T Nation

Crashed Again on TRT

Hey Guys –

I had an old progress thread a few years ago, but I can’t find it now, so need to start a new one.

Summary: 37yr old male, have been on TRT now for a few years. Found out I my T was low after going to the doctor for a physical, and soon after experiencing gallbladder-like attacks and major digestive problems. Appeared to the doc with ED, and he checked my T – to find it in the low 200’s. Since he was just a PCP, and basically an idiot – he immediately gave me a shot of T to see how it made me feel, and I felt great for a couple of weeks (Best sex of my life!)-- so we decided to continue the treatment. (No blood tests for LH, etc ever taken, so not sure the exact cause of my low T, or if it is even a chronic thing?)

I initially had an idiot doc who was doing the huge shots (200-300mg every other week), and other course found out by reading the stickies here that was the wrong treatment. I ultimately switched to Androgel and was able to recover about 80-85% of my erections and well-being for a good long time. Androgel worked for a couple of years, but stopped working around 6 months ago.

6 months ago, I found a new doc (urologist) who agreed to let me self-inject at home. He started me out on 150 per week. I felt OK after 30 days, amazing for a couple of weeks, and then my well-being has declined from there. He recently lowered my dose to 100 per week, and referred me to a specialist (Andrologist) in Denver who some of you know – Dr. Mills. I’ll be seeing him soon.

Current symptoms: Can get erections, but lose them quickly if wife isn’t touching it constantly. After about 15-20 seconds of no contact, I’m back to semi, and then flacid. I now suffer from high blood pressure all of the sudden, which has never been an issue for me before. It was as high as 160/110 recently for a couple of weeks, so my PCP put me on Amlodipine 5mg a day (Minimum dose), and now it is in 120/80 range.

Current Diagnosis: IBS, Fatty Liver Disease, High Blood Pressure, Hypogonadism

Current Medications: .5 (100) Testosterone Cypinate injected once per week in the glute. Occasional Cialis, which helps get erections, but they still quickly go down.

Vitamins: Right now I take Milk Thistle for my liver, AQUADEKS Chewable ADEK vitamins, kelp (Iodine), was doing Zinc for a long time, but was upsetting my stomach too much. Also GNC Mega-Men multi vitamin.

GOAL OF TREATMENT: To be a BEAST in the bedroom again!

Most recent blood work:

RBC: 5.47 (4.14-5.80)
Hemoglobin 17.9 (12.6-17.7) HIGH
Hematocrit 52.1 (37.5-51.0) HIGH
MCV 95 (79-97)
MCH 32.7 (26.6-33.0)
MCHC 34.4 (31.5-35.7)
RDW 12.8 (12.3-15.4)
PLATELETS 206 (140-415)
Neutrophils 69 (40-74)
Lymphs 24 (14-46)
Monocytes 7 (4-13)
EOS 0 (0-7)
Basos 0 (0-3)
Absolute Neutrophils 4.9 (1.8-7.8)
Lymphs 1.8 (.7-4.5)
Monocytes .5 (.1-1.0)
Absolute EOS 0 (0-.4)
Absolute BASO 0 (0-.2)
Immature Granulocytes 0 (0-2)
Immature Grans Abs 0 (0-.1)

Hepatic Function Panel

Protein Total Serum 7.6 (6.0-8.5)
Albumin Serum 5.0 (3.5-5.5)
Bilirubin Total .8 (0-1.2)
Bilirubin Direct .16 (0-.4)
Alkaline Phospatase 47 (44-102)
AST 34 (0-40)
ALT 50 (0-44) HIGH

Prostate Specific Serum .6 (0-4.0)

Testosterone Serum 894 (348-1197)
Estradiol 38 (7.6-42.6) – I think this is too high per KSMAN, stickies, etc

My thoughts are that my Estradiol is too high, and my idiot Urologist is not even checking my free-T to see how much SHBG is a problem, etc… Hoping the Andrologist is going to be able to help, but wanted to get your opinions also.

Thanks guys!

Update: Saw the Andrologist in Denver, and hired him as my new TRT doc because he was absolutely legit (Dr. Jesse Mills if anybody else is looking). First doctor I’ve encountered that I didn’t feel like I was smarter than. He was willing to try just about anything on me, including HCG, etc – but wanted to start out slow and tweak the treatment depending on how it goes. He’s going to try a few approaches:

1 – Daily Cialis for 3 months with Viagra when needed for extra kick. He mentioned the study I know many of us have read, where guys have completely cured their ED after going on Cialis for 3-6 months. He said with young guys like myself, especially, you stand a good chance of regenerating some of your sexual abilities if you keep good blood flow and use of the penis with the help of a PDE5 for an extended period.
** I had never heard of guys combining Viagra with Cialis, but he said he uses it in his practice all the time, and when you have a 5mg baseline of Cialis in your system on a daily basis, Viagra can really give it a kick on the nights you are certain to have sex. He mentioned trying 25 of Viagra and moving up slowly to find the right dose for me.

2 – Testosterone w/ Arimadex – He prescribed 1G of Adex 3 times per week (Too much in my opinion, based on the stickies here – but just psyched he prescribed it period) – And 150 a week of testosterone. He said I could split it up into 2 doses a week, per the stickies, etc. Awesome!

3 – L-Arginine twice daily (1GX2) – He mentioned that he’s seen great results in his practice with guys supplementing with L-A, in both the area of sexual health as well as energy and athleticism, etc…

4 – Daily cardio – He recommended I incorporate cardio into my treatment plan for obvious reasons. I’ve been neglecting myself in this department, and needed this push to get committed back to working out – so excited about that also.

If this doesn’t get me where I need to be, he mentioned that we can do HCG, and/or pellets (He’s done over 1000 men with pellet implants so far). Also he mentioned the possibility of combining shots with a transdermal. He said he has guys that use both to even out their ups and downs more, which can give them a better sense of well-being.

Anybody know if the thick blood can cause ED? My doc doesn’t seem very concerned since its barely high, but I’m just curious if anybody else has experienced that? Thinking its probably the E or the T to E ratio…

This is a problem: Hematocrit 52.1, yes can be a factor in ED, but not the major problem. ED can be hormones or degraded circulation. You need CRP and homocysteine labs to eval arterial inflammation. Need fasting cholesterol, fasting glucose and blood pressure.

You may need to have blood removed. You can easily be at a level where you cannot donate blood and perhaps that is not going to happen with fatty liver disease.

You need to avoid T spikes with your high HTC. So better to inject twice a week or EOD SC. Pellets will make your T levels too high for a while, then you slump low later and that does not feel right.

Too much anastrozole. Typical is 1mg/week for each 100mg of T cyp or eth. Suggest that you not exceed 1mg/week to start so you do not get clobbered if you are an over-responder. You should know this from the stickies. And your endo probably does not understand these fine points. Low E2 can wreck libido, cause mood problems and create adverse cholesterol problems.

Docs make $$$ on pellets and the hormone profiles are very inferior. Your anastrozole dose needs to match your T levels and with the moving target from pellets, this will never be right.

Suggest:
100mg/week T cyp injected in SC EOD divided doses
1mg anastrozole in EOD divided doses at time of injection
250iu hCG SC EOD at time of injection

Get balanced on the above.

Starting on 150mg/week T with your HTC is really idiotic. Proceed with caution.

Thyroid labs? Thyroid regulates mitochondrial function, energy levels cannot be right if thyroid is wrong. CoQ10 is vital to mitochondrial function.

Suggest:

  • mini aspirin every day
  • high potency B complex multi vit with trace elements and iodine
  • fish oil caps, nuts, flax seed oil or meal [grind your own flax seed]
  • DHEA if DHEA-S labs are low
  • keep E2 in low 20’s, E2 can drive arterial disease and prostate enlargement–>cancer
  • FT is important for endothelial function. Endothelial dysfunction is the foundation of arterial disease.

Test CoQ10 levels as that is made in the liver and you might need to supplement with Ubiquinol form of CoQ10.
Suggest 100mg/day until BP is corrected, then perhaps 50mg. Not cheap!


""" Cautions: Hepatic impairment""" <-- this is you

I agree, you should definitely do something about the high hemoglobin/hematocrit. It can contribute not only to ED but also cardiovascular disease. Close to the top of the range is unhealthy, even if not over but under, and you are over. in addition to phlebotomy, you should also avoid red meat and make sure that your multi doesn’t contain any iron.

Just to rule out another contributer to ED, make sure your multi does not contain Saw Palmetto, as do a lot of the multis targeted at aging men. Like propecia and otger drugs that counter DHT, Saw Palmetto often has sexual side effects.

KSMAN –

I genuinely appreciate your response sir. It’s going to take me a couple days on Google to understand everything you said, but it is definitely appreciated :wink:

Update: I am going with the lower dose like you recommended, and doing 100 per week split into 2 doses. Going to try Adex also in the lower dose, and re-tune when I get my next blood tests in October. Took my first Adex last night with a shot of T in the Glute, and woke up this morning already starting to feel better with ED improving, and getting some body acne I haven’t seen in months. Will have to begin taking my Minocycline again in order to stop the acne – but kind of glad to see it, because usually that’s a sign for me that I’ll be feeling even better soon.

Note: I did realize I had been using a multi-vitamin with Iron in it a few weeks ago, and stopped it. I forgot I did this in the past to help when I tested low for iron some time ago. Had no idea it could thicken the blood until recently. Lesson learned, and something else my doctors didn’t tell me!

Cheers,

-Hakrjak

The acne may slow down some once your hormones “level out”. I know mine really flares up whenever my E2 levels swing from missed doses/etc. Also - taking an extra shower will help, as will keeping fresh sheets on the bed.

[quote]catfish74 wrote:
The acne may slow down some once your hormones “level out”. I know mine really flares up whenever my E2 levels swing from missed doses/etc. Also - taking an extra shower will help, as will keeping fresh sheets on the bed.[/quote]

Thanks for the response. Much appreciated.

I am going to give blood next week (I have a cold this week, and haven’t been feeling well, so have to wait until next week). Does anybody know how many times I’ll need to give in order to get the HCT back into normal, or will lowering my T probably do the job on it’s own?

Hey Haykac: Bro a real idiot would of gave you a story on testosterone causeing prostate cancer,or something on the Law book’s I good thing about this physican is that he/she may be teachable and willing to accept say an article on this form from say one of our elder statemen. Most dr’s use Mono-therapy,as they are to misinformed to add an aromataze inhibitor,or hcg to prevent testicular atrophy.

I took uor information on Trt/hrt to an Endocrinologist and he would only RX of (One Drug) at a time.I presented him our literature and to no avail.He was willing to Rx:Clomid,test,or hcg but only One at a time.No Polypharmacy. see ya john

Interesting about the cialis. KSman or anyone else have thoughts on this?

hakrjak - Have you noticed as to if this seems to be helping?

[quote]hakrjak wrote:
He mentioned the study I know many of us have read, where guys have completely cured their ED after going on Cialis for 3-6 months. He said with young guys like myself, especially, you stand a good chance of regenerating some of your sexual abilities if you keep good blood flow and use of the penis with the help of a PDE5 for an extended period.
[/quote]

Do you happen to have that study available? This is the only one I could find after a quick half assed search, but it does not appear to be what you and your doc were referencing:

Thanks

Anyone? Bueller?

Hey guys, sorry about the long time to update. I’ve been a little busy having some of the best sex of my life for a few weeks. Immediately after starting the Anastrazole, my erections went to full speed – and I started having the best morning wood I’ve had since being a teenager.

My venous leak seemed to correct itself 100%. That lasted a few weeks at least, and now I’m starting to decline again. I am due for blood work in the next few weeks, so I expect to find out where I’m at shortly. I believe that I passed through the E2 “Sweet Spot” on my way down, and my E2 is now probably a bit too low. I can still have sex and all, my sex drive and erections just aren’t as crazy as they were there while I was in that sweet spot!

Cooper – I won’t know if the Cialis had a long term impact until I quit taking it, I guess. The other thing I haven’t yet tried, which my doc recommended, was to take Viagra on top of the daily dose of Cialis when I know I’m going to have sex.

He mentioned that this caused the Viagra to work a lot better, but only to take a little bit unless I want to have the worst headache of my life. I need to try this on a weekend coming up soon when I know the wife is agreeable.

Hey man, you mind sharing those links?

[quote]VTBalla34 wrote:
Hey man, you mind sharing those links?[/quote]

Sorry, the links I keep posting get deleted right away. I got an angry email from the owner of the site about posting links to other sites here, but you can find the same links I found by Googling the long term benefits of Cialis use for peak testosterone, etc.

Cheers!

[quote]hakrjak wrote:

[quote]VTBalla34 wrote:
Hey man, you mind sharing those links?[/quote]

Sorry, the links I keep posting get deleted right away. I got an angry email from the owner of the site about posting links to other sites here, but you can find the same links I found by Googling the long term benefits of Cialis use for peak testosterone, etc.

Cheers![/quote]

Yeah I kinda figured the garden gnomes kept running off with the links from the ways your words seemed to change with each subsequent visit of me to your page. It got frustrating after a while for me lol Thanks for the advice if you read this before it is spirited away.

No worries.

Quick update from this end – I had been feeling super awesome, then a slow decline, and recently had more bloodwork. It looks like as I expected my E2 level is now a bit low. I probably fell right through the “sweet spot” when I got super virile for a week there, and am not feeling kinda cruddy because of my new low levels. I’d currently rank my morning wood and libido at about a 2-3 on a scale of 1-10, where I had a 10 just a couple weeks ago for some time… I’ve also been experiencing insomnia for about 10 days now… Results:

T = 869
E2=10

I’m currently injecting .3ML of T twice a week, and taking 1mg of Adex with each injection. I knew this was going to be a little too much Adex, but didn’t want to completely disobey the Doc, so I just demonstrated to him why I’m right. He indicated he is OK with me lowering my dose of Adex to fine tune things. I believe the correct course of action will be to cut my Adex down by 1/2 and keep the T injections the same. Hoping to balance out at that sweet spot around 20 where I think I was a raving sexual beast.

There’s a formula floating around here to figure out your new AI dose…but I don’t remember it. You might be able to search for it.

[quote]catfish74 wrote:
There’s a formula floating around here to figure out your new AI dose…but I don’t remember it. You might be able to search for it.[/quote]

So far so good. After correcting to Adex dosage to 1/2MG twice weekly for a couple of weeks, I seem to be improving. Had great sex last night with the wife, and MW has been a 9 on a scale of 1 to 10 for the past few days – So hopefully I stay in this range for awhile!

[quote]
2 – Testosterone w/ Arimadex – He prescribed 1G of Adex 3 times per week (Too much in my opinion, based on the stickies here – but just psyched he prescribed it period) – And 150 a week of testosterone. He said I could split it up into 2 doses a week, per the stickies, etc. Awesome![/quote]Wow. Did he explicitly tell you to take this much adex? I ask because my urologist Rx’d exactly the same, and mentioned that it’s the standard dosing guideline…for women with cancer who need to zero out their estrogen!

We needed to write it this way for insurance coverage, but we privately agreed that I’d take just .25mg EOD, which is what works for my 160mg/wk T regimen. So if your doc is just blindly following that standard adex dose, that may indicate some real naivete on his part where AI’s & men are concerned.