T Nation

Issues with Endo Drs and HRT Prescriptions


#1

Hey guys,
Thanks for taking the time to read this and hopefully this will help anyone else that is in the same boat. Feel free to ask any questions if I leave anything out because I am going to try to keep a very long story short.

I am 25 years old, male, average but but never a muscular build or much definition in spite of years of improving my bodybuilding workouts and nutrition and years of constant research. Growing up and even still I have never felt quite right and I can only explain that in terms of the symptoms related to my recently diagnosed condition of Hypogonadotropic Hypogonadism which I was told I have been living with for my whole life (makes sense now). I made it 25 years of feeling terrible and it was just figured out that I have low test due to an under active pituitary. I guess I have always had crap healthcare but it's what was available.

When I was diagnosed with HH a few months ago my Total Testosterone was 114 ndgl so, I was put on 1000 Iu's HCG sub-q injunctions 3x week for a total of 2 months. I then had my dosage increased by my Endocrinologist to 2000 Iu's 3x week (Monday , Wednesday, and Friday). It has been about 4 months since I started this and according to my blood work done last week, my total test is 1490 ndgl and my Free Testosterone was high as well but I don't have that number in front of me at the moment and it's really not all that important in this application IMO.

Recently I started to develop some painful lumps under my nipples (yes, both of them but it started with only my left which seems to be incredibly common). I think this is real gyno from both having the low testosterone prior to HCG therapy and also From the giant and sudden rise in testosterone aromatizing into estrogen causing further gyno progression to the point where it is actually an every day issue for me.

In an attempt to combat this issue, I was given a prescription for Nolvadex (Tamoxifen) 10 mg to take daily as well as a prescription for Aromasin (Exemestane) 25 mg to take daily. In all of my research on SERMS and AI's, and I'm researching constantly, I am finding very conflicting information regarding the dosage, combinations, and even the general use of these drugs.

My Endocrinologist is the highest recommended in my area and he happens to be the only one that I have access to so I cannot change to another one no matter what which is why I am coming to you guys for help in fine tuning my understanding of how HCG works with these other drugs.

The Endo told me himself this is a rare condition and that he doesn't really know it well and needs to do research before answering any questions and did so before prescribing the HCG in the first place and He also knows very little about the Nolvadex and Aromasin that he prescribed me so I really need help as I am having some issues that have just sort of started this morning and I'm not sure what to blame medicine(s) on or if it is from a sudden Hormonal imbalance between T, E, Progesterone from these medications but, I am suddenly extremely angry, sort of enraged inside, and I have been very calm and at peace for a some time now.

I feel anxiety so strong I can't stand it and I have always been able to hold myself together and I am usually strong and shape minded when dealing with emotions but right now I feel like I'm pms'ing embarrassing but I need to be honest and I know I'm not the first guy out there to deal with similar symptoms after reading about climid and letro logs.

I feel emotional and when I got angry this morning over a meaningless and small argument, I was in tears because I was just feeling a sense of rage that made my eyes and nose runny as if I was sad or something, and I don't even know how to explain it. It was irrational and out of the norm.

My Endocrinologist does not have any answers for me and is even confused on the dosing protocol for my mediations and although this does not substitute for medical advice, I was wondering what if any, where some of your recommendations? I am hoping to here from anyone that has dealt with any of these drugs and especially HCG treatment with the combination of Gyno reveseral protocol and the proper dosing for these medications. Than you so much for any help, I really do appreciate it.


#2

You have gyno from high E2 and that is from too much hCG causing high levels of T-->E2 inside the testes. A competitive drug AI like anastrozole cannot reduce that component of E2 production.

Please study the advice for new guys sticky for more helpful info.

Note the first paragraph. If thyroid is not right, TRT will not resolve all of your symptoms.

Please post your labs. You must have E2 tested.

Please post all drugs in list form with doses.

Too much hCG leads can desensitize the LH receptors. Potentially a huge step backwards.


#3

listen to KSman on this one, he is dead on. If you are going to shut your system down with that dosage of HCG, why not go on test? Get E2 tested, gotta get this in check. Good luck man


#4

Great, thanks guys. I was a little worried about something bad coming form this down the line. He is hesitant to switch to Test injections right now for some reason and I am beginning to think I am his first patient with this type of condition and that he is more of a diabetes endo.

He literally seems to know nothing about this and when I ask him questions he doesn't have answers about the medications or anything. I will work on getting my labs and at the moment I do not have any labs done on my estrogen levels, none of them, and no progesterone either. I asked his to order me a full workup including everything that you mentioned KSman.

I will repost whenever they get back to me and I can get the blood work done. I am currently taking Aromasin(Exemestane) 25 mg on Monday , Wednesday, and Friday, as well as Noladex (tamoxifen) 10 mg ed as well as HCG 1000 iu sx week. I will get back with the full information though.

Thanks for your time and your help. I am also going to try to find a more experienced doctor to handle this.


#5

Man, I know this sucks having an idiot doctor but you are throwing way too much shit at a problem right now that you don't have a good data point on. I might look at throwing the HCG out the door at this point, continue with AI and Nolva, there is no reason with your current situation to be running all 3.

Your 25, get labs on E2 get this under control, cont with the AI and Nolva for 6 weeks, retest see what your HPTA is doing may be perfectly back to normal at this age. I know you don't wanna hear this because you want a fix now but you jumped the gun on a couple different things without the research. You will be prepared once this issue is resolved to not make the same mistakes again.


#6

Thanks for the info and the advice. Its hard to balance advice online with an Endocrinologist's orders you know? I only went in for low test which resulted in a diagnosis of hypogonadism and he put me on HCG because he said I had no LH and testicular function join on and that HCG would be the best treatment for me.

He prescribed Nolva 1 month after the HCG because I had sore nips, and then added Aromasin once I had painful lumps under my nips so, I just want you to know that I may have "jumped the gun" but it was only because I thought I was doing what a professional knew I should be doing.

For some reason its like him or his office does not want to do blood test for my estrogen levels or for anything other than Testosterone, I don't get this. As I said though, for now, I will be finding a new doctor as well as trying to get those levels checked and posted up here. Thanks for the input for now guys.


#7

Ksman is right on as always.

before you are to hard on this doc, Consider yourself lucky that you even got HCG, let alone Nolva and A-sin.

Any doc that i've mentioned HCG looks at me like a deer in the headlights. They never even HEARD of it.

All your problems come down to your dose of HCG being way to high. read the new guy stickies.


#8

Yea, docs are really bad on the estrogen thing, unless you go to an anti-aging clinic you are always gonna fight this with Endos and GPs. Test it yourself, we know most guys feel better in the 20-25 range give or take. Ned does have a decent point on at least your doc prescribed HCG but geez, clearly gave you no direction on how or what this mix would do. At least now you know man, HCG does was too high and gyno was the response, adjust accordingly.


#9

Thanks for the info and the support guys. Let me just be clear really quickly though. I am appreciative of his help, and I am thankful for his prescribing of these medications. I know that there is a benefit to being able to request and receive these drugs however, It is hard for me to get the blood work part taken care of.

For some reason they just don't seem concerned. I called my regular practitioner and explained that I have been put on some meds that will effect my Estrogen levels and some other levels so they said they would run a full work up on all my levels. I will take that new data when I get it an adjust accordingly.
I asked the Endo why the HCG was started so High and he said that its because my condition " Hypogonadotropic Hypogonadism", needs a dose like that and smaller doses are used for people in weight loss or who requiter less.

When I speak to him, I get more and more worried that I am his first patient with this issue and that he hasn't treated with these drugs much or at all before because he didn't know the difference between the Nolva and the Aromasin. Crazy, but he does prescribe without giving any direction or expectations. I am very much the type of person to need to know whats going to happen, what to do if it goes wrong, and keeping things balanced so, it has been hard to end up this far off when I thought the Endo originally had it all under control with his "professional training".

Most of these meds are used for women with breast cancer and often used of men in anti-aging clinics like you mentioned which is more similar to a drug dealer in many situations. In this case, I feel that this is a result of an overzealous and possibly under experienced Endocrinologist.

Its nice to know that there is a group of people on here that is willing to help, and I will take your advice and try to learn some of the new guy information. HCG has been harder for me to learn about that traditional TRT with actual test injections so its hard to get consistent information and direction in my dosing.


#10

FUBAR

Noladex (tamoxifen) 10 mg ed as well as HCG 1000 iu sx week.

WHAT DOES "SX WEEK" MEAN?

Too much hCG can create very high E2 levels that cannot be managed by an aromatase inhibitor.

250iu hCG SC EOD is a replacement dose for LH.

High hCG can also cause LH receptor desensitization.
- major step in the wrong direction

Never stack a SERM and hCG. Now you have high hCG doses affecting the LH receptors and the SERM now adds LH to the problem.
Do avoid the problem with estrogen in your breast tissues, which all males have, you need to lower E2 and you cannot get there on high dose hCG.

Read this: http://press.endocrine.org/doi/full/10.1210/jc.2004-0802
Print for you doctor(s)

"The dose of hCG required to maintain baseline ITT concentrations in men with maximal gonadotropin suppression is significantly lower than that historically used in the treatment of infertility due to hypogonadotropic hypogonadism."

This thread needs more lab data, in list form, with ranges.
- not buried in prose and not selected bits
- what E2 levels

Did doc test prolactin or attempt to find out why your FSH/LH levels are low? If not, you do have a condition but without a diagnosis you do not know the root problem - which might be treatable.


#11

Thank you that was extremely helpful actually. I plan to find an Endocrinologist that has dealt with my condition (HH) before and has had success and has more on hand knowledge of its treatment. I will also be getting the complete data that you asked for in order to make this a more complete thread. Thanks for sticking with me as this treatment is obviously a mess. Until they can see me again and I get in with a diff Endo, what should I do with what I have. Just to be clear this is just until I have the data from my new blood work.
Stop HCG or stop it completely like I have been told by another person?

Stop the Nolva, or keep it with the lowered dose of HCG?
And lastly should I adjust or remove my Aromasin (AI) dosage.
Also I meant 3x per week. I was explaining my currently prescribed schedule which is Monday, Wednesday, and Friday for my HCG injections. Thats what I meant by Sx week, just a typo. Thanks for your help and sharing your knowledge. I know its annoying to you that I don't have all the info but please understand that I didn't know to have that as I am just patient trying to seek help as I feel my treatment is messing me up and all I have to go by is my Doctor until now. I will definitely be getting that required info for you as soon as I can. Thanks again.


#12

Bro, I feel you. I'm 30 and just learning about this stuff too as I've been recently diagnosed but have learned I've had hypogonadism since childhood. I haven't learned enough about the meds to answer your questions but I've had those irrational and extreme emotional flares. Moments of unexplained rage. It's scary as hell and horrible and makes you question your very sanity. I've been thinking I might just be going crazy but it coincides too much with what I see now as episodes of worsening hypogonadism symptoms: weight gain, memory issues, tender gyno, joint and testes aches.

Your not alone man. Here's the techniques I've had success with during those episodes.
-Control your breathing
Control the intake by choosing a number of seconds for it to take to fill your lungs. Count them out in your mind. Do the same for the hold when the lungs are filled. Then again control it in a timed release. And again control the time before you take another breath and try to extend this time at each cycle. Repeat. This does two things I've found; frees up part of our mind and busies it with an activity causing some loss of focus on the intense and unwanted emotion, and it also sends a signal back to our brain telling us their is no danger.

-Exercise
Even if all you do is clench your muscles for a count of seconds and then release them all. You can do that at work, sitting on the bus, laying in bed, anywhere. In moments of mental stress the body will react by preparing for a fight or flight response. Part of this is tensing up the diaphragm in expectation of supplying the oxygen for it which we relax with the breathing exercise. So, give those muscles an out with whatever method you choose.

I believe our minds are trying to make sense of these flares in emotions (due to the hormonal imbalance) with rationalizations for why we could be or should be feeling that way. This pattern seeking is great and has allowed us humans to make it to the moon and cure disease with bread mold but it also can lead us to irrationally connect an episode of agitated emotions to some frivolous activity around us like how someone chews their food or how they don't clean up after themselves, or even with older memories. Making that connection, false though it be, satisfies that pattern seeking part of ourselves. This we can see is something to avoid as it can hurt our relationships but we can use it to our advantage when we take time to prepare ourselves.
Do the breathing exercise. Accept the emotions and their intensity. They'll pass cause you've felt them before. If you are too lost in the intensity of the episode flow with it to a place of less intensity and attempt again the breathing and physical exercises.

I've found this technique when researching Agoraphobia and other forms of phobias related to irrational but intense mental responses. My episodes were irrational and had no triggers but the cognitive behavioral techniques described above helped nonetheless.

I realize I haven't read the whole of your thread so you may not even have this issue anymore. Regardless, good luck man. message me anytime.
-


#13

Schwinning - Thanks for reaching out like that man. I have actually found that Breathing and meditative practices are of huge help to me so its cool to hear of someone else seeking natural and effective ways of collecting themselves as well. Great advice and you have reminded me of how important that is so thank you for that.

I had some talk therapy concealing for a while because I too have been living with this since childhood and it has caused all sorts of issues throughout a long period of time and even more emotional / psychological issues in the last few months throughout this hormonal roller coster I've been on with this treatment. In this therapy I have learned a lot of what you are sharing so I'd just like to back that up incase anyone else is reading this for their own similar experience because it is all very helpful.

I am Just really looking forward to getting my blood work done more thoroughly so I can get back to feeling more stable and hopefully get everything working optimal for once, I've never felt great before so its nice to know that this treatment can be improved upon unlike what my Endo is currently doing. I appreciate all the help and for sharing the personal experiences.


#14

Okay, Got the blood work done, Will be posting it as soon as I get the results back from my Doctor. He was completely fine with me requesting the extra labs and is on board with me researching and using the info that has been shared here to adjust the treatment.


#15

Ksman, sorry for the delay, I had to wait to get my results from my doctor today.
This is all the information that I got today.

Total Test: 1492 nd/dl
Free Test: 296.9 pg/ml
Progesterone: 1.0 ng/ml
Prolactin: 7.5 ng/ml
Estradiol: 45 pg/ml
TSH: 1.26 mIU/L
T4 Free: 1.9 ng/dl
IGF1, lc, ms: 209 ng/ml

Today I was given a script for androgel 1.62 (2 pumps per day) and told to stop everything else.


#16

Can you use the "edit" in the corner of your post above and add the lab ranges?

TSH and fT4 seem OK, would be better with fT3. Can you post your body temperatures as per the thyroid basics sticky?

E2=45 is horrible. You need anastrozole but it probably will not work with high dose hCG and/or SERM!!!!!!!!!!!!
A predictable mess.