My HRT Journey (So Far)

You look like you would need 300mg T cyp per week to get to high normal TT. I have seen one other guy who is like that who also needs to take high amounts of vit-D to get vit-D25 up. Vit-D25 is a steroid hormone. There may be a common factor in terms of the way your body metabolizes these. More of the 300mg/week guys might have the same vit-D issues, but few are testing vit-D25, so we do not know if this pattern is common or not.

If the kidneys were spilling steroids, by design they should not, then one might find that hormones in urine might be higher that expected from serum results. If such a kidney state was genetic, then that should have persisted all of one’s life. If that was so, it would be expected that such individuals would exhibit features consistent with lower T levels in terms of virilization [facial bone features, facial and body hair, muscle mass].

Your needs for anastrozole may be from a variation in aromatase structure, just as there is a variant for over-responders.

The answers may never be there, but the possibilities are interesting.

When lowering the dose of anastrozole, one normally can skip some doses to speed the process, a consideration of half-life. If, as you speculate, the half-life of anastrozole in your body is short, which makes sense, you would not need to skip doses.

interesting possibilities. Should I ask the doctor to check for kidney function through a urine hormone panel?

I have had problems my entire life with:
–excessive weight (I had gotten up to 6’2" 275lbs with little/no muscle - now I am at 220 in the best shape I have ever been - but still a very long way from where I could be),
–lack of physical fitness with no ablity to gain muscle even when I did try and workout (which was almost never),
–I use to have a profound lack of confidence and drive/focus
–I never had hair on my chest (some started when I hit 30, and much much more now that I am on HRT),

but I did not had issues with libido (until around 30) and “everything” developed normally as a kid.

It also does seem that my body clears things out really quickly. I have had problems my entire life with supplements. I try something new, and it works great to start with, but then my body adapts or finds a way to clear it out and then no effect. My new strategy is to try more frequent dosing - but I hope I don’t have to go to every day shots.

Blood test:
–1 day after 80mg T-Cyp shot E3D, 1mg Arimidex, 15,000iu D3
–2 days after .25iu HcG E3D
1500+ ng/dL Total T
doctor wouldn’t run Free T
17 pg/mL Estradiol
85 ng/mL D3

Blood test:
–4 days after 80mg T-Cyp shot E3D &
–1 day after 1mg Arimidex, .25iu HcG E3D, 15,000iu D3
634 ng/dL Total T
170 pg/mL Free T
19 pg/mL Estradiol
57 ng/mL D3

Either the 15,000iu Vit D isn’t doing that much for me, or more than likly, I am simply clearing it out too quickly (I take the entire 15,000iu dose every morning at 7:30am.) - which means I am overdosing in the morning and then clearing it out throughout the day. I will try splitting up the dose, which is inconvenient because it is liquid, or I can spend more for capsules. sigh…

btw, what is the ideal range for Vitamin D, 25-OH D3? What is dangerous? Google searches pull up a lot of information, but not the ranges.

The 50mg T-Cyp EOD ‘seems’ to be working, and today I reduced the Arimidex from .5mgx2 daily to .25mgx2 daily so we will see how that goes. I also reduced my HcG from 250iu to 200iu EOD. I feel a little sharper so far today, but need to see if I lose morning erections or see other side effects. It is hard to keep track of when you combine swiss chess memories (I have always been extremely absentminded) with mentally foggy.

ok… so more complications… and I need some quick help.

I dropped my Arimidex from 1mg daily to .5mg daily. I had an immediate improvement to my mood, my mental fog was gone, and my general drive to get up and do things returned. I was actually thinking, moving, acting, and feeling normal. That went on for about a week and a half, and then I started downhill again - not as bad, but i think I passed through my sweet spot (dividing 1mg pills up is not easy)…

what’s more I know have a pronounced sense of having a prostate - it has gotten larger fairly quickly… which is not something one would normally be aware of - and it has me extremely worried.

I felt my prostate one and off through the last two years - when I change my zinc dosage or started or stopped various hormone treatment plans - general heat or awareness - and even through I mentioned this two or three doctors none have ever done or recommended a DRE - which now I probably have to make a visit just for that - how fun.

so my thoughts are that 1mg daily Arimidex keeps my estrogen in check and where it should be, but the Arimidex was lowering the E2 in my brain too low which caused my mental fog, general malaise, etc. Lowering Arimidex therefore improved my brain functions, but is driving up my general estrogen levels too high overall now which is impacting my prostate.

Does anyone here know how clomid interacts with Arimidex, brain E2 levels, and the prostate? Should I give that a try?

What else should I be looking at?

2/16 OHE measured via urine are huge factor in BPH and also prostate cancer’s. I have seen alot of lower ratio in people with BPH. DHEA can add more fuel to the fire as well too. Why I use TD dhea it helps to take less stress on prostate. With T being so high that can also affect the BPH as well. It depends on where you SHBG is to determine were e2 should be. Obviously you are a hyper excreter of T which may be making up for low cortisol levels or even GH. I would look into 24 hour urine gh from labcorp or genova of rheins to see where your levels are at. Igf-1 seum is not always an accurate indicator over the day course of the day.

blah, just lost my entire post.

by TD you mean transdermal. I don’t abdorb transdermal T, so I would expect the same of TD DHEA.

What about keto-7 DHEA? would that be something to try?

Can someone explain how clomid works to “restore natural T production”? I understand how HCG and Arimidex work, but clomid is still a blackhole for me.

yesterday, I bumped my Arimidex from .5mg daily to .75 mg daily (actually taking .5mg day 1:7am & 10pm and day 2: 4pm). hopefully that will help with the prostate.

two weeks or so ago, I dropped my T-Cyp shots from 80mg E3D to 50mg EOD (a drop of 50mg monthly) and I raised my HCG by 20% by changing from 250iu E3D to 200iu EOD. Would a 20% bump in HCG have any impact on the prostate?

I am thinking about lowering my T-Cyp shots by another 20% to 40mg EOD. My thoughts are that I had to have so much T originally because my other systems were so messed up, but now that I am on cortisol and have some of the other balance issues worked out (plus I am taking the shots even more frequently), that there is a chance that I don’t need as much T any longer, and maybe now my body is reacting to having excess T and excess aromatase.

also, my new doctor is out for 3 weeks, but I will ask him about the 2/16 OHE test as soon as I can (he should be open to it, given he took 26 vials of blood for 36 tests the first and only time I have seen him so far).

I know I don’t have any standing here, but I really could use some input/help.

Does anyone know anything about:

  • keto-7 DHEA (is it better than regular DHEA, less impact on the prostate?)

  • clomid and how it works (should I give it a try given my varied response to Arimidex?)

  • if a 20% increase to HCG dose can be linked to BPH?

  • if 5mg hydrocortison has any beneficial or negative impact (I had cortisol blood readings of 5.5, 12, and 9 at 8am) - no 24 hour urine test, but I will ask for that.

  • what is the final word on how long HCG lasts once mixed? HAN says 30, Ksman says 80. No one else has said a thing.

  • if high progesterone levels in men is bad? The lab range says <1.4, but I don’t rely on ranges provided by the labs, and I can’t find much about excess male progesterone online. My last two tests showed 2.6 and 3 ng/mL. Is that high? If so, can that cause any problems?

  • my SHBG has always been low (it is now 12 from a high of 19). What are the implications of too low SHBG? Some here say none, but others seem to say that your system clears out T quicker if your SHBG is too low.

Thank you for any and all input you can offer.

isocelessmith - I got your PM, but your account setting do not allow for incoming PMs. You need to change your setting in order for me to respond.

[quote]PureChance wrote:

  • what is the final word on how long HCG lasts once mixed? HAN says 30, Ksman says 80. No one else has said a thing.

My HRT guy said 2 months.

The instructions that come with HCG say it only lasts 30 once mixed and must stay refrigerated . I asked the pharmacist and he confirmed it should only be kept for 30 days

I actually just started taking Kelp supplements (for Iodine) + switched back to Iodized Salt (wife bought the wrong type and I had no idea I was going iodine free for the past six months or more).

I also forgot to refill Armour so I was out for three days… but that may have been a good thing, because I think I learned that I didn’t need it… there was absolutely no change from when I was taking it compared to when I stopped it. The cortisol, Vit D, iron, iodine, and other supplements seem to have balanced out my thyroid - if I even had a Thyroid issue to start with. The other imbalances may have just mimiced hypothyroid symptoms.

Also the .75mg Arimidex seems to be working pretty well. I have less awareness of my prostate. Still need to go in for an exam, but trying to put if off until my next regular visit so I can combine it with other things. Making a trip just for that seems… well… awkward. “Hi yes, I would like to schedule an exam. Oh, why you ask? well… I think I need a prostate exam… … yes, that is it. Thanks.”

I am also bumping to see if anyone has any other input/answers to my questions above.

I had an epiphany yesterday - Oral DHEA is known to boost the CyP3A4 enzyme which inactivates drugs, toxins, and various hormones, allowing the metabolites to be excreted.

If I have a superpowered liver normally - per my previous experience with various supplements (immediate reaction, but then quickly dissipates, body returns to ‘normal suboptimal’ status) then the oral 50mg DHEA may just be boosting my body’s already high clearing power even higher. That plus my low SHBG means my body clears everything out of my system in extremely short order.

Epiphany #2 - Oral Pregnenelone can convert via the 5-ar effect during the first pass through the liver and then it acts like valium and is very sedating and depressing. If I have a hyper 5-ar effect (or a super converting liver) then the oral 60mg daily Pregnenelone may be a major cause of my mental fog and is counteracting my ADHD medication.

These two together may be the cause of my Arimidex tightrope walking.
I need to take .5 Arimidex every 15 hours or I can feel my prostate. any more than .75 and I get very foggy (day 1 @ 7am & 10pm / day 2 @ 2pm)
Tightrope with Arimidex - barely too much = extreme mental fog (I was taking 2mg daily at one point)

Tightrope with Arimidex - barely too little = aching/swelling prostate (.5 mg daily = very uncomfortable)

  • my swings with T E3D - even going to T-Cyp shots every 3 days still results in pretty big swings (1500 Total T day 2 after 100mg T-Cyp E3D Shot vs 600 Total T day 4 - day of next shot 80mg E3D)

I need to test for 2:16 OH imbalance - maybe aggravating prostate issues??
is 5mg hydro-cortisone simply shutting down my own cortisone production, or can doses under 20mg be helpful?
need to see about increasing Cortisole dosage up to 20mg daily - may be able to reduce other supplements.
need to think about liquid matrix pregnenelone treatment experiment (bypasses the first pass through the liver)
is oral DHEA producing too much CyP3A4 enzyme?
is oral Pregnenelone converting too much via the 5-alpha reductase and causing a valium like effect?
can HCG-boosted Pregnenelone production convert to the valium like effect via 5-ar? Or is that for oral pregnenelone only?
can low Cortisol cause low LH? If I fix my Cortisol, can I stop T-Cyp and Arimidex?
why couldn’t I absorb transdermal T (androderm, compounded T cream, Lypo-compounded T lotion)? I thought that it was due to hypothyroidism, but since it does not look like I have that, what else could be the cause?
I am testing out stopping my oral Pregnenelone and DHEA to see what impact that will have. Hoping for longer lasting and less ‘valium-like’ effects.

plus someone let me know about this great file sharing site. You can upload files, password protect them, then share the download sites with others.

So if anyone cares, here are all of my blood test results for the past 2+ years as well as a list of all supplements I was on at the time of each test.

The password to access the file is: purechance

Seems like too many things changing at once. You need to go by how you feel. Those amounts if anastrozole are insanely high. You can try lower doses of hCG, taking pressure off of T–>E2 in the testes and then lower anastrozole may allow for better E2 levels in the brain. Your use of hCG should be to maintain your testes, not to be a strong contributor to TT levels. Explore lower doses of hCG and less anastrozole.

Still need units with FT labs.

You are very much not normal and are expecting too much from others about your specifics.

a couple of comments:

  1. thanks for your thoughts on HCG. I know that HCG can drive extra aromatase in the testicles - that is why I was only dosing 200iu EOD instead of the recommended 250iu, but too low HCG = no or limited pregnenelone conversion from CHOL - so too low isn’t good either (and I am already at 67 ng/dL Pregnenelone while taking 60mg oral Pregnenelone daily. I may try dropping down to 100iu EOD for a week or two and see how I feel, but am concerned since I am also testing stopping the 60mg oral Pregnenelone due to possible 5-ar first liver pass through Benzine effect.

  2. I realize I am not normal, and it does seem that my case is not going to be a quick fix - eight doctors and 16 different multiple-blood draws kind of clued me in :wink:

  3. I am not expecting any answers or input on my specifics from this forum. The questions I posted are the ones I plan on asking my doctor. I was posting them in the hopes that other might be able to avoid some of my mistakes/complications. I have learned a lot from you and this forum, and I would like to help others where and when appropriate. I will post what my doctor advises later next week.

  4. All of my labs with ranges, results, and supplements at the time of each test are available @ - free file sharing and storage (The password to access the file is: purechance)

I tried to attach a PDF using the picture attachment function, but that doesn’t work so good.

ok - well I stopped my oral 60mg Pregnenelone and 50mg oral DHEA yesterday.

prior to that if I was taking .5mg Arimidex every 15-16 hours (7am, 10pm, 3pm). If I missed my window by one or two hours then I could feel that I had a prostate and in another hour or so it would start to ache.

Since I stopped the Oral Pregnenelone and Oral DHEA it has been 36 hours since my last Arimidex dose and I am just now becoming aware that I have a prostate (the time period has doubled which means I can get by with a smaller less frequent dose of Arimidex).

It appears that the oral Preg and/or the oral DHEA was aggravating my condition. Not sure it was due to the 5-alpha reductase (5-ar) effect on the Pregnenelone being processed by the liver or if it was the DHEA stimulating extra production of the CyP3A4 enzyme, or the Preg/DHEA converting directly to Estrogen through some side path that some hormone conversion charts show.

There is an interesting experiment going on at the musclechatroom. JanZ is trying a Lipid Matrix Pregnenelone 150mg a day. This type of Pregnenelone bypasses the normal first pass through the liver so it is not destroyed or converted and can act like a much higher dose of TD Pregnenelone. It seems to show some promise - immediate improvements and people needing less or stopping cortisol and Thyroid medications, etc. Seems like an interesting theory.

Low LH, FSH, ACTH = less conversion of CHOL to Pregnenolone
Low Pregnenolone = low Progesterone and low DHEA
Low Progesterone = low cortisol
low cortisol = multiple complications with other hormones and Thyroid + low Mineralocorticoids

Transdermal Pregnenolone = not sufficient quantities to absorb / reported problems that TD Preg does not show up on blood tests = no extra Pregnenolone present.

Normal Oral Pregnenelone = has to first pass through the liver where most is filtered out + some can go through 5-alpha Reductase conversion to a benzine like molecule? which has a valium like effect (can cause stupor - i.e. mental fog).

Lipid matrix micronized Pregnenelone = absorbed directly into the blood stream and bypasses the liver so there is no filtering/destruction or 5-ar conversion.

well, I have my first full consultation with my new doctor (with all of the blood test results) in 48 hours.

The list of questions I plan on asking is above, but if anyone can think of anything else that I may have missed, I would love to hear them.

Also I missed a page of test results from my last blood draw so here are some additional values:

Aldosterone: 2 ng/dL (range <28)
Lipoprotein(a): <12nmol/L (range <75)
SED Rate: 2 (range <15)
Free AM Cortisol: 0.29 mcg/dL (I don’t trust the lab range of .07-.93)
and a whole bunch of immunoglobulin A, G, M and G subclass 1,2,3,4. But all are almost exactly at the midpoint. I can post if anyone would like to see.

I have been searching but can’t seem to find what is considered the ideal Aldosterone range. Same goes for the ideal Folate range? I’m at 287 Folate (test range says >280 is “in range” but lab test ranges suck. Low folate = low SAM-E.

Read: Aldosterone - Wikipedia

What is your blood pressure? Steady or changes?
Any episodes of bloating?
Urinating excessively at times?
What signs of adrenal fatigue?
How do you react to major stress?

You might need to profile your adrenal hormones, including progesterone. When a lab has something really off, retesting makes sense as labs are some times bogus.

Blood pressure is normally not too bad I think. It dances around 130/80, but it was at 100/70 before I started the whole HRT mess.

I do get swelling ankles often, but I was always attributed that to excessive estrogen.

I also sweat profusely when working out or outside in the heat. I thought the workout sweat was the Testesterone displacing the Estradiol or some mechanism like that and therefore I started exuding water.

Prior to HRT, I didn’t sweat much and was extremely adverse to the heat - always complaining, always feeling like I was overheating. Now that I sweat so much, the heat doesn’t bother me as much.

My skin also seems to retain water. I shower, dry off, then sweat/exude water for the next 30-60 minutes.

I can not absorb TD creams (I could at first, but then it started decreasing, and then stopped completely.)

No excessive urination, freq, or volume - except when I change my Arimidex dosage.

Yes, I seem to have adrenal fatigue (back up with 5.5 AM cortisol blood tests). Major stress seems to help clear my mind and get me focused for a short time at least until I crash again.

I have most of my adrenals tested and posted per the file sharing pdf document. My new doc didn’t test Progesterone or Prolactin for some reason.

and yeah… well apparantly the mental fog has returned more than I first thought.

my phone consultation is today at 4pm cst, not Wednesday. I am sure glad that I called to confirm.

another insight - my ankle swelling gets worse the later it gets in the day. again I always just attributed that to E2 problems.

“Aldosterone stimulates Na+ and water reabsorption from the gut salivary and sweat glands in exchange for K+.” Low Aldosterone might increase sweating.

I would focus on the adrenals, stress, life style, nutrition and any drugs or supplements that might be causing problems. That includes stimulants and caffeine. Read the book on “adrenal fatigue” by James L Wilson.

Any degree of hyperthyroidism would make things worse. - feeling over heated etc

Be careful with any adrenal hormones like cortisol as the feedback effect might reduce Aldosterone production. Not everything has a clean isolated feedback loop. Many are cross coupled. Watch how things affect your fluid balance a a clue to what is happening to Aldosterone levels. Take note of anything that increases sweating. Note changes from potassium rich foods. Note effects of single dose 99mg potassium chloride tablets take when fluids seem normal or when bloaty/sweaty. You can take more than one tablet per episode. You are looking for what happens, if anything, when you introduce potassium. If you start taking potassium routinely, you can’t introduce and observe.

“I know that HCG can drive extra aromatase in the testicles”
hCG increases intratesticular testosterone levels [ITT] to high levels which probably drive more T–>E2 aromatization simply with the high ITT. There is no need for any increase [extra] in aromatase to do this. In young normal males, ITT can be up to 80 times higher than serum T concentrations. High dose hCG can take ITT to even higher levels. A replacement dose of hCG probably does not lead to testicular E2 production rates that are higher than that of young normal males. Once could state that there is “extra aromatization of testosterone”.

ok, well the conversation with the doctor went pretty well. I was secretly hoping for some brand new insight or revelation, but that didn’t happen. Most of what he said I already knew, but it was nice to get a confirmation that my theories were not completely off base. We also decided on a couple of changes.

What we discussed:

He does want to get my AM Cortisol up to the 15+ range (currently between 5.5 and 11) - and he wrote me a script for 5mg compounded SR hydro-cortisone up to slowly increase up to a maximum of 20mg daily (if needed).

Is anyone else here on SR (slow release or sustained release) compounded HC? How does that work for you? I am not sure how to dose or time SR HC. Any thoughts? I am going to call and speak with the compounding pharmacist. He does think that 24 hr salvia testing is beneficial to help determine cortisol levels, but we are going to wait for a month or so before testing.

My Reverse T3 was at 340 - should be at 110 or so. This means my RT3 was completely canceling out my Free T3 (@ 3.4 pg/mL) which explains why I didn’t feel any different when I stopped my 90mg daily Armour. My free T3 was at 3.4 pg/mL BEFORE medication, but my TSH was 2. My theory is that my low cortisol and low T levels were putting extra pressure on my Thyroid - causing the higher TSH and lower free T3. When I started the Armour it worked at first, but then all of that extra T4 had to go somewhere and eventually converted over to RT3. He wanted to start me on plain T3 only medication, but after discussing it, I got him to agree to wait for a month or two to see how the extra cortisol effects me first. I may need it, but I am willing to wait for now.

He is good with me going with EOD T-Cyp / HCG shots to try and level out the blood level swings as long I was ok with giving myself 364 shots a year. I think I am going to lower my T-Cyp down to 30mg EOD (or ~105mg weekly) to see how I do. With my low SHBG numbers I may be able to get by with lower Total T #s which may also help with my prostate issues.

He is good with me stopping the DHEA (since I was at 419 and over the ‘max’ that he likes) and he was concerned about the possible apparent fast conversion to Estrogen - per the swelling prostate symptoms. A DRE is in my near future. He seemed like he was kind of aware of the CyP3A4 enzyme problem with oral DHEA, but didn’t confirm or deny or theorize if that it could be a problem for me.

He wants me to take some form of Pregnenolone since my numbers were low (62) even when on the 60mg Oral standard Pregnenolone daily. I asked him about the lipid matrix micronized Pregnenolone, but he had never heard about it. I explained the theory behind it (skipping the first liver pass, benzo 5-ar effect, etc.) and he said that it didn’t matter to him what form of Pregnenolone I took as long as I was taking something to boost my Pregnenolone levels. so I think I am going to start off slow on the 50mg lipid matrix micronized Pregnenolone from herbpro if I can’t get it from my local health stores.

D3 levels are just a bit low (60+ is best according to him), but not bad. I personally want 70-90. He wants me to maintain my current 15,000iu daily for now. If they are still low next test, then maybe increase the amount.

He thought my iron/ferritin levels were fine. Ferritin could be higher, but Hemoglobin, Hemacrit, and RBCs all looked good, so he did not want me to increase iron supplements.

I asked about taking Folate and Magnesium, and he thought that there was no harm with basic supplements to boost these levels. He did not know if there were ‘ideal’ levels for these.

He asked about urine frequency, urgency, etc. in relation to the low Aldosterone levels, but since I don’t have any symptoms, he just wants to monitor it for now and test it again in two months.

He wasn’t sure about the benefit of a 2:16 Estrogen Metabolite test. He has never run it for men, only for women at risk of estrogen cancers, but since prostate cancer is estrogen related, he said he would order one for me if I wanted, but he uses Genova blood tests for that which is not covered by insurance and can be pricey. I decided to wait for now. Does anyone know of a good urine test for the 2:16 metabolites? any links?

Like I said no huge revelations.

I also decided to cut back and eliminate a couple of my supplements for now:
Vyvanse 60mg daily
T-Cypionate 30mg .15ml EOD (reduced from 40mg EOD)
HcG 150iu EOD (reduced from 200iu EOD)
Arimidex .25mg daily or EOD as needed (reduced from .75mg daily)
Hydrocortisone compounded SR 5mg x2 daily (increased from x1 daily)
Vitamin D 5,000iu x3 daily
Kelp(Iodine) 100mg daily (actually I now not sure if what I picked even has iodine in it since that is not listed on the package - need to check on this)
Multi Vitamin daily
Cod Liver Oil 1000mg x3 daily
Probiotic 2 pills daily
Zinc 50mg daily
Copper +2mg EOD
Reacted Iron 29mg daily
Magnesium Glyconate 150mg daily (added)
Folic Acid 400mcg daily
Green Tea, Ubiqinol, Resveratrol - all cut for now