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