T Nation

HRT & Pituitary Tumor....

big fan of the site. been lurking the forums for a few months now. there’s plenty of in-depth info about me and questions i have that i will post very, very shortly. as of this moment, i have one question to ask.

as i have been told by my endocrinologist, i seem to be heading for HRT (i’m 36). i show all the symptoms of low test, with BW to back it up. problem: to rule out all causes, had an MRI done of pituitary/ hypothalmus.

was just told they found a pituitary microadenoma. 3-4 mm in size. i had heard of this beforehand and as my dr. explained to me, it is very common and most likely is not affecting / causing any problems, let alone my low test levels. will be getting a second opinion in approx. one month or so.

question: assuming this is a benign tumor (as most microadenomas are, as far as i’ve heard), will this affect my getting HRT ? if i am able to do HRT, what risks, if any, do i face ?

i apologize for going about this ass backwards, but i was just hit with this diagnosis this a.m. and am a bit freaked about it, i guess. again, i will post my full “story” by this weekend. in the meantime, from all that i’ve read from you guys on this site, i’d look forward to your opinions, positive or negative.

The problem with the pituitary is something that you have to live with. That is the probable cause. But even if it is not, from a pragmatic point of view, you do TRT or you don’t.

You can inject or do transdermal. But at your age, you should be looking to keep your testes working and HCG is the only option for that. That will also allow you to produce some of your own T. Read this and print for your doc or email to him:

http://dspace.hsl.washington.edu/dspace/bitstream/2012/52/1/JCEM_2005_Low_Dose_Human.pdf

The dose should be 250iu SC/SQ EOD (under the skin, every other day). You inject that with a fine insulin syringe, suggest #29, .5" .5ml).

You need to have E2 tested and the ideal range for that seems to be 17-20. TRT will increase E, transdermal (TD) more so than injected. The increased E is caused by T aromatizing into E, which reduces T. The increased E causes the liver to produce more SHBG that then binds and renders T unavailable… reducing free testosterone (FT). The increased E also increases the competition with T at the T receptors. E docks in the T receptors and makes them unresponsive to T. The T:E ratio is important.

E can be reduced with Arimidex/anastrozole, typically 1mg/wk. But it is costly. There are some inexpensive alternative sources of anastrozole.

Some docs will want to have you come to the office for injections every two weeks. That is insane. Many of us here self inject and many find that injecting once a week leaves them feeling drained at the end of the week. Many are now injecting twice a week and some like myself inject EOD. For frequent injections of a test ester such as testosterone cypionate, the injections can be with an insulin needle.

You have a lot of research and reading to do so that you can discuss options and preferences when you get down to business with your doc. If you can start with T + HCG + AI, that would be ideal. IA= aromatase inhibitor (anastrozole).

Costs: Doctor visits and blood work will be costly. Transdermals are about 10 times more expensive than injectables. Injectables seem to be least costly at Sam’s Club with a business membership. So what insurance will cover is important. Some docs will not do all that is needed (HCG + AI). Some insurance will not cover those either. Some will not cover any injectable. Make sure that scripts and BW reference hypogonadism and never refer to fertility treatment, that will trigger rejections from insurance.

"Make sure that scripts and BW reference hypogonadism and never refer to fertility treatment, that will trigger rejections from insurance. "

Good point KSman.

[quote]Stiddy wrote:
"Make sure that scripts and BW reference hypogonadism and never refer to fertility treatment, that will trigger rejections from insurance. "

Good point KSman.[/quote]

I read about that happening to someone.

[quote]KSman wrote:
Stiddy wrote:
"Make sure that scripts and BW reference hypogonadism and never refer to fertility treatment, that will trigger rejections from insurance. "

Good point KSman.

I read about that happening to someone.[/quote]

thanks KSman. luckily already familiar w/ alot of what you mentioned. as far as the tumor, i should have been more precise w/ my question.

i was more worried that now, with that diagnosis, no doctor of any kind would administer hrt/trt. my reasoning being that from what little i’ve read so far, that testosterone has the ability to instigate/accelerate cancerous growth.

as i’ve been scouring the internet today, i realize now that that isn’t always the case (as long as sane dosages are used). as for the BW results and some history on me, i’ll try to post later today. thanks again.

[quote]poophead wrote:
KSman wrote:
Stiddy wrote:
"Make sure that scripts and BW reference hypogonadism and never refer to fertility treatment, that will trigger rejections from insurance. "

Good point KSman.

I read about that happening to someone.

thanks KSman. luckily already familiar w/ a lot of what you mentioned. as far as the tumor, i should have been more precise w/ my question.

i was more worried that now, with that diagnosis, no doctor of any kind would administer hrt/trt. my reasoning being that from what little i’ve read so far, that testosterone has the ability to instigate/accelerate cancerous growth.

as i’ve been scouring the internet today, i realize now that that isn’t always the case (as long as sane dosages are used). as for the BW results and some history on me, i’ll try to post later today. thanks again.

[/quote]

Many tumors are not hormone sensitive other than the fact that low hormones can make one weak and feeble and a tumor might not be as vital then. There are all kinds of unfounded statements out there. Doctors rant that folks doing HGH will make cause or accelerate cancers.

The whole point of cancers is that they have decoupled them selves from the body’s normal growth rate controls.

the divide uncontrollably. The idea that HGH would make a difference is insane. HGH adjusts the growth controls and will not have any effect when there is out of control growth. Those cells are already growing as fast as they can. And HRT can improve the immune system so that more abnormal cells will be destroyed as part of business as usual.

Example: clinical studies looking for small cancers in the lungs as part of early detection see cancer rates that are much higher than one sees with the general population. What happens to those small cancers? The immune system destroys them.

Note any vision disturbances with your condition and inform your doc of any such issues.

There is no evidence that guys on gear, taking 10 times more T than you will on TRT, have cancer rates that are higher than normal males. Off setting any influence of high T levels from gear is the fact that most guys doing gear are eating healthy, getting exercise, don’t smoke or stop, take supplements including anti oxidants, take essential fatty acids (EFAs), are not fat etc etc.

Most of the negative effects that you read about the effects of anabolic are steroids are lies, and the more they get repeated the more they turn into facts for most that read them.

Prostate cancer is the big fear. Those cancers can be T and DHT sensitive. But young men with raging T levels do not get prostate cancer. Old guys with low T, fat and with elevated E levels are typical. E causes more inflammation of the prostate (BPH) than T or DHT.

So the guys on gear or TRT who control their E levels may be at lower risk than the general hormone depleted lazy fat ass population. Because of this fear and the fact that once a cancer occurs, most will be T and DHT responsive, competent docs and docs covering there asses, will order PSA tests before starting TRT, and at the first followup bloodwork after that and annually thereafter.

Many docs will want a DRE (digital rectal exam) or ultra-sound before starting TRT. Many informed guys doing gear who get there blood work on their own do PSA tests.

Docs only know what they understand and guess the rest. Sometimes they are wrong. Years ago, docs treated prostate problems by dosing with estrogen. The estrogen would shut down the HPTA and effectively turn off T production. But the E would still stimulate the prostate cells. The men on that also had severe quality of life issues.

ok, here’s info i should have posted first. i’m a 36 year old male weighing 250 lbs. was diagnosed w/hypothyroidism back in 1992. take synthroid. have had a touch of gyno since puberty. i should say throughout my late teens and all of my twenties, diet was crap. three yrs ago, had a vein on inside thigh go varicose, had it removed a year later.

around the same time, been noticing energy levels dipping, inability to lose weight regardless of cardio and eating better. slight depression, brain
fog, libido decreased, erections also. basically felt like i was falling apart. final straw was the beginning of this year, had a few floaters appear in both eyes. figured it was due possibly to an allergic reaction or heavy weightlifting, etc…

went to my doc and asked his opinion. as i’ve read a million times on this site, my doc (endocrinologist) also is a very
condescending, conservative hmo bastard. said i was fine, it was all in my head, etc. i asked him about thyroid levels, testosterone levels, etc., and he became aggitated, though he did mention i was pre-diabetic and i should keep tabs on my blood sugar levels. i left, realizing he wasn’t too interested in helping me.

decided right then and there to pull my head
outta my ass and educate myself (mostly through this site). went back to the doc, loaded for bear. got copies of all my BW and things started to make sense. when he realized i wasn’t happy w/ the numbers and wanted new BW he complied. it wasn’t until this past month that i demanded certain tests be taken/ retaken.

with regards to my hypothyroidism, low test, and pre-diabetic state, i’m not sure what is causing what. as for my thyroid, i am looking into something other than synthroid as my T3 still is lagging. he has admitted that i seem to be a candidate for HRT due to the low free test, but would rather i have
a second opinion. so now i’m another endocrinologist in june. as i stated in the first post, i just found i have a pituitary microadenoma. but due to the size, it doesn’t seem to be underlying cause for the floaters (as per my doc).

i have an appointment w/ another opthamologist next week. my apologies for the super long post. will do my best to keep it short and
sweet from now on.

end of 2005 / beginning of 2006:

gh <0.2 (</- 10.0 ng/ml)
tot. test 484 (260-1000 ng/dl)
free test(%) 1.6 (1.0-2.7 %)
free test 76.9 (50-210 pg/ml)
t3, free 238 (230-420 pg/dl)
lh 4.1 (1.5-9.3 mIU/ml)
fsh 4.3 (1.6-8.0 mIU/ml)
prolactin 4.8 (2.0-18.0 ng/ml)
glucose,
fasting 104 (65-99 mg/dl)

end of 2006:

tsh 3.88 (0.40-5.50 mIU/l)
t4, free 1.0 (0.8-1.8 ng/dl)
t3, free 283 (230-420 pg/dl)

beginning of 2007:

cholest, tot. 239 (<200 mg/dl)
hdl cholest 57 (>/= 40 mg/dl)
cholest/
hdl ratio 4.2 (<5.0)
ldl chol,
calculated 168 (<130 mg/dl)
triglycerides 72 (<150 mg/dl)

within the past month:

lh 5.5 (1.5-9.3 mIU/ml)
fsh 4.0 (1.6-8.0 mIU/ml)
estradiol 34 (<52 pg/ml)
tot. test 494 (260-1000 ng/dl)
free test(%) 0.9 (1.0-2.7 %)
free test 46.8 (50-210 pg/ml)
estrogens,
total,serum 188 (130 or less pg/ml)
androstenedione,
lc,ms,ms 75 (40-190 ng/dl)

within the past 3 weeks:

lh 3.9 (1.5-9.3 mIU/ml)
fsh 4.0 (1.6-8.0 mIU/ml)
estradiol
(ultrasensitive) 18 (10-50 pg/ml)
tot. test 528 (260-1000 ng/dl)
free test(%) 0.9 (1.0-2.7 %)
free test 49.6 (50-210 pg/ml)

within the past 2 weeks:

estradiol 32 (<52 pg/ml)
shbg 42 (5-49 nmol/l)

note: have had full hepatic panels done twice. can’t remember the span between them but the both (most recent one done one month ago) of them show things are within their normal ranges although bilirubin and albumin were slightly high normal. all bloodwork shown done by quest diagnostics.

Your E is a bit high, ignoring the one test that was low.

TT not bad but free Y is low and SHBG is high… consistent with elevated E increasing SHBG that then reduces FT. The E levels are probably lowering T via HPTA feedback. Your hormone levels, pre-diabetic state, history of gyno concerns and body fat really speak strongly to syndrome-X aka metabolic disorder.

TRT would also straighten out your cholesterol, lead to fat loss and muscle gain. With your levels and history, you should start AI immediately with T… -also because of the fat related aromatase activity.

Suggest injections as transdermal will increase your E levels more than injections. Your T dose may need to be adjusted to your body weight. 100mg/wk might not be enough… perhaps 125 or 150 to start and adjust based on BW. The standard TRT starting dose of 1mg/wk of arimidex/anastrozole will probably not be enough. Maybe 1.5 to 2 mg per week until BW suggests otherwise.

Target E levels should be 17-20. If insurance will not cover the arimidex, you can get anastrozole very cheaply. Good to get a script, but you can obtain without. Keep the script in your file if you go the alternative route.

Another reason to get E levels down is to reduce SHBG and get free T up. Elevated E also kills libido and dampens the effects of what free T that you do have.

At your age, shrinking nuts is not something that need… HCG 250iu SQ EOD will keep the testes working when the TRT shuts down your LH production. When you get on TRT, stop testing for LH and FSH as those will be low and testing then simply is a waste of money (some docs are that silly). Many report an improvement in mood with HCG.

You will also need to get your thyroid levels corrected to get the weight loss that you need. Some see TSH levels over 2.0 as a call for action. You will need to research that.

Insist on proper treatment and be prepared to pay out of pocket for any of the T+HCG+AI that you need. I do not understand thyroid hormone replacement treatments. … but T3 is available as a research chem as well.

[quote]KSman wrote:
Your E is a bit high, ignoring the one test that was low.

TT not bad but free Y is low and SHBG is high… consistent with elevated E increasing SHBG that then reduces FT. The E levels are probably lowering T via HPTA feedback. Your hormone levels, pre-diabetic state, history of gyno concerns and body fat really speak strongly to syndrome-X aka metabolic disorder.

TRT would also straighten out your cholesterol, lead to fat loss and muscle gain. With your levels and history, you should start AI immediately with T… -also because of the fat related aromatase activity.

Suggest injections as transdermal will increase your E levels more than injections. Your T dose may need to be adjusted to your body weight. 100mg/wk might not be enough… perhaps 125 or 150 to start and adjust based on BW. The standard TRT starting dose of 1mg/wk of arimidex/anastrozole will probably not be enough. Maybe 1.5 to 2 mg per week until BW suggests otherwise.

Target E levels should be 17-20. If insurance will not cover the arimidex, you can get anastrozole very cheaply. Good to get a script, but you can obtain without. Keep the script in your file if you go the alternative route.

Another reason to get E levels down is to reduce SHBG and get free T up. Elevated E also kills libido and dampens the effects of what free T that you do have.

At your age, shrinking nuts is not something that need… HCG 250iu SQ EOD will keep the testes working when the TRT shuts down your LH production. When you get on TRT, stop testing for LH and FSH as those will be low and testing then simply is a waste of money (some docs are that silly). Many report an improvement in mood with HCG.

You will also need to get your thyroid levels corrected to get the weight loss that you need. Some see TSH levels over 2.0 as a call for action. You will need to research that.

Insist on proper treatment and be prepared to pay out of pocket for any of the T+HCG+AI that you need. I do not understand thyroid hormone replacement treatments. … but T3 is available as a research chem as well.[/quote]

thanks KSman. been checking out research chems already. one question. if one was only to go the route of using just an AI (ie: arimidex) to up free T and lower E, wouldn’t it stand to reason that after awhile if bodyfat is reduced enough, one could taper off the AI, and E would stay relatively lower than before due to less aromatase being produced because of less bodyfat?