T Nation

Doc Says no HCG/AI

Im a 33yr male. I have not started TRT. Test level are low while everything else appears to be normal with the exception of cholesterol. im going back for more blood test in may. however, while at the endo today, i asked about HCG and an AI. my doc stated they dont use them and wont prescribe them partially because of the cost but also because of the following:

HCG is only administered when coming off of TRT for reasons of fertility. it is known and exceptable for your system to shut down basically, and it comes with the territory. there may be side effect of HCG with TRT and they are fearful of that. there is also no medical evidence of HCG being of any assistance.

An estrogen blocker is not prescribed and wont be prescribed. estrogen levels will be tested before and during TRT. levels will and are expected to rise. however, at 100mg per week, they wont raise enough to cause issues related to high estrogen levels. if they levels get too high or there is side effects, they will reduce the dosage of test. there is no medical evidence of an AI helping with TRT.

I personally would like the option of both, but, as you can see, i dont have the option for HCG or an AI.

Advice Please

Most men on TRT do just fine without HCG or an AI.

DOC=IDIOT, endo’s are typically the worst, no surprise at all, but always sad.

Read the advice for new guys sticky and get on board with more info as suggested.

There is a sticky for finding a TRT doc too. Please share your location.

-age 33 from Massachusetts

-height 6-1

-waist 36in

-weight 220lbs

-describe body and facial hair…normal. Ability to grow a full beard. To keep a 100% clean face, id need to shave every day although I generally wear scruff.

-describe where you carry fat and how changed…fat is pretty spread through my body. Id say most is stored in my abs and love hndles

-health conditions, symptoms [history] asthma and allergies. Just found out my cholesterol is high

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever whey protein, multi-vitamin, fish oil, vitamin D, asthma and allergy meds,

-describe diet [some create substantial damage with starvation diets] diet is pretty normal. Recently have seen a nutritionist about cholesterol and advised to make minimal changes to my diet.

-describe training [some ruin there hormones by over training] I train along with crossfit football

-testes ache, ever, with a fever? No

-how have morning wood and nocturnal erections changed. I feel everything is on par for this area.

Recent lab results:11/9/12
testosterone total male >20: 392 ng/dl (241-827)
Sex Hormone Binding Globulin 17.8 nmo/L (17.3-65.8)
Test Free Male >20 101 pg/ml (47-244)
Test Free% 2.6 % (1.6-2.9)
Albumin Blood 4.70 g/dl (3.5-4.8)

Cholesterol-CFR 206 mg/dl H<200
Triglyceride-CFR 395 mg/dl H<150
Cholesterol-HDL 28 mg/dl L 40-59
Cholesterol-non-HDL 178 mg/dl
Cholesterol-LDL 99 mg/dl <130
Cholesterol-VLDL 79 mg/dl
Cholestol/HDL Ratio 7.4 H<5.0

Sodium Blood 140 mmol/l (135-145)
Potassium Blood 4.5 mmol/l (3.5-5.3)
Chloride Blood 106 mmol/l (97-110)
Carbon Dioxide 29 mmol/l (24-32)
Anion Gap 5 (5-15)
Glucose Random Blood 94 mg/dl (70-99)
Blood Urea Nitrogen 22 mg/dl (7-23)
Creatinine 1.08 mg/dl (0.60-1.30)
Glomerular Filtration >60 >60
Calcium Blood 9.9 mg/dl (8.7-10.7)
Thyroid Stim Hormone 3.03 uiu/ml (0.28-3.89)
Vitamin D 26 ng/ml (30-100)

Results from 2/28/13
Test Total Male >20 197 ng/dl (241-827)
Sex Hormone Binding Globulin 18.3 nmo/l (17.3-65.8)
Test Free Male >20 48 pg/ml (47-244)
Test Free Male% >20 2.5 % (3.5-4.8)
Albumin Blood 4.60 g/dl (3.5-4.8)

Results from 3/19/13
Ferritin (FER) 83 ng/ml (23-336)
Glycohemoglobin A1C (HgbA1C) 5.3% <or=5.6
Estimated Avgerage Glucose 105mg/dl
Prolactin (Plc) 12.80 ng/ml (2.64-13.30)
Prostate Specific Antigen (PSA) 1.09 ng/ml (0.00-4.00)
Follicle Stim Hormone (Fsh) 1.60miu/ml (1.27-19.60)
Luteinizing Hormone (LH) 2.10 miu/ml (1.24-8.62)
TSH Reflex Free T4 (TSHft4) 3.81 uiu/ml (0.28-3.89)
HCT 45.8% (42.0-52.0)
Cholesterol HDL 26 mg/dl (40-59)

Test Total Male >20 191 ng/dl (241-827)
Sex Hormone Binding Globulin 18.0 nmo/l (17.3-65.8)
Test Free Male >20 47 pg/ml (47-244)
Test Free Male% >20 2.5 % (3.5-4.8)
Test Bioavailable 118 ng/dl (130-680)
Albumin Blood 4.60 g/dl (3.5-4.8)

+1 to KSman. Your doc is a fool. Go find another. At this point it’s simply ridiculous that a doc would be so clueless to proper TRT. Unlike 10 years ago it’s pretty well known how to administer TRT properly today.

You will need HCG for several reasons and you will need an AI. I wouldn’t start TRT without either. It’s pointless.

Prolactin (Plc) 12.80 ng/ml (2.64-13-30) !!!
Range is ???, use [edit] to correct original post above
If prolactin is near or above range, could be the source of your problem.
Any sign of gyno?

You have secondary hypogonadism. E2 not tested, but low SHBG suggests that E2 is low. You might need AI with TRT and it would be valuable to avoid E2 increasing SHBG. Low SHBG allows for more FT, which is good!

Total cholesterol is OK. But you need to eat healthier and avoid simple carbohydrates that have a high glycemic index. Note that when you do TRT, cholesterol will go down, but typically, HDL does not change.

Your HDL is pathological:

  • take high potency B complex multi-vit with trace elements and iodine
  • fish oil
  • DHEA is DHEA-S labs below mid range
  • vit C and other antioxidants
  • natural source vit-E
  • Ubiquinol form of CoQ10, 50mg [not cheap]
  • 5000iu vit-D3, these are tiny oil caps

Is blood pressure OK?

More labs:

  • TSH
  • fT3 not T3
  • fT4 not T4
  • DHEA-S
  • AM cortisol, do at 8 AM
  • E2

TSH is too high. Read the thyroid basics sticky:

  • report history of iodine intake from iodized salt or vitamins that list iodine
  • report waking and mid-afternoon oral body temperatures

Look up your drugs on wikipedia and look for side effects and liver issues. Note that cimetidine is a severe endocrine disrupter.

What do do?

  • find why your HPTA is been inhibited [might be prolactin or meds]
  • resolve thyroid/iodine issues
  • adrenal fatigue?

PLC update
Prolactin (Plc) 12.80 ng/ml (2.64-13.30)

Any sign of gyno? NO

Is blood pressure OK? IT WAS REPORTED BACK AS GOOD. I DONT HAVE THE EXACT NUMBER AT THIS TIME.

I HAVE REQUESTED THE ADDITIONAL LABS YOU MENTIONED FOR MY NEXT TEST SCHEDULED IN MAY. IM WAITING TO HEAR FROM THE DOCTOR.

i actually spoke to the doctor earlier asking to add in an estrogen test for may. it was more of a minor argument. he dint want to test me because i show no signs of high levels. he said he would only test levels if i showed signs of high estrogen. i insisted on this test and he is referring back to someone about this matter.

i am in the process of finding someone new.

im working on the rest of your suggestions.

is there anything over the counter that i can take for an AI or something that replicates HCG

I just spoke with my doctor again. After much debate, he finally agreed to test me. He said hell test ft4 but wont test the following at this time:

  • fT3 not T3
  • DHEA-S
  • AM cortisol, do at 8 AM

He feels they are unrelated to my issues at this time

LEF blood work will soon go on sale:
http://www.lef.org/Vitamins-Supplements/Blood-Tests/Blood-Tests.htm

Cheaper if a member. - makes sense if you are ordering more labs

http://www.lef.org/Vitamins-Supplements/ItemLC100010/Male-Comprehensive-Hormone-Panel-Blood-Test.html

Is doc trying to avoid difficulties with insurance or HMO? You should pay out of pocket for what you need.

Could you please elaborate on the prolactin a bit?

He says there’s no evidence of high estrogen so there’s no reason to test. He states my t levels are low therefore my estrogen levels won’t be an issue.

What about OTC HCG or an AI? I probably called and spoke with about thirty people from the google earth search today. Nobody around here prescribes HCG or an AI, or at least it’s extremely difficult if possible, and the possibility of anyone prescribe it is extremely thin. And by thin I mean the possibility of one person that I’m waiting to call me back.

Would it b appropriate to start a thread asking where people have had success in Massachusetts?

I take an allergy med called loratadine. I’ve been take one 10mg tab daily for an extended period of time. Is there a link with these type of meds and low t

Loratadine (INN) is a second-generation[1] H1 histamine antagonist drug used to treat allergies. Structurally, it is closely related to tricyclic antidepressants, such as imipramine, and is distantly related to the atypical antipsychotic quetiapine.[2]

I’ve read some of the following links that might link anti histamine to low t issues

I get 150mg of iodine (as potassium iodine) via a multi vitamin that take daily.

6:50 a.m. temp- 97.7

1:45 p.m. temp-98.6

[quote]NeedT wrote:
I take an allergy med called loratadine. I’ve been take one 10mg tab daily for an extended period of time. Is there a link with these type of meds and low t

Loratadine (INN) is a second-generation[1] H1 histamine antagonist drug used to treat allergies. Structurally, it is closely related to tricyclic antidepressants, such as imipramine, and is distantly related to the atypical antipsychotic quetiapine.[2]

I’ve read some of the following links that might link anti histamine to low t issues


[/quote]

Nothing in those links prove antihistamines cause low T. There is no research connecting antihistamines with low T either.

I think you are worried needlessly. In any case, it is a non-issue for someone on TRT.

Also, people can keep calling doctors idiots but the fact remains that the overwhelming majority of TRT patients in the world have always done just fine without HCG or AIs. Various foremost experts on TRT in the U.S., who are hardly idiots, don’t use HCG or AIs, and not because they don’t know about it.

The vast majority of TRT guys do not understand that there are options. Those that feel that something is wrong often find there way here in their desperation.

Any medication that places demands on the same liver enzyme pathways that clear estrogens, can raise estrogen and that lowers T. That provides a double effect on the T:E ratio. Cimetidine is the poster child for OTC endocrine disruptors.

And the OP’s drug of concern is guilty:
“Substances that act as inhibitors of the CYP3A4 enzyme such as ketoconazole, erythromycin, cimetidine and furanocoumarin derivates (found in grapefruit) lead to increased plasma levels of loratadine. This had clinically significant effects in controlled trials of higher than usual doses of loratadine (20 mg).[citation needed]”

  • you need to know how to read the implications

These effects are liver mediated and we know that there are many differences in liver function across the population, compounded by other liver conditions and the effects of the demands of multiple drugs in many cases.

TSH is still too high, temperatures seem good, but monitor for good measure. You may be iodine deficient with TSH high in compensation. Need your long term history of iodine intake, not just what you happen to have in a supplement now.

150mg iodine cannot ever get one out of an iodine deficiency hole, only enough to tread water.

I hope you are both talking about 150 mcg not mg ? I think 150 mg is enough lol

Yes it is in fact 150 mcg of iodine

Here is my latest lab work. i was able to convince my pcp to run most of the tests. my endo would only run test, prolactin, and Vit D.

The endo says he wont treat my test issue because Im within “normal range” now. He also stated my cortisol was fine. The night before my cortisol test i took IC dexamethasone. He stated that my levels are fine where they are because the dexamethasone is supposed to suppress levels. The endo has referred me back to my pcp because my test levels are normal.

My PCP wants me on gemfibrozol or niaspan for the high triglycerides.

I have seen a few things in relation to high cholesterol levels actually lowering testosterone…can anyone add to this?

Test Result Out Of Range Flag Range

AST 22 10-40 IU/L
AL/T 18 10-40 IU/L
CHOLESTEROL TOTAL 236 H <200 MG/DL
TRIGLYCERIDE 681 H <150 MG/DL
CHOLESTEROL HDL 25 L 40-59 MG/DL
CHOLEST NON HDL 211 MG/DL
CHOLEST LDL <130 MG/DL
CHOLEST VLDL MG/DL
CHOL/HDL RATIO 9.4 H <5.0

GLYCOHEMOGLOBIN ALC 5.6 <OR = 5.6%
ESTIMATED AVG GLUC 114 MG/DL

CBC WITH AUTODIFFERENTIAL
WBC 4.9 4.3-10.3 TH/MM3
RBC 5.03 4.40-6.00 MIL/MM3
HGB 15.3 14.0-18.0 G/DL
HCT 45.1 42.0-52.0 %
MCV 89.7 82.0-101.0 FL
MCH 30.4 27.0-34.0 PG
MCHC 33.9 31.5-36.0 G/DL
RDW 13.1 12.1-14.6 %
PLATELET COUNT 257 140-440 TH/MM3
MEAN PLATELET VOL 8.4 7.6-11.6 FL
NEUTROPHILIS 49.5 43.0-72.0 %
LYMPHOCYTES 40.1 18.0-43.0 %
MONOCYTES 6.5 4.0-12.0 %
EOSINOPHILS 3.4 0.0-8.0 %
BASOPHILS 0.5 0.0-2.0 %
ABS 2.4 1.6-7.5 TH/MM3

ABS LYMPHOCYTES 2.0 0.9-3.4 TH/MM3
ABS MONOCYTES 0.3 0.0-1.2 TH/MM3
ABS EOSINOPHILS 0.2 0.0-0.6 TH/MM3
ABS BASOPHILS 0.0 0.0-0.3 TH/MM3

ESTRADIOL 23 <47 PG/ML

CORTISOL AM <0.4 L 6.7-22.6 MCG/DL
(1MG of IC Dexamethasone was taken the night before the am cortisol test)

FREE T4 0.71 0.58-1.64 NG/DL

PROLACTIN 3.60 2.64-13.30 NG/ML

VIT D 25 OH 42 30-100 NG/ML

TESTOSTERONE
TOAL T >20 278 241-827 NG/DL
SEX HORMONE BINDING 18.5 17.3-65.8 NMOL/L
FREE T MALE >20 70 47-244 PG/ML
FREE T % MALE>20 2.5 1.6-2.9%
TEST BIOAVAILABLE 174 130-680 NG/DL
ALBUMIN BLOOD 4.60 3.5-4.8 G/DL

Yes you should address cholesterol.

As for T, it is very low, but this is typical of many idiot docs and most of us have been there.

Find a new one. Read the finding TRT doc sticky.

I’m in the process of finding a new doc and acquiring as much info as I can.

I working on figuring out how one thing is connected to the next. I don’t want to treat the symptoms, I want to find the root, and fix that then hope everything else falls in line.

Has anyone fixed a cholesterol issue and then found their low T came back?