First Post - Desperate for Advice

First post here.

I decided to sign up and ask for advice because after lurking for a while it seems that the vets on this board know what thy’re talking about and I’m becoming desperate for advice.

I read the sticky “Finding a TRT doc” and realized that I’ve been dealing with physicians that are incompetent and uninformed on the topic of TRT.

Let me just give you a brief overview of all the different layers of garbage I’ve had to sift through to come to this realization.

First symptoms appear - gynecomastia:
I go to a doc and explain what’s been going on and I have to convince him to even order labs. Turns out that, although I’m in my early 30’s, I have a Total T of 256 and a Free T that was very low as well - but my FSH and LH were inappropriately normal in the presence of such low T levels.

The doc said it was fine however - I listened. Months later - the gyno persists so I escalated my concerns to an attending doc which then refers me to an endocrinologist. The endo puts me on a 4g/24h T patch. The next labs that are drawn put me in the Total T 400’s - but I’m still having no improvement of symptoms.

Next, the endo refers me to a urologist - they keep me on the inadequate 4g/24h T patch and then prescribe me Arimidex @ 1mg/day. I do my research (to my fault) a month after taking the Arimidex when my libido went to shit… and find out that this dose is way too high and frequent. So now I’ve stopped it.

Lastly, I explain to the docs at a later appointment that their regimen isn’t working for me; the patches are annoying, they should consider HCG to keep some function, and that they were giving me too high of an arimidex dose. Their response was that everything is going according to protocol. They then take me off the T patch and prescribe me… get this… 100 mg Test Cyp… not per week… but every other week… WTF? I’m in my early 30’s and protocol is to keep me with the Testosterone levels of an 85 year old?

Here I am, a year later since symptoms began, Fat (which I’ve never been in my life), brittle/dry nails and skin, stretch marks in places that don’t even make any sense, and no libido.

I’m a veteran and my providers are through the VA… So I have to work with what’s available to me.

I can really use some advice on what my next step should be.

Thank you.

I’ve been trying to fix all the strange symbols in my original post… but doesn’t look like it’s working out.

For us to help you we will need to see some blood results. You have read the stickies so that is good so you should have found what blood tests are recommended to get to start you off.

Dry skin brittle nails is a common symptom of Hypothyroid.

When you get your blood work post it up.

If you have any blood work results now post them up with ranges.

[quote]iroczinoz wrote:
For us to help you we will need to see some blood results. You have read the stickies so that is good so you should have found what blood tests are recommended to get to start you off.

Dry skin brittle nails is a common symptom of Hypothyroid.

When you get your blood work post it up.

If you have any blood work results now post them up with ranges.[/quote]

If you have medicare PM me…

[quote]iroczinoz wrote:
For us to help you we will need to see some blood results. You have read the stickies so that is good so you should have found what blood tests are recommended to get to start you off.

Dry skin brittle nails is a common symptom of Hypothyroid.

When you get your blood work post it up.

If you have any blood work results now post them up with ranges.[/quote]

Here are my labs:

Initial:
CHORIOGONADOTROPIN.BETA SUBUNIT < 0.5 mIU/mL >< 5.0
ESTRADIOL 35 pg/mL >< 57
TESTOSTERONE.FREE 0.85 Low ng/dL 0.95-4.30
FOLLITROPIN 7.3 mIU/ml 1.3-19.3
LUTROPIN 3.2 mIU/ml 1.2-8.6
PROLACTIN 7.47 ng/mL 1.61-18.77
TESTOSTERONE 268.8 ng/dl 175-781

8 monts later after complaints of persisting s/sx:
CORTISOL 13.4 mcg/dl
TESTOSTERONE 459.2 ng/dl 175-781
PROSTATE SPECIFIC AG 0.52 mcg/L 0-4
INSULIN-LIKE GROWTH FACTOR-I 212 ng/mL
TESTOSTERONE.FREE 1.59 ng/dL 0.95-4.30

1 month later:
CORTISOL 14.0 mcg/dl
PROLACTIN 8.53 ng/mL 1.61-18.77
TESTOSTERONE 460.5 ng/dl 175-781
ESTRADIOL 49 pg/mL >< 57
TESTOSTERONE.FREE 1.65 ng/dL 0.95-4.30

1 month later:
TESTOSTERONE 411.2 ng/dl 175-781
ESTRADIOL 55 pg/mL >< 57
TESTOSTERONE.FREE 1.63 ng/dL 0.95-4.30

1 month later:
ESTRADIOL 43 pg/mL >< 57
LUTROPIN 2.7 mIU/ml 1.2-8.6
TESTOSTERONE 505.6 ng/dl 175-781

1 month later:
ESTRADIOL 40 pg/mL >< 57
FOLLITROPIN 7.6 mIU/ml 1.3-19.3
LUTROPIN 3.4 mIU/ml 1.2-8.6

[quote]Hardasnails wrote:

If you have medicare PM me…[/quote]

I’m only covered through the VA… it’s my only option for now.

[quote]Q4more wrote:

[quote]iroczinoz wrote:
For us to help you we will need to see some blood results. You have read the stickies so that is good so you should have found what blood tests are recommended to get to start you off.

Dry skin brittle nails is a common symptom of Hypothyroid.

When you get your blood work post it up.

If you have any blood work results now post them up with ranges.[/quote]

Here are my labs:

Initial:
CHORIOGONADOTROPIN.BETA SUBUNIT < 0.5 mIU/mL >< 5.0
ESTRADIOL 35 pg/mL >< 57
TESTOSTERONE.FREE 0.85 Low ng/dL 0.95-4.30
FOLLITROPIN 7.3 mIU/ml 1.3-19.3
LUTROPIN 3.2 mIU/ml 1.2-8.6
PROLACTIN 7.47 ng/mL 1.61-18.77
TESTOSTERONE 268.8 ng/dl 175-781

8 monts later after complaints of persisting s/sx:
CORTISOL 13.4 mcg/dl
TESTOSTERONE 459.2 ng/dl 175-781
PROSTATE SPECIFIC AG 0.52 mcg/L 0-4
INSULIN-LIKE GROWTH FACTOR-I 212 ng/mL
TESTOSTERONE.FREE 1.59 ng/dL 0.95-4.30

1 month later:
CORTISOL 14.0 mcg/dl
PROLACTIN 8.53 ng/mL 1.61-18.77
TESTOSTERONE 460.5 ng/dl 175-781
ESTRADIOL 49 pg/mL >< 57
TESTOSTERONE.FREE 1.65 ng/dL 0.95-4.30

1 month later:
TESTOSTERONE 411.2 ng/dl 175-781
ESTRADIOL 55 pg/mL >< 57
TESTOSTERONE.FREE 1.63 ng/dL 0.95-4.30

1 month later:
ESTRADIOL 43 pg/mL >< 57
LUTROPIN 2.7 mIU/ml 1.2-8.6
TESTOSTERONE 505.6 ng/dl 175-781

1 month later:
ESTRADIOL 40 pg/mL >< 57
FOLLITROPIN 7.6 mIU/ml 1.3-19.3
LUTROPIN 3.4 mIU/ml 1.2-8.6

[/quote]

[quote]Q4more wrote:

[quote]iroczinoz wrote:
For us to help you we will need to see some blood results. You have read the stickies so that is good so you should have found what blood tests are recommended to get to start you off.

Dry skin brittle nails is a common symptom of Hypothyroid.

When you get your blood work post it up.

If you have any blood work results now post them up with ranges.[/quote]

Here are my labs:

Initial:
CHORIOGONADOTROPIN.BETA SUBUNIT < 0.5 mIU/mL >< 5.0
ESTRADIOL 35 pg/mL >< 57
TESTOSTERONE.FREE 0.85 Low ng/dL 0.95-4.30
FOLLITROPIN 7.3 mIU/ml 1.3-19.3
LUTROPIN 3.2 mIU/ml 1.2-8.6
PROLACTIN 7.47 ng/mL 1.61-18.77
TESTOSTERONE 268.8 ng/dl 175-781

8 monts later after complaints of persisting s/sx:
CORTISOL 13.4 mcg/dl
TESTOSTERONE 459.2 ng/dl 175-781
PROSTATE SPECIFIC AG 0.52 mcg/L 0-4
INSULIN-LIKE GROWTH FACTOR-I 212 ng/mL
TESTOSTERONE.FREE 1.59 ng/dL 0.95-4.30

1 month later:
CORTISOL 14.0 mcg/dl
PROLACTIN 8.53 ng/mL 1.61-18.77
TESTOSTERONE 460.5 ng/dl 175-781
ESTRADIOL 49 pg/mL >< 57
TESTOSTERONE.FREE 1.65 ng/dL 0.95-4.30

1 month later:
TESTOSTERONE 411.2 ng/dl 175-781
ESTRADIOL 55 pg/mL >< 57
TESTOSTERONE.FREE 1.63 ng/dL 0.95-4.30

1 month later:
ESTRADIOL 43 pg/mL >< 57
LUTROPIN 2.7 mIU/ml 1.2-8.6
TESTOSTERONE 505.6 ng/dl 175-781

1 month later:
ESTRADIOL 40 pg/mL >< 57
FOLLITROPIN 7.6 mIU/ml 1.3-19.3
LUTROPIN 3.4 mIU/ml 1.2-8.6

[/quote]

Were all these blood tests done in the am around 8-9?

Your really only low low testosterone reading was the 1st one. Your subsequent readings are around mid to high 400’s. Which is not catastrophic, sure they could be higher but they are not crazy low like others on here.

Your E2 is a bit on the high side and if you were to get that in check you might see favourable improvements possibly.

Your symptoms could also be because of your thyroid. But in the labs you have provided these tests are missing.

You don’t have labs for TSH,ft3,ft4 ?

The cortisol what is the range on that?

My initial numbers years ago were not far off yours. It is imperative to get your thyroid checked. Correct that, if needed and then use an AI to knock the E2 number down to mid-low 20’s and I think you will see a significant improvement. Adjust from there.

Looks like I skipped my very first set of labs… these were taken 4 months prior to the first labs I listed.

TESTOSTERONE.FREE         	0.65 Low	ng/dL	0.95-4.30

TESTOSTERONE	                        244.4	ng/dl	175-781

THYROTROPIN	                          1.06	uU/ml	0.4-6

THYROXINE.FREE                       10.9  	pmol/L	7.5-21.0

It might be a low normal range … but growing tits and sleeping all day tells me that the levels are way below my normal level of function.

isn’t 1mg/day of arimidex too high a dose to put the T : E2 ratio in my favor?

On that note, other than an increased likelihood of prostate cancer and hyperplasia… what are the possible negative consequences of maintaing a T level of 2x the upper limit?

I know this may sound like a naive… or even asinine question but it seems that if I’m going to need to be TRT for the rest of my life… why not take advantage of higher doses. If one has primary hypogonadism and their HPTA will never be normal regardless - what is there to lose?

[quote]Q4more wrote:

Looks like I skipped my very first set of labs… these were taken 4 months prior to the first labs I listed.

TESTOSTERONE.FREE         	0.65 Low	ng/dL	0.95-4.30

TESTOSTERONE	                        244.4	ng/dl	175-781

THYROTROPIN	                          1.06	uU/ml	0.4-6

THYROXINE.FREE                       10.9  	pmol/L	7.5-21.0

It might be a low normal range … but growing tits and sleeping all day tells me that the levels are way below my normal level of function.

isn’t 1mg/day of arimidex too high a dose to put the T : E2 ratio in my favor?

On that note, other than an increased likelihood of prostate cancer and hyperplasia… what are the possible negative consequences of maintaing a T level of 2x the upper limit?

I know this may sound like a naive… or even asinine question but it seems that if I’m going to need to be TRT for the rest of my life… why not take advantage of higher doses. If one has primary hypogonadism and their HPTA will never be normal regardless - what is there to lose?

[/quote]
Yes 1mg daily of adex is too high. Probably start off at .25mg e3d and adjust as necessary. Your e2 could do with some dropping shoot for between 20-30.

Your free T4 is on the lower end (not optimal as they say you want to be in the top 70% of range ) but then again tsh is around 1 so that is considered to be good.

You could retest for ft3,ft4,tsh and if doctor is willing get the antibodies tests too. Just to double check your thyroid.

So what is your current protocol now?

Having double the amount of T might cause other issues as a consequence. I don’t know exactly all the issues with that but if there were no consequences everyone would be doing it. So I assume there has to be a reason why most people on trt try and stick between the boundaries.

If you want the benefits of higher test then you might just want to blast and cruise. That way you hit the body hard and then give it rest.

I don’t really know if staying double the range is easier or harder on the body than blasting and cruising.

Someone with more knowledge might be able to answer that question.

cortisol ranges?
were blood tests in morning?

[quote]iroczinoz wrote:

Yes 1mg daily of adex is too high. Probably start off at .25mg e3d and adjust as necessary. Your e2 could do with some dropping shoot for between 20-30.

Your free T4 is on the lower end (not optimal as they say you want to be in the top 70% of range ) but then again tsh is around 1 so that is considered to be good.

You could retest for ft3,ft4,tsh and if doctor is willing get the antibodies tests too. Just to double check your thyroid.

So what is your current protocol now?

Having double the amount of T might cause other issues as a consequence. I don’t know exactly all the issues with that but if there were no consequences everyone would be doing it. So I assume there has to be a reason why most people on trt try and stick between the boundaries.

If you want the benefits of higher test then you might just want to blast and cruise. That way you hit the body hard and then give it rest.

I don’t really know if staying double the range is easier or harder on the body than blasting and cruising.

Someone with more knowledge might be able to answer that question.

cortisol ranges?
were blood tests in morning?[/quote]

Sounds good - I’ll look into methods of “blasting and cruising”. I’m unfamiliar with the term but sounds like a normal cycle except for the off-cycle consisting of a maintenance dose to keep me within normal ranges.

Google just told me that the normal cortisol range is 3 -13 mcg, but the results I received did not list any range.

The labs were all taken in the morning and all but one b/w 0730 - 0830.

Is it me, or are his TT reference ranges the lowest you guys have ever seen?

Like 175 bottom end? Are we talking women here. Wow.

[quote]Darkane wrote:
Is it me, or are his TT reference ranges the lowest you guys have ever seen?

Like 175 bottom end? Are we talking women here. Wow.[/quote]

No… It’s not just you. I keep trying to tell doctors about it and they keep disregarding what I say.

Reference ranges obviously depend on the particular assay done… but even this one is wrong.

I looked up the particular lab that does my lab work and the reference range is actually 250 -1100.

I printed it out… brought it to the appointment and they STILL ignored it!

[quote]iroczinoz wrote:

So what is your current protocol now?

[/quote]

[quote]iroczinoz wrote:

So what is your current protocol now?

[/quote]

They put me on the Androderm 4 mg per day transdermal patches with 1mg per day of arimidex.

I complained about the irritation of the patches and they put me on 100 mg Test. Cyp every 2 weeks… and 1mg arimidex every day.

Knowing that this dose is super low for someone of my age and size - I, “hypothetically speaking” should:

  1. Not take the Test Cyp

  2. Stay on remaining patches for now

  3. and NOT take patches for a few days prior to having labs drawn again

All so that my bloodwork is low enough for them to increase the dosage from 100mg every other week to at least 150 - 200mg every week or 400mg every other week.

I don’t understand why they think that low range testosterone levels is okay for a 30 y/o.

I don’t have the resources to shop around for reasonable docs.

I have a correction to make. In light of my inappropriately normal FSH & LH serum levels in the presence of low testosterone; secondary hypogonadism would be a more accurate description of my issue rather than primary.

[quote]Q4more wrote:
I have a correction to make. In light of my inappropriately normal FSH & LH serum levels in the presence of low testosterone; secondary hypogonadism would be a more accurate description of my issue rather than primary.[/quote]

How did you arrive at that conclusion?

[quote]VTBalla34 wrote:

[quote]Q4more wrote:
I have a correction to make. In light of my inappropriately normal FSH & LH serum levels in the presence of low testosterone; secondary hypogonadism would be a more accurate description of my issue rather than primary.[/quote]

How did you arrive at that conclusion?[/quote]

Because my testicular function itself does not seem to be the origin of hypogonadism - it’s a secondary effect.

If my FSH and LH were elevated it’d be indicative of my pituitary recognizing that something was off balance. Since these levels remained within normal range it’d seem that my pituitary/hypothalamus is the origin of this disruption rather than my testicular function (which would be primary had that been the case).

If my FSH and LH elevated due to low testosterone … and my serum testosterone showed no upward trending - then that would be indicative of primary hypogonadism.

As I stated in my initial post - on MRI they found a pituitary microadenoma - but they believe it is not to be functional nor the origin of my symptoms. Sadly they seemed to have given up on looking for the underlying cause and slapped me on TRT (which I agreed to because of the period of high stress that I’m dealing with right now).

I’m happy that you’ve joined in on this thread VTBalla - I’ve read a few of your posts and you appear to have a very logical way of analyzing and picking apart these issues. Can you tell me what you think should be my next step?

[quote]Q4more wrote:

[quote]VTBalla34 wrote:

[quote]Q4more wrote:
I have a correction to make. In light of my inappropriately normal FSH & LH serum levels in the presence of low testosterone; secondary hypogonadism would be a more accurate description of my issue rather than primary.[/quote]

How did you arrive at that conclusion?[/quote]

Because my testicular function itself does not seem to be the origin of hypogonadism - it’s a secondary effect.

If my FSH and LH were elevated it’d be indicative of my pituitary recognizing that something was off balance. Since these levels remained within normal range it’d seem that my pituitary/hypothalamus is the origin of this disruption rather than my testicular function (which would be primary had that been the case).

If my FSH and LH elevated due to low testosterone … and my serum testosterone showed no upward trending - then that would be indicative of primary hypogonadism.

As I stated in my initial post - on MRI they found a pituitary microadenoma - but they believe it is not to be functional nor the origin of my symptoms. Sadly they seemed to have given up on looking for the underlying cause and slapped me on TRT (which I agreed to because of the period of high stress that I’m dealing with right now).

I’m happy that you’ve joined in on this thread VTBalla - I’ve read a few of your posts and you appear to have a very logical way of analyzing and picking apart these issues. Can you tell me what you think should be my next step?

[/quote]

The only issue with your assumption is that you are disregarding the possibility even with higher LH your testosterone would remain on the low end.

So in effect you can’t really rule out testicular failure to some degree without testing this.

Your current protocol is no good, you will have to change that. If the doctor will not listen then either find another one, self treat or continue as you are.

[quote]Q4more wrote:

[quote]VTBalla34 wrote:

[quote]Q4more wrote:
I have a correction to make. In light of my inappropriately normal FSH & LH serum levels in the presence of low testosterone; secondary hypogonadism would be a more accurate description of my issue rather than primary.[/quote]

How did you arrive at that conclusion?[/quote]

Because my testicular function itself does not seem to be the origin of hypogonadism - it’s a secondary effect.

If my FSH and LH were elevated it’d be indicative of my pituitary recognizing that something was off balance. Since these levels remained within normal range it’d seem that my pituitary/hypothalamus is the origin of this disruption rather than my testicular function (which would be primary had that been the case).

If my FSH and LH elevated due to low testosterone … and my serum testosterone showed no upward trending - then that would be indicative of primary hypogonadism.

As I stated in my initial post - on MRI they found a pituitary microadenoma - but they believe it is not to be functional nor the origin of my symptoms. Sadly they seemed to have given up on looking for the underlying cause and slapped me on TRT (which I agreed to because of the period of high stress that I’m dealing with right now).

I’m happy that you’ve joined in on this thread VTBalla - I’ve read a few of your posts and you appear to have a very logical way of analyzing and picking apart these issues. Can you tell me what you think should be my next step?

[/quote]

The only issue with your assumption is that you are disregarding the possibility even with higher LH your testosterone would remain on the low end.

So in effect you can’t really rule out testicular failure to some degree without testing this.

Your current protocol is no good, you will have to change that. If the doctor will not listen then either find another one, self treat or continue as you are.