T Nation

Bad Experience: 8 Yrs of TRT, No E2 Management


#1

I am requesting suggestions on what others might do if they were in my situation. Below you will find:
1. Objectives.
2. My questions.
3. What I am considering as my plan of action.
4. A Brief history to understand my journey thus far.

  1. Objectives:
    O1: Get hormones in line with those of a healthy male.
    O2: Morning wood, it has been so long.
    O3: Lose my spare tires. Nothing cool about a skinny guy with a gut.

2.Questions:
Q1: What is the best way to up regulate T receptors, I have been on TRT for 8+ years? HappyDog48 provided a great write up on E2 that mentions overtime T receptors downregulate.

Q2: How do I return my ?marbles? to their number size after 8 years on Androgel w/o HCG?

Q3: Are there negative long term effects of using Adex? It looks like I am E2 dominate and might need Adex for many years.

Q4: Suggestions on how I might lose weight when I do have to motivate myself to do basic tasks like take out the garbage, etc.? I am 40 years old, 5?6?, small frame, 185lbs, 27% body fat, with most of the fat on stomach and thighs. If it is relevant, I weight 135lbs in highschool.

Q5: Where can in find information (ideally articles) on the safety of mixing DIM and Adex.

Q5a: Is there a way to tell how long it takes for my body to metabolize E2?

Q6: Am I better off taking Magnesium, Zinc, and B6 separately vs ZMA?

Q7: How might many of you modify my proposed plan (please include dosage amount, frequency of dose, and weather you would take it AM or PM)?

Q7a: Do I need to work HCG back into my plan?

Q7b: Is there a way to extend the life of HCG once mixed? It seems to not work as well after 30 days.

Q7c: HCG instruction call for mixing 10ml of solution with powder, is this the standard mix used on T-Nation for guys?

  1. Proposed plan:
    I currently have Rx for HCG, Arimidex, and Cabergoline. My current doc is open minded; however, I like to provide medical reports to back up what I am suggesting.

0.25mg Arimidex (pill form) every day (initial Rx was 1mg everyday)
1mg Cabergoline 5 days a week (same as Rx)
300iu of HCG every other day if it will enlarge the marbles (Rx is 600iu 3x week)
1mg Vitamin C 4x day, everday
3 BodyTech ZMAs every night
1000IU Vitamin E 1day a week
2mg Copper 2x week.

  1. Brief History:

-2001 Prolactin (PRL) secreting growth on pituitary ID; a Men?s Health article made me suspect I had low T. I had to plead with my primary care doc to test T levels; T=mid 100s & PRL=694 (upper limit of range is 18), E2 was not tested as I was not aware to consider it.

-2001-2004 TRT with Androgel and Dostinex/Cabergoline. AI not prescribed.
2004 Dostinex did not reduce size of pituitary growth, had it surgically removed.

-2004-2006 Dostinex and Androgel due to fragments of growth still producing PRL=60 (upper limit=18); again AI was NOT prescribed.

-2007-2008 Prescribed HCG at 1200iu 3x week, no AI prescribed. For 3 months in 2007 I dosed HGC at 1200iu 3x week. Great results! Morning wood for 1st time in decades! Re-realized the beauty of women (no interests in sex at all prior), I chased any and all tail!

I could not get enough; I entertained self several times a day. T spiked to over 1100ng/dl, PRL=35 (max=18), E2=156; doc wanted my T under 800ng/dl. He worked me down to 600iu of HCG 3x week. Gradually, libido and morning wood disappeared.
-Lost work insurance in 2nd quarter 2008, I have not been on HCG since May 2008.

Used Novedex XT, ZMA, Cabergoline (I had enough to get me to the time when I had insurance again), & Vitamin C. Lab results with these over the counters and Cabergoline were: TT=1000, E2=27, PRL=12. Interestingly no libido with these numbers. I also gained 35lbs with most of it in my gut which I have not been able to get rid of.

-2009 I got insurance back. Doc stated you cannot be sure what are in these unregulated supplements, they have low quality control. We agreed to try Cabergoline and an AI (Arimidex 1mg every day for 90 days).

After 90 days: TT=540, E2=13, PRL=10. I freaked out with E2=13 and stopped taking Arimidex for 2 weeks until my next office visit. In a 2 week period my E2 increased by about 150%, PRL increased by about 40% and TT dropped by about 170% (TT=320, E2=32, PRL=24).


#2

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#3

I am curious as to what some of the vets would suggest; hopefully they chime in. As BBB said, why not go to shots? Sorry if I missed it but did you list your T levels before you got on HCG? You may not be absorbing the adrogel well.

If you lose your insurance again you can pay out of pocket for injections - they are much cheaper than androgel. A 20 week supply (depending on dosage) should cost around $45. HCG is not that expensive either to pay out of pocket.


#4

BBB & Caged, thanks for the quick reply.

Yeah the post was long, more of a frustrated rant. Key points

BBB, At this point I am NOT on any HCG or Androgel. After 8 years, I and my doc are both surprised I am able to produce T=540 (although E2=13 is low). I am only taking Cabergoline (once known as Dostinex).

I still have plenty of Adex and HCG, but no Androgel. Seeing how my body is responding, it looks like I might have the ability to produce enough T on my own if I can keep E2 at the right level.

Caged: T=500 before HCG, when I was on Androgel. T=1000 on a high dose of HCG, again not T supplement and no AI.

Thanks for you feed back and not blasting me for the 1st rant.


#5

If your E2 increases…

In your current ‘natural’ state, you should take .5mg adex per week in divided doses. A liquid product is easier to dose. Get serum E2 labs and adjust adex to get E2=22pg/ml. If your were to get E2=28, then you would change the dose by 28/22. This same math can also reduce the dose.

Transdermals can create E2 levels that are much higher than injections.

Your prolactin was shutting down your HPTA. With prolactin levels corrected, your HPTA does seem be functional. You need to avoid E2 levels that throttle back your HPTA.


#6

KSman, thanks for the feedback.

My Rx is in the pill form. I got to E2=13 taking 1mg every day, 7 days a week for about 90 days per doctor. Based on the math you provided, to get to 22 it appears as if I should scale back to 3 mg a week. Providing my math is right, I’ll take 3 1mg pills a week (Sun, Tue, & Thu) or is Adex processed better at smaller more frequent doses? If yes, what frequency?

My PRL=14 at last lab, with less than 18 being “normal”. My Rx is for 1mg of Cabergoline/Dostinex 5 days a week. Based on what you have read or experienced, at what point would you start scaling back your cabergoline dose? My doc says anything under 18 is fine, what are your thoughts on what is the ideal PRL level?

Lastly, is it normal to be sleepy all the time? Since starting Adex, I seem to not be able to stay up throughout the day. At about 1-2PM I get sooooo sleepy.

Thanks again.


#7

Also, regarding the PRL, I had the growth removed from my pituitary several years ago. MRI does not show a regrowth, so there must be small fragments of the original growth left causing my high PRL readings.


#8

Care to share what the surgery was like? I’ve got the same issue… growth on the pituitary causing too much prolactin.


#9

The surgery was not too bad. They went through my nose. I had packing in my nose for about a week. And I was not allowed to bend over for about a month. Also sneezing is not good either as the force of a sneeze can do major damage!

Ontrack, most important thing is to !!!GET AN EXPERIENCED SUREGON!!! Make sure you get someone that has performed several thousand procedures. Of course experience only reduces the possibility of something going wrong.

Inexperience increases the chances of something going wrong. I have met several people that went to an inexperience surgeon, most are worse now than when they went in. In a few cases the surgeon made a mistake and had to remove the whole pituitary.

Now they have to take every known hormone and their yearly prescription bills are beyond comprehension! Not to mention being moody and other factors that result in a less than desirable quality of life.


#10

[quote]TPower wrote:
I am requesting suggestions on what others might do if they were in my situation. Below you will find:

  1. Objectives.

  2. My questions.

  3. What I am considering as my plan of action.

  4. A Brief history to understand my journey thus far.

  5. Objectives:
    O1: Get hormones in line with those of a healthy male.
    O2: Morning wood, it has been so long.
    O3: Lose my spare tires. Nothing cool about a skinny guy with a gut.

2.Questions:
Q1: What is the best way to up regulate T receptors, I have been on TRT for 8+ years? …[/quote]

Are you sure about Cabergoline 1mg 5 days a week? I’ve seek 1mg twice a week. That stuff is known to cause heart valve problems. You should ask your doctor to clarify.

When on TRT, thyroid function should also be examined.

I am not a doctor. My comments are just from my experience.

About androgen receptor upregulation, I’ve read that Acetyl-L-Carnitine is reported to do that.

Are you exercising regularly?
BD