T Nation

Cobra003 Case Study & Updates

Short Version: I did chemo for hep c on 6/23/2000. It believe it damaged my endo system, mainly testes and T production. Per Doctors prescriptions I have been on and off Androgel over the past 10 years. One year ago I was diagnosed with a under active thyroid and low T (102). Since then I have been on Test Cyp injections for the low T and Synthroid for Thyroid function. My Doctor does not specialize in TRT so I requested a referral to a specialist. I have been reading the stickies so I will be prepared when I have my appointment. If I have to I will take matters in my own hand. I will post new Tests when I get them.

Age: 52
Weight: 190lbs
Height: 6ft
Waist: 34in

Body hair: Male pattern hair loss on top of head, Full facial hair, hair on chest, patches
hair on back, hair on arms & legs.

fat: Small amount of abdominal fat.

Health: General good, can go a winter w/out a cold, hep c but no problems from it.

Symptoms: Major brain fog, poor erections, poor libido, low energy, sleep a lot, muscle loss,
gained 40 lbs in 2 years (I weighed 150lbs for 30 years before) no motivation,
fatigue, loss of interest in things I enjoy.

RX: Methadone: 30MG per day, Klonipin: 1MG as needed, Synthroid: .05 MG per day, Viagra: 50 MG
Test Cyp: 1ML every 3 weeks starting a year ago (started SC injections EOD
on 7/21/12)

Diet: 2 servings of yogurt, white meat chicken, 2 servings of vegetables, 1 serving pasta,
Several servings of fresh fruit, Trail mix(raisins, dry roast peanuts, 60% dark
chocolate, walnuts)daily. some fish and very little red meat.

Training: None, walk about a 1/2 mile at fast pace into work every night & physical work.

Lab:
6/15/2011 Total T=102 (212-755) low
9/13/2011 TSH=5.13 (0.40-4.10) high

(see post 20 for current lab)

After reading the sticky on what damages hormones it looks like the Methadone I take is a big player. My biggest problems did start to happen after I switched from Ultram to Methadone almost 2 years ago. Starting today I am cutting myself off a little at a time. Hopefully I can get off it completely.

Can we get cliff notes? Sorry

I’m not sure what cliff notes are?

lol. He wants the basics of your story…you actual gave a bit too much detail. Can’t see the forest for the trees. :wink:

I am still taking my injections from my regular Dr. until I go see the Endo on 8/27/12. Do you guys think that is the best thing to do?
He has me on 1ML every 2 weeks but my last TT was 1009 so he wanted me to switch to every 3 weeks. I have been taking 17 units in a 1/2 ML insulin syringe 2 times a week. Is that the correct amount for 1ML every 3 weeks?
Is there a good calculator or chart showing conversions?

How many units in the full 1/2 ml on your syringe?

Sorry, it’s the same as in the protocol #29 0.5mL 50 units 1/2" needle length. Another note I have been feeling fairly well with these injections. I do have a hard time sleeping on injection days, lots of energy, good mental function and mood. No libidio or erections and my nuts have been really tight and aching some. This morning I had a raging hard like I was on 100mg Viagra and horny as hell. It’s crazy how fast things can change!

I was wondering when guys are talking about testes shrinking from TRT, do they actually shrink in size or is it when they pull up close to the body? I don’t think mine have gotten smaller, but they are always pulled up tight against my body during the day, and ache sometimes. After I settle down at night they will eventually drop down and hang normal. When I get up in the morning it is the same thing again they are tight against my body.

they will actually shrink, along with what you are describing…some get it worse than others, and for some its not an issue at all.

I am still having a hard time understanding the difference in units of measurements. My prescription says to inject 1ML every 2 weeks. Since I have switched to injecting 2 times a week, I am doing 17 units with a #29 0.5ml 0.5" (50iu) syringe for each injection. KSman’s protocol is given in 100mg every week. So how many ML’s is there in 100mg? Where can I find a SIMPLE conversion table? I want to make sure I am giving myself the right dosage.

Still would like to make sure I am taking the right amount 2 times a week. See above.

There is no “conversion”. It depends on the concentration of your product. In the US, most Testosterones are either 100 mg/mL or 200 mg/mL (mostly the latter from what I’ve seen). Your vial or insert that came with it from the pharmacy will tell you the concentration.

But since you are prescribed 1 mL every 2 weeks, this is almost irrelevant (for this discussion anyway). This means you will be injecting 0.5 mL/week, with two shots/week, so each shot will be .25 mL. This will be the 25 cc mark on your insulin syringe.

Okay thanks,I will up it from 17cc to 25cc. I was doing the 17cc because my Doc wanted me to switch to 1ml every 3 weeks because he thought 1009 TT was to high. I don’t agree and I’m not feeling as good. Can’t wait for my Endo appointment.

Is there anything I can take over OTC for test atrophy. My appointment isn’t for a while and my nuts are really tight and aching most of the time.

I have a few questions before I go to my first Dr appointment with new Endo. In Dr Crisler’s publications he states to do a more complete lab as baseline before starting TRT. Then after TRT has started a different lab. Since I have been on T for about a year with my primary Dr and the only lab ever done was TT, FT and TSH, at random times (see first post). I have no good baseline lab work. Should I have the pre TRT lab done for a baseline?

Also I have know idea if this new Dr will be on board with the new treatment protocols for TRT. I was thinking of printing off DR Crisler’s “TRT A Recipe For Success” and “HCG Update”. What other articles would be worth taking in if needed?

Just a note I have been feeling a little better since being on the SQ injections for over two weeks now. I still have Test atrophy during the day pretty bad and I am going on vacation in a week. I would like to know if there is any thing OTC that would help until I get on the right treatment? I have also cut my methadone down to 20mg by going down .5mg a week. I may need to go a little slower once I get down to 10mg so I don’t go through any unnecessary withdraw symptoms. This may be helping in the way I feel as well.

No need to have the pre-TRT bloodwork done, since you are on TRT…but there are certain bloodworks you should monitor throughout your treatment. These are listed in the stickeys.

Well I finally had my appointment with the Endo this morning. I couldn’t read him for sure but I think he is on board with what I want to do. I left him a copy of Dr Crisler’s TRT protocol. He wants me to stop the Test Cyp for 1 week then go in to my GP for lab. He ordered Chem PR, Lipid Profile, TST, Free T4, Cortisol @ 8:00am, Total & Free Test, DHEA-S, Estradiol, Prolactin, LH, FSH, IGF-1, PSA, & SHGB. I will go in next Monday for lab. Looks like he has everything on there. Is there anything he is missing?

He also checked my nuts and said they are on the small side. I asked about the HGG and he said he would be willing to prescribe, but said it was expensive and insurance would not cover it.

Last Tuesday I was having my blood drawn at the Dr’s office and after the 5th tube the nurse pulled the tourniquet and then she noticed there was one more tube to fill. I think she was prepping to pull the needle and when she stuck the last tube on nothing came out so she moved the needle around and jabbed it in more. It hurt like hell, and I’m thinking WTF! So she throws it in the trash and says your good to go. I left wondering what was going on, and thought maybe she was going to rob some blood from the others for the last tube.

So Saturday I get my lab in the mail and everything that was ordered was on there except total, free T, Estradiol, and IGF-1. I don’t know if it is on other lab or if it is a screw up on there part. If it is I am going to be a MMF and some one will have to answer for the screw up which was probably the nurse.

Sorry I’m just venting I am so tired of being screwed around for the last 10 years I am beside myself. For there sake I hope they have the rest of it. I will post results as soon as I get all of them. Also I am now down from 30mg of methadone a day to 10 mg, it has been a bitch and probably confusing part of the withdraw symptoms with low T symptoms.

Lab was taken at 10:00am, 8 days after stopping SQ injections, fasting overnight.

DHEA-S=22--------------(80-56)----->Low
TSH=1.13-----------------(0.40-4.10)
Estradiol=66-------------(0-56)------->High
Prolactin=3.6-------------(2.5-17.0)
Free-T4=1.1--------------(0.9-1.8)
Total-T=1180------------(240-950)–>High
Free-T=40----------------(9-30)------->High
LH=0.1---------------------(0.8-7.6)---->Low
FSH=0.1------------------(0.7-11.1)—>Low
PSA=1.4------------------(0.0-3.5)
CortisolAM=15----------(7-18)
IGF-1=68-----------------(84-223)------>Low
SHBG=40----------------(10-57)
Cholesterol=109-------(50-200)
Triglycerides=67-------(0-150)
HDL-Cholesterol=34–(40-85)------->Low
LDL-Cholesterol=62–(0-130)
VLDL-Cholesterol=13-(0-28)
Non-HDL=75
CardiacRisk=3.2-------(0.0-5.7)

I have know idea of what to make of this. My erections, and libido are just okay, but I still have bad brain fog, low energy, and sleep a lot. Looks like I need to lower my test cyp injections until my Endo schedules follow up. Any thoughts?