T Nation

55 Y/O with Questions


#1

Feeling like crap for a year all the classic symptoms . Make appointment with endo from list blue cross blue shield gives in NJ. He was anti TRT from the start. I get 370 on a scale 348-1197 serum test.

Retest this time 300 on same scale with free test at 6 on scale of 5-21. We do fsh and lh i am 2.8. Pituitary is good. So we consult over the phone and I am expecting to just suck it up. He initially wanted to treat depression,ed and statin. To my surprise he said we can put in for androgel with insurance. He said its a big back and forth and doesn’t always work… So I mentioned compounding pharmacy that is 5 miles from his office. He said there strength is not the same…yada yada yada. So I am going to his office tomorrow. Can he just write a script for the compounding test?


#2

There is a big disconnect between quality of life and lab numbers. Endos as a group are the worse when they should be the best.

Please read these links found here: About the T Replacement Category
advice for new guys
things that damage your hormones - but you are mostly age related
protocol for injections
finding a TRT doc

Androgel probably will not work if your thyroid is suboptimal. Does not absorb and that is a symptom of low thyroid function - that docs do not understand and not in literature.

Phone compounding pharmacies and ask for a doc that does:
patient self injections
with hCG - your option
and anastrozole to manage estradiol [E2]

Thyroid function can be low if not using iodized salt long term.
do you get cold easily?
dry skin?
outer eyebrows sparse?
thyroid problems in your family?

TRT is easy, but most docs are clueless. You can read up and ask questions here for a few weeks and know more than almost all of them.

When you do TRT, your sex drive may get very strong for a while. Sometimes wives can get upset by this.


#3

First, I agree with everything KSMan said.

From the limited labs you posted, you seem to be secondary, but at your age, you can also be primary also.

If cost is a concern and you are secondary hypogonadism, SERMs are a cheap option that shouldn’t be overlooked. I don’t bother going through my insurance (20$ for a 3 month supply of clomid at costco pharmacy) for my meds.

Pituitary is good? So you had a prolactin test? Post your labs so we have more information.


#4

You recommend SERMs a lot to people! While I advocate the use for restarting hpta for secondary people, I wouldn’t recommend for indefinite use. I felt like absolute shit on clomid. Restarts don’t work most of the time even in younger people and to keep chasing a dream to get your natural production on when that has not happened to someone in the first go to keep trying trying and fail is not advisable in my opinion. A person who has a problem will probably end up on TRT regardless, so the amount of work this takes and the sides it produces, it would make sense for people to restore QoL with TRT IF I he restart is unsuccessful.

We also dont know the effects of these drugs long term. We do know how T works in the body long term.


#5

You are right, if it’s an option I usually recommend it. They can be a great option if you also control E2. If SERM fails, you can go straight to pinning T with no problems. You can’t always go from T to SERM with success. Also, keep in mind that if a thread is strictly about primary hypogonadism or post-cycle, I tend to stay out of the thread. My knowledge about HCG / T / HGH / pinning / creams is more limited compared to my knowledge of SERMS + AI. Therefore, what looks like a 100% SERM recommendation rate is more like 40% recommendation, 60% silence.

From your thread, IMHO, I suspect your sides were from a lack of controlling E2, which can be a problem with SERM or injectable T.

In this case, he’s a getting a little old for a SERM, but he mentioned cost. SERMs can be very cheap (injecting T also) and they are very convenient. People don’t always have success with topical T (also can be cost prohibitive) and there may be some resistance from his doctor about him injecting.


#6

If I haven’t made it clear, I appreciate you helping. I was trying to add to the advice that you give.

I controlled e2 for the first 3 weeks(with tamoxifen), then experimented without AI. The thing is that the most people don’t feel anything different with Serms even when numbers look great. You should be happy that you had such a great response. But most people are not so lucky.

If you are able to restart that would be great, but being on SERM for long time is not advisable in my opinion. I could be wrong. But I would be more comfortable with TRT even though I hate pinning.


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#13

Thanks Everyone… Just got back from endo he gave me sample of Axiron 30mg…just applied . Working thru Insurance for future supply…
I am almost 56 yo…220 lbs 6, 2" 100% Italian decent( though taller and fairer skin than stereotype). Always in good health. Active, I guess what you would call type A personality. Self Employed,great wife(beautiful married 34 years and counting). Kids great all doing very well. Positive upbeat attitude. Knocked down I get up brush myself off and try again. Last year downhill…ed(dead meat),libido(and I invented the term hot blooded italian),sore,fog,unmotivated etc. Hobbies bow hunting,road bike,golf,gardening,etc very much persued the outdoors. Did 10 miles 2 months ago on bike and was dead with no urge to try again. It was not me. My friend has Low T so I got checked out. Funny Doc was trying to disparage Low T based on lack of empirical evidence. He mentioned depression,Lyme(neg),stress, etc. Only result not posted was fsh…lh which was 2.8 yesterday. Second testosterone test was within a week of first and dropped from 378 to 300.
So lets see what happens. Thanks once again…great site which I have spent hours going through. God Bless


#14


2 more testosterone is first result


#15

You need to get active, your cholesterol is through the roof.

Not many are familiar with Axiron, it would be better if you could self inject. Please provide Thyroid labs, they could be contributing to symptoms and even low T itself.


#16

is that TSH? if it is 1.76…range 0.45-4.5


#17

Yes, and fT3 and fT4 which gives a better representation of thyroid function. Please read thyroid sticky in about T replacement forum and take oral body temperatures per the sticky.


#18

I welcome the debate.

If you are getting flak, you are over the target. :wink:

Controlling E2 with nolva (tamoxifen) IMHO is a misconception. Nolva blocks the E2 receptors, however the doses we are using aren’t a “full blockade”. Doses used for cancer are a “full blockade” dose. That means, if your E2 gets high (as it may on SERM) because of more T production, that increased E2 is still hitting some receptors, probably more than it would have beforehand. An AI (tamoxifen is NOT an AI) will reduce the levels of circulating E2 through either blocking the reaction OR destroying the aromatase enzyme. Completely different mechanism, and different effects.

I do not suggest anyone take enough SERM to get a full blockade.


#19

I said AI with tamox, not tamox as AI. Anyway let’s not hijack this thread.