot for prescribing Test Cyp and that I wasted my money on the “T” clinic (which is probably true).

He did a thorough examination of me but refused to take more blood or even take into consideration the blood tests I brought in. He does want to rule out a tumor and wants to do a much more thorough examination of my blood in 3 months once the, “testosterone is out of my system.”

I like that he wants to find the source of my problem, but I’m not sure I’m willing to wait this long or work with a guy who is probably not going to do anything. He did say with a 341, he would not recommend HRT or TRT. He also does not know anyting about HCG and says AI are far to dangerous.

11/1 - I have NO idea as of today what I am going to do. I have this vial of Test Cyp on my counter but am hesitant to inject without knowing why I have low T. At the same time, I am sick and tired of feeling this way.

My social life is in the tank, my gf is very suportive but I can tell this is stressing her out, and my work is suffering. Below are my questions for the group.

  1. How hard do I push for an MRI to rule out a tumor?

  2. Based on my LH and FSH I would self diagnos as secondary…would Clomid or HCG work for me and would you recommend it?
    - My doctor doesn’t know anything about HCG or AI, so I would need to go somewhere else for it.

  3. How long do I have to wait after this 1 Test shot on 10/12 to get another blood test so i can get a better baseline on ALL the important things to look for?

I know its a long read and I thank anyone who has made it this far.

Hoss

I would definitely push for a pituitary MRI. Would also have prolactin levels checked, as hyperprolactinemia can cause libdo and ED issues. Hopefully your doctor knows to check this but just in case…

Hey Hoss, I read your story. It’s not unlike hundreds that you and I have both read on this site.
It’s so frustrating to see how incompetent our medical system truly is wrt to these cases, especially
when you consider the price we pay.

The thing I learned most from reading here is to be in charge of your own care, and be the assertive director of it. Too many doctors think they are unquestionable. Theses are people that you fire.

I applaud you for wanting to find the root cause, and not just going on T.
As DX said above, you should check your prolactin levels, they will clue you in to the need for an MRI
should they be high.

I have a feeling that it isn’t your problem though. At 6" 275 I would imagine that
you are on the heavier side, and that your low T is being caused by excess E2 arising from obesity and fat tissue. Glancing at your blood work, your E2 is crazy high as must be your SHBG based on your free t #. Your E2 clearance rate, which seems low may also be why your AST level is high. I know your E2 is spiked as a result of the T shot you had, but I would imagine that before the shot you were estrogen dominant. It happens. Look around and you will see many men in the same boat…they are quietly suffering. The good news is that you are doing something about it for yourself!

If you lose weight and adipose tissue the balance between e2 and T should become more favorable to T making the weight loss a little easier as it accelerates. I know its a hard road to lose weight, I know its even harder with a poor balance in the e2 to T ratio. You may want to consider short term T + AI + HCG therapy to get you on the road to weight loss. The HCG would preserve your boys for children, and from the looks of things you would really benefit mentally and physically from lowering your E2. However, you can do it on your own without these things.

To answer your question about baseline T levels, I believe with T Cyp its one month…I could be wrong though, perhaps one of the more educated members can give you a more exact figure.

Whatever path you choose, be assertive with your doctors, keep your goal in mind and stay positive.
Good Luck.

[quote]…

If you lose weight and adipose tissue the balance between e2 and T should become more favorable to T making the weight loss a little easier as it accelerates. I know its a hard road to lose weight, I know its even harder with a poor balance in the e2 to T ratio. You may want to consider short term T + AI + HCG therapy to get you on the road to weight loss. The HCG would preserve your boys for children, and from the looks of things you would really benefit mentally and physically from lowering your E2. However, you can do it on your own without these things.

[/quote]

Do you recommend doing a cycle to aid in fat loss while being obese? I am just wondering because I myself is trying to loose weight but correct me if I’m wrong its difficult for someone with low T.

Before you push for the MRI, which depending on how great your insurance is, will be expensive. Get blood tests done for prolactin. Get them done soon.

Prolactinomas are patient killers. They act so slow you can’t even know they are there. Do you find yourself appreciating the female form while not even contemplating sex? Do you wake up with a morning chub not wood (be honest)? Can you lose an erection if not constantly being stimulated?

These were my silent and subtle messages that I didn’t have the opportunity to acknowledge. My prolactin was 330 before I caught it.

I wanted to add one more thing. About 11 years ago I had a couple of terrible years where I felt off. I was in college at the time and all my friends were running around chasing women. I had lost the ability and desire to chase women. I described it as “operating on a different plane than everyone else”. I also refer to that time as “the dark”.

Anyway, of course I had no idea at the time that something was growing slowly in my head and caused all this, but looking back I know exactly when it began. If you can think of a similar experience, that might be cause for alarm.

Howdy. I wanted to post an update and ask for some assitance. After many doctors visits to different doctors I found a Urologist who specializes in fertiliity and HRT. After a thorough examination and looking at my bloodwork (in first post), he recommended HCG + AI. I’ve been on some sort of that therapy for 6 months now and I’ve hit a brick wall…so has my doctor I think. I’m not sure what to do and I’d really like some feedback. Even if it is…start all over.

Below are my last 5 blood tests and the therapy I was on at the time. I know it is only T and E, but that is all the Dr looks at when making changes. Not sure I can find another doctor willing to prescribe HCG and work with my insurance.

12/28/12

  • 5000iu 1x week IM
  • 1mg Arimidex ED
    • After 1 week I had bad sides on the Adex and knocked the dosage down to .5mg 3x week but still had the sides so I cut it out all together and didn’t take any AI
      Blood taken after 5 weeks on this therapy
      Test = 691 (348-1197)
      E = 57 (7.6-42.6)

02/15/13

  • 2500iu 2x week IM
  • 2.5mg Letro daily
    • Although I think this did help with my high E, I had to stop taking it after 1 week as I could no longer get an erection and my libido was non existant so again I stopped and didn’t have an AI for 4 weeks. Was hoping the doses split up over 2 injections would help the high E.
      Blood taken 5 weeks after being on therapy
      Test = 235
      E = 31.5
      **My doctor said HCG didn’t go bad, but I’m pretty sure this went bad or I shook it or something. Not sure how the T could be this low? That being said…look how high my E still is.

04/05/13

  • 1000iu 3x week Sub Q
  • 12.5mg Aromasin 3x week on the day of the shot
    • NO sides with the Aromasin
      Blood taken 4 weeks or so on this therapy.
      Test = 615
      E = 74.8

05/10/13

  • 800iu 3x week Sub Q
  • 12.5mg Aromasin every day
    Blood taken 4 weeks or so on this dose.
    Test = 506
    E = 59.8

06/21/13

  • 800iu 3x week Sub Q
  • 25mg Aromasin every day
    Blood taken 4-5 weeks on this dose
    Test = 661
    E = 72.0

As you can see, I continue to struggle with high E and dont seem to be responding to Aromasin. My doctor wants me to increase the Aromasin dose to 50mg (2 pills) daily but from what I understand this is not recommended long term. This doctor doesn’t know much about Aromasin…I basically introduced it to him and he let me be his guinea pig on it.

Thought about adding Test Cyp, but I think I am still going to have these high E issues. I am overweight by about 40lbs or so…but my gym routines have been horrible the last few months and I just can not lose weight right now…even with a very clean diet.

Might try Arimidex again, but the sides were pretty rough.

Please help…what are your thoughts?

Howdy. I wanted to post an update and ask for some assitance. After many doctors visits to different doctors I found a Urologist who specializes in fertiliity and HRT. After a thorough examination and looking at my bloodwork (in first post), he recommended HCG AI. I’ve been on some sort of that therapy for 6 months now and I’ve hit a brick wall…so has my doctor I think. I’m not sure what to do and I’d really like some feedback. Even if it is…start all over.

Below are my last 5 blood tests and the therapy I was on at the time. I know it is only T and E, but that is all the Dr looks at when making changes. Not sure I can find another doctor willing to prescribe HCG and work with my insurance.

12/28/12

  • 5000iu 1x week IM
  • 1mg Arimidex ED
    • After 1 week I had bad sides on the Adex and knocked the dosage down to .5mg 3x week but still had the sides so I cut it out all together and didn’t take any AI
      Blood taken after 5 weeks on this therapy
      Test = 691 (348-1197)
      E = 57 (7.6-42.6)

02/15/13

  • 2500iu 2x week IM
  • 2.5mg Letro daily
    • Although I think this did help with my high E, I had to stop taking it after 1 week as I could no longer get an erection and my libido was non existant so again I stopped and didn’t have an AI for 4 weeks. Was hoping the doses split up over 2 injections would help the high E.
      Blood taken 5 weeks after being on therapy
      Test = 235
      E = 31.5
      **My doctor said HCG didn’t go bad, but I’m pretty sure this went bad or I shook it or something. Not sure how the T could be this low? That being said…look how high my E still is.

04/05/13

  • 1000iu 3x week Sub Q
  • 12.5mg Aromasin 3x week on the day of the shot
    • NO sides with the Aromasin
      On this protocol a little over 4 weeks.
      Test = 615
      Estradiol = 74.8

05/10/13

  • 800iu 3x week Sub Q
  • 12.5mg Aromasin every day
    On this protocol about 4 weeks.
    Test = 506
    Estradiol = 59.8

06/21/13

  • 800iu 3x week Sub Q
  • 25mg Aromasin every day
    On this protocal about 4-5 weeks
    Test = 661
    Estradiol = 72.0

As you can see from the above, I am not responding to Aromasin…or something else is going on. My doctor wants me to increase my Aromasin dose to 50mg per day (2 pills) to see what that dose, but from what I have read, this is A LOT of Aromasin and not advise for extended periods of time.

I had to talk my doctor into letting me be the guinea pig for Aromasin as he had never used it before. Obviously he doesn’t know much about it.

Can anyone help me? What do I do? These high E sides are really a pain in the butt. Joint pain, water retention, lack of energy, still having issues in the bedroom. It’s been 6 months and although I will say I feel better than before therapy, I dont think I am anywhere near where I should be by now.

I’m afraid if I try introducing Test Cyp into the equation I’m still going to have high E issues. I’m thinking about trying Arimidex again…see if the sides are still there.

Please help!

Before I say anything, if anyone sees what I am posting is wrong, can you please mention the issue what I am saying.

Hi LowTHoss.

hCG is attributed to high estrogen levels, extra estrogen is created in the testes, more then what would usually be created just with an exogenous testosterone. You have concern for fertility issues. If there one thing I understand is, you will cause permanent infertility if you take just exogenous testosterone and an AI for 6 months to a year. Even after 3 years of TRT, hCG can be used. I’d like to note though, fertility is governed by FSH levels and not LH levels. hCG is used to keep your leydig cells, and your balls in general, working. Your sperm count will be reduced, albeit probably still borderline-low, while on exogeous testosterone.

My point is, have a talk with your doctor about going on just Test Enanthate and an AI and ditch the hCG for a little while. See how you go with 100mg/week with 0.5mg E2D and see how that pans out for you.

On another note, your TSH is slightly elevated. It’s commonly thought on this board that it’s recommend to have your levels at 1.

Do you think you are colder then usual? More sensitive to the cold then what you are used to?

Check your temperature orally, under the tongue. Post 3-4 tests spread throughout the day, one right out of bed also. Make sure your test when you are sedentary and not physically stimulated. Don’t test after eating, drinking, talking etc. It is thought here that if you are hitting temperature values below 97.5 F in the morning, there is a problem indication, which can be possibly cause be iodine deficiency. Have a read with the stickies, especially the thyroid basics one.

Have a talk with your doctor about it. I am very sure he will say you are fine because he’ll base his result on bio-chem data (like many doctors, they are inclined to think quantitativly instead of subjectively on your symptoms).

Many men who have low T also have hypothyroidism. If the thyroid issues are not resolved, TRT treatment never really works, and may even make symptoms worse. Check for Hashimoto’s, graves and Lyme disease. It may seem drastic, but it’s better to know then not.

Do alot of research and asset yourself constructively when consulting with your doctor. If you have researched and have found something that you think applies to you, print out studies providing proof for your belief and consult with the doctor about it, showing proof to why you think this may be the case.

It’s sad that your first doctor put you straight onto T without hesitation. My doctor did that to me too. As soon as he found low T, he gave me a prescription for sustanon and a free bottle of transdermal cream, and I am 19!

Doc may have not see the hCG–>high E2 problem before. Competitive AI drugs do not work inside the testes and once E2 is created, AI’s cannot remove that, only the liver removes E2 from circulation.

So there are two technical possibilities:

Aromasin simply does not work for you. [not likely]
or
Aromasin cannot lower T–>E2 because T–>E2 inside the testes is high from hCG. [ know issue]

Suggest that you keep lowering hCG. Standard recommendation is 250iu SC EOD. You can approach that slowly.

Note that high levels of hCG or high LH levels from high SERM doses can desensitize the LH receptor. Think about that. That makes everything worse. Hi dose hCG is dangerous and stupid. You have secondary hypogonadism, you do not want to create any degree of primary hypogonadism. When it comes to these agents, more is never better.

Note couple of guys here found that 250iu SC EOD was too much for them. Some simply react differently. Those individuals could try nolvadex to see if that avoids the E2 problems.

If you cannot beat this problem because the dose small enough to avoid E2 issues leaves you with low T, you can do T+hCG[low dose]+AI

@Shouk: When I first started this journey I did a lot of reading and looking at the thyroid. Nothing I found ever pointed to the Thyroid…although I never did the temperatures. That being said, on this last round of bloodwork my TSH came back a little higher than 6 months ago at a 2.040 (.450 - 4.5). For kicks I took my temperature last night (98.7) before bed and this morning (97.7). I’ll keep taking temperatures and do some more reading on the Thyroid. As far as I know, my family does not have a history of Thyroid issues, but I’ll keep that as a possibility. No…I hardly ever feel cold. If anything it is the opposite. I’m typically always warm. Wear loose clothing, have a fan at work, sleep outside the covers in a 74 degree home.

@KSman: Thank you very much for your input. You mention the liver removes E2…you think given my high AST levels there may be an issue with my liver and this conversion? Not sure if they are related at all.

The doctor I work with doesn’t really believe in LH receptor desensitization. I know…stupid and probably enough of a reason to dump him. However, he is the only guy I have found that will even talk to me about HCG and he works with my insurance. I do agree with you though and that is why I have dropped my dosage down over time and spread out. I’m going to drop my dosage to 500iu 3x week and see what that does to my T. I also tried Arimidex again this morning. So far so good on the sides, but time will tell. Today is a shot day and with the Arimidex, I do feel a lot better today. May just be in my head, but I’m going to keep track of it.

The only way this doctor seems open to prescribing Test Cyp is if the HCG doesn’t work…and clearly it is raising my T levels. I’ll run it past him again on my next visit and see what he thinks about a test trial. I dont want to add it if I dont have to, but I’m slowly beginning to realize it may be the only way for me. He mentioned if we did do it, he would want to do a sperm analysis first to see what adding T does to the counts. Having kids is a priority for me…might be a good idea to see if I can anyway.

Thanks again all. Still not exactly sure how this high E thing is going to work out but I’ll keep at it.

UPDATE 8/7/13
Current Protocol 750iu’s HCG 3x week & 3mg Arimidex 3x week (same day as shot)

Well, I’m officially stumped. I’ve got no real idea what to do next and I’m getting very frustrated. I’ve been on this journey since November and I’m just not satisfied at where my numbers are or how I feel.

After 4-5 weeks on the above therapy, my total T came in at 479 (348-1197) and my E came in at 45.3 (7.6-42.6). Even with all this Arimidex in my system and what most would consider an excessive dose of weekly HCG, my numbers are not where I thought they would be. How can my E be so high with this much Adex? Am I just a hyperaromatizor (sp?)? The last 4 weeks or so I’ve even lost about 9lbs (changed up some things on my diet and added an extra day to the gym).

So…how do I feel? About the same as I have on any of my therapies. My E sides are down…but I still have some bloat and get moody. Morning wood is so so and very hit or miss, libido is definately better on therapy, but still not great. Workouts are about the same as before therapy…sometimes I get an extra pump and feel better, but it is nothing consistent. Not sure I would say my memory is any better. Overall, I’m glad I’m on therapy and definately dont want to stop…but there has to be a better one for me?

I just got the blood test in the mail yesterday so I have not had a chance to talk to my doctor yet about the next step. On the blood test he wrote…“continue current dosages and retest in 3 months.” I’m NOT happy with that. I think he is getting a little frustrated with this also. I dont think most of the guys he works with question him or push for somethign better. They just take his standard 5,000iu HCG once weekly with daily 1mg Arimidex and call it a day. However, those guys are actively trying to get pregnant…I’m just trying to hang onto my fertility for when we want to start having kids in a year or so.

I think I’m going to request a trial on Test cypionate. 1000mg weekly with 2x 400iu’s HCG and Arimidex 3mg weekly. It’s my understanding that the aromotization occurs in the testicles and because I am stimulating them with so much HCG and I am a hyper aromotizer, I’m just producing too much E and that ratio sucks. With less stimulization, maybe I’ll get less E conversion…then let the test cyp do it’s job and get my total t where it needs to be.

The more and more I read…the more I realize that HCG mono may just not be the right treatment for me?

Thoughts?

Your liver is not clearing E2 properly… AI cannot fix this!! Yes there is a direct relationship between a poorly functioning liver and E2 clearance… Someone should have told you this already…

A few tips that worked for me…

Liver support by Himalayan

St. John’s wort- Hypericum perforatum - Wikipedia <~~ read down by the bottom- also has many other good perposes

Milk thistle from the seed not the whole plant

Stay away from soy

Eat organic meats

You need to make sure your guts are working good try flora 12 as a probiotic and get some good enzymes in you…

Find out why AST is so elevated!!?? Do we know? You need to heal the liver not add more AI. Go see a naturopath or homeopath who does biomaridian and free radical testing. They will help you man!!!

Just a side note, liver enzymes ast, alt are not liver specific… You should refrain from working out for a few days before your labs… Muscular injury could raise these values. In your case with E2 this high I think we can rule that out…

Tell your doctor you want to know what’s going on with your liver… Ultrasound and go from there…

Good luck Sir

Wow - your situation is alot more complex than most - you don’t seem to respond to the AI - If I was taking in all those chemicals and still not FEELING better I would consider coming off all stuff for a while and start a new course of treatment in about 6 months IF I still don’t FEEL right ( keep in mind your body makes 340 testosterone naturally and by being on Test you shut off your body completely ) 340 is a fine number IF YOU FEEL OK .

sure you could have a higher number , but at what cost ( literally and figuratively ) . Take my situation : I have always had tiny nuts . And T levels around 120 ( no idea what E2 levels were then ) most of life - I am 45 - I had 0 sperm and did a cycle of clomid 20 years ago and yielded 3 kids from it . My body has always been chubby , but very muscular as well .

I always had strong erections with high libido . About 2 months ago my dr offered Test Cyp injections to me @ 100mg per week . No AI , no HCG . He said it will bring a better metabolism to me and help me loose fat . I took him up on offer and self injected . He was correct on fat loss - and I added muscle ( I lift weights daily ) but 6 weeks into it I developed ED for a week .

Got some labs back and had 63 estradiol . I started injecting twice a week to divide dose for steadier stream in blood ) seems to be working for now . I have been to 3 drs , each has opinion that E2 is not a big deal ( although data says it is ) each wants different delivery style ( pellet , gel , shot ) none will give AI . So my choices are to weigh pros and cons - pros won for now and I will continue with shots .

MY POINT TO YOU IS : look at your pros and cons and decide if TRT is for your situation .