RESTART Attempt? Please Help with Labs?

Pharma / TRT Testosterone Replacement
21

T3 is good and will mostly tell you waht you need to know (make sure it is Free and Total). The reason you also want T4 though is because if its high and T3 is lower, you need to investigate RT3 as your T4 is not converting properly. But if T3 is high, this is usually not a problem (unless you are taking thyroid meds).

Aromasin is an AI that has not been shown to interfere with SERMs. But you have no indication that your E2 is even high at this point. I would not throw it in if it were me, especially without bloodwork.

22

[quote]dhickey wrote:

SERM will block feed back from E levels. Hypothalamus sees no E, assumes low hormone levels, and signals the pituitary to produce more LH. Testes see more LH and make more T. More T = more E conversion = higher E levels. While on the SERM it doesn’t matter as the receptors we are concerned with aren’t seeing it.

This will matter when you come off the SERM. You don’t want the receptors in question to see sky high E levels, so you do something to bring them back down before coming off the SERM.
[/quote]

This is more or less my understanding as well, and why I’m trying to expand my knowledge of SERMs and AIs right now. Looks like you’ve made the smart choice w/ nolva; based on research and VT’s advice aromasin may be the better AI to take, at least while still on the Nolva.

I hope your efforts are successful dhickey - best of luck on your restart

23

Okay, so I’m heavily researching SERMs and AIs at the moment. Main conclusions from readings:

  • HCG and SERM should not be stacked, at least for PCT or restart bc they both have effect of increasing the body’s perceived level of LH - can be further suppressive

  • Nolvadex is preferable over clomid due to 1) lower effective dosage, 2) less occurrence of sides, 3) it is thought to increase pituitary responsiveness to LHRH - is this established?

  • use of AI is often beneficial to effectiveness of PCT at restoring homeostasis bc SERMs, while blocking the effects of estrogen at the receptor level, also increase estrogen levels which may remain elevated after cessation of SERM - once the receptors “see” this, it causes negative feedback inhibition of the HPTAs T production and decreases effectiveness of what the SERM accomplished during PCT

  • Arimidex and Nolvadex interact with eachother to lower blood levels of both drugs and therefore decrease eachother’s effectiveness. While taking Nolvadex the only viable AI would be aromasin which is a type I AI, meaning it binds to aromatase and initiates hydroxylation - permanently rendering the enzyme inactive. Aromatase activity only recovered by new enzyme synthesis. This would mean Aromasin should be used sparingly if at all depending on E2 levels, so as not to create semi-permanent drops in E2 below the desirable range.

[quote]VTBalla34 wrote:

Aromasin is an AI that has not been shown to interfere with SERMs. But you have no indication that your E2 is even high at this point. I would not throw it in if it were me, especially without bloodwork.[/quote]

Agreed VT, I wouldn’t proceed with any of this before I get those E2 results. But, I’m thinking that once on the SERM, E2 levels are expected to increase, yes? So at that point an AI might be beneficial to reduce the amount of E2 building up which may become suppressive of the HPTA response - of most concern after SERM is stopped.

If this is the correct way of looking at it, I’m wondering if minimal use of aromasin while on SERM would be good to assist HPTA restoration by eliminating extra inhibition from E2(just a couple low doses maybe since effect is semi-permanent, don’t know enough about this idea yet). This of course would be contingent on E2 levels having risen above the desired range (or should we consider temporarily dropping them below the 20-24 pt mark, just for the purpose of encouraging the hypothalamus and pituitary to produce the GnRH and LH / FSH needed at this time?)

Just before, or upon cessation of SERM the AI could be switched to Arimidex at a low dose to keep E2 from rebounding and ruining HPTA recovery. Arimidex could then be maintained at low dose for a longer period of time since it will not permanently disable aromatase activity and cause unwanted changes in E2 production ability. This would theoretically allow the HPTA to “get used to” running at proper capacity again while keeping inhibition from E2 in check.

Would love to hear thoughts from yourself or anyone else on any of this

24

The only input I can give is that I tried Nolvadex at only 10mg a day for 2 weeks. Testosterone raised by 100% from approximately 10nmol to 20nmol. SHBG went up but I never got E2 tested. Free testosterone also had a 100% increase which was good. FSH went from 2 to 5, and I assume LH had a similar response but did not get that tested. So yes it works very well, and I think you don’t even need to take the bigger dosages to get these effects. The common dosage is like 40mg,20mg etc… 10mg gave great results.

Currently trying clomid now, and again I know they recommend 50mg a day. But having read peoples results on 12.5mg and had great improvements I figure I will try the same.

If you can get away with a lower dosage and achieve the same results I think that is the way to go. This way you probably minimize the side effects to some degree I assume.

25

[quote]iroczinoz wrote:
The only input I can give is that I tried Nolvadex at only 10mg a day for 2 weeks. Testosterone raised by 100% from approximately 10nmol to 20nmol. SHBG went up but I never got E2 tested. Free testosterone also had a 100% increase which was good. FSH went from 2 to 5, and I assume LH had a similar response but did not get that tested. So yes it works very well, and I think you don’t even need to take the bigger dosages to get these effects. The common dosage is like 40mg,20mg etc… 10mg gave great results.

Currently trying clomid now, and again I know they recommend 50mg a day. But having read peoples results on 12.5mg and had great improvements I figure I will try the same.

If you can get away with a lower dosage and achieve the same results I think that is the way to go. This way you probably minimize the side effects to some degree I assume.

[/quote]

Thanks for your input irocz,

I agree with your view on keeping on low doses as much as possible. From what I’ve been reading this may help to avoid any extra suppression while still still attaining the benefits we seek. IMHO, it may be easier to pull off w/ nolva than w/ Clomid due to the larger dosages that drug requires → more mgs, more margin for taking more or less than needed for effect. However, I’m sure it can be done by someone who knows what they’re doing and it sounds like you do.

Were you taking the nolva as PCT, or attempting a restart? And did you find the effects lasted? ie. sustained increase in natural T production after cessation of SERM?

26

[quote]Robert Paulson wrote:

[quote]iroczinoz wrote:
The only input I can give is that I tried Nolvadex at only 10mg a day for 2 weeks. Testosterone raised by 100% from approximately 10nmol to 20nmol. SHBG went up but I never got E2 tested. Free testosterone also had a 100% increase which was good. FSH went from 2 to 5, and I assume LH had a similar response but did not get that tested. So yes it works very well, and I think you don’t even need to take the bigger dosages to get these effects. The common dosage is like 40mg,20mg etc… 10mg gave great results.

Currently trying clomid now, and again I know they recommend 50mg a day. But having read peoples results on 12.5mg and had great improvements I figure I will try the same.

If you can get away with a lower dosage and achieve the same results I think that is the way to go. This way you probably minimize the side effects to some degree I assume.

[/quote]

Thanks for your input irocz,

I agree with your view on keeping on low doses as much as possible. From what I’ve been reading this may help to avoid any extra suppression while still still attaining the benefits we seek. IMHO, it may be easier to pull off w/ nolva than w/ Clomid due to the larger dosages that drug requires → more mgs, more margin for taking more or less than needed for effect. However, I’m sure it can be done by someone who knows what they’re doing and it sounds like you do.

Were you taking the nolva as PCT, or attempting a restart? And did you find the effects lasted? ie. sustained increase in natural T production after cessation of SERM?
[/quote]

No not PCT, just wanted to restart since for some reason my pituitary is lazy.

I did it only for 2 weeks because doctor wanted me off it to try and figure what is wrong with me. Probably was too short to keep the effects of it. Not sure what my test levels stayed at but just going by the way I feel and strength drop off I have a feeling that it dropped off.

So on the clomid now, will take it longer and see. So far can’t feel any difference either dose is too low or need to wait longer.

But what I read from 1 guy he said that after a clomid trial his testosterone began to gradually fall over a number of months. Think he mentioned 8 which is a long time.

27

Through much unnecessary labor, I’ve gotten a hold of some new labs which cover some new values not included in the original panel I posted on pg 1. Results as follows:

BLOOD RESULTS FEB 24/2012, (940 AM)

(hope conversions are accurate please alert me if anything looks off, chem 101 was a long time ago

DHEAS 9.0 umol/L [<17.5], or 33.16 ng/mL [<64.48] … not sure, prob less than ideal?

B12 422 pmol/L [>150], or 521.857 pg/mL [>203.2520]

Cortisol, AM 324 nmol/L [120-620], or 11.743 ug/dL [4.349-22.472]… no idea, seems mid range

Estradiol 59 pmol/L [<200], or 16.072 pg/mL [<54.481] … seems slightly low from what I’ve read? (ideal 20-24?)

Ferritin 134 ug/L [12-300] (equivalent in pg/mL), or 134,000 ng/mL [12,000-300,000]

FSH 2.1 U/L [<7.0] … lower than previous

LH 2.2 U/L [<12.0] … lower than previous - these 2 concern me and suggest the prob is at hypothalamus or pituitary

Prolactin 7.0 ug/L [<21.0]

Progesterone 1.3 nmol/L [<3.0], or 408.8 ng/dL [<943.38]

Test (total) 12.1 nmol/L [10.3-29.5], or 349.00 ng/dL [297.08-850.86] … up about 30 pts from 320, prob just a fluctuation

TSH 2.94 mU/L … highish, elevated from last test

Next will include T3, AST, IGF-1, CRP, INS, Vit D

28

[quote]Robert Paulson wrote:
Through much unnecessary labor, I’ve gotten a hold of some new labs which cover some new values not included in the original panel I posted on pg 1. Results as follows:

BLOOD DRAWN FEB 24/2012, (940 AM)

(hope conversions are accurate please alert me if anything looks off, chem 101 was a long time ago

DHEAS 9.0 umol/L [<17.5], or 33.16 ng/mL [<64.48] … not sure, prob less than ideal?

B12 422 pmol/L [>150], or 521.857 pg/mL [>203.2520]

Cortisol, AM 324 nmol/L [120-620], or 11.743 ug/dL [4.349-22.472]… no idea, seems mid range

Estradiol 59 pmol/L [<200], or 16.072 pg/mL [<54.481] … seems slightly low from what I’ve read? (ideal 20-24?)

Ferritin 134 ug/L [12-300] (equivalent in pg/mL), or 134,000 ng/mL [12,000-300,000]

FSH 2.1 U/L [<7.0] … lower than previous

LH 2.2 U/L [<12.0] … lower than previous - these 2 concern me and suggest the prob is at hypothalamus or pituitary

Prolactin 7.0 ug/L [<21.0]

Progesterone 1.3 nmol/L [<3.0], or 408.8 ng/dL [<943.38]

Test (total) 12.1 nmol/L [10.3-29.5], or 349.00 ng/dL [297.08-850.86] … up about 30 pts from 320, prob just a fluctuation

TSH 2.94 mU/L … highish, elevated from last test

Next will include T3, AST, IGF-1, CRP, INS, Vit D[/quote]

Well your results look very similar to mine. Except that you do have cortisol a little lower. Lh,Fsh low, low test, I think you would probably see a difference with a restart in numbers. If that will correspond to feeling better hard to say.

Your TSH is high and I would advise to get Thyroid Antibodies (Anti TPO, Anti TG) to rule out autoimmune disease (Hashi’s) and also get Ft3 and Ft4. Dont bother with T4 or T3 make sure to get the Ft3 and Ft4 tests.

I think you are on the right track. At least with a tamoxifen restart you will find out if your boys are capable of producing more testosterone when instructed. Definitely well worth the test in my opinion.

29

[quote]iroczinoz wrote:

Well your results look very similar to mine. Except that you do have cortisol a little lower. Lh,Fsh low, low test, I think you would probably see a difference with a restart in numbers. If that will correspond to feeling better hard to say.

Your TSH is high and I would advise to get Thyroid Antibodies (Anti TPO, Anti TG) to rule out autoimmune disease (Hashi’s) and also get Ft3 and Ft4. Dont bother with T4 or T3 make sure to get the Ft3 and Ft4 tests.

I think you are on the right track. At least with a tamoxifen restart you will find out if your boys are capable of producing more testosterone when instructed. Definitely well worth the test in my opinion.
[/quote]

Thanks irocz,

I agree the TSH is high, which is disconcerting as I am pretty sure the initial problem is a result of AAS induced inhibition and downregulation. But now I guess I need to learn more about how the thyroid ties in and figure out whether it’s a secondary problem I’ve caused that would improve if I jumpstart my HPTA, or a contributing factor to what would otherwise be a milder case of low T (my guess is no b/c my LH sucks).

I’ll have to try and add the fT4 onto the panel this new Doc has sent me to have done, he’s only called for fT3. The antis I’ll prob wait and ask him for when I go in, I think if I fill in too many of my own on his panel he might get pissed - and this Doc looks like might be a good find so don’t want to lose him yet.

For now I’m focusing research on specifically where and how negative feedback inhibition occurs in the hypothalamus and pituitary, and involvement of thyroid and adrenals in HPTA function.

Itching to try a restart but want to get all my ducks in a row first and get pharm grade drugs from a Doc.

30

Can anyone comment on these recent results? I’m still a bit confused by ranges, and not completely sure where “optimal” usually lies for some of these values. If anyone can tell me how E2 looks that would be great, or if anything else is looking off - I’m not really grasping the “<" or ">” ranges, aren’t these less useful than “-” ranges?

31

E2 is where it should be for a man with test on the low side. No sense in worrying about it when your T is that low.

Agree with iroc about thyroid.

32

Thanks for the input guys.

I’m glad it looks like estradiol is not disproportionate. I hope this will translate to an easily maintained optimal E:T ratio once I start working on raising T levels.

While I wait to get in to the hormone Doc, I’ll be working on getting the rest of my endo system in the best shape possible for a better chance at restart. Thyroid appears to be an issue, supplementing w/ kelp extract iodine regularly now, hopefully it helps. Research focus now on thyroid until I’m closer to restart.

33

Brief update - super bummed out today as I’ve just been told I have to wait until August to get into the hormone doc I’ve been looking forward to seeing. I really don’t think I can continue to leave my situation until then for treatment. I’ve foolishly wasted over a yr dealing with doctors on this, being told to wait it out etc.

I did want to attempt a restart under the supervision of a good Dr. bc I don’t feel I have a full grasp of everything involved. However, I have researched heavily regarding my hpta deficiency and the use of hcg / SERMS / AIs. I’m thinking self treatment might be the only direction for me at this point. I guess I’ll need to look into getting my own bloods done (Canadian system requires Dr to order blood tests), sourcing, and really tighten up my knowledge on the hpta and the drugs to be used. Shit I guess I was really hoping to use pharm grade drugs and run proper bloods throughout the process, be able to bounce a few questions off a knowledgeable Doc.

Thoughts?

34

I understand your desire to self treat given the shitty nature of the health care industry for this kinda stuff in your country. Lay out your plan and I will help critique it.

35

[quote]VTBalla34 wrote:
I understand your desire to self treat given the shitty nature of the health care industry for this kinda stuff in your country. Lay out your plan and I will help critique it.[/quote]

Thanks VT, ya it’s pretty frustrating. I’m just trying to sort out a couple more grey areas today and should have a pretty good idea of what my final treatment plan should look like at that point. Will post shortly and would be very glad to have your input. Unfortunately, my plan will now somewhat be determined by sourcing options which I also must consider.

36

Ok, sorry I’ve been having trouble posting / researching without my GF looking over my shoulder - she has no idea what is going on with me and it is best that it stays that way.

I was able to get my hands on my most recent bloodwork ordered by the hormone “specialist” I was waiting to get in to. I thought that he had ordered a fairly comprehensive panel until I realized that he hadn’t ordered total T, FSH, or LH. HOLY F****! Seriously? I don’t know if that is incompetence or a ploy to get me back in to the clinic after an unnecessary extra round of testing down the road, but either way I’m glad I didn’t waste my time getting jacked around by that place! /end rant

Anyways, some other useful values I think:
BLOOD DRAWN MARCH/15/2012

Cortisol AM 289 nmol/L [120-620], or 10.47 ug/dL [4.349-22.472]

Estradiol 44 pmol/L [<200], or 11.98 pg/mL [<54.481]

Free T3 5.9 pmol/L [3.5-6.5] **think this is the appropriate measurement for this value, if not please let me know and I will convert

IGF-1 168 ug/L [115-430]

Progesterone 1.0 nmol/L [<3.0], or 314.46 ng/dL [<943.38] - sorry I may have botched this conversion, not too sharp at the moment

TSH 3.89 mU/L [0.20-4.00]

SHBG 14 nmol/L [6-65]

Insulin 40 pmol/L [35-140]

**I think these are the standard measurements for all these values, but if any need to be changed to ng/dL etc. please let me know and I will figure out the conversions

TSH seems to have climbed even higher here but free T3 looks to be also high - indicating a sufficient thyroid response to the TSH? This would suggest to me there is no serious lack of thyroid function (sorry my thyroid research is still lacking)

Are IGF-1, insulin, and progesterone all not a little low?

37

Your high TSH is not congruent with your very adequate T3. This could mean one of 3 things, IME:

-Your pituitary is not getting the signal that thyroid hormones are adequate (least likely)
-You have a high degree of Reverse T3 pooling that your body is trying to address (not sure how likely but your lowish cortisol lends credence)
-You have Hashimoto’s

I would definitely investigate #3 and get your thyroid antibodies checked if I were you.

38

[quote]VTBalla34 wrote:
Your high TSH is not congruent with your very adequate T3. This could mean one of 3 things, IME:

-Your pituitary is not getting the signal that thyroid hormones are adequate (least likely)
-You have a high degree of Reverse T3 pooling that your body is trying to address (not sure how likely but your lowish cortisol lends credence)
-You have Hashimoto’s

I would definitely investigate #3 and get your thyroid antibodies checked if I were you.[/quote]

Thanks for the analysis VT, I will definitely have to look into all of this. And the research continues… One question, any idea how likely it is that this situation is somewhat resultant of my low T situation? I know hypothyroidism can cause problems w/ T production, but not sure how it works going the other way. I never really had any problems prior to this shutdown and the shutdown I’m almost certain is the result of my botched cycle. I’m just thinking that maybe if I successfully restart then there’s a chance the thyroid abnormalities will level off a bit. Sorry, I’ll get cracking on the research and may be able to uncover my own answers - just trying to figure out my priorities going forward.

39

I would say its not very likely that its a result of your low T…but I could be wrong…I would actually think the thyroid issue (if it does exist) contribute to your inability to recover properly from your botched cycle.

40

[quote]VTBalla34 wrote:
I would say its not very likely that its a result of your low T…but I could be wrong…I would actually think the thyroid issue (if it does exist) contribute to your inability to recover properly from your botched cycle.[/quote]

lol f*** my life, another piece to the puzzle. And I guess if it is indeed Hashi’s I can’t just fix it w/ supplemental iodine. I don’t seem to have any symptoms of Hashi’s that aren’t also seen w/ low T, ex. no goiter or swelling of thyroid and never feel hyperthyroid - however my symptoms very well could be the result of both low T and thyroid disorder, as they are non-specific in this way. Also, I guess it could be Hashi’s in early stages.

Looks like the only way to find out is to test for those anti-bodies, would testing FT4 add anything here or is FT3 the better indicator anyway? The problem is I’ve run out of cooperative doctors at this point - does anyone know of some way to do this testing without a doctor? I’m looking for stuff I can do online in Canada but haven’t come up with much yet. I’ll also need to be able to do my own testing during and post restart to evaluate success / need for ancillaries like an AI