T Nation

Almost F'd Over by Endocrinologist Nurse


#1

Howdy,

I was first dx hypogonadic in 2000. I was re-dx'd last year......Both Total Testosterone levels were 220-240. In 2000 I was 220 lbs and 6'2". Now I am 330 lbs....... I was on Androgel for 10 months and TT levels were 179- 425. I stopped taking the gel crap for 3 weeks and went to an Endocrinologist who did some more test as follows:

Testosterone, Serum 142 (241-827)

Test, %F+W Bound 38.1 (9.0 - 46%)
Test, F+W Bound 54.1 (40- 250ng/dl)

Estradiol 36!

The Nurse called me the results and said the doc said I was not truly hypogonadic and my testosterone results were "fine." I am a RN and a recently graduated FNP............ I work at the same hospital and printed my results up before they called......I asked her what my total testosterone was and she said " wait a minute...uh it is 142" I said how the hell is 142 normal if they recommend tx below 300? She then said well Doc xyz did say you could take the Testosterone shots if they make you fell better............ I pick up my Rx later today.

Here are my questions:

1) Is Nolvadex a good tx for the high estradiol? Or is Arimidex vastly superior?

2) Do you think a Estradiol level goal below 30 or the Testosterone/ estradiol ratio is
better for tx.

3) I wonder if I should have tried to block the estrogen and not try test supplementation
first.

4) The LABCORP Bioavailable Testosterone could have been off due to the low Total
Testosterone, High estradiol, androgel use, etc? Correct?

Thanks for your time

Revo

P.S I know I need to lose weight.......once I get my test "normal" I think I can do it........I would like to avoid a roux-n-y mutilation!


#2

How old are you now?

Yes, your prior TRT could leave your HPTA in bad shape, but that really does not matter.

You are estrogen dominant.

You should ask the moderators to move this to the over 35 lifter forum where the TRT traffic is.

Inject T cyp or eth 100mg/week as two 50mg shots per week. Adjust dose to get high youthful TT or FT levels. TT should be 900-1100. TF is more important. Some docs do not care about TT and do not measure it.

250iu hCG SC EOD to preserve your testes and pregnenolone production.

1.0mg anastrozole per week in divided doses. After next E2 labs, adjust dose to get close to serum E2=22pg/ml. The dose adjustment is linear. If you get E2=28 when taking 1mg/week, new dose would be 1.0mg/week * 28/22. Note that this can down scale your dose as well. Some inject T EOD with #29 .5" .5ml insulin syringes. Do not use 1.0ml. Canadian clinical experience shows that T injected SC works better, steadier levels. Do not inject with 1.5" into your gluts.

Some guys are anastrozole over responders who have very low E2 with the standard dosing. They need to use around 1/4th of the expected dose. Read up on symptoms of very low E2.

You need adex to control E2. Do not use a SERM to mask effects of E2 in selected tissues!

If you have gyno, you need to use adex and short term SERM.

Go to amazon.com and get Eugene Shippen's "The Testosterone Syndrome". It is a great general read. The book does not know how T should be injected and predates use of aromatase inhibitors.

Check your thyroid levels. Ft3, Ft4 not just TSH.

TRT can lower cholesterol levels. If on a statin drug, you may need to reduce or stop.

What drugs are you taking? - Rx&OTC send a PM to me. Many can mess up your hormones.

T+AI+hCG


#3

There are a lot of us doing exactly what KSman is recomending and it seems to work well for the majority. "The Testosterone Syndrome" is a great book as well.


#4

I am 33...I was first dx in 2000. I though about putting it in the over 35 cat.......but my mind was to foggy from lak of T...lol

Thyroid panel was fine, had 2 drawn. Cholesterol panel was perfect......No heart dx hx in family. Fatigue and depression hx that greatly responded initially to Androgel.

The endocrinologist did make a comment about blocking estrogen so I think he would be up to Arimidex. I am going to pickup the Testosterone now.......let me see how much he Rx'd.......I swear to all that is holy if it is 100 mg q 2 weeks I will go bat shit crazy.


#5

ok he gave me 200 mg IM q 2 weeks........... $22 A MONTH!! Beats the hell out of 300- 400 a month of gel...... Ordering the Test book by Shippen....also going to order this Oxford press Testosterone Deficiency in Men it looks like a good book.....

Damn pharmacy gave me a 1.5 inch 20 gauge devil needle.............lol.


#6

Ordered the Shippen book....also ordered a book Testosterone Deficiency in Men that looks promising.

Doc Rx'd me 200mg every 2 weeks of Depo Testosterone.

Pharmacy gave me a 20 gauge 1.5 inch devil needle with 3 cc syringe!!!!!!!!!!

Chance would have it that I found some 1 ml 24 gauge syringes hiding in my house......


#7

Why the hell are you 330 pounds?


#8

330......Probably from the fatigue and depression of low T.....or the not exercising and eating too much thing........thank god I am not 5'2"

p.s... I was thinking about taking up MMA and BJJ.....


#9

Injecting every two weeks would mess you up. Good to see that you have some other syringes. In many states one can get insulin syringes without a script.

Weight gain is in part from estrogen dominance and low thyroid levels can do that too.


#10

Thyroid panel was normal...but I do have swollen thyroid nodules that are easily palpable. I was going to try and inject 100 mg once a week...... Syringes and needles are not that difficult to get.....My wife has some insulin syringes left over and I am a RN...........


#11

You should inject twice a week to avoid peaks and crashes. The peaks will increase E2 levels and that increases SHBG which lowers FT. With T levels that rise and fall, ones adex dosing cannot be matched to the T levels, so one is under dosed when T spikes and over dosed as T levels go low.


#12

I will do the 2x a week inj.......... When I go for my followup when should I inject prior? Should I wait about 2 or 3 days after the last injection for my doc appt?

Do you refrigerate the Test vial in between injections? I know it will have to rewarm to dissolve the crystals.....


#13

No need to put in fridge. I found that by running warm water over the vial for a minute helps tremendously when drawing with small needles (I use a 25g). Don't get it hot, just a little above room temp is enough. Shake the vial to dissolve the crystals then warm a little.
The 2x / wk protocol is really helpful. Listen to KSman he has helped a lot of us get the help we need.


#14

did first inject didn't hurt until I put the testosterone in......burned a bit not bad...........used the vastus lateralis. used a 1 cc and 5/8 25 gauge needle...need to find a 0.5 ml insulin syringe.....


#15

Veins hurt in a diffuse manner when hit. Nerves can be electric, remove and retry. Some injections will miss a nerve, but the stretching of the muscle by the oil can sometimes be close to a nerve. Best to have the muscle relaxed for injections. If your muscles are tight all of the time, massage them to fix that and injections can be more comfortable. It seems like things get more comfortable over time.

Are you aspirating? That can be hard with small needles that are hard to handle. I do not aspirate for my small EOD doses.


#16

Yeah I do aspirate......dang nurse training it is second nature now.....lol. I would hate to put that cottonseed oil into a vein.....muscle was loose when I injected but I tensed when I injected......


#17

Keep forgetting about the RN.... But good to play this out for others.


#18

If you are located in the North eastern USA PM for good dr.


#19

no I am in Tennessee.....if I am not happy at my follow up I may go see Dr Crisler.....


#20

Just curious why everyone is still injecting T cyp IM for TRT purposes? SC works fine. I've been doing it for a year and have no issues. I use a 1/2" 29 gauge. It makes it convenient for me to use the same type of syringe for everything.