T Nation

Is TRT My Only Option?


#1

Hi guys,

I’m dealing with what I see is a dishonest doc, so please forgive me if what I’m asking may seem like a waste of time.

Basically, I’m in SA and don’t have access to quality PCT drugs so went to see a doc to try get some. However, doc is saying only option is TRT.

Background:
Did some prohormones, msten and then an epistaine bridge to PCT, but then moved to SA and can’t get clomid or other SERM. Used only a transdermal AI which worked OK to stop puffy nips. Blood test done 3 weeks after end of prohormones, and after puffness went away: test 5.9 (low), DHEA and estradiol ‘normal’.

Despite repeated asking, doc is refusing to prescribe clomid and hcg, says my test is too low so won’t work. Also says, despite repeated asking, that test undecanoate will not shut down natural test production, due to it being a ‘biological analogue’. This I know to be untrue, but he is adamant.

He definitely is pushing the trt.

I’m 35 and always had a physique that resembles high natural test. Do not want to go on trt, yet. Want to get back natural test levels.

Please advise on best option? Would I be wasting my time going to another doctor to get clomid?

Thank you


#2

Perhaps a pharmacist knows of a doc that prescribes what you need.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • HPTA restart <<<<<<<<<<<<<<<<<<<<<<<<<<
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thanks KSman, really appreciate the response.

I read the stickies and much other stuff, not as ignorant as I may have come across, just wanted to ask a more hypothetical question rather than one which related specifically to me and my situation.

One sticky which I concentrated on was the HTPA restart, as I understand that to be my best alternative to trt. Managed to get Nolva, but not sure of the quality, or dosage as is not stated on the pack! Just says one a day. Therefore taking one every other day, as per your sticky. Is there anyway to know/feel of its legit? Also getting AI.

Also got new bloods, but they seem to have just used the old sample or readings as the tests that were also done previously (LH, FSH and Total T (only tests requested by doc)) have exactly the same result. I was hoping for some increase in T, but don’t seem to have a new reading. Anyway, let’s not get side tracked with that and use this as my baseline reading:

FSH: 2.13 mIU/mL
LH: 3.68 mIU/mL
Oestradiol: <18.4 pmol/L (Ref range: 0 - 160)

Test (total): 5.9 nmol/L (9.4 - 37)
SHBG: 35.0 nmol/L (10 - 55)
Free Androgen Index: 16.85 (32.2 - 136.1)
Free Test (calculated): 107 pmol/L (180 - 536)

If you don’t mind, I’d appreciate insights into the following:

Total and free T are low, yet E2 seems normal? LH and FSH not too low either? And SHBG is also in range?

  • My understanding is that actually this E2 level is probably high for an adult male, and the range is for males and females? Also too high for this low T. Therefore, safe to assume conversion of T to E is high?
  • Also SHBG is probably too active. Otherwise free androgen index wound not be so low?

Therfore, raising LH may lead to more E2. But does this mean an AI may be better than a SERM, in this case? I see you say in your sticky that Nolva causes E2 to rise, so use AI after. If LH and FSH normal and E2 high then maybe no need for SERM first, may avoid raising E2 further?

I note from your other post: ‘If E2 is high, LH may be high, cut SERM by 50%, anastrozole can be ineffective’.

In summary, do I need to raise LH more with SERM or just focus on lowering E2 and freeing up T: how long should I continue with SERM?

Will update with temps as suggested.

Finally just want to say I respect those who chose trt, but feel I’m not quite there yet. It’s not the right choice for me now but I understand it may be at some time in the future.

Thanks again


#4

E2 is good around 80pmol/L when T levels are good.

E2<18.4 pmol/L is very low and <n is actually shorthand for undetectable by that lab method.

Low FT means low FT–>E2

SHBG may be higher than expected with low E2 because FT is so low.

LH/FSH are not been repressed by the negative feedback of E2. That leaves the possibility that prolactin might be high which would then be from a prolactin secreting adinoma. That is easily manageable with 0,5mg/week Dostinex/cabergoline. If adinoma gets large it can threaten optic nerves.

Your doc is wrong.

All testosterone esters are time released in oil and the free molecules then have the ester groups removed and that yields bio-identical testosterone. Doc is confused with some body building steroids that are not testosterone.

Clomid or Nolvadex would increase LH/FSH which would increase T. LH/FSH levels can be tested.

A few guys have major problems from prohormones. In these cases, it is like there is a permanent change to gene expression.

Nolvadex is probably 20mg. Dose every other day. Too much may create problems with high E2.


#5

Thanks for correction on E2 actually being low, will continue with nolva, and not start AI yet.

One question: when you say ‘LH/FSH are not been repressed by the negative feedback of E2.’, are you suggesting low E2 causes suppression of LH/FSH? Or what do you mean?

Lab didn’t give a ref range for LH but I found online adult male is 1.8-12.0 mIU/L, or between 5 and 15 mIU/mL, so either way I’m below with 3.68 mIU/mL. Do you agree that this also supports continuing SERM?

http://emedicine.medscape.com/article/2089268-overview

http://www.msdmanuals.com/professional/genitourinary-disorders/male-reproductive-endocrinology-and-related-disorders/male-hypogonadism

Will include prolactin test if available. Also reduce sugar and start Vit B6. Apparently should avoid fenugreek, which I have taken a lot of in the past. Thanks for this info, definitely worth checking.


#6

yes, the male HPTA is actually based on the female HPOA blueprint. E2 is more repressive than T.

SERMs hide some of the estrogen visibility to the hypothalamus and LH/FSH increases, sometimes too much.


#7

Thanks KSman,

I was asking about low E2 causing suppression, my E2 is apparently undetectable. Assume only high E2 is suppressive, not low?

You suggested I check prolactin, as I assume you inferred T and E2 may be low due to high prolactin, potentially from a pituitary adinoma. I got this as part of a ‘pituitary screen’.

But first I must say I have been feeling much better now, and stopped nova and test booster after ten days as was feeling better but also a bit strange (may have been a placebo adverse effect). And have been feeling even better these few days since stopping nova. For example, morning wood everyday and the boys are back to size, and general confidence is back (not exactly related, I don’t think!).

Here are results (5 days after starting nova, when I had seen some improvement, but not as good as after the full 10 days - apologies for not posting at the time, got results late for some reason). Got the lab’s ref ranges for males as well:

PITUITARY SCREEN
TSH 1.47 (0.27-4.20) uIU/ml
FSH 2.61 (1.5-12.4) mIU/ml
LH 7.08 (1.7-8.6) mIU/ml
Prolactin 14.5 (0.0-17.0) ng/ml

E2
Oestradiol <18.4 (28.0-156.0) pmol/l

TESTOSTERONE Profile
Testosterone (Total) 6.70 (9.40-37.00) nmol/l
SHBG 36.71 (0.0-55.0) nmol/l
Free Androgen Index 18.25 (32.20-136.10)
Free Testosterone (Calc) 119 (180-536) pmol/l

Main question:

  • Is prolactin too high? It’s just within the lab range, and I read that over 200 ng/ml is what would suggest pituitary tumor, and pregnant women go up to 400, so maybe not. However, if T and E are low, maybe it is relatively too high? Is cabergoline required? What dose vitamin B6? Can prolactin be at this level without an adinoma?

Other questions:

  • Why has LH doubled but T and TT not up by much? I would say this is due to only taking nova for about 5 days at that stage. Will update with new test soon, but T can’t have gone up that much more after another 5 days. Is it possible I feel good but lab test shows low T and FT? Will start nova again when I’m happy with prolactin situation.

  • Why is E2 still so low (<18.4 pmol/L)? Is prolactin blocking this somehow? Maybe further test will show a rise, not sure at this stage. Why no symptoms of low E2?

  • Puffy nipples appeared again after I stopped nova. Assume this is the prolactin? Assume some E2 is required, or can this happen with low E2? Would adex be any use?

  • Is TSH/thyroid ok? Temps seem normal, but haven’t yet got a decent run of waking temps, will update soon.

Have been taking high dose 5 htp, so will stop that too, as it may increase prolactin, as serotonin apparently does.

Really appreciate any input!